How Important is a Diagnosis?

[bob]

I have been to a see a psychiatrist twice and she wouldn't give me any kind of diagnosis other than that I have an anxiety disorder. She prescribed me Zyprexa 2.5mg and referred me for CBT, which I should be starting shortly. The Zyprexa helps my anxiety. I have also started taking omega 3 supplements to help with brain function.

I know I have PTSD. I have all the symptoms - nightmares, exaggerated startle response, poor concentration and memory, insomnia, anxiety, avoidance, etc. I feel that having suffered with this for over 10 years that I deserve a diagnosis.

My question is, how important is a diagnosis for you, and how long did it take you get one, if at all? Am I right to think I deserve a diagnosis, or should I not get too hung up on it?

[Claire]

Hello Bob, I dont think it's that important to me. Its just a label. I was told by the doctor, my therapist and a psychiatrist.

Why is it important to you? Is not having a diagnosis holding you back?

Claire

[brainless_twit]

I will answer your question both as a mental health professional and as a person with PTSD, bob.

As a professional - Diagnoses are necessary for insurance billing and to document the interventions used with a patient. However, there can be danger in applying a "label" to a person. What I see as PTSD may be an attachment disorder, adjustment disorder, personality disorder, depression, anxiety, or psychosis to someone else. If a person goes to several different professionals, s/he could end up with "alphabet soup" due to differences in perception. It can be very damaging to one's self-esteem to think everything in the world is wrong! Sometimes a professional knows all the symptoms a person is experiencing but doesn't want to make a diagnosis until s/he is able to rule out other things.

As a person with PTSD - It has been very helpful to me to know that I have PTSD. When I was diagnosed in 1996, my parents were told but I wasn't (for many of the reasons I mentioned above). There were times I thought I was losing my mind because no one ever explained to me that the voices I heard were flashbacks or why I woke up screaming in the middle of the night. When my mom happened to mention a few years later that I was diagnosed with PTSD, I was able to look it up and get information that explained all the things I experience. I was able to find this forum and talk to people who are dealing with the same symptoms. I find it much easier to cope when I know what I'm coping with, if that makes sense.

[She Cat]

Bob,

I think that for me....Knowing finally not only made sense, but it helped me to understand that I could do something about it. So I understand what you are saying... Even though it's a "Label" it also gives us something to hold on to. Something that explains why, we are as we are. It explains things and make it easier for us to accept...

Knowing if you have PTSD would help you to work toward an end. Not knowing would cause you to have more anxiety about what you might have.......or might not have....

I think that I would feel like you if I was in the same position. I wasn't Dx'ed until I was 41, before that I was labeled an Juvenile Delinquent and put away in a detention center, later I was Dx'ed as having Social Anxiety Disorder, and again as having G.A.D and Seasonal affective disorder. Then DX'ed as having Chronic depression. At age 41 I was finally Dx'ed as PTSD... Light bulbs went off, things made sense, and I finally decided to get my butt going on getting healthy.... It's been a challenge to say the least, and I have fallen from grace a few times, but I get back up and move forward....

You will too.......Keep fighting till you get healthy...

Wendy

[Lisa]

Here is someone who is not currently diagnosed by a Psychiatrist... however a psychologist and 2 therapists have independently told me and I fit the criteria to a T. The only reason I don't have the diagnosis from a Psychiatrist, is because I don't have one. When I did, I didn't know I had PTSD and was not very trusting of them.

Do I think having the diagnosis would benefit me personally? No. If anything having the label could only complicate my life further unecessarily.

As I am in England, I don't have health insurance and suchlike issues, as we have the NHS. I'm a student so currently it is convenient, because if I was working, I would probably need a diagnosis for being off work. So there are practical issues that diagnoses are important for, but I'm lucky in that these don't affect me at the moment.

Do I think finding that I fit the diagnostic criteria helps? Yes. It was one of the best things I have ever discovered... that what I was going through was not abnormal and unusual. That I'm not a 'lost cause', plenty of people suffer exactly the same way (and now I can talk to those and feel less isolated), plenty of professionals are dealing with it on a daily basis, plenty of research is going into PTSD and services and treatments are getting better. If I need to I can now say 'I have been told that I have PTSD'. I may not be officially diagnosed, but I don't need to be right now.

If I had to have the diagnosis to get treatments, I would then want the diagnosis though. At the moment, I am working with a therapist who is using techniques that are used in treating PTSD so I feel I am being treated for PTSD and am hopeful.

Having the name to put to my problems has helped but for making me feel less alone and knowing what to research and read to help myself.

However... one thing I will say is... if you are seeing a Psychiatrist, it is not uncommon at all that PTSD is not diagnosed, and those suffering with PTSD end up with multiple diagnoses or misdiagnoses altogether...and that is a dangerous thing when we are playing with chemicals and the brain, and effectively may not help a person much in the long run.

If you suffer with PTSD, you should be treated for it. It is not the same as any other diagnoses. It may have anxiety in it as a symptom... but treating anxiety alone will not cure some of the other symptoms of PTSD.

It is common in PTSD sufferers to go through several therapies and treatments which are geared for different problems and not PTSD specialised, and for the sufferers to not get very far. So in that respect, when dealing with Psychiatry and treatment, I do think it's important to have the problem recognised, in order to treat it. Otherwise the treatment may not be appropriate or adequate. If a diagnosis is needed for that, then I would say that is paramount.

[pandora]

PTSD made so much more sense to me. My doctor once wrote attatchment disorder.like WTF? From what..made no sense at all, PTSD, now that is me.

[anthony]

I believe BT really summed it up quite perfectly. It really is a two fold effect, though I do believe knowing is far better than not knowing.

What your describing here though Bob is that your shrink has given you a diagnosis of anxiety disorder, which is an actual diagnosis, along with a few other variations. PTSD is merely the worst, where they can look at you and know the difference between anxiety and PTSD.

Do you have PTSD? Even doctors take a certain guess at it without an MRI in front of them, as that is the only conclusive way to tell. They do get good at it though if experienced. Maybe you need to see a trauma specialist, and if they say you also have anxiety disorder, then that is what you would have, and not PTSD itself.

Your trying to look at syptoms, and most of the symptoms for PTSD are the same for anxiety disorder itself, being that stress causes the same symptomatic repercussions. PTSD differs not only in the first two criteria which must be met, but more the extent of the symptoms themselves. Again, a shrink with any experience can usually tell the difference between a person with anxiety disorder vs. PTSD (which is a type of anxiety disorder). Seek a second opinion, and if both are saying the same thing, then maybe you need to focus that you are curable, and getting yourself healed quickly. If the second opinion comes back saying PTSD, then you need to seek another opinion to clarify.

All doctors are not created equal, far from it. You need to seek those who specialise in trauma, as they will be able to provide a much more accurate diagnosis for you.

Maybe your shrink knows you have PTSD, but also knows as BT above stated, it can be damaging to know. Lots of maybe's, all of which are only doing you damage, as they do. Seek more information from your specialists, get second opinions if needed, and if they all come back with the same thing, then accept maybe you just have severe anxiety which is treatable, not incurable. I'd be happy with that.

[bob]

Thanks for the replies. My shrink doesn't specialise in trauma, she specialises in other things (depression, work related stress, alcohol problems and bereavement). She didn't actually give me a diagnosis as such, I think her words were "you have problems with anxiety".

I have read a lot about PTSD and other anxiety disorders, and PTSD is the label that seems to match closest with my symptoms.

As a bit of background, I was bullied in and out of school and by my older sister. Kids at school used me as a punchbag and called me all sorts of names. They used to wait for me outside school and kick me off my bike and beat me up. I got into trouble at school for misbehaving and the headmaster used to scream and yell at me. I was unable to tell anyone about the bullying and I coped with it by shutting myself away in my room. My sister hit me, called me names and made up stories to get me into trouble. My parents always believed her, she was the favourite. My parents abused me emotionally, as much by emotional neglect as by positive emotional abuse. My mother is a narcissist and incapable of showing love. She was hospitalised with post natal depression after I was born, and I never formed an emotional attachment to her. My father was hard on me and used to call me "useless" and a "waste of space". They used to argue a lot and they both used to hit me on occasion, sometimes they would come into my room and go ballistic and start punching me. I also suffered a number of physical assaults and muggings as a teenager including being beaten up by two police officers being attacked with a big spanner, needing stitches in my head. I have recurring nightmares where I am screaming at my parents and punching and kicking them, trying to get them to listen to me. I sometimes wake up screaming and swearing. To this day I have a great deal of difficultly expressing my feelings verbally and tend to let others walk all over me. You can probably see why I feel I deserve a diagnosis.

I have been struggling with PTSD-like symptoms for over 10 years. I never really knew what was wrong until I started reading about PTSD and I knew straight away that's what I have. I have been diagnoses with depression and anxiety a number of times, and have been on several different kinds of anti-depressants. I have struggled to explain myself to a number of different specialists but I have never seemed to get a satisfactory response. I have found the whole process very frustrating.

I'm not really sure where to go from here, my sessions with the psychiatrist are being covered by health insurance. I'm not sure if they will cover a second opinion with another one. I am also on a waiting list to see an NHS specialist, but I have been waiting for over 18 months. Maybe I should call a trauma specialist and talk it over briefly with them.

Thanks for listening.

[becvan]

Personally, I think it's very important. There is a difference between having something curable and having something non-curable. That difference can cause a lot of useless frustration when you think you can fix it.. but really you need to learn how to manage it! It's like banging your head against the wall.

Also, I believe knowledge is power. Knowing you have PTSD enables you to make informed choices or seek out the information you need to be informed.

PTSD is also well known for an aspect of denial. How are you supposed to get out of denial if you don't even know what is wrong? (food for thought there!)

In my experience, knowing what it was made all the difference. It was a relief.. I'm not crazy! LOL I know that others feel it's a burden, but to me it's all positive.

I think this is something you will have to decide is positive or negative for you and go from there!

bec

[bob]

I know what you mean about denial, I have been there. Sometimes I convince myself that I'm fine but my symptoms have been so bad recently that it's impossible to deny.

I was wondering if anyone knows of a trauma specialist in the UK, preferably in the South West?

[Marlene]

Tossing in my two cents.

I think a diagnosis (from a suffer's point of view) is important as a way to say, 'Yes, there's a problem. It's not just you, it's not in your head, you're not crazy'. Finding that out gave me quite a lot of mental relief from worry. Also finding out as much as you can about what PTSD entails (mentally/emotionally/physically) and how it can affect your life.

Beyond that we all have to take responsibility for our lives and our actions. No one is going to live them for us and we all have one shot at life. Some will use PTSD as a crutch and a reason not to fight. Some will use it as a reason to fight. I find being in the latter group is the only way I can live with it.

Lisa

[kers]

...important as a way to say, 'Yes, there's a problem. It's not just you, it's not in your head, you're not crazy'.
I've found this true as well, Lisa. The diagnosis and list of symptoms is something that I mostly dwelled on at the beginning of my treatment--it was a constant relief to be reassured that the symptoms (of which I had been very ashamed) were typical of a specific disorder. Once those were normalized for me (more or less), it has become easier to focus on changing my behavioral and thinking patterns. I'm not as focused on simply dismissing myself as "screwed up," so I can actually so something about my problems.

[anthony]

Bob, best place to find a trauma specialist is go to local veteran centres and ask them who the general therapists and doctors are that treat soldiers. They are trauma specialists. You don't need to be a veteran to ask, nor be one to use those people. Whilst military have their own specialists, they also use civilian, and once a veteran is discharged from the military, they then use civilians generally. Seek them and you will find your answers quickly.

The reason your current physicians have not given you a PTSD diagnosis is because of the method in which you have suffered your trauma, ie. bullying. Bullying does cause PTSD in some extreme cases, however; due to the nature of PTSD diagnosis, by itself it is not normally "traumatic enough" to meet the first two criteria, hence why most will not diagnose it for bullying.

The first two criteria which must be met, are:

Did you experience, witness, or were confronted with an event/s that involved actual or threatened death, serious injury, or a threat to the physical integrity of yourself or others?
Did your response involve intense fear, helplessness, or horror?Now, what you explained does fit this in certain aspects, though to a physician, they are also looking for the event that was "traumatic enough" to cause it. Diagnosis is not just about symptoms, because simply having anxiety disorder, you can have all the same symptoms of a person with PTSD does, but it does not mean you have PTSD, it means you have severe anxiety.

If you read http://www.ptsdforum.org/thread1114.html then you will get the general idea of what physicians are looking for in order to diagnose PTSD, because its not just about the symptoms you present, but the larger picture of your trauma experienced, how you feel about that, the events themselves, the extent of symptoms, your body language, and more. There are a lot of aspects measured for diagnosis of PTSD, beyond what is mentioned on paper. The paper criteria are that only a guide for diagnosis, and physicians are looking for other aspects in conjunction with those theory aspects for a diagnosis to be made. Otherwise, they go to the lesser diagnosis which is more often the correct one at that time, because not all physical attributes are being shown to them.

That doesn't mean you don't have PTSD, but it means they are not convinced you do, so they cannot make the diagnosis. You can't fake PTSD, trust me on that. If presented before a trauma specialist, they will know whether you have PTSD or you whether you simply have severe anxiety, which comes along with depression, etc etc... all the symptoms which may look like PTSD.

[bob]

Anthony, I agree 100% and I can assure you that I meet these two main diagnostic criteria as well as the other lesser ones. In fact, it was only after reading about the diagnostic criteria that I realised I have PTSD. Previously to that, I had thought I was going insane, which I gather this is pretty common with sufferers. Now I realise that is not the case.

After having a rather frustrating chat with my shrink, I have canceled my next appointment with her and asked her to refer me to a trauma specialist. Our chat basically involved me saying I want a diagnosis, and her saying she thinks I should get more exercise and go for CBT. We went round in circles from there, she ignored my request for a diagnosis. I didn't really like her anyway and hopefully my new specialist will be more helpful.

I would like to thank everyone who has replied to me so far for validating how I feel about the situation.

[bob]

RE the diagnostic criteria, I notice that bullying is absent from the list. I believe that bullying is significant enough to cause PTSD. After reading up on it, it seems that I am not the only one (bullyonline.org/stress/ptsd.htm#PTSD,%20PDSD%20and%20bullying). In my case the beatings I received were quite severe and I did fear for my life. As I mentioned, I was bullied in and out of school and also at home over a period of several years. I really thought the bullies were out to kill me and all efforts to get help went unrewarded. It is when the perceived threat to one's safety exceeds one's means of coping that I believe traumatic injury occurs. In my case, I had little or no means of coping and the perceived threat to myself was very real indeed and lasted for a number of years.

[bob]

I forgot to mention - the type of traumatic injury that I believe I am suffering from is known as Complex PTSD. See the wikipedia article on Complex PTSD (http://en.wikipedia.org/wiki/Complex_post-traumatic_stress_disorder) for more info.

[Lisa]

Hey there Bob...Fellow brit, hi!

It is recognised that bullying can cause PTSD alone, if there is perceived or actual threat to life, or physical and/or psychological integrity...at least that is my understanding of it, but correct me if I am wrong. I read the other day that the new DSM IV due to come out will have more specified symptoms listed to make the diagnosis clearer, as well as some branches of complex PTSD with adjusted criterion to that also. So there is hope for people like your Psychiatrist who are not open minded enough to actually listen to their patients (which I find ridiculous!).

I just want to point out that it would be impossible for Anthony to type up a list listing every possible trauma, so don't take that list as definitive because I don't think it was intended that way!

Bullying comes in many forms and many of us here have PTSD due to it at least in part - domestic abuse, work related bullying, school bullying, sibling abuse...

I understand your need to be validated. At times sometimes I have found myself up against the 'everyone gets teased at school' line and I find it the most offensive sentence anyone could ever give me. I often find I don't bother talking about the bullying so I just pick a different trauma to talk about from my list! Though I now have a therapist who is actually sensible for once.

But there is the world of a difference between 'natural' teasing children give and take in and outside of school, and bullying -which is abuse (and nobody ever belittles the effects of the word 'abuse'). Bullying not only causes PTSD, but also death by suicide in a proportion of those suffering at the hands of their bullies. They give it the word 'bullying' but I think it has a negative connotation to it these days, and isn't taken seriously enough by the government in the UK, that is for sure. I have heard too many sad stories of people connected to me where bullying has ended tragically. I had a friend in school hang herself (though she luckily lived). When she was back, the kids all walked around holding their ties up. So the school advised my friend to move schools... check out the irony there.

Anyway, there is a website on bullying and PTSD by Tim Field, I think its bullyonline... i think he relates some of it to work bullying but there's obviously school bullying and PTSD and stuff on there too... I don't have the link right now, but I'm sure if you search him up you'll find him. I just thought that it may be good for you to read up on some bullying specific PTSD websites so that you know that they are there and it is recognised generally know that bullying comes in different forms, different places and causes PTSD. Since you've felt invalidated by your psychiatrist (who sounds very similar to some I have had!), you might find as much validation as you can find helpful until your own validation is enough....

I was bullied similarly. It wasn't the only cause of PTSD for me, but I'm sure if there was only that I'd have PTSD anyway. I feared for my life under threat of being stabbed, alongside being beat up, humiliated, controlled etc.. Looking back, I doubt they ever would have stabbed me, though having said that I really don't put anything past them so, no I don't doubt they would have...but the important point is the PERCEIVED threat was most definitely there. I would be classed as complex PTSD too and a part of the trauma was consistently never being helped or believed, which only compounded it.

By the way - well done ditching the Psychiatrist and going for a trauma specialist! Good luck!

Sorry for the ramble... I have strong feelings on this subject!

[anthony]

Bob, I believe the best thing you have just done is made a decision for a second opinion. Again, if a trauma specialist says you don't have PTSD, then you need to listen to them and begin treatment for what they do believe you have, not what you believe you have. If that fails, then they will look further, have no doubt. Yes, some shrinks are idiots, especially towards bullying because of its nature. They want hard core physical abuse.

Now, whilst bullying is being recognised for some who have PTSD, is actually is a very limited percentage of those bullied who actually get PTSD vs. an anxiety disorder. You have to understand the difference of PTSD diagnosis compared to just what your reading. No, the list you read is not exhaustive, as Lisa pointed out above, thanks Lisa. What you must understand is the shrinks DO NOT look at the worst end of the scale, being PTSD, for something like bullying because whilst you believe it fits the first two criteria, I am going to give you what they work from, being the full understanding of "traumatic enough." You see, you can meet all the criteria theoretically, you can meet the criteria symptom wise, however; where some people confuse having PTSD vs. a near equal diagnosis of severe anxiety disorder, the that magical two words, "traumatic enough" and another two words that must be met are, "abnormal trauma."

The death of a loved one, whilst traumatic and can give a person all the symptoms of PTSD, is not classified by context as "traumatic enough" and/or "abnormal trauma", which is the difference as to why physicians DO NOT easily diagnose PTSD for bullying. Bullying is seen as a "normal" part of growing up in society, and that is the factual orientation of what bullying is, it is classed as "normal". Most children get bullied at some point during their childhood lives, for years, months or the entire time, it is classified as "normal trauma" of life. This is why you cannot be diagnosed with PTSD for having all the signs and symptoms if your partner dies. Death under fairly normal circumstances cannot be classified as "abnormal trauma" and/or "traumatic enough" and this is where sites such as bullyonline confuse listing PTSD, because they leave out those little facts within the diagnostic criteria, instead they go looking for everything around those facts, ie. if they discard that, it makes their statement / cause look better.

Again though, I will state, a very small percentage of people bullied do get PTSD and can be diagnosed from a trauma specialist. You may, you may not, have PTSD. You may simply have a severe anxiety disorder, and if so, you must accept that your trauma, whilst still very valid is trauma to you, may simply not be classified as either "traumatic enough" and/or "abnormal trauma" by the guidelines for diagnosis. You may find it is exactly "traumatic enough" or "abnormal trauma" when advised by a trauma specialist, but only they can tell you that.

I think you have probably sparked my mind a little now though, in that maybe I should include something about those two aspects which specialists are looking for, and not just the theoretical and physical symptoms that go with a diagnosis.

I don't believe many people truly believe just how serious PTSD is if diagnosed, and as society becomes more PC, they believe a little anxiety attack gives them PTSD, which we all know does not. This is how severe a diagnosis of PTSD is, and the extent of trauma one must suffer in order to get PTSD itself:
Revert again from what you know as a civilian, and now look at the Governments around world, which are the military.
A diagnosis of PTSD is that severe when looked upon as "traumatic enough" and/or "abnormal trauma" that PTSD is the only illness that military around the world rate equally too losing an actual limb.
You read that correctly, that is how severe the diagnosis is. Military around the world DO NOT provide pensions for anything lesser. You either lose a limb or have PTSD. By definition, have PTSD is actually defined as worse than only losing half a leg. Losing both legs is worse than having PTSD, both physically and mentally attributed.That is how severe a trauma one must endure for a physician to diagnose PTSD, because that is the very level they are comparing your trauma against, or equal to the level off the loss of an actual limb.

This is why there is a unique different to diagnosis towards death. Natural is simply not looked at, period. If your partner hung themselves, though you did not find them, you would not get diagnosed with PTSD, because whilst their death is traumatic to you, you did not witness, where confronted with or your physical integrity where not affected. Your partner simply hung themselves and you will have a natural anxiety affect as a result.

Now if you found your partner who had hung themselves, that changes everything in your response. You where confronted with their death, you found them, thus you now meet the means off "abnormal trauma" in relation to the first two criteria. The second is a given if you found someone hung. The immediate response would be helplessness.

Now, back to bullying. Some bullying has been recorded to the same extent as a child who was physically and emotionally abused by their parents their entire youth. It is rare, but it is recorded. These are usually the few who meet the full criteria. In relation to yours Bob, you have mentioned physical abuse, and this may/may not meet the criteria because it depends on the length of time and extent, beyond what is classified as "normal" school yard bullying, fighting, etc. We have all been bullied, most have been in fights at school, even sustaining stitches, broken bones, etc... I have, and my brothers, though none of which gave me PTSD. That does not mean it wasn't a pre-cursor to my own PTSD, ie. the straw that broke the camels back.

It really is a developing issue within the diagnostic criteria, being bullying, and one which will see more light no doubt as the years pass and society becomes more PC. But the undisputed facts must still be reviewed, and that is for someone to be diagnosed with PTSD, it cannot be lessened to what the intent of the diagnosis is, being the extreme end of all scales and incurable. A person diagnosed has met "abnormal trauma" and "traumatic enough", met all theoretical and physical impairment guidelines, obviously met the first two criteria though the traumatic enough instances.

I think you have done the right thing though Bob, being to seek a second opinion to find out once and for all what a trauma specialist believes, because there is a huge difference between a know it all shrink using personal bias vs. a trauma specialist who knows trauma inside out, back to front, and excludes personal judgement or bias from their diagnosis. Well done Bob.

The DSM IV is also not the latest version of the DSM, you must actually look at the DSM IV (TR), which is a text revision of the manual. The DSM V is scheduled to break apart PTSD into multiple categories, in that you will be diagnosed with: Combat PTSD, Childhood PTSD, etc etc... labels that allow physicians to know what your trauma was, or close enough too. That was the initial statement made in relation to the next revision of DSM. Whether that will occur or not, yet to be seen. I will tell you when it comes out, as I will purchase a copy for myself.

[Lisa]

Apology for mentioning the wrong DSM version... I didn't have the book I was referring to (where I got the information, not the actual DSM whatsit) handy so I obviously got it wrong. Anyway, Anthony clearly has the diagnostic criteria firmly in his head, as opposed to me!

I have to reply with my personal opinion on this, I hope this is okay.

Personally - I think mainly on a psychological viewpoint when it comes to thinking around PTSD, but I am still learning myself. I hate disagreeing with people (and admittedly I am scared to disagree with you Anthony!) but I come from things differently in relation to whether or not bullying is 'normal trauma' or 'abnormal' trauma. To me, trauma is trauma. If the effects are the same as 'abnormal trauma', then what does it matter whether it's considered normal or abnormal by a psychiatric professional body based on the fact that it is not a rare enough occurrence to be considered traumatic? Sexual abuse happens a lot... but that is not considered 'normal' trauma. As I said, there is a difference between every day teasing, and severe bullying where a child is left victimised, psychologically and physically injured, terrified, emotionally, mentally and sometimes physically tortured, and, effectively, traumatised by it years later. However, as Anthony touched on, this is a developing issue and could all change as the criteria is being constantly adjusted.

But that is just my personal opinion, and this is about diagnosis, which is purely a psychiatric issue... therefore my post and psychological viewpoint doesn't really belong in this discussion!

But I do agree that you cannot be diagnosed with something lesser than the diagnostic criteria, and that the best thing to do is to get a second opinion.

[bob]

Lisa and Anthony, thankyou for your posts. You both make some excellent points and have given me lots of food for thought.

Anthony, you make the point of PTSD only being considered if there is evidence of "abnormal trauma". I would like to point out the difference between the diagnosis for PTSD and Complex PTSD. To quote wikipedia, Complex PTSD is a clinically-recognized condition that results from exposure to prolonged interpersonal trauma. The keyword here is prolonged. Arguably there is no single incident that I have encountered that would cause PTSD, although some do come close*. Instead, my problems are caused by lots and lots of lesser traumatic incidents over several years. I believe that Complex PTSD is not included in DSM IV but is under consideration for inclusion in DSM V, so getting a diagnosis thereof may be tricky without a very good doctor.

Whilst I agree with Anthony that the doctors are looking for abnormal trauma in a PTSD diagnosis, I believe that traumatic injury is sustained when the trauma experienced exceeds one's ability to cope with it. There are two very important points to consider here. Firstly, (Complex) PTSD can be caused by situations that are less traumatic than considered necessarry for PTSD, as long as they are prolonged in nature. Secondly, the point at which traumatic injury is sustained is subjective. That is to say it varies from person to person depending on how well they are able to cope with trauma. For someone with limited coping resources, traumatic injury may be sustained from incidents that someone with better coping resouces would be able to deal with. At any rate, the net result is the same whether PTSD or Complex PTSD - it's all traumatic injury.

I was going to write some more about bullying and emotional abuse but I've worn myself out and my mind has gone blank.

* the ones that come to mind are being beaten in the head with a spanner needing stitches, being punched by a guy with a sovereign ring and then having my head slammed in a door needing stitches, being beaten by two police officers in the back of a police car, being shut in a bin by children at school, setting off a trap that spiked me in the head requiring stiches, seeing a friend beaten with a baseball bat and lots of blood coming from his head, witnessing a woman killed by a bus and bleeding lots

[Claire]

Hello Bob, I recommend you read a book called PTSD, the invisible injury. I cant remember who its by but I think its the guy that Lisa mentions Tim Field or a collegue of his. Its written by a policeman. its very good and was a real awakening for me when I found it.

I hope you get an answer one way or the other from the new specialist.

[anthony]

I hate disagreeing with people (and admittedly I am scared to disagree with you Anthony!)
Lisa, no need to ever be scared of me, I don't bite. I like people to disagree with me, because I value others opinions. Some things I write here may be my opinion, which I usually use IMO or IMHO, and some are facts that I have studied / self educated about. Please do disagree with though Lisa, because I am certainly not always right, nobody is. I would rather someone correct me if I am wrong, or if they have a better way of doing things, I certainly love change.

Anthony, you make the point of PTSD only being considered if there is evidence of "abnormal trauma". I would like to point out the difference between the diagnosis for PTSD and Complex PTSD. To quote wikipedia, Complex PTSD is a clinically-recognized condition that results from exposure to prolonged interpersonal trauma. The keyword here is prolonged.
You are correct Bob in what you state, though complex PTSD is more an in-house diagnostic assessment label, and yes, again correct that it is not in the DSM IV (TR) though this is the topic on how the PTSD diagnosis will be broken down in the DSM V. You are correct in that aspect, absolutely.

What I think your missing here though, is that regardless what your looking for in relation to the labelling, the outside characteristics for the further labelling are only part of the diagnosis once a person meets the actual PTSD diagnosis itself. PTSD is diagnosed as acute or chronic only, at present by the DSM criteria, however; what I must add here, is that the DSM is only a "guide" to diagnosis, and is not by any means a "legal" bible for the mental health industry. Some think it is, but it is not, and this is why we have in-house diagnostic criteria such as "severe PTSD" and "Combat PTSD" and "Complex PTSD" etc. This is why the industry is calling for a more standardized approach I believe, in that from what I have read about the topic, so far the additions will be made to help standardize the PTSD diagnostic labels instead of some working only from the DSM, others working from the in-house word of mouth rules, and so forth.

Regardless of all this, the actual basics for PTSD as defined by the DSM IV (TR) must all be first met, including "abnormal trauma" and/or "traumatic enough". Again though, my list does not rule out bullying because its not mentioned, as several trauma types are not within it, though can be used for PTSD diagnosis. The list is not exclusive, that is for sure. I know two people with PTSD diagnosed from bullying, though I will add, the bullying they had to actually prove, go figure, then it was proved as being so severe the diagnosis from anxiety disorder to PTSD was made, from what I am aware in these two cases.

Bullying can be "traumatic enough" to cause PTSD, no doubt about it. The only issue I believe they had to prove was that it was not classified as "normal" type playground bullying as part of growing up. I believe that was the issue. For example, I had fights at school, even though I hated fighting and avoided it at all costs, and did injure myself, though have no traumatic recollections beyond them being a normal aspect of growing up and school yard bullying / pissing contests that go on. I could certainly think back though to one, maybe two kids, that could likely have PTSD from school yard bullying that I attended school with, in that the typical bullies of the school honed in on them constantly, and with what I know now, could undoubtedly state they should have PTSD because their near entire high school years would off been hell, and no doubt caused more conflict when taken home, the typical teen mentality of keeping it all in, not talking with parents, etc; all the things we know are wrong now, but still occur regardless.
Firstly, (Complex) PTSD can be caused by situations that are less traumatic than considered necessary for PTSD, as long as they are prolonged in nature. Secondly, the point at which traumatic injury is sustained is subjective.
I would have to agree and disagree with this. As already stated, even to meet complex PTSD you must meet the PTSD diagnosis, which already encompasses and is recognised for long standing trauma, ie. childhood abuse, molestation, bullying, etc. From my understanding, and I will have Dr. Roerich have a look at this thread if he has time, is that the label of "complex" is just that, a label after diagnostic criteria has been met, basically saying that the extent of trauma is from the prolonged duration of events, constant events, and off a significant nature to "compound" and become over-whelming for the mind.

I think you are correct, though I am pretty sure you must still first meet the actual diagnostic criteria. Again though, I will ask Dr Roerich if he can read this thread and clarify, as he would be a better person to outline due to being a traumatic specialist.
That is to say it varies from person to person depending on how well they are able to cope with trauma.
Absolutely agree mate, and that is a definite, in that two people can be exposed to the same trauma, one get PTSD, one not, all because of their unique individuality perceptions in how their mind interprets the event.

I was going to write some more about bullying and emotional abuse but I've worn myself out and my mind has gone blank.
* the ones that come to mind are being beaten in the head with a spanner needing stitches, being punched by a guy with a sovereign ring and then having my head slammed in a door needing stitches, being beaten by two police officers in the back of a police car, being shut in a bin by children at school, setting off a trap that spiked me in the head requiring stiches, seeing a friend beaten with a baseball bat and lots of blood coming from his head, witnessing a woman killed by a bus and bleeding lots
Bob, this is exactly what I mean mate, when I say its not just about bullying itself, but you have now been physically injured with the mental compounding nature of bullying. You witnessed a women killed by a bus, nothing to do with bullying. You have been beaten by police, etc. You very likely may have PTSD because of these events, where the bullying may off been the pre-existing issues, though seeing a women get killed by a bus was the one that just tipped the scale for your mind.

I definitely believe you need that second opinion though, and the more you mention about the injuries sustained and especially the witnessing of the women killed, you need to be telling this to a trauma specialist so they can help make an accurate diagnosis. Again, they will know just by looking at your actions, reactions, the way you walk, talk, sit, everything, whether you have PTSD or not.

Either way mate, I truly do hope you atleast get the answers you need, being you have it or severe anxiety, whichever it is, both must be treated immediately, because even the severe anxiety left untreated could manifest to PTSD if you don't have it already. Not good though, that is for sure, and I definitely agree that your last physician likely took things a little too lightly. Again though, they can see you, I cannot.

[anthony]

Ok, I have spoken with Dr Roerich in relation to this issue, and whilst he cannot give specific information to you Bob as personal advice, I can give you a break down of what I interpret our conversation to determine. In point form, it goes something like this:

A diagnosis has been made, anxiety disorder, yet the causes of it can be many and varied.
Besides anxiety what else is going on and what is the cause of the anxiety. Is it situational?
When did it occur and when did it get worse that you sought treatment from a psychiatrist?
Have you received treatment for anxiety before?
Have you been hospitalized for depression or psychosis? What about family members?
Have you been screened for bipolar disorder or PTSD? While you may feel you have all the symptoms, those very symptoms described can be from many causes. How open are you to detailing your problems?
How detailed is the psychiatrist in asking for signs and symptoms in a differential diagnosis?
A psychiatrist who prescribes Zyprexa is thinking of paranoia, hypomanic or manic state of bipolar disorder, psychosis, or a need to temper aggressive behavior towards self or others.
The correct diagnosis is always based on doctor and patient working together to piece together the pieces of a puzzle: what is causing distress or dysfunction? What is causing anxiety? Is a diagnosis important? Yes, but unless there is an honest exchange of what is being experienced and what is being reported to the psychiatrist, the correct diagnosis may be elusive. The doctor should screen for bipolar disorder and PTSD. An organic workup for physical causes of anxiety should be done:

Acute Coronary Syndrome
Alcohol and Substance Abuse Evaluation
Congestive Heart Failure and Pulmonary Edema
Costochondritis
Depression and Suicide
Hyperthyroidism, Thyroid Storm, and Graves Disease
Hyperventilation Syndrome
Hypoglycemia
Mitral Valve Prolapse
Myocardial Infarction
Neoplasms, Brain
Pneumonia, Bacterial
Pneumothorax, Iatrogenic, Spontaneous and Pneumomediastinum
Pulmonary Embolism
Schizophrenia
Toxicity, Benzodiazepine
Toxicity, Narcotics
Toxicity, Sympathomimetic
Toxicity, Thyroid Hormone
Withdrawal Syndromes

Other Problems to be Considered

Neuropathies
Pheochromocytoma
Sinus tachycardia
Brugada syndrome

Source: emedicine

Bob, in the above referenced material, Zyprexa is not mentioned as a medicine used for treatment, which typically outlines something more is going on with you than meets the eye.

[bob]

Hi Anthony. I have sent you a PM with some responses to the questions. I didn't post it here because some of it feels a bit personal.

Many thanks for your help, I'm really greatful to you.

[piglet]

Hi Bob,

If you are looking for a private trauma specialist, you might want to try the Oxford stress and trauma centre: oxdev.co.uk

Not sure how far that is for you, but they have a very good reputation and I can personally recommend them.

Piglet.