Submitted by Pfeffer_Prinz t3_10lw1rz in todayilearned
Reply to comment by Pfeffer_Prinz in TIL of Complex PTSD, which arises from prolonged, inescapable trauma (like child abuse/neglect, sex trafficking, or solitary confinement). It's hard to spot & treat, and can last a lifetime. Victims have a diminished sense of self, and issues with trust, boundaries, cognition, motor skills, & more. by Pfeffer_Prinz
Putting slavery, human trafficking, concentration camps and bullying on the same list makes no sense to me at all.
I really hope they come up with some sort of clinical severity cutoff because otherwise this reads like "adverse events are bad" when I'm sure it is meant to relate to a severe form of PTSD that results from serious adversity.
Even "regular" PTSD definitions likely would reject simple bullying as a cause because there is rarely a severe safety threat.
Bullying for a child can be terrifying. Especially when there's no out and it's continuous. It's not 'simple' bullying always.
How would you put a scale between sex trafficking / plain sexual abuse and bullying?
Note, It's not about the safety threat we perceive as adults, taking into consideration facts we know, but how the receiver percieves it. A child may not realise the difference between being trafficked or facing very strong and consistent bullying. They don't have that much knowledge. They can only experience what they feel, and that could be terror.
You know, I'll have to disagree. I may be totally wrong on this, but it's very difficult for me to believe that a child would have trouble differentiating bullying from being trafficked.
Bullying may involve an element of fear and intimidation, certainly. It involves elements of rejection and isolation, for sure. It can even involve an element of threat. But you would have to be very young to not understand the difference between a situation when your peers are bullying you and when you get kidnapped, moved to another country, involuntarily confined, sold, moved again, and eventually raped repeatedly or sold into slavery.
To make the argument that both can be scary is one thing. But to make the argument that a child can't differentiate those experiences is to argue a degree of naivete that few children would have by the time they're old enough to experience actual bullying (at least school age).
If we are going to do that, I'll take it a step further and say that an invalidating environment at home can also be seen as similar to bullying, and we can just expend the definition to "adversity". While we are at it, we can look at the criteria for cptsd, compare them to borderline personality pathology, decide that they're effectively the same down to diffusion in sense of self, and pat ourselves on the back for renaming borderline personality disorder cptsd.
But that still leaves the Holocaust survivors and victims of repeated rape and slavery in a position where they share a diagnostic label with a child who was on the receiving end of bullying at school. As someone who was on the receiving end of severe bullying in their youth, I'll put my two pennies in by saying "that's excessive". We need to draw the line somewhere.
To answer your other question: >How would you put a scale between sex trafficking / plain sexual abuse and bullying?
I would probably start with the sexual abuse component. Bullying doesn't involve penetration or other forms of sexual abuse. If it does, I say we focus on the sexual abuse - which would then obviate the need to focus on the bullying. To me, "simple" bullying doesn't involve sexual abuse. If it does, it's bullying and also sexual abuse, in which case we can use our normal definitions of PTSD and move on without diluting diagnostic categories.
It's like saying: what if I'm being bullied and someone sticks a gun in my mouth. Well, then what you've experienced is severe intimidation with a weapon. Not bullying.
Again you are using adult metrics. And extrapolating based on false premise. Let me give you some reality.
I was both sexually abused and bullied. For me the bullying was tougher because it was day in and day out. Harsh and unrelenting. The abuse was temporary, short lived and I was even made 'comfortable'. Too naive even yes, to realize extent of what was happening.
Don't want to go into the details but penetration is not the worst thing about sexual abuse, there's too much psychological loss of power and violation of body integrity that precludes that. The lasting trauma is not the physical component but the mental fuckery.
Regarding trafficking:
You're thinking of sex trafficking as something they show in movies to scare you. It always isn't like that. Its often some schmuck enticing you with a reward, making you feel cared and finally given attention, promising you great things and then finally delivering you to a place where you are used. Even then they may promise to get you back. Or convince you it's a better life than what you'd have had back 'home' in poverty.
They're all fucked up situations. How scary you think of them from impressions from outside through news reports and imagination isn't what is going to decide how f'd up they are in the mind. Let the psychs figure out that from actual observation and study of victims. Your disagreement doesn't change the science. If you actually want to understand why they seem to be put together, perhaps taking some time to read the actual research papers, might give a better understanding of the things involved.
Bests.
Look, I see your point and I understand that not all these experiences are as depicted in movies. I am sorry to hear that you have first hand knowledge of these things.
Patients are as heterogeneous as anything else, and everyone experiences and perceives different things. But this is precisely why our definitions of things matter and why we need to, in your words, let the psychs figure it out.
The psychs (I'm sure at least some of them prefer to be called psychiatrists) have chosen not to include cptsd in the DSM for the time being. I think there might be good reasons for that, some of which we are discussing right now. The line between subjective experience and standardized diagnoses is hard to draw, but important nevertheless. It affects things like research protocols, and translates to how we understand and treat disorders. For example, how we define depression can translate into guidelines about pharmacology and therapy techniques. Before you say it, yes I know the DSM isn't the end all and be all of psychiatry.
For the time being, psychiatry as a field seems to recognize that there is a syndrome that results from prolonged repeated abuse, but some classify it under attachment disorders, some under trauma, and some prefer to stick to personality disorders due to the similarity in symptoms.
I don't know that it's helpful for us to argue about labels online because we aren't about to start flashing credentials and throwing papers at eachother. I take your point for what it's worth, and I hope you consider mine - I feel that we need careful definitions or else we risk blurring diagnostic boundaries to such an extent that everyone feels included when its time to self diagnose, but at the same time few people are helped by therapies because they are researched and delivered under highly heterogeneous research conditions.
When I ask myself if psychiatry has a bigger problem with diagnostic labels or with validated therapies it's a bit of a chicken and egg situation, but I lean towards poor therapies as a result of broad diagnostic categories for heterogeneous conditions.
Yes I agree with you that psychiatry has a broader labelling, and finding relevant treatment for the individual problem.
And people self diagnosing is a problem too, but I don't think the solution is to disregard some possible experiences from the understanding/context of these labels.
Yes the definition need be cleaner, and I think the actual fully defined criteria for C-PTSD must be so.
Note that the above quoted text was not a definition for C-PTSD, but context of possible experiences that might result in it. The actual evaluation would (should?) ofcourse be done by a professional who'd evaluate exhibited symptoms and not just go on history.
People self-diagnosing simply from the context are hurting themselves, true. And should probably seek a professional for more trained evaluation.
Couldn't have said it better myself. I like that we can have a discussion, disagree on some things, agree on others. This has been very fun and I learned some things too. Cheers!
To add to my other comment. I am sorry to hear you were at the receiving end of bullying.
I don't want to draw a line between simple bullying and _(?) bullying. But that feelings of body violation and lack of control etc can also happen with some cases of physical bullying that need not be sexual.
Again, glad that you don't seem to have had as bad of a reaction and felt not as distressed chronically from it. But it's not the same for everyone.
(Note that There are people that are driven to suicide by bullying. If that's not proof that it is perceived very intensely by some then i don't know what else I can say).
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