PTSD vs C-PTSD vs personality disorders...?

[Friday]

simply don’t understand this statement. Especially coming from a treatment perspective, where it is very clear that many people live in persistently abusive situations without going on to develop all the nuances of pathological disorder associated with complex ptsd

Ditto.

 

[brokenpony]

as @brokenpony "pile of shoes, none of which fit"

it wasn’t me who said that but i do somewhat relate. i have wondered about the possibility for some PDs, “tried them on,” and may be subthreshold for some but it doesn’t really seem to work out to disorder level for any one. i personally think closest would be avPD but—not for all of me. i can also see how the trauma history plays such a major part in my behaviors differently at different times in a way that’s contradictory, confusing and incoherent to me and it seems my therapist also. i very easily fit the ptsd diagnostic box but the rest is harder to figure.

 

[Charbella]

So you have a therapist who is playing a psychiatrist, not actually his job to diagnose and additionally he claims that while he doesn’t have a doctorate he’s better than all the doctors and research that came together to create both the ICD and DSM. Wow the balls on that guy!

I mean we’re all entitled to our opinions and while his might be wonderful dinner/colleague conversation his statement has no business in his JOB. He had no business telling you that the leading experts are wrong. That MOST of the people on this site have all been misdiagnosed. That all veterans have been incorrectly diagnosed and treated. Because the statement that multiple incident traumas can’t be PTSD says all of the above.

How many veterans can say that they went into one battle and now have PTSD? I know this exists but it isn’t the norm. It’s the cumulative effect.

He’d have to be really good at the therapy part of his job for me to even consider seeing him further. Not just because it’s insulting to group every other multi event trauma into personality disorder but because it ignores the vast majority of symptoms that don’t have cross over between personality disorders and PTSD. I’m insulted by his supposition.

 

[Ecdysis]

Yeah @Charbella it doesn't sit well with me either... Wait and see tho... It was a brief comment near the very end of the session and no time to clarify it.

And yeah, he is very good at the "therapy" side of things... and I want to continue treatment with him... So this issue doesn't feel "that bad" to me... It irritates me and I want it sorted out, but I'm not hugely upset or thinking about terminating treatment over this.

I also don't think that he's going to randomly dole out a diagnosis "against my will" - so if I speak up about it, I'm pretty sure it's going to get clarified to some degree of satisfaction.

As regards whether this is the pdoc's job... sort of... where I live, T's can do diagnoses too, or at least suggest them and then have them confirmed by a pdoc... Unfortunately, a couple of years ago, my old T retired and my old p-doc went to work at a clinic, so I'm dealing with 2 new people who still feel like strangers much of the time. My new pdoc is really young, I have super short appointments with him and diagnosing seems something he's not... I dunno... comfortable with? good at?

I'm doing so poorly atm and have so many life stressors to deal with, so my ability to deal with problems is so limited... So I asked my T to go through the diagnoses with me and do some diagnostic questionairres, etc... Cos we have 50 minute sessions and plenty of time to go over all the details, which pdoc does not... So it's me that's explicitly asked T to deal with this diagnostic stuff...

Anyway, I've emailed him asking for questionairres, voicing my concerns and my personal thoughts about diagnoses and was able to do so calmly and eloquently, which feels like a win, rather than stewing on my frustrations and then saying something awkward that doesn't get my point across.

I'm trying to see it this way:

That doesn’t mean that assessing your personality is a waste of time. To the contrary, anything that helps you understand yourself, what’s going on and why, is helpful to recovery. Take the insight part, dump the stigma part.

I do struggle with some things that I can understand sort of "presenting" similarly to a PD to some observers... I don't think T is wrong, per say, to at least be considering this... And if we do a thorough, open-minded exploration of this, then it could actually yield helpful results... even if we end up still kind of confused and not finding a label that fits, other than C-PTSD, which is not an "official" label at this point in time...

 

[Sideways]

he is very good at the "therapy" side of things...

This is actually the most important part.

If he’s helping you, right now - that’s the single most important thing.

I reckon I’ve disagreed with my all of my Ts at some point about how they intellectualise what they do. But if they’re good at what they’re helping me with? I usually go with it.

At some point, you may outgrow what this T has to offer. But agreeing with our T isn’t always necessary to benefit.

You’re now aware that this T may have a bit of a bent towards over-pathologising. But if that’s not interfering with the way he’s helping you? It doesn’t have to be problem.

 

[Weemie]

What researchers found, however? Is that if enduring personality change happened after a "single" event? There was always a history of trauma/complex trauma primed that this "single" event lot the match & exploded all of it.

I think we also have to be very careful in diagnostics that the reverse isn't applied as well - many people who have complex trauma stemming from adulthood, for example, don't display any observable difference in fixed/stable traits (in fact, most don't - the changes in their behavior are solely described by PTSD symptoms alone and would not qualify as a fixed/stable trait, things like psychomotor agitation/anger, avoidance, etc).

Thus CPTSD would not be an appropriate diagnosis even if their trauma is complex. Everyone with crit A trauma who has PTSD will have PTSD symptoms, but not everyone who has trauma - including complex trauma - will have CPTSD symptoms. Personally I have experience with this: I don't have CPTSD, I have PTSD + schizoid. But every clinician who believes in the CPTSD criteria has stated incorrectly I have CPTSD, because I have complex trauma.

Unfortunately due to Pete Walker, we also have an influx of people who almost certainly have a personality disorder and not any form of PTSD because he has given the erroneous impression that people can have PTSD without having criterion A trauma (such as from "narcissistic"/emotional abuse, improper family dynamics, divorce, infidelity, substance abuse, career loss in that one dude's case lol, etc), being misdiagnosed with CPTSD and diluting the term entirely.

 

[Ubergirl]

I have a relatively new trauma therapist and we're doing a weird mish-mash of treatment while me also trying to get him updated about my entire past history, which at nearly 50 years of age, is a lot.

We're currently dealing with the issue of diagnoses and he said something weird at the end of the last session, that I'm trying to get my head around.

I understood him as saying: PTSD is really only an appropriate diagnosis for "single event" type traumas - for example, experiencing a sexual assault as an adult.

If trauma occurs in childhood and goes on for any length of time (as opposed to a "single event" trauma) then it will *necessarily* affect the child's developing personality so will *always* entail a personality disorder.

This reasoning seems a bit off to me...

I asked whether it wouldn't be C-PTSD then, as oppsed to PTSD, but we agreed it's not an ICD / DSM diagnosis.

It was the end of the session, so no more time for asking for clarification, which I'll have to do at the next appt in 2 weeks time.

It strikes me as very over-generalised tho and I'm not sure I agree.

Also, I have a strong negative reaction to the words "personality disorder" whereas I don't have that kind of reaction to the words "PTSD" or "C-PTSD".

Why is that? Is there a much bigger stigma attached to personality disorders?

Does it sound like an insult to my subconscious if someone says "personality disorder"?

I'm not sure I even truly understand what a personality disorder is vs. what it's not.

I'm not sure about a full list of "all" personality disorders either.

I dunno... As a feminist, I feel a lot of resistance to how easily women are given the lable of a personality disorder in treatment.

I know a good psychiatrist who is very critical of personality disorder diagnoses because he says they're just used to lable people a therapist/ Dr views as "too challenging" for "simple treatments" to work.

I dunno... a lot of questions and a lot of resistance about those kinds of diagnoses being dodgy and wondering whether they're helpful...

Edit to add.... done some googling:

The DSM has 10 personality disorders:
1 paranoid
2 schizoid
3 schizotypal
4 antisocial
5 borderline
6 histrionic
7 narcissistic
8 avoidant
9 dependent
10 obsessive–compulsive

and also "unspecified personality disorder"

They're grouped into 3 clusters:

Cluster A (odd or eccentric disorders)​

Paranoid personality disorder, Schizoid personality disorder, Schizotypal personality disorder

- often associated with schizophrenia
- greater grasp on reality than those with schizophrenia
- can be paranoid
- unwillingness and inability to form and maintain close relationships

Cluster B (emotional or erratic disorders)​

Antisocial personality disorder, Borderline personality disorder, Histrionic personality disorder, Narcissistic personality disorder

- characterized by dramatic, impulsive, self-destructive, emotional behavior

Cluster C (anxious or fearful disorders)​

Avoidant personality disorder, Dependent personality disorder, Obsessive–compulsive personality disorder

- characterized by anxious and fearful behaviours (e.g. perfectionism, dependency, anxiety)

This is hella interesting to me because I know c-ptsd and borderline personality is very similar.

It makes me wonder if ptsd constantly in childhood, changes your growth/personality, as in it sends you off on a different branch than you’d usually be on because of the trauma and that makes it a personality disorder?

This is actually the most important part.

If he’s helping you, right now - that’s the single most important thing.

I reckon I’ve disagreed with my all of my Ts at some point about how they intellectualise what they do. But if they’re good at what they’re helping me with? I usually go with it.

At some point, you may outgrow what this T has to offer. But agreeing with our T isn’t always necessary to benefit.

You’re now aware that this T may have a bit of a bent towards over-pathologising. But if that’s not interfering with the way he’s helping you? It doesn’t have to be problem.

Btw I think I would be thrown by the generalisation and lack of clarity given as well

For example, when I went through a period of diagnostic investigation and reinvestigation to figure out what was going on for me, the personality assessments indicated I had symptoms of a particular type of Narcissistic PD (yeah - you reckon BPD comes with stigma, imagine being told you may have NPD! The horror!).

Once I got over the horror of that (!!), it was actually immensely helpful. Because what they’d actually identified was I had delusions that were the opposite of, but equally as dysfunctional as, delusions of grandeur (I genuinely believed my mere presence could make good men do bad things).

See this is very interesting because I always believed that narcissists couldn’t ever see their faults. Like that was a big identification of the disorder “it’s everyone else’s fault”
I’m so sorry you were saddled with that title but the way you have worked thru it is so healthy. Kudos

 

[Rose White]

Unfortunately due to Pete Walker, we also have an influx of people who almost certainly have a personality disorder and not any form of PTSD because he has given the erroneous impression that people can have PTSD without having criterion A trauma

Reminds me a bit of Gabor Mate’s hypothesis that every addiction stems from trauma.

My 2c is that when BPD was linked to trauma it loosened some of the stigma. I actually hear kids at school beginning to self diagnose with it which tells me it has made the rounds on social media. Maybe only us oldies feel the stigma.

Also though, for me, shifting my symptoms from being caused by OCD, depression, BPD, random unlucky brain chemicals, to PTSD from childhood trauma gave me a foothold to exert myself on to my mental state. If my T had said, “Oh it’s just a PD.” I would have collapsed. Even though PD’s can be coped with for me it sounds like “stable instability.”

On the one hand I think shifting from a trauma-based mindset to a PD-based mindset is damaging. On the other hand I think the word trauma has become too widely defined and is losing it’s meaning and so we are going to have to shift our language in order to continue helping people.

 

[Ubergirl]

Reminds me a bit of Gabor Mate’s hypothesis that every addiction stems from trauma.

My 2c is that when BPD was linked to trauma it loosened some of the stigma. I actually hear kids at school beginning to self diagnose with it which tells me it has made the rounds on social media. Maybe only us oldies feel the stigma.

Also though, for me, shifting my symptoms from being caused by OCD, depression, BPD, random unlucky brain chemicals, to PTSD from childhood trauma gave me a foothold to exert myself on to my mental state. If my T had said, “Oh it’s just a PD.” I would have collapsed. Even though PD’s can be coped with for me it sounds like “stable instability.”

On the one hand I think shifting from a trauma-based mindset to a PD-based mindset is damaging. On the other hand I think the word trauma has become too widely defined and is losing it’s meaning and so we are going to have to shift our language in order to continue helping people.

Good musings. I agree that BPD for me was frightening and sent me spiraling after one Psychiatrist determined it for me (I think he really helped medication wise but wasn’t the best for diagnonsense.)

BPD or “manic depression” as it was called has been really looked down on, even though these are good people who are suffering. I agree that it’s much better handled now it’s linked to trauma.

 

[Rose White]

BPD or “manic depression” as it was called has been really looked down on, even though these are good people who are suffering. I agree that it’s much better handled now it’s linked to trauma.

I meant Borderline Personality Disorder (my mistake for not clarifying) but I think Bipolar Disorder does have stigma too and I didn’t realize it had a link to childhood trauma, but again trauma seems to be linked up with so many diagnoses now—either causing the diagnosis or an outcome of just having the diagnosis. (In the case of autism there is now a widely held belief that having autism guarantees trauma due to the structure of society. I think this stems from disability studies which say that the category of “disabled” only exists because society doesn’t have supports in place to allow people with disabilities access to all areas. This outgrowth of disability studies started with a focus on physical disabilities (a person in a wheelchair is disabled by stairs but not ramps) and has bled out to mental illnesses (a person with time-blindness is disabled by their job’s requirement to be to work on time.)

But I digress. The model we are discussing here is whether childhood trauma leads to a stress disorder or a personality disorder and whether one is more of a hurdle than the other in terms of recovery.

 

[Ubergirl]

I meant Borderline Personality Disorder (my mistake for not clarifying) but I think Bipolar Disorder does have stigma too and I didn’t realize it had a link to childhood trauma, but again trauma seems to be linked up with so many diagnoses now—either causing the diagnosis or an outcome of just having the diagnosis. (In the case of autism there is now a widely held belief that having autism guarantees trauma due to the structure of society. I think this stems from disability studies which say that the category of “disabled” only exists because society doesn’t have supports in place to allow people with disabilities access to all areas. This outgrowth of disability studies started with a focus on physical disabilities (a person in a wheelchair is disabled by stairs but not ramps) and has bled out to mental illnesses (a person with time-blindness is disabled by their job’s requirement to be to work on time.)

But I digress. The model we are discussing here is whether childhood trauma leads to a stress disorder or a personality disorder and whether one is more of a hurdle than the other in terms of recovery.

I apologise, I keep getting borderline and bipolar mixed up as the same. I honestly had such a confusing time reaching out to psychiatry and psychology for help as both have different ideas about diagnosis and how to tackle problems.
I shouldn’t put down the psych because he actually helped me with medication for over a year until I was stable.
His want to diagnose me I realised for me personally didn’t really help as my c-ptsd is so similar to borderline pd.
I let go of wanting a firm diagnosis and accepted c-ptsd.

You’re right it’s become very broad but personally i feel way more comfortable with c-ptsd. Rather than borderline pd.

The TRAUMA is the root cause and I’m working with the versions of myself that are stuck (The me’s of different ages who are wanting to be heard because of what they went thru, they’re worried it will happen again so I’m learning to self soothe)

Anyway that’s my 2c

 

[Rose White]

The TRAUMA is the root cause and I’m working with the versions of myself that are stuck (The me’s of different ages who are wanting to be heard because of what they went thru, they’re worried it will happen again so I’m learning to self soothe)

I found this mindset very helpful as well. I hope it works for you too.