Developmental Trauma Disorder: What Trauma Specialists Need to Know
Many trauma specialists and helping professionals encounter children and adolescents with a history of multiple chronic traumatic events throughout their young lives. In the past, we have referred to this as “complex trauma,” or Type II or even Type III trauma; in brief, trauma specialists generally agree that youth who have experienced multiple traumatic events involving abuse, violence, or abandonment react differently than those who may have experienced an acute, single incident of trauma or loss.
The Complex Trauma Taskforce of the National Child Traumatic Stress Network (NCTSN) undertook a significant step in identifying and resolving the problems associated with diagnosing complex trauma in children. In 2005 Bessel van der Kolk and colleagues proposed “developmental trauma disorder” (DTD) to more accurately describe children and youth who present a range of difficulties as a result of exposure to early, chronic and severe trauma. These individuals may have experienced developmentally adverse trauma involving abandonment, physical abuse or assault, sexual abuse or assault, emotional abuse, witnessing violence or death, and/or coercion or betrayal. Understandably, these types of repeated events cause feelings of rage, fear, shame, defeat, and withdrawal; they are reactions to years filled with adverse and inhumane treatment by parents, family members, caregivers, or others who impact these children’s lives.
Youth with DTD often have problems with attachment and authority, are unable to regulate their emotions and impulses, and can experience cognitive impairment and attention deficits. Trauma experts concur that these individuals may benefit more so from our efforts to help them recognize and regulate their trauma reactions rather than pharmacological approaches that are used in desperation to control or medicate behaviors such as attention deficit disorder, cognitive and behavioral problems, and anti-social behaviors.
As we continue to learn more about complex, chronic trauma, just how should trauma specialists address DTD and make appropriate interventions with these children and adolescents? Here are some simple recommendations, based on my work with children from violent homes, abused children, and youth who witness homicides:
1. Establish a sense of safety. This includes helping children establish both an internal sense of safety and identification and support for safety within their homes, neighborhoods, and communities.
2. Regulate affect. Help children understand that what has happened is “not their fault,” and assist them in learning methods to regulate and moderate arousal [limbic system] with the long-term goal of restoring emotional equilibrium.
3. Reestablish attachment. Chronic, complex trauma disrupts basic trust because it is often caused by dysfunctional or abusive interpersonal relationships; our goal as helping professionals is to help children reestablish attachment with positive adult role models and to learn how to empathize and productively interact with peers.
4. Enhance the brain’s executive functions. Serious and repetitive trauma impacts cognition, disrupting cortical functioning; our goal is to help children effectively engage attention, comprehension, and problem-solving skills to allow for the experiences of mastery, self-esteem, and self-efficacy.
5. Reframe and integrate traumatic experiences. Chronic, complex developmental trauma cannot be erased from memory; however, with our help children can learn to how to manage their reactions, enhance adaptive coping skills, and cultivate present-oriented responses to current stresses. Our ultimate goal in intervention is to help these youth transform, incorporate, resolve, repair, and construct meaningful lives, post-treatment.
You can download a PDF of a white paper on Developmental Trauma Disorder by van der Kolk and colleagues here. Dr. Bill Steele, TLC founder, would enjoy hearing your reactions to this proposed diagnostic category through the National Institute for Trauma and Loss Fan Page on Facebook (go to Discussion tab or post on our fan page wall) or simply email TLC at firstname.lastname@example.org.
Cathy Malchiodi, PhD, LPCC, LPAT
van der Kolk, B. (Guest Ed.). (2005). Child abuse and victimization. Psychiatric Annals, 35, 374-430.
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