The pathology giver gives you your pathology based on your symptoms. Your pathology is not your symptoms. They are different things. I give you your pathology based on your symptoms. Your pathology is what I give you.
So let me ask you about your symptoms. Then I will give you your pathology.
Dr. Childress: What is your symptom?
Parent: I’m sad.
(depression; mood pathology)
Dr. C: Why are you sad?
P: Because I miss my children.
(grief and loss)
Dr. C: Why aren’t you with your children?
P: Because they were taken away from me.
(trauma; traumatic grief)
Dr. C: Is that happening now? (current trauma?) Or did this happen before, and now you’re having trouble coping with it? (post-traumatic?).
At this point, I have three pathologies in the DSM-5 to choose from, I will give you one of these three.
Your sadness is caused by trauma. It’s called traumatic grief. That’s not your pathology, it’s your symptom. I’m going to give you your pathology in a moment.
My choices in trauma pathology are:
Acute Stress Disorder: Current abuse causing current trauma;
Post-Traumatic Stress Disorder (PTSD): Past abuse and trauma causing current adjustment problems;
Adjustment Disorder: Adjustment difficulties and over-reaction to normal-range stressors.
But I cannot give you a pathology, not yet.
I will not give you Adjustment Disorder, because the loss of your children is not an over-reaction to a normal-range stressor. Losing your children is not normal-range.
That leaves two trauma pathologies I can give you; Acute Stress Disorder (ongoing abuse and trauma) to the parents whose children are under the age of 18, and Post-Traumatic Stress Disorder (problems in adjusting to past abuse and trauma) to parents whose children are older than 18.
But the DSM-5 will not allow me to give these pathologies to you… yet.
There are two types of trauma – death-trauma and complex trauma. The DSM-5 pathology system only recognizes death trauma.
In the DSM-5 pathology system, a sexually abused child is not traumatized – sexual abuse of the child (complex trauma) is not a trauma experience for the child according to the DSM-5 pathology system.
Childhood trauma professionals strongly disagree. Sexual abuse of the child is a trauma to the child. Complex trauma is a trauma.
The DSM-5 does not allow that. The reason is that the current genre of DSM wants to be completely an individual pathology system – no relationship-based pathology.
Complex trauma is a relationship-based trauma, and so complex trauma is excluded from recognized pathologies in the DSM-5.
Acute Stress and PTSD require death-trauma.
Let me describe the boundary line of death-trauma as allowed in the DSM-5 and complex trauma that is not. Rape is not, exactly, a death trauma. Rape is not, exactly, the Boston Marathon Bombing. There was much discussion. It was decided that rape is a death-trauma. Rape qualifies for Acute Stress Disorder and PTSD.
Child sexual abuse and a child exposed to chronic and severe physical abuse and domestic violence is traumatic to the child. There – continues to be – much discussion. The DSM-5 decided that child abuse and domestic violence are not traumatic for the victim – or at least are not identifiable as a trauma.
The DSM-5 is a psychiatric manual, written by psychiatrists. In an earlier version of the DSM, the DSM-II, homosexuality was a pathology. I could give you the pathology of homosexuality. The DSM-3 said that homosexuality was not a pathology. I could no longer give you the pathology of homosexuality. Probably the most widespread cure of any pathology ever.
Pathology givers give pathology, and we take it away.
I am not a psychiatrist, I am a clinical psychologist. I am a pathology giver, I will give you a DSM-5 pathology, even when the DSM-5 is not… adequate – because I have choices and options in this type of situation.
I will give you your pathology. I am a pathology giver.
I now have paths and options to choose from in giving you your pathology. I will give you a DSM-5 pathology – the question is, what is your pathology?
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857