The latest version of ICD and DSM are now available, and many are asking: Is Complex PTSD in the ICD or DSM?
Is complex PTSD in the ICD or DSM? Many psychiatrists consider Complex PTSD as a distinctive diagnosis different from PTSD. In the final draft of the ICD-11, Complex PTSD is included under the category of “Disorders specifically associated with stress”. But, there is no mention of Complex PTSD in the DSM-5.
So, what’s the implication? How may this affect you? Read on…
Inclusion or Exclusion of Complex PTSD: Impact on Benefits And Support?
The very cruel fact is that DSM-5 diagnostic criteria is being used by organisations such as social support departments, social security and benefits departments as well as insurance companies to determine whether you can get the support or not.
While it is true that you could still be diagnosed with the broader term PTSD, the level of support is likely to be inadequate. For example, in addition to PTSD symptoms, Complex PTSD patients also experience:
- negative self-concept (NSC)
- low self-esteem
- feelings of guilt, shame and vulnerability
- distorted view of self
- believing that they are unlovable
- disturbances in relationships (DR)
- self isolation as a protective mechanism
- difficulty to communicate and interact socially
- difficulty to trust and engage with other people
- affective dysregulation (AD)
- self-harm
- dissociation
- emotional numbness
- outbursts of rage
- irritability
- excessive crying
- depression
- suicidal ideation
So, there is really a lot more to complex PTSD than meets the eye.
The sad thing is: even if the medical professional recognizes Complex PTSD as a special case, they would have no way to record that on that system. For example, to record a PTSD diagnosis, the medical professional would have to enter the code “DSM-5 309.81” to signify that this patient has been diagnosed according to the DSM-5 protocol.
But without the existence of a code for Complex PTSD in the DSM-5 system, how would a psychiatrist enter this into the system. By contrast, Complex PTSD is clearly specified in the ICD-11 Final Draft as ICD-11 6B41, a different code from the standard PTSD (ICD-11 6B41).
So, which system is your country using? To find out, read on…
What is DSM-5 and Who Does It Affect?
DSM-5 stands for Diagnostic and Statistical Manual of Mental Disorders, 5th edition. As the name signifies, it is a publication that focuses on mental disorders only. Published by the American Psychiatric Association as purchase only manual, and a money-maker, it is not available on the internet for public use. Although DSM-5 is a very well respected resource, it is by no means the only system permissible for diagnostic-use. That applies even if you live the United States.
In fact, Juan Mezzich’s research surveyed 205 psychiatrists from 66 countries and found that the ICD was more frequently used for for clinical diagnosis than the DSM. So, what is the DSM for? Apparently it is used mainly for research updates and not clinical diagnosis. Phew!
Since we already know that Complex PTSD is in the ICD-11 Final Draft, it is good news for those suffering from the condition. So what is ICD-11 and who can benefit from it?
What is ICD-11 and Who Can Benefit From It?
ICD-11 stands for International Classification of Diseases, 11th revision. Unlike the DSM, which limits itself to mental disorders, the ICD is a classification system for any diseases and health problems. It therefore covers a much wider range of sickness. Also, the World Health Organization (WHO) has made this publication freely available to the world. Most importantly, with the support of 193 WHO member countries, it is no wonder that the ICD is adopted almost all over the world. That means no matter where you are living in the world, there is a very good chance that the ICD would in use.
I Think I Have Complex PTSD not PTSD. What Should I Do?
While this is not a website to endorse or encourage self-diagnosis, there is absolutely nothing to wrong to be educated about your own condition, especially when it is done in partnership with your healthcare professionals. If this situation applies to you, I would strongly recommend discussing your symptoms with your doctors.
One word of warning though: No doctors like to be told how to diagnose their patients. So, be specific about the symptoms and the help or support you hope to benefit from a formal recognition of your symptoms. If the symptoms and diagnostic criteria matches, you will get the formal recognition to access whatever support is available to you.
How Do I Discuss This With My Doctor?
First, have a look at the symptoms list in the beginning of this article and highlight the ones that you feel applies to you. Then, for each highlighted item, list a few examples to show how that particular symptom manifest itself in your life, and what impact it is having on your quality of life.
Your doctor would be naturally attuned to the use of symptom keywords, and he would be keenly interested to hear how these symptoms present themselves in your daily life.
In addition to the symptoms listed above, which are specific to Complex PTSD, you may also find it helpful to look at the following list of symptoms that are common to both conditions:
- Re-experiencing
- intrusive memories
- flashbacks
- nightmares
- Avoiding anything that can trigger the memory, eg
- certain activities
- certain situations
- specific people
- certain places
- Hypervigilance
- extreme alertness to perceived danger
- easily starled
- over-reaction to sudden unexpected changes
Remember, it is dangerous to self-diagnose. So focus on your symptoms and experiences, and let your doctor do the diagnosis. You may also find the International Trauma Questionnaire helpful.
International Trauma Questionnaire (ITQ), What Is It?
The International Trauma Questionnaire (ITQ) is a simple questionnaire that the patient may be asked to fill out. The questionnaire is designed to be used together with the ICD-11. It is also a way for patients to report their symptoms in a systematic way that makes sense to the medical professionals who are using the ICD-11. You may find following screenshots of the questionnaire helpful.
With such a powerful tool in our hands, it is easy to forget that the questionnaire is not a self-diagnosis tool. So we would do well to remind ourselves from that even psychiatrists would not use the questionnaire on it’s own. Instead, they would always conduct in-depth interview and use other diagnostic techniques to ascertain the best way forward for us.
If any of the listed items are bothering you. Highlight them, and make notes on how they are affecting you and give some examples. This would be most helpful for your doctors.
So, go ahead, play with the questionnaire and see what you come up with. It may well be the very tool that would give you the structure you need to communicate with your doctors, friends and family.
If you would like to share your story, I would love to hear from you.
Related Questions
What is the ICD 11 Complex PTSD diagnostic criteria? In addition to PTSD symptoms (Re-experiencing, avoidance and hyper-vigilance), the ICD-11 also specifies evidence of negative self-concept (NSC), disturbances in relationships (DR) and affective dysregulation (AD)
What is the Complex PTSD DSM 5 criteria? The DSM-5 does not specific diagnostic criteria for Complex PTSD. Although some have argued that there is a one-sentence mention of Complex PTSD in the DSM-5, the context itself is about PTSD, and the DSM-5 makes no mention of Complex PTSD as a term or phrase. For all intents and purposes, the general consensus is that Complex PTSD is NOT in the DSM-5.
Is there an ICD-11? Currently, ICD-11 only exists in draft form. The draft was released on 18 June 2018 and is available to the public. It scheduled to be presented at the World Health Assembly in May 2019, and is planned to be in use from 1 January 2022.