DTD – 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 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.
This article will be updated with further research and sources soon.
Sources DTD
Developmental Trauma Disorder
A new, rational diagnosis for children with complex trauma histories.
Bessel A. van der Kolk, MD
https://traumaticstressinstitute.org/wp-content/files_mf/1276541701VanderKolkDvptTraumaDis.pdf
Addressing childhood trauma in a developmental context
J Child Adolesc Ment Health. 2013 Oct; 25(2): 105–118.
Published online 2013 Jun 10. doi: 10.2989/17280583.2013.795154
Claire Gregorowski and Soraya Seedat*
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104825/
“The lack of a developmentally appropriate psychiatric nosology for the pervasive emotional, behavioural and neurobiological effects of developmental trauma means that children and adults with a history of developmental trauma are often diagnosed with comorbid psychiatric and medical disorders where the common aetiological factor of chronic trauma exposure can go unrecognised (van der Kolk et al. 2009, Lieberman et al. 2011, Schmid, Petermann and Fegert 2013).”
Childhood trajectories of anxiousness and disruptiveness explain the association between early-life adversity and attempted suicide
Alicia F Lieberman 1, Ann Chu, Patricia Van Horn, William W Harris
PMID: 23786685 DOI: 10.1017/S0954579411000137
Abstract
Children in the birth to 5 age range are disproportionately exposed to traumatic events relative to older children, but they are underrepresented in the trauma research literature as well as in the development and implementation of effective clinical treatments and in public policy initiatives to protect maltreated children. Children from ethnic minority groups and those living in poverty are particularly affected. This paper discusses the urgent need to address the needs of traumatized young children and their families through systematic research, clinical, and public policy initiatives, with specific attention to underserved groups. The paper reviews research findings on early childhood maltreatment and trauma, including the role of parental functioning, the intergenerational transmission of trauma and psychopathology, and protective contextual factors in young children’s response to trauma exposure. We describe the therapeutic usefulness of a simultaneous treatment focus on current traumatic experiences and on the intergenerational transmission of relational patterns from parent to child. We conclude with a discussion of the implications of current knowledge about trauma exposure for clinical practice and public policy and with recommendations for future research.
In the best interests of society
William W Harris 1, Alicia F Lieberman, Steven Marans
PMID: 23786685 DOI: 10.1017/S0954579411000137
Abstract
Children in the birth to 5 age range are disproportionately exposed to traumatic events relative to older children, but they are underrepresented in the trauma research literature as well as in the development and implementation of effective clinical treatments and in public policy initiatives to protect maltreated children. Children from ethnic minority groups and those living in poverty are particularly affected. This paper discusses the urgent need to address the needs of traumatized young children and their families through systematic research, clinical, and public policy initiatives, with specific attention to underserved groups. The paper reviews research findings on early childhood maltreatment and trauma, including the role of parental functioning, the intergenerational transmission of trauma and psychopathology, and protective contextual factors in young children’s response to trauma exposure. We describe the therapeutic usefulness of a simultaneous treatment focus on current traumatic experiences and on the intergenerational transmission of relational patterns from parent to child. We conclude with a discussion of the implications of current knowledge about trauma exposure for clinical practice and public policy and with recommendations for future research.
DEVELOPING THE COVERT TRAUMATIC EXPERIENCE SCALE (COTES): A RETROSPECTIVE EARLY PSYCHOSOCIAL TRAUMA ASSESSMENT TOOL
Tiffany E. Vastardis PhD, LMHC, CCTP, CMHIMP
Clinical Education Specialist • Florida Residential Clinical Training Liaison • Mental Health Researcher • Licensed Psychotherapist • Clinical Trauma Specialist • Integrative Medicine Practitioner
Developmental Traumatic Disorder (DTD)
Along the same vein as cPTSD is the diagnosis of Developmental Traumatic
Disorder (DTD), a childhood and adolescent diagnosis proposed by van der Kolk et al.
(2009) for inclusion in the DSM-5 (APA, 2013).
According to Putnam, Perry, Putnam, and Harris (2008), adults reporting four or
more childhood traumas or markers of family dysfunction met full Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; APA, 1994) diagnostic
criteria for an average of 6.29% (+/- 0.3%) lifetime DSM diagnoses. Markers included
(but were not limited to): sexual abuse, physical abuse, verbal abuse, neglect, exposure to
domestic violence, crime victim, chronically ill parent, mentally ill parent, substance
abusing parent, incarcerated parent, and/or loss of a parent. Of this observed population,
only 19% of males and 54% of females met criteria for a lifetime diagnosis of PTSD.
Rather, common comorbid diagnoses for both genders were: Substance Use Disorders,
Panic Disorder, MDD, and Intermittent Explosive Disorder (IED). While the diagnosis of
these comorbid disorders did capture expressed symptomology, they failed to include the
existence of the traumatic antecedents.
