Official Diagnosis of Complex PTSD by World Health Org

[Kizzie]

The work of crafting the official diagnosis for Complex PTSD by the World Health Organization for the 11th International Classification of Diseases has finally been completed  (see https://icd.who.int/dev11/proposals/f/en#/http://id.who.int/icd/entity/585833559?readOnly=true&action=ContentEnhancementProposal&stableProposalGroupId=904bb7e6-14cc-462c-b31f-79ca70b8f628&notifsystem) (If you can't get into the link you may have to make an account.)  To the best of my knowledge it is supposed to be published in 2018 and this is what what they are going with:

Complex post-traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). The disorder is characterized by the core symptoms of PTSD (including brain and HPA Axis alterations); that is, all diagnostic requirements for PTSD have been met at some point during the course of the disorder. In addition, Complex PTSD is characterized by 1) severe and pervasive problems in affect regulation; 2) persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the traumatic event; and 3) persistent difficulties in sustaining relationships and in feeling close to others. The disturbance causes significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

So the definition we came up with was rejected but at least we entered into the conversation and made our voice heard.  Hopefully by continuing to reach out we will help organizations and professionals see and better understand the nuances of this psychological injury.

[sanmagic7]

this is better than what it was.  thanks, kizzie, for all your work on this.  yay, WHO.

[Kizzie]

I had an email notification from WHO about the definition of COmplex PTSD and lo and behold the working group is asking for comments      

So I posted this:

"Emotional" abuse should be included in this definition as this form of abuse is prevalent and a major cause of what leads to those "persistent beliefs about oneself as diminished, defeated or worthless" identified as a symptom. The latter half of the same sentence is somewhat of a misnomer (pervasive feelings of shame, guilt or failure related to the traumatic event). It is the repeated or ongoing nature of trauma rather than a traumatic event that is so common in the development of Complex PTSD.  This also makes the word "post" somewhat misleading.  As in my previous submission it is also important to point out that many of us who have Complex PTSD find the word "disorder" quite stigmatizing and prefer the word "injury."   

It may not get anything except the "Rejected" button again, but at least we are part of the conversation 

[Fen Starshimmer]

Yay, Kizzie... it's great that OOTS is being included in the WHO's conversation about the definition of CPTSD. Feels like we are part of something bigger, and have influence. 

I clicked on the link you provided and found myself directed to a page to register with a variety of options on how I would like to participate and details of the rules and regulations involved when you sign up. I was too tired to go through it all, and decided I needed more time to think about it. So I haven't signed up.

[Blueberry]

Yay, Kizzie... it's great that OOTS is being included in the WHO's conversation about the definition of CPTSD.

I echo that! And it's thanks to Kizzie's work that we're being included.    Kizzie

[Elphanigh]

Thank you for advocating for us Kizzie. It is great that we are part of this conversation 

[Kizzie]

I wasn't sure if anyone could see the proposals submitted and then follow-on comments without an account. OK, so you have to have an acct, oh well.  I'm following it though Fen (and everyone) and I'll post any updates if/when anything interesting happens.

[Jdog]

Many thanks, Kizzie, for your extreme dedication and persistence as we struggle to be understood.

[PeTe]

It's so good that you're working to give them input, Kizzie! I really hope emotional abuse will be part of their definition, as that's why I've got cPTSD. I now realise I feel very vulnerable around having problems that can be written off as nothing or forced into a mold that doesn't fit, like it's a shortcoming of mine.

[Blueberry]

I really hope emotional abuse will be part of their definition, as that's why I've got cPTSD. I now realise I feel very vulnerable around having problems that can be written off as nothing or forced into a mold that doesn't fit, like it's a shortcoming of mine.

    Even though in my case there was some CSA and CPA the emotional abuse was the worst. And anyway CSA and CPA of types that can be written off as easily as emotional abuse. It's terrible when docs and Ts persistently say it wasn't bad enough when it plainly was bad enough!

[PeTe]

    Even though in my case there was some CSA and CPA the emotional abuse was the worst. And anyway CSA and CPA of types that can be written off as easily as emotional abuse. It's terrible when docs and Ts persistently say it wasn't bad enough when it plainly was bad enough!

Most definitely. We're not here for the fun of it, it's because it was that bad. I haven't been living the high life the last six months, I'm on a sick leave. Even if emotional abuse is included in the description, though, we'll still have to face a multitude of others who choose to believe us or not. I'm really glad I have this forum 

[Elphanigh]

I too, really hope they include emotional abuse in the description. Although I experienced "enough" CSA, and CPA the emotional abuse took such a gigantic toll. I feel like it is really important to recognize that form of abuser formally just like any other. It is great that this place exists because it is such a widely accept thing here

[Kizzie]

It surprises me that it wasn't included. As  many of us know only too well here at OOTS, Complex PTSD can develop from emotional abuse/neglect alone.  Perhaps it's that the World Health Organization is very focused on major political, economic and social crises around the world so emotional abuse such as many of us have experienced in our homes/workplaces/relationships/religions/etc may be too nuanced for them to take into account. 

I'd like to think if the American Psychological Association ever gets around to including it in the DSM, it will cover emotional abuse because the organization is focused on psychological diagnoses.

[Fen Starshimmer]

I finally got round to registering an account with the WHO and have been able to see for myself how CPTSD is being discussed and Kizzie's excellent contribution.

I have done the equivalent of a Facebook 'Like' to Kizzie's recommendation of including  emotional abuse in the definition. If other people feel strongly about this issue and would like the WHO to change its stance on CPTSD so that it includes emotional abuse, you could do likewise, register and support Kizzie's statement. It might help to show there is widespread support for its inclusion, even if they do appear to have made their minds up at the moment. I can also provide a comment of my own if I wish. I am considering it. Need to get the words right for WHO.

Kizzie said:

It surprises me that it wasn't included. As  many of us know only too well here at OOTS, Complex PTSD can develop from emotional abuse/neglect alone.  Perhaps it's that the World Health Organization is very focused on major political, economic and social crises around the world so emotional abuse such as many of us have experienced in our homes/workplaces/relationships/religions/etc may be too nuanced for them to take into account. 

It's alarming to see that emotional trauma wasn't included, given the prevalence of it as shown here at OOTS and through my own experience and reading of recommended texts.  It suggests that the majority of people entering into the discussion about the definition of CPTSD have not done their research thoroughly, and are/were ill-equipped for the task. It's a shame that CPTSD experts like Pete Walker, Judith Herman, Bessel Van Der Kolk and others, were not invited to take lead roles in such an important assessment, a decision that could, and probably will, have heavy repercussions for survivors worldwide.  People will continue to get misdiagnosed, stigmatised and marginalised as they suffer the devastating longterm effects of emotional abuse and neglect in childhood. The medicating of symptoms will continue apace, while they will be guided onto CBT courses (for which they should be grateful).

[hereforhope]

I had an email notification from WHO about the definition of COmplex PTSD and lo and behold the working group is asking for comments      

So I posted this:

"Emotional" abuse should be included in this definition as this form of abuse is prevalent and a major cause of what leads to those "persistent beliefs about oneself as diminished, defeated or worthless" identified as a symptom. The latter half of the same sentence is somewhat of a misnomer (pervasive feelings of shame, guilt or failure related to the traumatic event). It is the repeated or ongoing nature of trauma rather than a traumatic event that is so common in the development of Complex PTSD.  This also makes the word "post" somewhat misleading.  As in my previous submission it is also important to point out that many of us who have Complex PTSD find the word "disorder" quite stigmatizing and prefer the word "injury."   

It may not get anything except the "Rejected" button again, but at least we are part of the conversation 

I noticed the lack of a mention of emotional abuse immediatelly. Didn't these guys do their homework? Pete Walker (I guess he's book is one of the largest on C-PTSD) cleary states that emotional abuse (in the form of abandonment) is what's at the core of the wounding of trauma. He mentions children who are physically abused and get trauma, but don't get C-PTSD because they aren't emotionally abandoned by at least one care-taker.

Why are people so incompetent? Everyone here has been waiting so long for an official diagnosis and first thing they do is screw up the fundamentals.