Developmental Trauma Disorder (DTD) is a proposed psychiatric diagnosis that emphasises traumatisation that can occur early in life. Since 2002, it has been proposed as a diagnosis by clinicians and researchers to address early life exposure to victimisation that extend beyond posttraumatic stress disorder (PTSD). The proposed diagnosis involves children’s exposure to family and community adverse circumstances (i.e. abandonment, betrayal, physical assaults, sexual assaults, threats to bodily integrity, coercive practices, emotional abuse, witnessing violence), and the complex psychological, biological, and interpersonal consequences 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 victimisation 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 led 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.” Despite the extensive work done over the past 18 years to validate and establish this diagnosis, many clinicians have adopted the term Complex Trauma (C-PTSD) instead, not understanding the importance of the attachment part in the developmental traumatisation. 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 appalling 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 historically recognised or acknowledged, and that they have a powerful relationship to adult health. The 1998 ACEs 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. Further to this, the more adverse childhood experiences experienced, the more likely the adult had developed heart disease, cancer, stroke, diabetes, skeletal fractures, and liver disease. Chronic early traumatisation 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 recognise and to differentiate traumatisation that happens early in life to the traumatisation that happens during later life. The proposed DTD diagnostic criteria is: 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) Behavioural (eg, re-enactment, cutting) Cognitive (eg, thinking that it is happening again, confusion, dissociation, depersonalisation). 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.
