In my previous body we took a look at the diagnostic criteria for post traumatic stress disorder and discussed how the ICD and the DSM defines that.
Today we are going to take a look at the diagnostic criteria for something known as Complex PTSD.
We are going to be using the ICD11 criteria for this one as the ICD separates the diagnosis of PTSD and Complex PTSD. The DSM doesn’t, its all wrapped up within the PTSD diagnosis as explained in my previous video.
The first required feature is
Exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible.
So, just as an aside here, the criteria for PTSD didn’t mention this element of prolonged or repetitive from which escape is difficult or impossible, they’ve added this bit in.
And they go on to give some examples of what these events might be. So please remember these are just examples to give you an idea, its not a list where you have to check something off it.
These events include torture, concentration camps, slavery, genocide campaigns and other forms of organised violence, prolonged domestic violence, and repeated childhood sexual of physical abuse.
Please remember that if you are watching this video and becoming unsettled, or overwhelmed, or becoming outside your window of tolerance, please practice some self care and don’t forget I created some grounding videos on the channel for exactly that reason.
The second requirement is that following the traumatic event, the development of all three core elements of PTSD are present lasting for at least several weeks.
I discussed those core components in my last video at length, so i won’t go into detail about them again, but to summarise they were:
Re-experiencing, which is more than just remembering, this is as if the experience is happening in the here and now. Usually there are intrusive memories or flashbacks, or repetitive dreams or nightmares about the event.
The second core component is deliberate avoidance of reminders which can be internal reminders (such as thoughts or memories) or external reminders such as people, conversations, activities, or situations that remind you of the event.
And the third core component is persistent perceptions of heightened current threat, or sometimes known as hypervigilance.
We then move onto three additional components that are unique to complex PTSD. And these three additional components are sometimes called Disturbances in self organisation.
The first one is Severe and pervasive problems in affect regulation. Essentially this means problems in emotion regulation. The ICD does give some examples of what this might look like:
heightened emotional reactivity to minor stressors.
Violent outbursts
Reckless or self destructive behaviour
Dissociative symptoms when under stress.
Emotional numbing particularly the inability to experience pleasure or positive emotions.
The second additional component is.
Persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt, or failure related to the stressor. For example, there might be guilt felt about not having escaped from or succumbing to the adverse circumstance, or not having been able to prevent the suffering of others.
The third additional component is persistent difficulties in sustaining relationships and in feeling close to others. You might consistently avoid or have little interest in relationships and social engagement. Or sometimes there might be occasional but really intense relationships that are unsustainable.
And then we have the same criteria in terms of functioning and quality of life as we do with PTSD and that is that there must be significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
That all seemed quite wordy so to summarise those additional components.
Problems in emotional regulation
Beliefs about oneself as worthless, along with feelings of shame, guilt or failure related to the event
And difficulties in sustaining relationships and in feeling close to others.
I once again apologise for the very clinical nature of this video, and perhaps coming across as a bit cold. But the reality is this is currently the language, and the criteria that is used so i think its important to acknowledge that and to understand what these terms mean. And once we know what they mean, and we understand these terms in their clinical context, we can take a look at slowly challenging it, and perhaps consider moving toward systems based on need rather than diagnostic criteria.
So let me know what you think of this criteria, are there any glaring holes in it that jump out at you, or experiences that aren’t covered. I am genuinely interested as that helps me to reflect on my own practice and how I can better advocate for my clients.
Thanks for watching.
Take care.
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