A Complex Diagnosis

I mentioned I was diagnosed with PTSD, but I'm going to focus on CPTSD because I believe that's more accurate for me. The C is for Complex.

I had never heard of CPTSD until I stumbled upon some information about it last summer. I immediately recognized myself in the diagnostic criteria and suddenly my entire adult life made sense. For years before that I knew there must be something wrong with me, but I didn't have a word for it so I figured I was just weird. (As a friend helpfully pointed out, "They're not mutually exclusive!")

So why was I diagnosed with PTSD? According to the official rules, you can't have CPTSD. In the US, the rulebook we use is the Diagnostic and Statistical Manual of Mental Disorders (DSM). The rules change a lot, so I don't mind breaking them.

I recommend the DSM for entertainment purposes only, so I'm including this brief history just for context: PTSD wasn't officially recognized in the DSM until the 1980s. It soon became apparent that this diagnosis was insufficient for survivors of complex trauma, and when the DSM-IV came out in 1994, it included Disorders of Extreme Stress Not Otherwise Specified (DESNOS) under the PTSD label. The term DESNOS didn't really stick (shockingly) but is basically the same thing as what is commonly called CPTSD today. The most recent edition, the DSM-5, tacks on the additional symptom clusters of CPTSD in a single sentence under "Associated Features Supporting Diagnosis." It also allows for a dissociative subtype, which is closer to CPTSD. This edition was published in 2013, but there is still a lot of controversy over whether CPTSD should be classified as a subtype of PTSD or as a separate disorder.

This chart I stole from the internet shows the difference between PTSD and Complex PTSD symptoms. I think this is taken from the ICD-11 (another classification system that I won't get into now), but the three symptom clusters of PTSD seem to reflect the DSM-IV. In the DSM-5, Avoidance has been split into two clusters: Avoidance and Negative Alterations in Cognition/Mood, which absorbs some of the CPTSD symptoms. So the PTSD diagnosis has expanded to become more inclusive of CPTSD than this chart shows.

Fun times.