In 2009, professionals researching and treating Complex Trauma in children proposed a new diagnosis of Developmental Trauma Disorder be included in the Diagnostic and Statistical Manual to capture the dysfunctions experienced by children and adolescents exposed to chronic traumatic stress. Some of these children did not meet the criteria for Post-Traumatic Stress Disorder (PTSD), the disorder in the DSM-IV that most closely relates. Others had been diagnosed with a laundry list of unrelated disorders because their symptoms and behaviors meet the criteria for everything from Oppositional Defiance Disorder to Autism Spectrum Disorders. Yet these children’s problems have developed in the context of trauma and developmental disruptions. Because no other diagnostic options are available, the symptoms professionals see often lead them to diagnosing unrelated disorders such as bipolar disorder, ADHD, conduct disorder, RAD, autism, and a host of anxiety disorders.
Dr. Bessel van der Kolk and the staff at The Trauma Center at JRI have been researching “Disorders of Extreme Stress” in children for a decade. Together with the National Child Traumatic Stress Network, they proposed the inclusion of Developmental Trauma Disorder into the DSM-5, to be published in 2012. At this point the proposal is being considered and research trials are underway. The disorder has not yet been included in the drafts of this manual. However, professionals treating attachment disorder and trauma in children are supporting this diagnosis and are more frequently using it to describe what they see in many clients.
A. Exposure. The child or adolescent has experienced or witnessed multiple or prolonged adverse events over a period of at least one year beginning in childhood or early adolescence, including:
- Direct experience or witnessing of repeated and severe episodes of interpersonal violence; and
- Significant disruptions of protective caregiving as the result of repeated changes in primary caregiver; repeated separation from the primary caregiver; or exposure to severe and persistent emotional abuse.
B. Affective and Physiological Dysregulation. The child exhibits impaired normative developmental competencies related to arousal regulation, including at least two of the following:
- Inability to modulate, tolerate, or recover from extreme affect states (e.g., fear, anger, shame), including prolonged and extreme tantrums, or immobilization.
- Disturbances in regulation in bodily functions (e.g. persistent disturbances in sleeping, eating, and elimination; over-reactivity or under-reactivity to touch and sounds; disorganization during routine transitions.)
- Diminished awareness/dissociation of sensations, emotions and bodily states.
- Impaired capacity to describe emotions or bodily states.
C. Attentional and Behavioral Dysregulation: The child exhibits impaired normative developmental competencies related to sustained attention, learning or coping with stress, including at least three of the following:
- Preoccupation with threat, or impaired capacity to perceive threat, including misreading of safety and danger cues.
- Impaired capacity for self-protection, including extreme risk-taking or thrill-seeking.
- Maladaptive attempts at self-soothing (e.g. rocking and other rhythmical movements, compulsive masturbation).
- Habitual (intentional or automatic) or reactive self-harm.
- Inability to initiate or sustain goal-directed behavior.
D. Self and Relational Dysregulation. The child exhibits impaired normative developmental competencies in their sense of personal identity and involvement in relationships, including at least three of the following:
- Intense preoccupation with safety of caregiver or other loved ones (including precocious caregiving) or difficulty tolerating reunion with them after separation.
- Persistent negative sense of self, including self-loathing, helplessness, worthlessness, ineffectiveness, or defectiveness.
- Extreme and persistent distruct, defiance or lack of reciprocal behavior in close relationships with adults or peers.
- Reactive physical or verbal aggression toward peers, caregivers, or other adults.
- Inappropriate (excessive or promiscuous) attempts to get intimate contact (including but not limited to sexual or physical intimacy) or excessive reliance on peers or adults for safety and reassurance.
- Impaired capacity to regulate empathic arousal as evidenced by lack of empathy for, or intolerance of, expressions of distress of others, or excessive responsiveness to the distress of others.
E. Posttraumatic Spectrum Symptoms. The child exhibits at least one symptom in at least two of the three PTSD symptom clusters (B, C, & D).
F. Duration of disturbance (symptoms in DTD Criteria B, C, D. and E) at least 6 months.
G. Functional Impairment. The disturbance causes clinically significant distress or impairment in at least two of the following areas of functioning:
- Scholastic: under-performance, non-attendance, disciplinary problems, drop-out, failure to complete degree/credential(s), conflict with school personnel, learning disabilities or intellectual impairment that cannot be accounted for by neurological or other factors.
- Familial: conflict, avoidance/passivity, running away, detachment and surrogate replacements, attempts to physically or emotionally hurt family members, non-fulfillment of responsibilities within the family.
- Peer Group: isolation, deviant affiliations, persistent physical or emotional conflict, avoidance/passivity, involvement in violence or unsafe acts, age-inappropriate affiliations or style of interaction.
- Legal: arrests/recidivism, detention, convictions, incarceration, violation of probation or other court orders, increasingly severe offenses, crimes against other persons, disregard or contempt for the law or for conventional moral standards.
- Health: physical illness or problems that cannot be fully accounted for, physical injury or degeneration, involving the digestive, neurological (including conversion symptoms and analgesia), sexual, immune, cardiopulmonary, proprioceptive, or sensory systems, or severe headaches (including migraine) or chronic pain and fatigue.
- Vocational (for youth involved in, seeking or referred for employment, volunteer work or job training): disinterest in work/vocation, inability to get or keep jobs, persistent conflict with co-workers or supervisors, under-employment in relation to abilities, failure to achieve expectable advancements.
To learn more about Developmental Trauma Disorder and Dr. van der Kolk’s research:
Understanding Interpersonal Trauma in Children: Why We Need a Developmentally Appropriate Trauma Diagnosis – D’Andrea, Ford, Stolbach, Spinazzola & van der Kolk, 2012
When Age Doesn’t Match Stage: Challenges and Considerations in Services for Transition-Age Youth with Histories of Developmental Trauma -Blaustein, Kinniburgh, Focal Point: Youth, Young Adults, & Mental Health. Trauma-Informed Care, 29, 17-20, 2015
Understanding Developmental Trauma Disorder
Imagine a child’s world filled with constant fear, uncertainty, and pain. This is the reality for countless children who suffer from developmental trauma. But what is developmental trauma, and how does it impact a child’s life? In this blog post, we will delve into the complexities of developmental trauma disorder (DTD), its causes, and how it affects the mental health, emotional regulation, and interpersonal relationships of those who experience it. We will also explore the importance of accurate assessment, diagnosis, and treatment approaches that can make a significant difference in the lives of these children and their families.
- Developmental Trauma Disorder is a condition characterized by chronic and multifaceted adverse experiences during childhood.
- It can have long-term impacts on mental health, emotional regulation, and interpersonal relationships.
- Treatment approaches include trauma-informed care and evidence based interventions to help children heal from developmental trauma disorder.
Developmental trauma disorder is a condition characterized by chronic and multifaceted adverse experiences during childhood, which can impact a child’s mental health, emotional regulation, and interpersonal relationships. Children with DTD may exhibit symptoms such as habitual self-harm, extreme distrust, and verbal or physical aggression towards others, putting them at risk of developing other psychiatric disorders, such as bipolar disorder and conduct disorder, later in life.
The consequences of DTD can be severe, including:
- Generalized anxiety disorder
- Post-traumatic stress disorder
- Difficulty managing emotions
- Difficulty controlling impulses
- Difficulty managing stress
One should be aware that DTD is not presently recognized as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Causes of Developmental Trauma
A child’s world can be turned upside down by repeated maltreatment, abuse, including sexual abuse, or disruptions in attachment to primary caregivers during childhood, resulting in psychological and neurological damage. The impact of these traumatic experiences can be profound, disrupting the sequential development of the brain and potentially leading to various mental disorders, including autism spectrum disorders.
The damage done by developmental trauma, including complex trauma, can have long-lasting consequences, with the potential to shape an individual’s entire life. Grasping the causes of developmental trauma is fundamental for identifying effective interventions and extending support to impacted children and their families.
DTD vs. PTSD and Complex PTSD
Though developmental trauma disorder shares some similarities with post-traumatic stress disorder (PTSD) and complex PTSD, it is important to distinguish between these conditions. DTD is separate from PTSD and complex PTSD as it specifically involves repeated exposure to trauma during childhood and has a more profound impact on a child’s development. This differentiation holds significant importance for precise diagnosis and treatment, as children with DTD might require varied interventions and support compared to those with other trauma-related disorders.
Gaining a deep understanding of the unique aspects of DTD and distinguishing it from PTSD and complex PTSD, allows us to offer better support to children who have endured developmental trauma, aiding them to surmount the challenges they face.
The Impact of Developmental Trauma on Mental Health
The repercussions of developmental trauma, often rooted in childhood trauma, can be far-reaching, affecting not only a child’s mental health but also their emotional regulation and interpersonal relationships.
In the ensuing discussion, we will delve into the different psychiatric disorders, emotional regulation difficulties, and interpersonal relationship issues that can emerge from developmental trauma.
Research indicates that developmental trauma is associated with a range of psychiatric disorders, such as developmental trauma disorders, including:
- Post-traumatic stress disorder (PTSD)
- Dissociative disorders
- Anxiety disorders
- Mood disorders
- Borderline personality disorder (BPD)
- Substance use disorders
Children with developmental trauma are more likely to develop psychiatric disorders, including depression, anxiety, and substance abuse. They may also be at risk of developing other psychiatric disorders, such as eating disorders or personality disorders, later in life.
The increased risk of psychiatric disorders highlights the importance of early intervention and support for children with developmental trauma. Addressing the underlying trauma and providing suitable treatment can assist these children in developing healthier coping strategies and enhancing their mental health outcomes.
Emotional Regulation Difficulties
Children with developmental trauma often struggle with emotional regulation, experiencing:
- Persistent sadness
- Mood swings
- Difficulty controlling their emotions
These difficulties can contribute to the development of various mental disorders if not addressed properly.
In some cases, emotional regulation difficulties can contribute to the development of oppositional defiant disorder, which is characterized by a pattern of angry, irritable, and defiant behavior.
Recognizing and addressing the emotional regulation difficulties encountered by children with developmental trauma is of utmost importance. Providing support and appropriate interventions can help these children learn to manage their emotions more effectively, improving their overall well-being and functioning.
Interpersonal Relationship Issues
Developmental trauma can also disrupt a child’s ability to form and maintain healthy relationships. Children with DTD may experience difficulty forming and sustaining relationships, difficulty trusting others, and difficulty comprehending and responding to social cues. These challenges can contribute to the development of mental illness if not addressed properly.
Assisting children with DTD in fostering healthy relationships and cultivating trust in others is vital for their overall well-being. Cognitive-behavioral therapy, mindfulness, and trauma-informed care can be utilized to facilitate the development of healthier relationships and attachments for individuals with DTD.
Diagnosing Developmental Trauma Disorder
Accurate assessment and diagnosis of developmental trauma disorder are crucial for providing appropriate treatment and support to affected children and adolescents. In the following discussion, we will cover the existing diagnostic criteria for DTD and the role of precise assessment in comprehending the severity and impact of the trauma on a child’s development and functioning.
Accurate assessment is essential for determining the best course of treatment for a child or adolescent.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for developmental trauma disorder are still evolving, but it is essential to differentiate it from PTSD and complex PTSD for accurate diagnosis and treatment. DTD is characterized by symptoms related to the inability to modulate, tolerate, or recover from extreme affect states, such as fear, anger, or shame. Objective procedures, such as standardized interviews and psychometric assessments, can be utilized to diagnose children with indications of DTD, though it is not currently recognized as an official diagnosis in the DSM-5.
Refineing the diagnostic criteria for DTD and distinguishing it from other trauma-related disorders enables us to comprehend the unique needs of children with developmental trauma better and offer more effective interventions and support.
Importance of Accurate Assessment
Proper assessment of developmental trauma disorder is vital for understanding the severity and impact of the trauma on a child’s development and functioning. Inaccurate assessment may result in misdiagnosis, inadequate treatment, and additional distress for the child.
As our comprehension of developmental trauma continues to develop, it’s imperative for professionals assisting affected children to keep abreast with the most recent research and diagnostic criteria. Accurate assessment can help ensure that children receive the appropriate treatment and support they need to heal and thrive.
Treatment Approaches for Developmental Trauma Disorder
Various treatment approaches, including trauma-informed care and evidence-based interventions, can help children with developmental trauma disorder heal and develop healthier coping mechanisms when treating complex trauma.
In the following discussion, we will examine these treatment approaches and their role in supporting children on their path towards healing and resilience.
Trauma-informed care focuses on:
- Establishing safety
- Helping children process traumatic memories and integrate them into their life story
This approach acknowledges the potential impact of trauma on an individual’s physical, mental, and emotional health and takes this into account when providing care.
Creating a secure environment, instructing the patient in self-regulation and self-reflection techniques, and facilitating healthy relationships are all beneficial practices in trauma-informed care. Providing a safe and supportive environment through trauma-informed care can foster healing and resilience in children with developmental trauma.
Evidence-based interventions, such as play therapy and cognitive-behavioral therapy, can help children with developmental trauma disorder develop healthier responses and coping mechanisms. These interventions have been rigorously tested and evaluated to ensure their efficacy in addressing the unique challenges faced by children with DTD.
Incorporating evidence-based interventions into the treatment plan for children with developmental trauma can aid their healing process and equip them with the skills and resilience necessary to confront the challenges they face.
Supporting Children and Adolescents with Developmental Trauma
Supporting children and adolescents with developmental trauma involves implementing effective parenting strategies and providing school support to promote healing and resilience.
In the following discussion, we will touch upon the key components of these support systems and their potential to bring about a positive change in the lives of children affected by developmental trauma.
Effective parenting strategies for children with developmental trauma include creating a safe and nurturing environment, fostering healthy attachments, and promoting emotional regulation. These strategies can help children feel secure, supported, and understood, allowing them to heal and develop resilience in the face of adversity.
As parents and caregivers, exhibiting patience, understanding, and empathy towards children with developmental trauma is of paramount importance. By providing a nurturing environment and implementing effective parenting strategies, we can support their healing process and help them develop healthier coping mechanisms and relationships.
Schools play a critical role in supporting children with developmental trauma by:
- Providing accommodations
- Implementing trauma-sensitive practices
- Collaborating with mental health professionals to ensure students with DTD receive the tailored support they need.
Incorporating trauma-informed practices in the classroom, creating a structured and consistent environment, communicating with counselors or social workers, assisting the child in identifying effective calming techniques, and fostering relationships in a secure and supportive atmosphere are some of the most effective school support strategies for children and adolescents with developmental trauma disorder.
Understanding the distinct needs of these students and extending appropriate support enables schools to aid in promoting healing and resilience for children affected by developmental trauma.
Throughout this blog post, we have explored the complexities of developmental trauma disorder, its causes, and its impact on a child’s mental health, emotional regulation, and interpersonal relationships. We have also discussed the importance of accurate assessment and diagnosis, as well as the various treatment approaches and support systems that can make a significant difference in the lives of these children and their families.
As we continue to learn more about developmental trauma and its long-lasting effects, it is our responsibility to provide the necessary support, understanding, and care for children and adolescents affected by this life-altering condition. By working together, we can help these children heal, develop resilience, and ultimately lead fulfilling, healthy lives.
Frequently Asked Questions
What are the symptoms of developmental trauma disorder?
Symptoms of Developmental Trauma Disorder (DTD) include habitual self-harm, extreme distrust, aggression towards others and other behaviors across emotional, cognitive, behavioral and relational domains.
What is an example of a developmental trauma disorder?
Examples of developmental trauma disorder can include having a parent with mental illness, substance abuse, divorce, abandonment or incarceration, witnessing domestic violence, lack of love and closeness in the family, as well as direct verbal, physical, or emotional abuse.
These experiences can have a lasting impact on a person’s mental health, leading to symptoms such as depression, anxiety, post-traumatic stress disorder, and difficulty forming relationships. It can also lead to difficulty regulating emotions, difficulty concentrating, and difficulty managing stress.
What is the difference between PTSD and developmental trauma disorder?
The main difference between PTSD and developmental trauma disorder is that the latter occurs over time within the context of close relationships, while the former is usually the result of a single traumatic event.
Developmental trauma disorder is a complex condition that can have a lasting impact on a person’s life. It is caused by a combination of factors, including neglect, abuse, and other forms of trauma that occur over a long period of time. Symptoms of developmental trauma disorder can occur.
Is DTD the same as CPTSD?
DTD and CPTSD are two different disorders; DTD is a proposed complex post-traumatic stress disorder (PTSD) syndrome for children, while CPTSD normally forms in adulthood due to chronic sexual, psychological, physical abuse and neglect.
CPTSD is characterized by a range of symptoms, including difficulty regulating emotions, difficulty trusting others, and a heightened sense of threat. It can also lead to feelings of guilt, shame, and self-blame. Treatment for CPTSD typically involves a combination of psychotherapy, medication, and lifestyle changes.
How does developmental trauma impact a child’s mental health?
Developmental trauma can significantly impact a child’s mental health, leading to psychiatric disorders, difficulty with emotion regulation, and issues with interpersonal relationships.
These issues can have long-term consequences, such as an increased risk of substance abuse, depression, and anxiety. They can also lead to difficulties in school, work, and other areas of life.
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