Diagnostic Criteria

[festive1]

This has been bothering me for some time. Perhaps some of you will have different views on the subject which will help to reconcile my botheredness…
My issue is with the diagnostic criteria for complex-PTSD (which I've been diagnosed with). Which can be found on the wiki page here: http://en.wikipedia.org/wiki/Complex_pos...s_disorder
Behind the hide tag there's a list of the 7 proposed diagnostic criteria, it's longish, so I hid it. The bolding is mine.

---

The following criteria were used while C-PTSD was under consideration for inclusion in the DSM-IV.[1]
1. A history of subjection to totalitarian control over a prolonged period (months to years). Examples include hostages, prisoners of war, concentration-camp survivors, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including those subjected to domestic battering, child physical or sexual abuse, and organized sexual exploitation.
2. Alterations in affect regulation, including
persistent dysphoria
chronic suicidal preoccupation
self-injury
explosive or extremely inhibited anger (may alternate)
compulsive sexuality or extremely inhibited sexuality (may alternate)
3. Alterations in consciousness, including
amnesia or hypermnesia for traumatic events
transient dissociative episodes
depersonalization/derealization
reliving experiences, either in the form of intrusive post-traumatic stress symptoms or in the form of ruminative preoccupation
4. 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)
5. 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)
idealization or paradoxical gratitude
sense of special or supernatural relationship
acceptance of belief system or rationalizations of perpetrator
6. 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
7. Alterations in systems of meaning
loss of sustaining faith
sense of hopelessness and despair[31]

---

Guess where my problem lies? The 7th criteria: Alterations in systems of meaning, loss of sustaining faith…
Surprise! I'm an atheist. I recognize my lack of belief, at least in part and definitely in my early years, is/was related to my experience.
My issue is, why is a lack of faith a diagnostic criteria for a mental illness? If anything, my grip on reality has been more sustaining than faith ever could be for me. I view atheism as acceptance of the reality that a deity, in all likelihood, does not exist. I'm offended (not really the right word, perhaps, perplexed, annoyed, or displeased are better words?), that my lack of belief helps to qualify me for a mental illness, when being an atheist alone isn't a reason for diagnosis of any mental problems.
Most of the support groups, therapists, etc. I've encountered for treating C-PTSD attempt to establish some form of faith based system, and I don't have faith. Does this imply in order to overcome the C-PTSD one must establish a faith?
I'm rambling, but I'd love to hear thoughts on this.

[Tonus]

Are they to be considered separately, or in possible relation to the others? The first one mentions being subject to totalitarian control, as with a religious cult. Would such an experience lead to what seven describes as "loss of sustaining faith"?

[pocaracas]

Americansky propaganda by "christian doctors".
Edit wikipedia.... citation required.

[festive1]

I think that when one is subject to a totalitarian control system, that it does indeed lead to a loss of faith. Because once one realizes the control system isn't valid, why should one believe in any system of control? If you enter a dysfunctional system like these, having faith, and pray and ask god for help, which never comes, eventually you realize there is no god in the first place, or at least not a compassionate god that most religions preach about. I think a loss of faith is appropriate and a logical outcome of the system itself.

[Psykhronic]

The connection between mental disorders and faith is an interesting one. My guess is they are implying that due to a traumatic event a person suddenly loses their faith and their faithlessness remains such for a long period of time. There is also cause for concern when a person has a sudden spike in their faith and starts becoming hyper-religious - which tends to happen to those suffering from psychosis-inducing disorders (which can be PTSD, apparently, so I wonder why this is not mentioned).

But of course, there is a lot of "FAITH IS GOOD FOR YOU" around therapy circles. I don't miss that shit. Ultimately, it's pretty fucking stupid to try to solve problems using faith.

[pocaracas]

But of course, there is a lot of "FAITH IS GOOD FOR YOU" around therapy circles. I don't miss that shit. Ultimately, it's pretty fucking stupid to try to solve problems using faith.

It's not stupid... to a lot of people, it works... and if it works, hey, thumbs up!
However, if you're an atheist like me, then it'll never work and would be idiotic to attempt such approach.

[Psykhronic]

Fair point. I'm just being bitter - the group therapies I went through were bullshit and there was too much jesus for me.

[festive1]

The support group I've been going to is in parts great and sucky. Great, because its helpful to speak and be with people who "get it." Its open, patient, and accepting. It's sucky, because it is a vehicle for establishing faith. I've seriously and earnestly quested for faith in anything, I just come back with indifference or outright rejection of everything I've explored. The people from the support group accept in some form or fashion a benevolent something (be it god, karma, whatever), and I just don't see that.

[Angrboda]

I'm going to comment without doing some necessary research in the matter, so consider these remarks tentative and provisional.

First, let's restore the original formatting of the Wikipedia entry, as your reformatting of the text seems to alter its meaning.

---

7. Alterations in systems of meaning

• loss of sustaining faith
  
• sense of hopelessness and despair
  

---

So, first off, it's not clear either that a) this is a conjunctive list, that all elements under seven are required, or that the two elements listed are examples of 7, and b) it doesn't specify religious faith in particular. People have sustaining faith in many things, from humanity, to their own competence, to the idea that things will ultimately turn out all right; loss of faith in these would parallel the second term, hopelessness and despair. So I don't think they're necessarily referring to a loss of faith in a particular religious doctrine, nor including absence of faith in the mix; however, there may be some justification for including a recent and exaggerated loss of religious faith. If someone has been a devout Catholic their whole life, and they suddenly become a hand-wringing nihilist, it may very well be symptomatic of a larger issue.

Second, it's worth noting that this is a proposed inclusion and is not currently a part of either the DSM or the ICD. And I'll note that, from personal experience, DSM diagnoses tend to follow a pattern of listing a number of symptoms and then noting that a certain number of those listed are required for diagnosis. Not all people with any particular syndrome will display all characteristics of the syndrome, and perhaps all this is saying is that alterations in systems of meaning are typical for a large class of patients suffering from this disorder.

Third, I'd have to track down the specific passage, but somewhere in the back of the DSM in the section on differential diagnosis it remarks that if some belief or trait is considered normal for that person's culture or religion, it is not to be included in the differential diagnosis. Since a lack of religious faith is normal for your culture [atheism] and your religious community, it would ordinarily be discarded in the diagnostic process.

Fourth, diagnoses are, imo, geared toward identifying people with common characteristics (syndromes) in order to guide treatment, not to diagnose etiology or specific malfunction. Symptoms consonant with depression are common in PTSD, standard, and it's not surprising that a trait which is commonly associated with depression would end up in the laundry list of traits associated with complex PTSD. Moreover, since the list is diagnostic, and doesn't indicate a causal relationship between the two (that alterations in meaning are a cause of complex PTSD), I'm not sure I understand what your difficulty is; I think the only real criteria here needs to be whether or not the symptom is strongly correlated with the presence of other symptoms in the disorder, and I think it's reasonable to suspect in this case that it is.

Anyway, my two cents worth, on first gander at the wiki page. I understand a major revision of the DSM is in the works, so there are likely to be a lot of controversial items related to potential changes and inclusions in the new DSM. (For example, it's historically been an r.o. [rule out] condition that a person not have suffered a major loss recently in diagnosing depression; removing that r.o. has caused considerable controversy by people who suggest that it "medicalizes ordinary grief.") I'd say wait until the dust clears on this and other potential inclusions.

(For another take, I've got a book on psychopathy which talks about the politicalized atmosphere surrounding the creation of the original DSM which many found shocking. And it would be an exaggeration to say that those days are entirely behind them, as creation and development of diagnostic categories is still a highly politicized and somewhat unscientific exercise. For another example, look at accounts of the deliberations over what to include in the case of PMS and PMDD.)

The DSM has attracted praise for standardizing psychiatric diagnostic categories and criteria. It has also attracted controversy and criticism. Some critics argue that the DSM represents an unscientific system that enshrines the opinions of a few powerful psychiatrists. There are ongoing issues concerning the validity and reliability of the diagnostic categories; the reliance on superficial symptoms; the use of artificial dividing lines between categories and from 'normality'; possible cultural bias; medicalization of human distress and financial conflicts of interest, including with the practice of psychiatrists and with the pharmaceutical industry; political controversies about the inclusion or exclusion of diagnoses from the manual, in general or in regard to specific issues; and the experience of those who are most directly affected by the manual by being diagnosed, including the consumer/survivor movement. The publication of the DSM, with tightly guarded copyrights, now makes APA over $5 million a year, historically adding up to over $100 million.

Ben Goldacre has a book on big Pharma that I will be reading for a group in the upcoming months. I'm sure there will be interresting tidbits in there; I'll try to keep you in mind.

[Faith No More]

Well, loss of faith is one of two benchmarks that make up the seventh criteria. Often times when multiple sub-criteria are clumped together as one whole criteria it is because meeting any one of the sub-criteria will qualify you for having met the whole criteria. Think of it as there is an "and/or" between the two.