Recent conversations with C regarding my experiences of child sex abuse have been highly suggestive that there’s a lot more to what happened than that which is recalled in my forefront, conscious memory. In recent sessions, and outside them at times too, I keep getting flashbacks of incidents of which I’d not previously been aware, and certainly a lot of my symptoms seem to imply that I am (or have been) afflicted by considerable dissociation. On Thursday (about which I must write soon) I accused myself of having false memory syndrome, but C defended me, advising that trauma memories are very often fragmented and dissociated in this way, and are recalled in random, disordered ways like those I was reporting.
Anyhow, if indeed the abuse was more sustained than I had previously supposed, I am wondering to what extent I am troubled by some version of post-traumatic stress disorder. C has bandied the term about a few times, but hitherto I’ve rejected any sense of it, as my ‘trauma’ was fuck all in comparison to that of many others of whom I’m aware. I still agree with this assessment of my experiences relative to others, but I can, in light of the apparent new memories, begin to accept that PTSD might apply. In particular, I believe I fit (at least some of) the criteria for complex-PTSD.
I have never disputed my BPD diagnosis, but I wonder to what extent the criteria for C-PTSD would also apply. Or perhaps one is more appropriate than the other? I am (rather pointlessly) going to examine the evidence.
Diagnostic Criteria for Borderline Personality Disorder (BPD)
Frantic efforts to avoid real or imagined abandonment.
I do fear abandonment considerably, that is undeniable. The mere thought of it upsets and terrifies me, though I’d have to admit that that doesn’t universally apply to all individuals in my life. I have made a concerted effort to fight the imminent abandonment from C; however, I would not say that any of my abandonment-avoidant issues have involved ‘frantic efforts’. It is a fear, but not something I am wont to actually do much about.
A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.
I certainly don’t have unstable relationships, and they’re not ‘intense’ by comparison to some. I am certainly known to swing between idealising and devaluing individuals with whom I have interpersonal relationships, but it’s usually quite episodic and would not be a consistent thing.
Identity disturbance: markedly and persistently unstable self-image or sense of self.
I’m conflicted about this. I do have a clear sense of who I am most of the time, but my self-image is certainly unstable, as I can go from despising myself to thinking I’m really quite alright within minutes (though admittedly the former position dominates).
Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving).
I’m not at all guilty of the stereotypical borderline behaviour of promiscuous sex. However, in fairness to my ‘diagnoser’, I still do fit this criteria – I binge eat, I purge, I am known to drive recklessly, I am known to drink heavily, etc.
Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
Can’t really deny any of this. I haven’t attempted suicide or seriously self-harmed since January, which I suppose is good, but I still think about such things all the time and engage in the picking / scar interference behaviour mentioned.
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).
I don’t agree that it generally lasts less than ‘a few days’, but otherwise this is absolutely true.
Chronic feelings of emptiness.
Yes.
Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
I have very, very rarely been involved in physical altercations, but the rest is absolutely spot on.
Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms.
Undeniable.
So, that gives a total of six symptoms out of nine, with one or two of the others being debatable. To meet the threshold for the diagnosis, one must exhibit at least five of the nine criteria (under the current incarnation of the DSM anyway). Ergo, I haz BPD innit. Fair enough. (Source for the above information: Wikipedia).
Proposed Criteria for Complex Post-Traumatic Stress Disorder (C-PTSD)
A history of subjection to totalitarian control over a prolonged period (months to years).
My instinct is to deny this…but I don’t think I really can anymore. Certainly, some of the more minor instances of the abuse were over many months, and quite probably years. The new memories suggest that more serious stuff may also have fitted this pattern, but I just cannot be sure. ‘Totalitarian control’ seems like a harsh term in my mind but, thinking (ostensibly) rationally, I suppose what else do you call it when some old cunt pushes a child forcibly to the ground or wall and sticks his fucking cock in her?
Alterations in affect regulation, including:
- persistent dysphoria
- chronic suicidal preoccupation
- self-injury
- explosive or extremely inhibited anger (may alternate)
- compulsive or extremely inhibited sexuality (may alternate)
Yes to all of these, in broad terms at least. The first three, as you know, are certainties. Furthermore, I am a very angry person and tend to ‘explode’ with certain individuals – but with others, I’m extremely submissive therefore hiding my raging anger. Consequently, I think it’s fair to say it alternates. Re: sexuality, I couldn’t say that ‘compulsive’ has ever been an especially accurate term, but it was for quite a while incredibly inhibited. It’s not so much the case now that I know sex – as in normal, consensual sex – is really not that much of a big deal (in the sense that it’s just one of many enjoyable things in which adults engage), but during my childhood and teenage years I had pretty conservative views on how I wanted to express my own sexuality.
Alterations in consciousness, including:
- amnesia or hyperamnesia for traumatic events
- transient dissociative episodes
- depersonalisation/derealisation
- reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation
You see, my instinct is to absolutely refute any suggestion of amnesia – but then, if I’m ‘suffering’ from it, I’m not exactly going to know I’m suffering from it, am I? That’s kind of the point of amnesia. All one can do is look at the other evidence available. The new flashbacks and other symptoms I present do seem to hint strongly at it, so I will reluctantly accept it as at least a possibility.
The rest of these all absolutely apply. I can’t say that I experience flashbacks with considerable frequency, but they do happen and I do ruminate on events a lot.
Alterations in self-perception, including:
- sense of helplessness or paralysis of initiative
- shame, guilt, and self-blame
- sense of defilement or stigma
- sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)
All of the first three apply absolutely, especially the shame / self-blame bit. I do feel different from other people in many ways, though in more nebulous terms than this criterion suggests. I’m not entirely sure how to describe it, but it applies in some inexplicable way.
Alterations in perception of perpetrator, including:
- preoccupation with relationship with perpetrator (includes preoccupation with revenge)
- unrealistic attribution of total power to perpetrator (caution: victim’s assessment of power realities may be more realistic than clinician’s)
- idealisation or paradoxical gratitude
- sense of special or supernatural relationship
- acceptance of belief system or rationalisations of perpetrator
This is really the main area in which I feel that I deviate from this diagnosis. None of these strongly apply to me; I don’t think he’s that powerful, we don’t have a special relationship and I don’t idealise him at all. However, I don’t dislike him particularly, and have been known to defend him despite what he’s done. I also rationalise his behaviour towards me on the grounds that I’m a slag who led him on. Whilst ridiculous, this is of course a genuinely held belief.
Alterations in relations with others, including:
- isolation and withdrawal
- disruption in intimate relationships
- repeated search for rescuer (may alternate with isolation and withdrawal)
- persistent distrust
- repeated failures of self-protection
All of these apply, to varying degrees. I withdraw so considerably from society at times that I might as well be a hermit, and I trust absolutely no one until they have all but definitively proven themselves over a period of months. I wouldn’t say that I experience or cause disruption in my interpersonal relationships a lot – but I suppose in small ways it can be true (losing my rag with Mum or A, for example, some discussion of which has already been featured on this blog). I’ve been looking for a rescuer for years, and think my obsessive desire for C to protect and take care of me currently exemplifies this. And I can’t say that I’m especially successful in protecting myself, now can I?
Alterations in systems of meaning:
- loss of sustaining faith
- sense of hopelessness and despair
To be honest I’m not sure what the first one even means, but “yes, definitely” to the second one.
So, let’s say there are seven broad diagnostic criteria for this disorder. I’m not sure how many one would have to meet to be considered to be suffering from it, but I think I can say that six of the seven generally apply to me, which sounds like pretty categorical to me. (Source for the above information: Sasian. Oddly, C-PTSD doesn’t yet seem to be included in either the DSM or the ICD, though it is certainly recognised by the discipline of psychiatry, as this leaflet from the Royal College of Psychiatrists attests).
The more general syndrome of PTSD additionally includes traits such as hypervigilance, avoidance of anything that may trigger memories, distrust of authority, cynicism, sleep disturbances and psychic or emotional numbing – all things highly evident in the mentalness of yours truly. And, as stated, I sometimes have flashbacks too; in fact, Thursday’s session with C was almost characterised by them at points.
I’m not really sure why I’m writing this. If I were disputing the BPD diagnosis, it would make more sense – but I’m not. Part of me would love to get rid of it, given the unfair but deeply entrenched stigma attached to the illness; on the other hand, how can one meaningfully fight against that unreasonable stigma if one is not from within the bracket of people to whom it is applied?
I think what I’m trying to do is make clear to myself that there actually has been trauma in my life. Every time C (or anyone else) speaks the word I wince, because I find it difficult to accept on anything but an intellectual level that there actually was any trauma. If I fit the criteria for post-traumatic stress disorder, even if it’s only via a silly self-diagnosis, then perhaps somehow I can allow myself to actually believe that I am traumatised. Although often also (in part) caused by ‘trauma’, BPD doesn’t immediately convey that potential causation through its name in the way PTSD does.
At the end of the day it doesn’t really matter; it’s ultimately a semantic debate that doesn’t really mean anything, and psychiatric diagnoses are often a pile of old crap anyway. But I know that sooner or later I need to properly realise that I was not to blame for the sexual violence levied against me, and if I can advance that realisation in any way then I suppose that is to be welcomed. Alas, though, it is still a pipedream for now.
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I particularly like that last paragraph ‘But I know that sooner or later I need to properly realise that I was not to blame for the sexual violence levied against me’ – and it feels like this is the main point really, it may be a pipe dream but it is the direction you are heading towards. This feels like a step that way. Good for you, this is tough stuff.
xx
Thanks hun. I suppose it’s a start to be even thinking about modifying my position of “I am a slut”, given as it has been something I’ve lived with since I was a child.
xxx
My own psych has suggested from the start that PTSD was more an apt DX for me over BPD, like you my anger is often directly at one person although it’s a lot more controlled in the past 12 months… I think group therapy helped things somewhat but I still have a lot of issues with this person, hence wanting to return back to therapy. The inhibited sexuality is a big issue for me which is something that’s been discussed at length with my psych over the past few sessions.
I see NewVCB tomorrow and am hoping I have the nerve to broach this subject with her. I don’t dispute that I have BPD, but if she would throw PTSD in there somewhere, I would feel somewhat vindicated, I think.
I’m glad you’ve been able to talk to your shrink about various aspects of your PTSD Alison. It makes such a difference when they take time to explore all the symptoms.
xxx
This is not related to your post, but I thought you might find this article interesting, although you may have already read it. http://www.guardian.co.uk/society/2010/mar/03/clare-allan-mental-health
xxx
Sigh. I suppose it’s good that I’m not alone, but it’s so horribly frustrating that this is system we have. You can get long-term treatment for a physical condition, but not for a psychological one. That doesn’t make any sense to me at all
xxx
You may think this was a bit of a pointless post, but I think it’s good to just take a few minutes (or hours >.>) to analyse diagnoses. If you get the feeling something might be off about it or it doesn’t fully cover everything then it’s good to think it over even if you don’t end up with a revelation.
I can relate to a lot of what you’re saying here, particularly with this quote ‘I find it difficult to accept on anything but an intellectual level that there actually was any trauma.’ In my studies (both personal and for college) on psychopathology, I’ve always skimmed right past PTSD; disregarding it as a possible diagnosis for me, without even reading the criteria (which is odd because I read everything regardless of whether it relates to me usually). Your post has made me realise that it may well be ‘possible’. I don’t believe self-diagnosis to be a good thing, but it is good to read up on things and have an idea. Psychs aren’t perfect after all
Thanks FD, I’m glad you were able to think about it being a possibility for you too. It sounds like maybe you skimmed over PTSD for fear of recognising symptoms in yourself…I know I had, because I didn’t want to accept ‘trauma’ and a degree of lack of culpability for being mental. I don’t know why but I know others understand it – getting rid of self-blame is almost an unbearably difficult thing to do. Logically you’d think it’d be the opposite.
Anyway, as I said to Alison above, I’m seeing the psychiatrist tomorrow. I’m scared of psychiatrists so don’t know if I’ll get the balls up to raise this with her, but as you say – they aren’t perfect, so fingers crossed
xxx
When I read the comments you made about your experiences of abuse and the way you almost downplay the trauma you went through, it really rang true with me. I hope you don’t mind but I used a paragraph that you wrote in this blog post I have just done http://mycrazybipolarlife.wordpress.com/2010/03/08/0344-downplaying-our-traumas/ and if you want me to delete it please just leave a comment on it and I will do it straight away. Thanks for sharing both a very personal and interesting post about the similarities and yet the differences in C-PTSD and BPD. I think a lot of people who have experienced trauma in their life will be able to relate to many parts of the C-PTSD criteria, sadly.x
I don’t mind at all – in fact, thank you! And thanks for sharing your experiences on your own blog, I know how difficult it can be
*hugs* to you hun xxx
I’m so proud of you, SI. I just am.
Aww, thanks Ethereal – really touched. Thank you
*big hugs* xxx
I remember writing a similar post to this when I was first diagnosed with BPD because I didn’t want that diagnosis for obvious reasons. I spoke to nice psychiatrist about it and he said that he saw it as the two diagnoses being on a continuum and it was just a matter of where you decided you lay on said continuum. If that makes sense. I do think there is a place for PTSD and thats been recognised in my diagnosis. I know it’s abhorrant to face the idea of trauma, naming it as such makes it badder than attempts to minimise it finds acceptable. It’s horrible and thats something I’ve had to organise in my head a fair bit.
An excellent book on the subject is Judith Herman’s Trauma and Recovery http://www.jimhopper.com/trauma_and_recovery/ which I found really helpful when looking at C-PTSD.
Take care sweetie and hugs xxxx
I would second this recommendation – it’s a brilliant book.
Having read your blog on and off for months now it’s seemed to me that PTSD seems reasonable- how could you not be traumatised by what was done to you. You’re very brave to be starting to really confront it all.
Best wishes
Kate
Thank you Kate. I hope I can get the shrinks to agree!
xxx
I agree about the continuum thing. I was so glad that your psychiatrist recognised the PTSD as well as the borderline diagnosis. I’m hoping to gain the courage to speak to NewVCB about this, but I’m horribly deferential towards the psychiatrists for some reason.
On the strength of your and Splintered Ones’ advice, i bought that book. It’s sitting beside me right now, and after I’ve written up last week’s session, I’ll be reading it in more detail. Thanks for the suggestion hun.
Lots of hugs, take care xxx
hi
i think this is a really brave and informative post, not pointless (your word) at all.
I too have a question mark of c ptsd diagnosis, alongside bpd. I had never read the criteria before but it makes so much more sense now. I havent got a diagnosis as havent been able to discuss in detail as yet. Thanks for writing this, it has helped me, i do hope it helps you too, to think about such tough stuff x
I’m really glad it helped you, Jo, and thanks for your kind words. I hope that over time you’ll be able to discuss things in more detail with your psychologist and/or psychiatrist, but I know how hard it is
Wish you lots of luck for that. Take care and hugs xxx
Ah the joy of diagnosis.
I believe I remember reading somewhere that some psychiatrists believe BPD and C-PTSD are different versions of the same thing – occurring in a spectrum/continuum/weird graph thing which also includes the ‘other’ dissociative/trauma diagnoses.
But then BPD has also been said to be a mood disorder, and not necessarily connected with a “specific trauma”.
Actually current thinking in certain areas is that all mental health issues originate from trauma of one sort or another – be it one big identifiable thing, or the culmination of lots of little things…
But I digress…
Anyway, if accepting the diagnosis of C-PTSD is some way enables to you accept that you weren’t to blame and helps you along your path to recovery, then it’s a very positive thing.
With regards its seeming absence from DSM-IV and ICD-10, I think this is in part because it’s a fairly ‘new’ diagnosis. Have you checked if it appears in the draft of the DSM-V?
Take care,
Differently
I just checked DSM-5 on this last night. As I understand it, C-PTSD wasn’t in DSM-IV because it was felt that anyone with such psychopathology would meet the threshold for (non-C)PTSD, thus rendering the “complex” addition useless. I fundamentally disagree with this assessment; I am not for a second diminishing the effects of a single traumatic event, but if one has been subjected to trauma over a prolonged period, then surely that is considerably different.
Anyhow, I see no evidence in DSM-5 for the inclusion of this diagnosis, which is unfortunate. Even adding “complex” as a specifier or something would have been an improvement, but alas it doesn’t look like that’s being planned. They are proposing a few changes to PTSD in general, but this doesn’t seem to impact on the issue of any ‘complex’ form of the disorder.
I do broadly agree with the continuum hypothesis, but of course BPD isn’t necessarily catalysed by trauma, so I suppose it’s difficult to say for sure.
Anyway, thanks Differently
Shrink appointment tomorrow, so we’ll see what happens.
Take care xxx
There is only one reason to accept a diagnosis and that is if it has some practical use value to you;
a) it explains something about you to yourself, so making it easier to live with yourself.
b) it gives you access to useful help, or helpers.
c) it helps you to act differently, to get things you want that you don’t already have.
Why do we hang-on to beliefs, routines, habits which appear illogical and sometimes positively self-destructive? Because they appear safer than the alternative. All change (good or bad) is at first experienced as stressful (occasionally terrifying). Others will be reassuring and tell you of the benefits of change, but this of course counts for nothing! Any change requires acting before we really feel competent to do so.
(Hey Pan! The black screen, the Gothic type face and the single eye are being to bug the hell out of me! I know why, the writing is warmer than the context.)
*Reads*
*Reads again*
*Buries head in the sand*
Blimey. I’d heard of it, but never read the criteria. It’s pretty close to BPD in a few ways isn’t it, but in some ways totally different.
Lola x
The more I read about C-PSTD, the more the diagnoses fits. My former shrink told me I had BPD “lite” which I supposes mirrors the idea of being on a continuum. The problem is this: Treatment for the two is completely different. As someone who has been in the system for over 30 years who still has the same core issues-covert anger, avoidance of known triggers, depression, shifting ego states as a direct result of external stimuli resulting in an unstable identity, and sociophobia, I have to question why therapy so far has not been anywhere near successful. One of the main shortcomings of BPD treatment is the predominant dynamic of “blaming the victim”. Yes, I have experienced this myself. My former shrink told me I had to start “sucking things up”! Unbelievable! Many of you have read or heard of Judith Herman’s work and efforts (struggles really) to get c-ptsd into DSM-V. The all-male panel originally wanted to call it “self-destructive personality disorder”! ( Did you know that the inception of the DSM was to make it easier for insurance companies to determine coverage criterias ?! Scary!!) There is a newer book out called The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (Norton Series on Interpersonal Neurobiology) (Hardcover)
~ Onno van der Hart
Here is the the blurb on the book and note it includes a treatment protocol. No more guesswork for the clinician!
“Life is an ongoing struggle for patients who have been chronically traumatized.
They typically have a wide array of symptoms, often classified under different combinations of comorbidity, which can make assessment and treatment complicated and confusing for the therapist.
Many patients have substantial problems with daily living and relationships, including serious intrapsychic conflicts and maladaptive coping strategies. Their suffering essentially relates to a terrifying and painful past that haunts them. Even when survivors attempt to hide their distress beneath a facade of normality—a common strategy—therapists often feel besieged by their many symptoms and serious pain. Small wonder that many survivors of chronic traumatization have seen several therapists with little if any gains, and that quite a few have been labeled as untreatable or resistant.
In this book, three leading researchers and clinicians share what they have learned from treating and studying chronically traumatized individuals across more than 65 years of collective experience. Based on the theory of structural dissociation of the personality in combination with a Janetian psychology of action, the authors have developed a model of phase-oriented treatment that focuses on the identification and treatment of structural dissociation and related maladaptive mental and behavioral actions. The foundation of this approach is to support patients in learning more effective mental and behavioral actions that will enable them to become more adaptive in life and to resolve their structural dissociation. This principle implies an overall therapeutic goal of raising the integrative capacity, in order to cope with the demands of daily life and deal with the haunting remnants of the past, with the “unfinished business” of traumatic memories.
Of interest to clinicians, students of clinical psychology and psychiatry, as well as to researchers, all those interested in adult survivors of chronic child abuse and neglect will find helpful insights and tools that may make the treatment more effective and efficient, and more tolerable for the suffering patient.”
I have not read it yet, but plan to get a copy from my local university. I think I will be spending a wee bit of time near a photocopier! I plan to present it to my new shrink and ask if he is open to reading it before we get started. After 30 years, I won’t have my time wasted anymore. I hope some of you can read it and get some hope like I did when I came across it. (It got good reviews on Amazon!) Happy reading!
I just stumbled upon this page today. I have c-ptsd, currently known as disorders of extreme stress not otherwise specified (or desnos).
There is often a lot of confusion about bpd vs cptsd.
I found this… and thought it might be helpful. It does go into the differences between the two as well as lists more of the criteria necessary for cptsd. It also lists treatment options for it. I hope it helps.
http://www.traumacenter.org/products/pdf_files/DESNOS.pdf
This is a great article, thanks for sharing it with me. I’ve downloaded it and will be reading it in more detail over the weekend. Thanks very much, and all the best to you