A former student (HT Armando!) sent me this link today about a woman who experienced PTSD like symptoms after receiving an out-of-the-blue text from her husband telling her he was leaving and divorcing her.
She experienced flashbacks, nightmares, became hyper-alert to dangers, unable to sleep and other such symptoms that are common to PTSD. She did not have an actual or perceived threat on her life–a necessary requirement for the current diagnosis of PTSD. However, she did seem to respond to the surprising evidence that her husband had deceived her for some time as having been “sleeping with the enemy.”
This question for you is whether you think it harms those who suffer classic PTSD (i.e., those who do experience a threat on their life) to lump them together with those who have similar symptoms from non-life threatening trauma. Yes? No?
I have observed pastors in significant conflict with church leaders exhibit PTSD like symptoms. I have observed individuals who learn in late adolescence or adulthood that their parents were actually adoptive parents. It appears that some of the same symptoms exhibited by those who experienced rapes, car crashes, or war trauma show up in some individuals whose world is turned upside down by another’s deception and duplicity.
So I ask the question again: What is gained or lost by expanding PTSD diagnosis to include those with similar symptoms but without the threat of physical injury or death?
Here’s one gain and loss for someone having this kind of divorce reaction. Those who have the symptoms without the physical threats may find some comfort in knowing their reactions are had by many others. However, I would imagine that most of these same people may find their symptoms abate more quickly than that of those who see actual death and destruction. Thus, a diagnosis of PTSD may end up hurting them due to an over-estimation of recovery time needed.
Musings on Faith and Psychology 
Phil,
As someone who has experienced an unwanted divorce/betrayal by another person who was let in behind all defenses and pretenses, I can speak from personal experience. As someone who is a graduate of one of the finest counseling programs in the country (personal opinion but if I had the funds I think I could prove it) I can also speak from a clinical perspective. I think the definition for PTSD has in some ways inhibited a true understanding of what is going on within a person. It seems to me that the real driving force behind PTSD is not the threat of bodily harm or loss of life but the challenge to ones definition of self. I use as evidence examples of persons who endure similar or identical life events where some may develop signs and symptoms of the disorder and others seem to easily fit it in to their life’s narrative.
In this particular case it would suggest that the woman defined herself in a fundamental way by her marriage relationship. The sudden and surprise removal of this relationship removed a cornerstone of her psychological definition of self, leaving her with little to support the rest of her self-image. Her life as viewed by her is being threatened in no less a manner than it would be viewed if her personhood was violated by rape or sever physical harm. To her, if this could happen than nothing in her world is safe. This would also explain why those who have a strong foundation of faith are less likely to suffer as severely from PTSD if at all and why those who subsequently dedicate their lives to helping others find healing. Being at peace with an element of life where we have no control as well as having a mission that is larger than ourselves and where we feel we can exercise some control may be the best inoculation against PTSD. It would be interesting to do some research into PTSD among actively serving military personal at the forefront of conflict verses the incidence among those either rotated to the rear or at home after their tour. I am willing to bet that the mission would delay manifestation of symptoms.
Individual therapy in order to be successful must focus on how threatened the client is by the event and not by whether or not the therapist thinks the event rises to their standard for a level of trauma worthy of the symptoms. One man’s opinion and you know what they say about opinions.
Complicated grief at times is treated using a variation of Prolonged Exposure therapy for PTSD, which conceptually makes sense given the symptoms without having to have a diagnosis of PTSD. E-mail me if you have further questions about
What is gained? I suppose, having a dx code so that the insurance company will reimburse. Probably all the pros and cons of having diagnostic labels in the first place also enter into the discussion.
I think PTSD is already too often written as the diagnosis. Perhaps because the DSM-IV doesn’t provide any real alternatives, practitioners aren’t careful to accurately fit client to criteria. Yet, if it isn’t PTSD, what is it? Is it Anxiety Disorder, NOS? Is it an adjustment disorder? The PTSD label either needs to expand to become more generic (as it is already being used) or separate categories need to be created, or perhaps variations under the PTSD umbrella. What is DSM-V doing with this?
The PTSD label was already expanded beyond veterans to others, and beyond directly experiencing to only observing. Physical safety is the only part of personhood currently covered. It is likely that sense of safety is the issue for this woman. Perhaps this event shattered assumptions. Perhaps this is an earthquake to her worldview. Is it possible that this event has triggered past trauma, hence the trauma response?
Whatever the case, whether or not this woman’s symptoms accurately fit PTSD, she IS experiencing symptoms of trauma. Label or not, this is traumatic for her. Would having a label help her? Would it harm her? How might a PTSD label for this benefit or hinder the helper? Could expanding PTSD to cover these type of trauma responses be hurtful in some way to those who suffer with classic PTSD?
Yes, I recognize that I have only circled around and re-asked the question. Sorry about that. Nah. Not sorry. 🙂