Complex PTSD Should Be Included in DSM-V

There are many strange disorders being proposed by outside parties or by the American Psychiatric Association for inclusion in DSM-V. Oddly enough, however, complex PTSD is not among them. C-PTSD is not just gradually different from regulat PTSD, but encompasses other features such as those seen in personality disorders. It is a disorder caused by captivity or other situations of long-term, severe trauma.

Of course, the subtype of chronic PTSD is included in DSM-IV as well as DSM-V, but this is merely regular PTSD that lasts for more than six months, without the additional features of impaired self-concept, trust, and emotion regulation, among others. In my opinion, complex PTSD is more warranted as a specific disorder than such things as parental alienation syndrome and body integrity identity disorder, both of which are proposed by outside parties.

There are many people who would meet the criteria for complex PTSD but not the full criteria for regular PTSD. What do they end up being diagnosed with, if anything at all? Do they fall within a treatment loophole, getting no counseling because they don’t have a legitimate mental condition? Or do they end up with stimgatizing and incorrect diagnoses that don’t reflect the fact that they are trauma victims?

Today, June 27, is PTSD Awareness Day. Let’s stand up for the rights of victims of long-term, severe child abuse, war camps, or other states of captivity, to get the recognition and treatment they deserve.

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Against a Hierarchy of Trauma-Based Disorders

There was a discussion on a DID forum I participate on, in which someone asserted that there is a hierarchy of trauma-based disorders from PTSD via chronic PTSD and other dissociative disorders to dissociative identity disorder. I have read similar things before, such as in the dissociative spectrum, where depersonalization is on one end and DID is on the other, with dissociative amnesia and dissociative disorder not otherwise specified being inbetween.

I strongly disagree with this hierarchy of disorders. After all, both depersonalization disorder and PTSD – the “mildest” forms according to either spectrum – can be very severe and disabling. It is true that depersonalization and other dissociative phenomena often accompany DID, so in that respect the dissociative spectrum makes some sense. However, it is not always true that DID encompasses all other dissociative phenomena.

Secondly, there is a lot of overlap between dissociative disorders and (chronic/complex) PTSD. There is also a lot of comorbidity. This makes it harder to presume a hierarchy between PTSD and DID: most people with complex or chronic PTSD, also have some dissociative features or disorder, and most people with DID or DDNOS also have a form of PTSD.

Lastly, it is simply invalidating to presume a hierarchy of trauma-based disorders. No trauma is “mild”, and its consequences should never be trivialized. Presuming a continuum of trauma or its consequences, is therefore offensive to people presumed to be “mildly” affected.

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My Truth on Dissociation and Childhood Trauma

In my previous post, I discussed whether I’m exaggerating the effects of my traumatic experiences. This is a common theme for survivors of trauma. Often, we’re either told or think ourselves that we exaggerate or make stuff up. When dissociative identity disorder complicates the matter, this is even worse.

Some people deny that DID even exists, and believe it is created by unethical therapists. Other people diagnose it quite quickly or believe it’s significantly underdiagnosed. My opinion is somewhere in between, and I draw it from my own experience. I knew I was multiple for almost ten years before coming out to my current psychologist. I’d never seen a therapist when I realized I was multiple. I didn’t know I lost time, and, hence, didn’t believe I had DID, but I was told by my boyfriend that I couldn’t remember stuff when I switched some of the time back in 2009, before I’d come out. Consequently, I believe my multiplicity is real, whether it can be objectified or not

It is quite likely that an implicit memory test would reveal most, if not all, dissociators do know what their alters learned. In fact, there is research to this effect with a small group of DID sufferers. It is also possible – another research study that I forgot the reference to, claims this -, that time loss in DID is “simulated”, in that people score below chance level on a recognition task. I put “simulated” between scare quotes, because it is not a deliberate action, but possibly some kind of metacognitive problem.

All of this does not mean that DID is not real to the person who experiences it. And even if the multiplicity had been created by a bad therapist, that doesn’t mean the trauma memory has. Childhood trauma is very real and likely not recognized enough. Multiplicity is very real to the person who is multiple. Whether time loss can be objectified or not, it is real to the person who experiences it. Denying these things may look good for a legal psychologist like Willem Wagenaar – whom I otherwise hold in high esteem, by the way -, but it deeply affects survivors of childhood trauma, who’ve often lived their lives being told their truth is a lie.

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Post-Traumatic Stress Disorder: DSM-IV and DSM-V

I have very recently been labeled with PTSD. I am not sure that I agree with this sort-of diagnosis – I’m not sure whether it’s an official diagnosis or not. I checked the DSM-IV criteria and unfortunately do seem to meet them. I was particularly reluctant to believe I avoid stimuli associated with the trauma, since most triggering things are also particularly fascinating to me. However, in DSM-IV, avoidance and numbing of emotions are categorized together into one criterion, and I do meet that criterion, because I have enough symptoms of detachment, expecting to have a limited future, etc.

In DSM-V, however, avoidance is its own criterion. One must either avoid internal or external stimuli associated with the trauma. I’m not sure I do that. Further, negative alterations in cognition and mood are collected in their own criterion. I do definitely meet that criterion even in DSM-V, where a higher threshold for a diagnosis is required than in DSM-IV. This is still under consideration though. The other two symptom criteria – reliving the trauma and hightened arousal – are pretty much retained as in DSM-IV.

The definition of trauma, most notably, has been made much more strict in the proposal for DSM-V than it currently is. First of all, threat to physical integrity (DSM-IV) had been renamed actual or threatened sexual violation. Whether this is significant remains to be seen. Secondly, however, witnessing violence through electronic media is explicitly excluded from the definition of trauma, unless it is work-related (such as for police officers). I can sort of see where the DSM-V workgroup is coming from there, but I’m not sure I agree. Lastly, death of a relative must be violent or accidental in order to meet the definition of trauma, except in children, where it is considered that death of an attachment figure can count. Again, I can see where the workgroup is coming from, but I’m not sure I agree.

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Disability Doesn’t Cause Abuse

I gerenally appreciate Harold Doherty of Facing Autism in New Brunswick for his advocacy for better adult autism services, particularly for those with the most severe disabilities. However, his most recent severe autism reality post had me rather up in arms.

In short, Harold describes a situation in 2007 where a severely autistic woman was abused by two staff members at the care home she lived in. I agree with Harold that this is a strong warning that we need better autism services for severely disabled adults. However, what I strongly disagree with, is his allegation that this is an “autism reality”, rather than an abuse reality.

As an argument, Harold tells me that this woman is more vulnerable to abuse due to her disability, particularly her inability to communicate. This is true. However, that does not turn the disability into the cause of the abuse. It would be the same as saying that rape is a “female reality”, because women are far more likely than men to be raped. This is abuse apologism, and I strongly disagree with that.

Of course, we need to identify vulnerable groups of people, and make sure they are protected from abuse. But blaming a characteristic – be it disability or gender or whatever – for the abuse, is not going to solve the problem. You might say we need to help vulnerable groups to protect themselves, for example by teaching a non-verbal autistic to have a way to communicate abuse, but that is not the same as making the disability responsible for what happened. And if someone is unable to protect themself, for example by being so severely disabled that they have no way of communicating, the solution is to protect them from the outside. Either way, abuse of any kind is unacceptable, and calling it a reality of the person’s minority status, suggests otherwise.

ETA: Harold has responded to my blog post at his own blog.

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18-Year-Old Man Restrained in Room for Three Years

I received an E-mail from my boyfriend alerting me to a news story from a Dutch television program. 18-year-old Brandon lives at ‘s Heeren Loo, a well-known institution for people with intellectual disabilities. There, he has been fixated to the wall of his room using a leash for three years consecutively. His room is empty and looks like an isolation room. Brandon has not been outside since 2007.

Of course, it is aruged that Brandon’s unpredictable behavior – whatever that may be – is the cause for his needing to be restrained. In reality, however, there is no behavior too bad to warrant this sort of harsh and long-term restraining. Besides, this restraining will make matters much worse, in that it likely escalates Brandon’s behavior only more. Fortunatley, the Labor Party is asking for an emergency debate in Parliament, but this is way too late already.

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Announcement: New Forum for Trauma Survivors and People with Serious Mental Illness

I have set up a new support forum for survivors of trauma and abuse and people with borderline personality disorder, dissociative identity disorder, PTSD and related conditions. In order to join, you don’t need to be both a trauma survivor and have BPD or something similar – it’s okay if you fall into just one of these categories. For now, members need to activated by me before being able to participate. This is to prevent trolls and spammers from using the forum, so don’t worry about not being allowed on the boards. Go to the forums and enjoy.

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Repressed Memories in the Dutch Court System

There are two countries where the emergence of repressed memories of sexual abuse is common: the United States and the Netherlands. In the Netherlands, the controversy around whether one can repress memories at all and whether they are to be trusted, led to strict regulations for people seeking court action in cases of repressed memories.

Firstly, unlike in some states of the U.S., the expiration period for crime does not start at the moment of remembering, but at one’s eighteenth birthday. This way, the risk is lessened that people will have their family members charged over some dispute later in life.

Secondly and more importantly, alleged victims of represssed sexual abuse – and any form of ritual abuse – will have to be evaluated by a team of experts. This team includes a forensic researcher, a clinical psychologist, and a psychologist with expertise in memory. It is said that these experts are not there to allege that repressed memories or ritual abuse are not real per se, but to make sure the testimony is looked at carefully. In practgice, however, many cases are dismmissed over this sort of evaluation.

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Life After Trauma, Part 2: Possible Effects of Trauma

Chapter one of Life After Trauma starts by defining trauma. It is made clear with an example that the same experience may be traumatic to one person, but not another, depending on circumstances.

Then, possible reactions to trauma are dicussed. They are divided into:

• Physical reactions, such as tension


• Mental reactions, such as changes in the way you think


• Emotional reactions, such as anger, sadness, or other unpleasant feelings, or numbness of affect


• Behavioral reactions, such as irritability or withdrawing

Of course, one person doesn’t need to have all reactions – there is a long list in the book -, and someone may have reactions not listed.

It is also discussed how trauma may affect your relationship with others. You may no longer feel safe with or trust people that used to be comforting to you. But even if this doesn’t happen, others may not understand how you feel, and may not react adequately to your trauma. In a box, tips are provided for friends and family members on how to help trauma survivors. You can copy this information and give it to trusted people.

Reading about the possible reactions to and effects of trauma may have upset you, so the authors recommend laying aside the book for a while and doing a self-care activity. I had to lay aside the book for an entire week before I could pick it up again. At the end of chapter one, a relaxation and visualization exercise is provided. Fortunately, it is made clear that you can modify it as needed, because I was not able to follow all the steps.

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Three Years

Today, I have been in the mental institution for three years. This third year – which will be my last full year in this institution since I was accepted to the workhome -, was quite important. I made quite a lot of progress in trusting people. I came out multiple to my psychologist and primary nurse last May, and came out about some of the bad things that happened in the past. I still find it difficult to talk about that though.

It opened doors, because I may be able to get
EMDR treatment for the bad stuff. The psychologist who does that has a waiting list a mile long, so it will take a while if it is at all possible before I move to the workhome. And that is of course assuming I meet the criteria, which I have a vague feeling that I don’t. However, even if the EMDR isn’t going to work out, my having trusted the psychologist with the information I trusted her with, has already opened possibilities.

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