Large Group of Patients Cannot Be Found
Part of the challenge in diagnosing and treating PTSD is based on the unsatisfactory differentiation of section F43 in the ICD-10 (Reaction to severe stress …), as this includes only three diagnoses: acute stress reaction (F43.0), PTSD (F43.1), and adjustment disorders (F43.2).
A large group of patients cannot be found in section F43 of the ICD-10 and will therefore be grouped under one of these three diagnoses, which are incorrect for such patients—namely, those with “cumulative traumatic stress disorder” (CTSD) (1). The traumatic event has not reached its conclusion but continues in a perpetrator–victim constellation that is usually characterized by psychological violence. Such patients are continually exposed to the perpetrators and cannot remove themselves from the psychological terror. CTSD includes the subdiagnoses “mobbing (adult bullying) syndrome” (2), “stalking syndrome,” “domestic violence syndrome,” etc.
Patients with CTSD either do not meet all the criteria for PTSD or exceed the time limit for the duration of acute stress reactions, or they are even accused by their therapists, with a diagnosis of “adjustment disorder,” of not adjusting to the psychoterror of mobbing, stalking, or domestic violence. In contradiction to the misdiagnosis of an adjustment disorder, CTSD has a traumatic component and does not have any discrepancy between the (low-level) trigger and the (high degree of) suffering. Non-compliance and non-responsiveness to therapy are pre-programmed for patients with CTSD if they are misdiagnosed or even accused of being victims because of an unsatisfactory range of diagnoses and therapeutic options. How are therapies meant to work if patients are continually exposed to the trauma of psychological violence, which therapists cannot stop and can even exaggerate?
Including CTSD in the ICD-10 would document the prevalence rates in section F43.- and thus emphasize the urgency of intervention by the legislators.
Dr. med. Argeo Bämayr
Specialist in psychiatry and psychotherapy
Conflict of interest statement
The author declares that no conflict of interest exists.
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