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Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
Complex PTSD and Bordeline Personality Disorder
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Complex PTSD and Bordeline Personality Disorder

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  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • The goals for today’s presentation are to take a look at a cluster of symptoms not yet included in the DSM. The concept of CPTSD has been around for at least 17 years, since the term was first used by Judith Herman in Trauma and Recovery (1992). In 1997 it was called Disorders of Extreme Stress, Not Otherwise Specified (DESNOS) studied in a field trial for potential inclusion in the DSM-IV. Rather than introducing CPTSD as a new diagnosis, as recommended by Pelcovitz, Kaplan, & Spitzer and the field trial group, 9 of the 12 recognized symptoms were included in the Associated Features of PTSD. We will look at the ways in which the current PTSD diagnosis does not properly describe the symptoms experienced by those who would be diagnosed with CPTSD, as well as a number of diagnoses that might be comorbid with PTSD or subsumed under CPTSD. One of the more controversial conclusions dranw by some researchers is that many people currently diagnosed with Borderline Personality Disorder might actually have CPTSD, which might have the benefit of reducing the stigma attached to BPD. 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • This slide is an abbreviated version of the DSM-IV TR criteria for BPD. We will be looking at these more later. The full criteria follow. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:     1. frantic efforts to avoid real or imagined abandonment. Note : Do not include suicidal or self-mutilating behavior covered in Criterion 5.   2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.    3. identity disturbance: markedly and persistently unstable self-image or sense of self.    4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note : Do not include suicidal or self-mutilating behavior covered in Criterion 5.    5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior    6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).    7. chronic feelings of emptiness    8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)    9. transient, stress-related paranoid ideation or severe dissociative symptoms The essential feature of Borderline Personality Disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts. 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • Now we will shift gears briefly to discuss Dissociative Disorders. 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • Here we have the six general criteria for the diagnosis of PTSD. In the following sections we will consider the ways in which these criteria may be inadequate to describe the closely related, yet distinctly different, cluster of symptoms ‘unofficially’ called Complex Posttraumatic Stress Disorder. 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • The associated features of PTSD are subsumed within the aspects of CPTSD as defined by the DSM-IV field trial for DESNOS. 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • FIND CITATION 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • Splitting off of elements of trauma 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • Here is a comparison between CPTSD and BPD. As you can see, there are significant similarities between the two. 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 46 questions within 6 subscales 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • ADD ROTH 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • 11/12/2009 Complex PTSD Dave Butler: Differential Dx Facilitation
  • Transcript

    1. Prelude <ul><li>http://www.youtube.com/watch?v=JdEJB7UPmUc </li></ul>
    2. <ul><li>“ Classic” PTSD </li></ul>
    3. PTSD, Complex PTSD and Borderline Personality Disorder A Complex Dx David Butler Differential Diagnosis November 11, 2009
    4. Goals for today <ul><li>Comparison between 3 often co-occurring Dx </li></ul><ul><ul><li>Borderline Personality Disorder </li></ul></ul><ul><ul><li>Dissociative Disorders </li></ul></ul><ul><ul><li>Complex PTSD (CPTSD) </li></ul></ul><ul><li>Introduction to CPTSD </li></ul><ul><ul><li>PTSD </li></ul></ul><ul><ul><li>CPTSD </li></ul></ul><ul><ul><li>DSM-V </li></ul></ul>
    5.  
    6. Core Concepts of Axis II <ul><ul><li>“ presence of a pervasive and enduring </li></ul></ul>
    7. Core Concepts of Axis II <ul><ul><li>“ presence of a pervasive and enduring pattern of maladaptive spontaneous behaviors, responses, and modes of thought </li></ul></ul>
    8. Core Concepts of Axis II <ul><ul><li>“ presence of a pervasive and enduring pattern of maladaptive spontaneous behaviors, responses, and modes of thought that begin by early adulthood, </li></ul></ul>
    9. Core Concepts of Axis II <ul><ul><li>“ presence of a pervasive and enduring pattern of maladaptive spontaneous behaviors, responses, and modes of thought that begin by early adulthood, often interfere with normal interpersonal relationships, </li></ul></ul>
    10. Core Concepts of Axis II <ul><ul><li>“ presence of a pervasive and enduring pattern of maladaptive spontaneous behaviors, responses, and modes of thought that begin by early adulthood, often interfere with normal interpersonal relationships, and produce functional impairment or subjective distress” (Fauman, 2002, 376-377) </li></ul></ul>
    11.  
    12. DSM-IV TR Criteria for BPD <ul><li>A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:   </li></ul><ul><li>  1. Avoidance of real or imagined abandonment </li></ul><ul><li>  2. a pattern of unstable and intense interpersonal relationships </li></ul><ul><li>  3. identity disturbance: markedly and persistently unstable self-image or sense of self.  </li></ul><ul><li>  4. impulsivity in at least two areas that are potentially self-damaging </li></ul><ul><li>  5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior  </li></ul><ul><li>  6. affective instability due to a marked reactivity of mood.  </li></ul><ul><li>  7. chronic feelings of emptiness  </li></ul><ul><li>  8. inappropriate, intense anger or difficulty controlling anger </li></ul><ul><li>  9. transient, stress-related paranoid ideation or severe dissociative symptoms </li></ul>
    13. Borderline Personality Disorder <ul><li>Essential feature: “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts.” (American Psychiatric Association, 2000) </li></ul><ul><li>Associated with childhood abuse (Golier et al., 2003) </li></ul>
    14. Case Study
    15. Case Study <ul><li>Does Dal’s case meet the essential criteria for BPD? </li></ul><ul><li>Name at least five of the diagnostic criteria for BPD that are met by this case. </li></ul>
    16.  
    17. Core Concept <ul><li>“ The core concept of the Dissociative Disorders is a temporary disruption in the normally integrated functions of memory, identity, or consciousness, leading to amnesia, feelings of depersonalization, or multiple distinct personalities in the same individual” (Fauman, 2002, 274-275) </li></ul>
    18. Dissociative Disorders <ul><li>300.12 Dissociative Amnesia </li></ul><ul><li>300.13 Dissociative Fugue </li></ul><ul><li>300.14 Dissociative Identity Disorder </li></ul><ul><li>300.15 Dissociative Disorder NOS </li></ul><ul><li>300.6 Depersonalization Disorder </li></ul>
    19. Depersonalization Disorder <ul><li>“ persistent or recurrent experiences of feeling detached from their own thoughts or body” </li></ul><ul><li>“ reality testing remain intact” </li></ul>Fauman, 2002, 278
    20. <ul><li>Also known as Disorders of Extreme Stress, </li></ul><ul><li>Not Otherwise Specified (DESNOS) </li></ul>
    21. Overview <ul><li>1992: Introduced by Herman </li></ul><ul><li>1992: DSM-IV Field Trial; DESNOS (Pelcovitz et al.) </li></ul><ul><li>1994: DSM-IV: Associated features of PTSD </li></ul><ul><li>2012: DSM-V? </li></ul><ul><li>Results from prolonged interpersonal trauma (Choi et al., 2009) </li></ul><ul><li>Strongly related to early childhood trauma, especially CSA </li></ul><ul><li>92% of people with CPTSD may meet criteria for PTSD (Roth et al., 1997) </li></ul><ul><li>May be comorbid with PTSD </li></ul><ul><li>Shares symptoms with </li></ul><ul><ul><li>Other anxiety disorders </li></ul></ul><ul><ul><li>Mood disorders </li></ul></ul><ul><ul><li>Borderline Personality Disorder </li></ul></ul><ul><ul><li>Dissociative disorders </li></ul></ul>
    22. Diagnostic Criteria for PTSD <ul><li>Criterion A - Exposure to trauma </li></ul><ul><li>Criterion B - Re-experiencing event </li></ul><ul><li>Criterion C - Avoidance and numbing </li></ul><ul><li>Criterion D - Increased arousal </li></ul><ul><li>Criterion E - Duration of at least one month. </li></ul><ul><li>Criterion F - Significant distress or impairment of social or occupational functioning. </li></ul>
    23. Criterion A: Exposure to trauma <ul><li>PTSD </li></ul><ul><li>CPTSD </li></ul><ul><li>The person has been exposed to a traumatic event in which both of the following have been present:  </li></ul><ul><li>(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others </li></ul><ul><li>(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior. </li></ul><ul><li>Most often associated with single or combat related trauma </li></ul><ul><li>Most often results from long-term, chronic abuse, typically beginning in childhood </li></ul><ul><li>Childhood sexual abuse most highly predictive </li></ul>
    24. Criterion B: Re-experiencing event <ul><li>PTSD </li></ul><ul><li>CPTSD </li></ul><ul><li>The traumatic event is persistently re-experienced in one (or more) of the following ways:  </li></ul><ul><li>(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. </li></ul><ul><li>(2) recurrent distressing dreams of the event. (3) acting or feeling as if the traumatic event were recurring </li></ul><ul><li>(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. </li></ul><ul><li>(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event </li></ul><ul><li>Individual may not be able to connect with a particular event </li></ul><ul><li>Event may have occurred before person had words to describe it </li></ul><ul><li>Could be somatic </li></ul>
    25. Criterion C: Avoidance and numbing <ul><li>PTSD </li></ul><ul><li>CPTSD </li></ul><ul><li>May not be able to explain why he or she avoids certain places or situations </li></ul><ul><li>Presenting trauma may not be the original trauma </li></ul><ul><li>May experience symptoms of one or more dissociative disorders </li></ul>C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma),
    26. Criterion D:Increased arousal <ul><li>PTSD </li></ul><ul><li>CPTSD </li></ul><ul><li>Affect dysregulation </li></ul>D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:  (1) difficulty falling or staying asleep  (2) irritability or outbursts of anger  (3) difficulty concentrating  (4) hypervigilance  (5) exaggerated startle response
    27. Criteria E and F <ul><li>Criterion E: Duration of at least one month </li></ul><ul><li>Criterion F: Significant distress or impairment of social or occupational functioning. </li></ul><ul><li>No difference between PTSD and CPTSD in these criteria </li></ul>
    28. DSM-IV TR: Associated features of PTSD <ul><li>More commonly seen in association with an interpersonal stressor (e.g., childhood sexual or physical abuse, domestic battering, being taken hostage, incarceration as a prisoner of war or in a concentration camp, torture): </li></ul><ul><li>impaired affect modulation; </li></ul><ul><li>self-destructive and impulsive behavior </li></ul><ul><li>dissociative symptoms </li></ul><ul><li>somatic complaints; </li></ul><ul><li>feelings of ineffectiveness, shame, despair, or hopelessness; </li></ul><ul><li>feeling permanently damaged; </li></ul><ul><li>a loss of previously sustained beliefs, hostility; </li></ul><ul><li>social withdrawal; </li></ul><ul><li>feeling constantly threatened; </li></ul><ul><li>impaired relationships with others; </li></ul><ul><li>or a change from the individual's previous personality characteristics. </li></ul>
    29. Aspects of Complex PTSD (Luxenberg, Spinazzola, Hidalgo, Hunt and van der Kolk, 2001; Blaz-Kapusta, 2008) <ul><li>Affect dysregulation </li></ul><ul><li>Disturbances in attention or consciousness </li></ul><ul><li>Disturbances in self-perception </li></ul><ul><li>Disturbances in relationships </li></ul><ul><li>Disturbances in meaning systems </li></ul><ul><li>Somatization </li></ul>
    30. Affect Dysregulation <ul><li>Extreme responses to neutral or mild stimuli </li></ul><ul><li>Self-destructive behaviors </li></ul><ul><li>Preoccupation with suicide </li></ul><ul><li>Problems modulating or expressing anger </li></ul><ul><li>Difficulty self-soothing </li></ul>
    31. Attention or Consciousness <ul><li>Amnesia: “spacing out”, trouble remembering recent events, gaps in life story </li></ul><ul><li>Dissociation/depersonalization </li></ul><ul><ul><li>Clients may not know what it feels like to be in their own body </li></ul></ul><ul><ul><li>Worse for those who experienced multiple traumas </li></ul></ul><ul><ul><li>Extreme cases lead to Dissociative Identity Disorder </li></ul></ul><ul><ul><li>Similar to, but more profound than, the “numbing” associated with classic PTSD (van der Hart, Nijenhuis & Steele, 2005) </li></ul></ul>
    32. Self-Perception <ul><li>Sense of being inherently flawed </li></ul><ul><li>Feel “dirty” or stigmatized </li></ul><ul><li>Childlike sense of responsibility </li></ul><ul><ul><li>Blame selves for their abuse </li></ul></ul><ul><ul><li>Problems taking responsibility for their own (real) actions </li></ul></ul><ul><li>Tend to minimize their experiences </li></ul><ul><ul><li>May not respond affirmatively to questions about having been victimized </li></ul></ul><ul><li>Often feel helpless/hopeless </li></ul><ul><ul><ul><li>Misdiagnosed as, or comorbid with, MDD </li></ul></ul></ul>
    33. Relationships <ul><li>Trust: Too much or too little </li></ul><ul><li>Revictimization </li></ul><ul><ul><li>May not pick up on warning signs </li></ul></ul><ul><ul><li>No internal template for healthy relationships </li></ul></ul><ul><li>Victimizing others </li></ul><ul><ul><li>Reenacting their abuse </li></ul></ul><ul><ul><li>May occur during treatment </li></ul></ul><ul><li>Difficulty developing social supports </li></ul>
    34. Somatization <ul><li>Nonverbal form of re-experiencing the trauma? </li></ul><ul><li>Irritable Bowel Syndrome </li></ul><ul><li>Chronic pelvic pain </li></ul><ul><li>Headaches </li></ul><ul><li>Poor response to typical medical treatments </li></ul><ul><li>Symptoms appear more severe or persistent than typical </li></ul><ul><li>May be symbolic representation of trauma </li></ul>
    35. Meaning Systems <ul><li>Existential cynicism: life has no meaning or purpose </li></ul><ul><li>Malevolent god </li></ul><ul><li>Fatalistic </li></ul><ul><li>“ This is a profound, persistent and physical sense of learned helplessness that dramatically affects the capacity to formulate options, make choices, act on one’s own behalf, or implement changes in one’s life.” (Luxenberg et al., 2001) </li></ul>
    36. Similarities between CPTSD and BPD CPTSD BPD Affect dysregulation <ul><li>inappropriate, intense anger or difficulty controlling anger; affective instability due to a marked reactivity of mood.  </li></ul><ul><li>chronic feelings of emptiness  </li></ul>Disturbances in attention or consciousness <ul><li>transient, stress-related paranoid ideation or severe dissociative symptoms </li></ul><ul><li>Avoidance of real or imagined abandonment </li></ul>Disturbances in self-perception <ul><li>Identity disturbance: markedly and persistently unstable self-image or sense of self.  </li></ul>Disturbances in relationships <ul><li>a pattern of unstable and intense interpersonal relationships </li></ul>Disturbances in meaning systems <ul><li>recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior  </li></ul><ul><li>impulsivity in at least two areas that are potentially self-damaging </li></ul>Somatization
    37. Differences?
    38. Assessment Tools <ul><li>Clinician-Administered PTSD Scale for DSM-IV (CAPS) </li></ul><ul><li>Structured Interview for Disorders of Extreme Stress, NOS (SIDES) </li></ul><ul><ul><li>Only instrument validated for CPTSD Diagnosis assessment </li></ul></ul><ul><ul><li>Developed for DSM-IV field trial to measure </li></ul></ul><ul><ul><ul><li>current and lifetime DESNOS/CPTSD </li></ul></ul></ul><ul><ul><ul><li>current symptom severity </li></ul></ul></ul><ul><ul><li>45 questions and 6 subscales </li></ul></ul>
    39. SIDES (Structured Interview of Extreme Stress) <ul><li>1. Alterations in regulation of affect and impulses </li></ul><ul><ul><li>Affect </li></ul></ul><ul><ul><li>Anger </li></ul></ul><ul><ul><li>Self-destructive </li></ul></ul><ul><ul><li>Suicidal&quot; </li></ul></ul><ul><ul><li>Sexual involvement </li></ul></ul><ul><ul><li>Risk taking </li></ul></ul><ul><li>2. Alterations in attention or consciousness </li></ul><ul><ul><li>Amnesia </li></ul></ul><ul><ul><li>Dissociative </li></ul></ul><ul><li>3. Alterations in self-perception </li></ul><ul><ul><li>Ineffectiveness </li></ul></ul><ul><ul><li>Damage </li></ul></ul><ul><ul><li>Guilt and responsibility&quot; </li></ul></ul><ul><ul><li>Shame&quot; </li></ul></ul><ul><ul><li>Understand </li></ul></ul><ul><ul><li>Minimize </li></ul></ul><ul><li>4. Alterations in relations with others </li></ul><ul><ul><li>Trust </li></ul></ul><ul><ul><li>Revictimization </li></ul></ul><ul><ul><li>Victimizing others </li></ul></ul><ul><li>5. Somatization </li></ul><ul><ul><li>Digestive </li></ul></ul><ul><ul><li>Chronic pain </li></ul></ul><ul><ul><li>Cardiopulmonary </li></ul></ul><ul><ul><li>Conversion </li></ul></ul><ul><ul><li>Sexual </li></ul></ul><ul><li>6. Alterations in system of meaning </li></ul><ul><ul><li>Hopelessness </li></ul></ul><ul><ul><li>Beliefs </li></ul></ul>
    40. Comorbidity <ul><li>Substance Abuse </li></ul><ul><li>Depression (Brand et al., 2009) </li></ul><ul><li>BPD – may be better subsumed under CPTSD (McLean & Gallop, 2003) </li></ul><ul><li>Dissociative Disorders </li></ul><ul><ul><ul><li>Symptoms similar, but superseded by PTSD </li></ul></ul></ul>
    41. DSM-V <ul><li>Anxiety, Obsessive Compulsive Spectrum, Posttraumatic Stress and Dissociative Disorders Work Group </li></ul><ul><ul><li>Posttraumatic and Dissociative Disorders Sub-work group </li></ul></ul><ul><li>Currently (4/2009) planning field trials for PTSD, ASD, DESNOS, and Adjustment Disorder </li></ul><ul><li>Key questions under consideration: </li></ul><ul><li>Revising PTSD A1 criterion </li></ul><ul><li>A2: possibly include posttraumatic stress reactions of panic attacks, dissociation, shame and guilt </li></ul><ul><li>Cross cultural factors </li></ul><ul><li>Potential new Dx of: </li></ul><ul><ul><ul><li>DESNOS </li></ul></ul></ul><ul><ul><ul><li>Developmental Trauma Disorder </li></ul></ul></ul>(Phillips, 2009)
    42. Diversity <ul><li>Gender </li></ul><ul><ul><li>Most sexual abuse victims are female </li></ul></ul><ul><ul><li>CPTSD may be better fit and less stigmatizing </li></ul></ul><ul><ul><li>Women of color more likely to experience psychological trauma, but less likely to report PTSD or CPTSD symptoms (Ford, 2008) </li></ul></ul><ul><li>Culture </li></ul><ul><ul><li>Some cultures more likely to minimize trauma </li></ul></ul>
    43. Ethical and Policy Issues <ul><li>CPTSD may be a less stigmatizing Dx than BPD, which tends to be diagnosed more often in women. </li></ul><ul><li>Veterans could lose benefits if CPTSD were to take precedence over PTSD. </li></ul><ul><li>Cross cultural implications being considered by APA for DSM-V </li></ul>
    44. Recommended resources <ul><ul><li>Assessment tools ( http://dpelcovitz.googlepages.com/ ) </li></ul></ul><ul><li>APA Report of the DSM-V Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group ( http://www.psych.org/MainMenu/Research/DSMIV/DSMV/DSMRevisionActivities/DSM-V-Work-Group-Reports/Anxiety-Obsessive-Compulsive-Spectrum-Posttraumatic-and-Dissociative-Disorders-Work-Group-Report.aspx ) </li></ul>
    45. References <ul><li>American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders : Dsm-iv-tr (4th ed.). Washington, DC: American Psychiatric Association. </li></ul><ul><li>Blaz-Kapusta, B. (2008). Disorders of extreme stress not otherwise specified (DESNOS) -- a case study. Archives of Psychiatry & Psychotherapy, 10(2), 5-11. </li></ul><ul><li>Brand, B., Classen, C., Lanins, R., Loewenstein, R., McNary, S., Pain, C., et al. (2009). A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians. Psychological Trauma: Theory, Research, Practice, and Policy, 1(2), 153-171. </li></ul><ul><li>Choi, H., Klein, C., Shin, M.-S., & Lee, H.-J. (2009). Posttraumatic stress disorder (ptsd) and disorders of extreme stress (desnos) symptoms following prostitution and childhood abuse. Violence Against Women, 15(8), 933-951 </li></ul><ul><li>Fauman, M. A. (2002). Study guide to dsm-iv-tr. Washington, DC: American Psychiatric Pub. </li></ul><ul><li>Ford, J. D., & Smith, S. F. (2008). Complex posttraumatic stress disorder in trauma-exposed adults receiving public sector outpatient substance abuse disorder treatment. Addiction Research & Theory, 16(2), 193-203. </li></ul><ul><li>Golier, J. A., Yehuda, R., Bierer, L. M., Mitropoulou, V., New, A. S., Schmeidler, J., et al. (2003). The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events. Am J Psychiatry, 160(11), 2018-2024. </li></ul><ul><li>Herman, J. L. (1992). Trauma and recovery. [New York, N.Y.]: BasicBooks. </li></ul>
    46. References (cont.) <ul><li>Luxenberg, T., Spinazzola, J., & van dek Kolk, B. (2001). Complex trauma and disorders of extreme stress (DESNOS) part one: Assessment. Directions in Psychiatry, 21, 373-388. </li></ul><ul><li>Pelzovitz D, van der Kolk B, Roth S, Mandel F, Kaplan S, Resick P. Development of a Criteria Set and a Structured Interview for Disorders of Extreme Stress (SIDES). Journal of Traumatic Stress 1997, 10: 3—16. </li></ul><ul><li>Phillips, K. A. (2009). Report of the DSM-V anxiety, obsessive-compulsive spectrum, posttraumatic, and dissociative disorders work group Retrieved 11/08/2009, 2009, from http://www.psych.org/MainMenu/Research/DSMIV/ DSMV/DSMRevisionActivities/DSM-V-Work-Group-Reports/Anxiety-Obsessive-Compulsive-Spectrum-Posttraumatic-and-Dissociative-Disorders-Work-Group-Report.aspx </li></ul>

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