So what exactly is Developmental Trauma Disorder? Some folks – practitioners, researchers and people suffering from this condition – call it Chronic Post Traumatic Stress Disorder or CPTSD as well as Relational Trauma. I have one friend who was worried about identifying as someone with CPTSD simply because she hadn’t served in the military. PTSD is often associated with military service personnel, and the impact of war on our veterans. War veterans tend to be adults, over the age of 18, some of whom have served in more than one military event. PTSD can also be the result of a car accident, natural disaster or other singular traumatic experience.
Developmental Trauma Disorder (DTD), however, is the kind of trauma which takes place as children are growing up over an extended period of time. DTD might also be seen in children who live in war torn countries, yes. It might also be seen in a child living with a single parent who is often alone or handed off to relatives, hungry and lonely. DTD might manifest as drug and alcohol use and later as mental illness / poverty / homelessness.
The Diagnostic and Statistics Manual 5 (DSM-5) doesn’t recognize DTD as a disorder. I’m both pleased and highly disappointed in their rejection of the proposal from Bessel van der Kolk, a well known practitioner working with patients and researcher in this field. Bessel van der Kolk (2015) has been working with victims of various forms of trauma for more than 40 years. He highly values the use of somatic therapies and the arts as supportive approaches for working with trauma. He founded the Trauma Center, located at the Justice Resource Institute (JRI) in MA (www.jri.org, 2015) over 30 years ago. He previously served as president of the International Society for Traumatic Stress Studies, is currently a Professor of Psychiatry at Boston University Medical School and was the Medical Director of the Trauma Center at JRI (www.jri.org, 2015). Van der Kolk has conducted research under the Trauma Center at JRI, National Institute of Health (NIH), National Institute of Complimentary Medicine (NICM), Center’s for Disease Control (CDC), numerous private research organizations and has taught world wide.
My ambivalence regarding this decision has to do with pathologizing our condition, but also one of providing access to healing resources that insurance would cover. Although the DSM was not originally published as a tool for billing and coding by the insurance industry, they do it regardless. The APA (2009) denied the inclusion of DTD into the DSM-5 citing a lack of “prospective studies” and “research-based fact” (van der Kolk, 2014, p. 159). Van der Kolk (2014) has found, however, that patients often exhibit rapidly shifting moods, tantrums, panic, detachment, flat affect and dissociation, as well as self-harming behaviors such as cutting, biting, hair pulling, and burning. They show signs of diminished cognition, language processing, attention span and fine-motor skills while also having experienced a significant quantity of disruptive childhood events. I believe that gathering current case study information from the fields of eating disorders, prison populations, alcohol and drug use, homelessness, psychiatric clinics, and more would provide ample research to prove that DTD does exist and requires our immediate attention.
Why does DTD happen? What treatment protocols are being used for DTD? The theory of Developmental Trauma Disorder is proposed to be the result of ongoing destabilizing events, taking place during normal developmental milestones of children. These events coupled with a feeling of helplessness, powerlessness, and the inability to communicate at pre-verbal stages, result in DTD and undermine children’s crucial development for physical, emotional and mental well being. In a February 2009 letter submitted to the American Psychological Association (APA) along with a proposal for DTD’s inclusion in the DSM-5, van der Kolk states:
“Children who develop in the context of ongoing danger, maltreatment and disrupted caregiving systems are being ill served by the current diagnostic systems that lead to an emphasis on behavioral control with no recognition of interpersonal trauma. Studies on the sequelae of childhood trauma in the context of caregiver abuse or neglect consistently demonstrate chronic and severe problems with emotion regulation, impulse control, attention and cognition, dissociation, interpersonal relationships, and self and relational schemas. In absence of a sensitive trauma-specific diagnosis, such children are currently diagnosed with an average of 3 – 8 co-morbid disorders. The continued practice of applying multiple distinct co-morbid diagnoses to traumatized children has grave consequences: it defies parsimony, obscures etiological clarity and runs the danger of relegating treatment and intervention to a small aspect of the child’s psychopathology rather than promoting a comprehensive treatment approach. (2014, p. 159)”
As a child, I experienced a severe number of destabilizing events combined with the silence of adults over many years, that resulted in my inability to take care of myself in a sustainable fashion in my adult life. Most of my life, I’ve suffered from dissociation, nail biting, confused thoughts of self-doubt and insecurity. Paranoia in relationships ruled, blanketed by terror and fear of abandonment. I was often angry and abrasive – tools designed to keep people at bay even though I craved closeness, relationship and community. I used drugs and alcohol, minimally, to cope with my utter terror at being in ANY kind of new situation, but I didn’t always use them. Why? Because I simply needed to feel in control of my surroundings more than I needed to numb out. As I child, I had no control over my environment. The flip side to avoiding drugs or alcohol to cope with fear, was that I would often dissociate from my body and the fearful situation anyway. No matter what I did, I just couldn’t stay present and in the moment. I was too terrified. I will speak more about my experience in future blogs, but I felt it was important to lay the groundwork for what DTD is and how it showed up in my young life. More on this in an upcoming blog!