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What is developmental trauma disorder?

Developmental Trauma Disorder (DTD) is a proposed diagnosis to recognize the traumatization that occurs early in life, and to differentiate it from PTSD that has a different set of symptoms and consequences, and which is the only diagnosis officially recognized for trauma.

Since 2002, DTD has been formulated and proposed as a diagnosis by clinicians and researchers to address children’s exposure to victimization that extend beyond posttraumatic stress disorder (PTSD).

The proposed diagnosis involves children’s exposure to family and community violence and disruption of primary attachment relationships, and the complex psychological, biological, and interpersonal sequelae that it leaves in the children’s nervous system.

Study findings strongly support the hypothesis that children meeting DTD symptom criteria are highly likely to have experienced both interpersonal victimization and attachment adversity, and that these types of childhood adversity are more closely related to the complex symptoms involved in DTD than to PTSD.

Bessel van der Kolk —the leader of the team that proposed the diagnosis and made the research— states that childhood trauma, including abuse and neglect, is probably the single most important public health challenge in the United States, a challenge that “has the potential to be largely resolved by appropriate prevention and intervention.”

He and his team proposed the diagnosis and have done the research to demonstrate its validity for the last 18 years. What they have achieved is still very modest because most people have adopted the term Complex Trauma (C-PTSD) instead, not understanding the importance of the attachment part in the developmental traumatization. Complex trauma can happen at any point in life, and doesn’t include the damage to the brain that happens when the brain is deprived of love (attachment) and of safety. The brain stops developing, and that has terrible consequences.

The ACE (Adverse Childhood Experiences) study (about adverse childhood experiences, including childhood abuse, neglect, and family dysfunction) showed that adverse childhood experiences are much more common than we have recognized or acknowledged, and that they have a powerful relationship to adult health. That study found a highly significant relationship between adverse childhood experiences and depression, suicide attempts, alcoholism, drug abuse, sexual promiscuity, domestic violence, cigarette smoking, obesity, physical inactivity, and sexually transmitted diseases. Furthermore, the more adverse childhood experiences experienced, the more likely the adult had developed heart disease, cancer, stroke, diabetes, skeletal fractures, and liver disease.

Chronic traumatization then, interferes with neurobiological development and delays or disables the capacity to integrate sensory, emotional and cognitive information into a cohesive whole. That’s why it is important to recognize and to differentiate traumatization that happens early in life to the traumatization that happens later on.

Van der Kolk argues that people with childhood histories of trauma, abuse, and neglect make up almost the entire criminal justice population in the US and that physical abuse and neglect are associated with very high rates of arrest for violent offenses. “Most interpersonal trauma on children is perpetuated by victims who grow up to become perpetrators or repeat victims of violence.”

The proposed DTD diagnosis criteria is as follows:

Developmental Trauma Disorder

A. Exposure

• Multiple or chronic exposure to one or more forms of developmentally adverse interpersonal trauma (eg, abandonment, betrayal, physical assaults, sexual assaults, threats to bodily integrity, coercive practices, emotional abuse, witnessing violence, and death).

• Subjective experience (eg, rage, betrayal, fear, resignation, defeat, shame).

B. Triggered pattern of repeated dysregulation in response to trauma cues

Dysregulation (high or low) in the presence of cues. Changes persist and do not return to baseline; not reduced in intensity by conscious awareness.

• Affective

• Somatic (eg, physiological, motoric, medical)

• Behavioral (eg, re-enactment, cutting)

• Cognitive (eg, thinking that it is happening again, confusion, dissociation, depersonalization).

• Relational (eg, clinging, oppositional, distrustful, compliant).

• Self-attribution (eg, self-hate, blame).

C. Persistently Altered Attributions and Expectancies

• Negative self-attribution.

• Distrust of protective caretaker.

• Loss of expectancy of protection by others.

• Loss of trust in social agencies to protect.

• Lack of recourse to social justice/retribution.

• Inevitability of future victimization.

D. Functional Impairment

• Educational.

• Familial.

• Peer.

• Legal.

• Vocational.

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