Article for ISTSS Complex Trauma Newsletter

  • 7 Replies
  • 481 Views
*

Kizzie

  • Administrator
  • Member
  • 8217
    • View Profile
Article for ISTSS Complex Trauma Newsletter
« on: March 30, 2020, 06:38:02 PM »
Just thought I'd share an article I wrote for the first edition of the ISTSS Complex Trauma Special Interest Group (I am a Co-Chair) newsletter.  It's supposed to go out in May but the pandemic may delay that a bit.  Here's hoping it will convey the message we are an underserved trauma population everywhere.  :yes:


RELATIONAL TRAUMA SURVIVORS WITH COMPLEX
PTSD: AN UNDERSERVED POPULATION

In 2014 I founded the online web site and forum group Out of the Storm for trauma survivors with Complex PTSD. (As I write this there are over 7500 registered members.) I did so because at the time there was little if any public information about Complex PTSD despite it having been on the radar for almost thirty years (Herman, 1992). I personally learned about it when I read the book “CPTSD: From Surviving to Thriving” (Walker, 2013). For the first time I recognized what I had been dealing with for most of my life. I was in my mid fifties and had been to many therapists over the years.
 
One apparent reason for the lack of information was that Complex PTSD was not an official diagnosis in either of the two most widely used diagnostic manuals, the APA DSM or WHO ICD. Despite a growing body of research and recognition of this more complex form of trauma, inexplicably in 2015 a bid to include Complex PTSD in the DSM-IV failed:

In response to our lobbying, the American Psychiatric Association funded a field trial for a new diagnosis: complex PTSD or DESNOS. After that study was completed, the PTSD committee voted 19 to 2 to create a new diagnosis in the DSM. But to our amazement, that diagnosis was eventually left out of the DSM-IV, despite overwhelming research evidence for a much more complex developmental response to trauma (van der Kolk, 2019).

This meant PTSD was the only diagnosis available to mental health/medical professionals, insurers, government health funders and others providing treatment, services and supports. In turn, this left a sizable population of people dealing with the debilitating and lasting effects of relational trauma underserved:

PTSD was a pretty good diagnosis for war veterans, but it was clear that there’s a much larger population of traumatized people. For every vet who comes back messed up, there are at least 30 kids who get abused, molested, abandoned, and neglected at home (van der Kolk, 2019).

Three years later in 2018 Complex PTSD was accepted as diagnosis in the ICD-11 by the World Health Organization. While this was a step forward many professionals and providers use the DSM and as a result, survivors with Complex PTSD are still being treated as though they have PTSD. As research continues to demonstrate, however, there are major differences between PTSD and Complex PTSD (Hyland et al., 2017; Karatzias et al., 2017).

PTSD involves short term/single incident, non-relational trauma (natural disasters, crime) and results in three major symptoms (which Complex PTSD shares): AV - Avoidance of Traumatic Reminders; RE – re-experiencing the past; SOT - persistent sense of threat. Complex PTSD results from ongoing trauma which is predominantly relational in nature (abuse/neglect) and results in three additional symptoms: AD – affective dysregulation; NSC – negative self-concept; and, DR – disturbed relationships (Hyland et al., 2017).

Treatment for Complex PTSD must necessarily address additional symptoms that develop in the face of the cause (relational) and ongoing nature of the trauma (Karatzias, et al., 2019; Karatzias & Cloitre, 2019).  In the 6 years since I started Out of the Storm, however, it has become abundantly clear that we (the vast majority of whom are from first world countries), struggle to find effective, accessible and affordable treatment as well as services and support for Complex PTSD. 
 
There is a pervasive lack of knowledge about/training to identify and treat Complex PTSD in all of the countries OOTS members are from – first world countries. The few professionals who do know about and treat Complex PTSD are typically in private practice in large cities. Private sessions cost between $180 and $225 per session, unaffordable for most survivors. There are long waiting lists for any publicly funded care which is predominantly for PTSD; treatment for Complex PTSD is simply not available.
 
We are underserved and yet there are many more of us than those with PTSD (van der Kolk, 2019). We must consider why this is still the case some thirty years after Judith Herman (1992) identified Complex PTSD. Perhaps there are politics involved as van der Kolk suggests (2019). Whatever the case, it seems only logical that the solution is for survivors with Complex PTSD to be identified and treated as a trauma group distinct from those with PTSD.
 
Toward this end, ISTSS/CT SIG members could collaborate to: have Complex PTSD included in the APA DSM-IV; educate mental health, medical and other professionals and the public about Complex PTSD; and, influence governments, insurers and other providers to increase funding for treatment, services and supports.

The COVID-19 global pandemic is causing ongoing traumatic stress to millions around the world. Now more than ever it is crucial to recognize how pervasive Complex PTSD is, and actively begin to assess what research, treatment, services and supports are needed. Those of us with Complex PTSD and at risk of developing it deserve no less; it’s time.

LH, EdD
Co-Chair ISTSS CT SIG
Founder Out of the Storm
Relational Trauma Survivor

References

Herman, J. (1992, 1997). Trauma and Recovery: The Aftermath of Violence - From Domestic Abuse to Political Terror. New York: Basic Books. ISBN 9780465087303

Hyland, P., Shevlin, M., Elklit, A., Murphy, J., Valličres, F., Garvert, D. W., & Cloitre, M. (2017). An assessment of the construct validity of the ICD-11 proposal for Complex Post Traumatic Stress Disorder. Psychological Trauma: Theory, Research, Practice, And Policy, doi:10.1037/tra0000114

Karatzias, T., et al., (2019). Psychological interventions for ICD-11 Complex PTSD: Systematic review and meta-analysis.  Psychological Medicine.  DOI:  10.1017/S0033291719000436

Karatzias, T & Cloitre, M. (2019). Treating adults with Complex Posttraumatic Stress Disorder using a modular approach to treatment: Rationale, evidence, and directions for future research. Journal of Traumatic Stress.  DOI: 10.1002/jts.22457 

Karatzias, T., et al. (2017). Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ), Journal of Affective Disorders, 207, 181-187.

van der Kolk, B. (2019). The politics of mental health. Psychotherapy Networker. Available: https://www.psychotherapynetworker.org/magazine/article/2368/the-politics-of-mental-health

Walker, P. (2013).  CPTSD: From Surviving to Thriving. USA: Azure Coyote
« Last Edit: March 31, 2020, 04:41:39 PM by Kizzie »

*

Blueberry

  • Member
  • 6879
  • 'Should' is never good for me.
    • View Profile
Re: Article for ISTSS Complex Trauma Newsletter
« Reply #1 on: March 30, 2020, 07:52:21 PM »
 :thumbup: :thumbup: :thumbup:

*

marta1234

  • Member
  • 531
    • View Profile
Re: Article for ISTSS Complex Trauma Newsletter
« Reply #2 on: March 31, 2020, 09:26:28 AM »
Amazing article Kizzie, really proud of it. I was unaware of some of the figures that you wrote about, opened my mind a bit.
Great job, as always :thumbup: :thumbup: :thumbup:

*

Hope67

  • Member
  • 2550
    • View Profile
Re: Article for ISTSS Complex Trauma Newsletter
« Reply #3 on: March 31, 2020, 10:25:13 AM »
Hi Kizzie,
This is a great article and very well written, comprehensive and helpful. 
Hope  :)

*

Kizzie

  • Administrator
  • Member
  • 8217
    • View Profile
Re: Article for ISTSS Complex Trauma Newsletter
« Reply #4 on: March 31, 2020, 04:38:09 PM »
Tks, glad it resonated.  The ISTSS is scheduled to have its annual meeting in Nov and the theme is "Bridging Science and Practice to Reach Underserved Communities: Barriers, Opportunities and Innovations" so the article was meant to prompt some reflection before then. Not sure if the meeting will run in Nov but it will at some point so worth getting the article out to members.   

My next step at the ISTSS CT SIG will be to ask for a volunteer (psychologist/psychiatrist member) to write up a proposal to the APA to add CPTSD to the DSM.  There's a process by which you can submit proposals to add to/edit any section. 

It's beyond my knowledge to do so as it has to be a clinically oriented proposal supported by a lot of research and written in the vernacular psych professionals use. I won't do so until there are enough signatures on the petition and we are past the worst of the pandemic though - too much happening at the moment and possibly for the next few months. 

Together with the petition, let's hope it helps 'git er done' so to speak.  ;D   
« Last Edit: March 31, 2020, 04:46:57 PM by Kizzie »

*

Kizzie

  • Administrator
  • Member
  • 8217
    • View Profile
Re: Article for ISTSS Complex Trauma Newsletter
« Reply #5 on: May 17, 2020, 05:52:15 PM »
The first ever newsletter for the Complex Trauma Special Interest Group at the ISTSS did go out on May 1st via listserv and got a great response I'm happy to say. It will also be posted on the CT SIG site but I think only members will be able to see it unfortunately (https://istss.org/membership/for-members/special-interest-groups-(1)/complex-trauma-sig). If you'd like a pdf of it though you can email me at OOTSManager@gmail.com. 

We're aiming for 2-3 editions in 2020 but then are hoping to do one every second month in 2021. Every edition will have at least one article by a survivor - in the first edition there were two, mine and another from an artist survivor.  So, we now have a voice that reaches professionals internationally. 

*

notalone

  • Member
  • 2214
    • View Profile
Re: Article for ISTSS Complex Trauma Newsletter
« Reply #6 on: May 20, 2020, 03:18:25 AM »
Very well written. A big thank you for being a strong voice for cptsd.

*

Blueberry

  • Member
  • 6879
  • 'Should' is never good for me.
    • View Profile
Re: Article for ISTSS Complex Trauma Newsletter
« Reply #7 on: May 20, 2020, 09:49:55 AM »
Yes, many thanks for your continuing advocacy work, Kizzie! :yes: :thumbup: :thumbup: