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Developmental Trauma Disorders

Many people have experienced trauma in their childhood that has had lasting impacts on their mental health. Traumas can include physical, emotional and sexual abuse and neglect. The majority of people who experience childhood trauma will not develop Post Traumatic Stress Disorder (PTSD) but instead may have what is referred to as developmental trauma disorders. While developmental trauma disorder (DTD) was rejected in submission to the DSM-5 as a formal diagnosis, it is still a useful framework to understand some of the symptoms people who have experienced childhood trauma might present with.

DTD is defined as “a cluster of psychiatric symptoms that occur in children and adolescents exposed to multiple adverse childhood experiences (ACEs), including severe maltreatment, and who do not meet criteria for PTSD.” Children and adults with DTD have comorbidities such as panic disorder, separation anxiety and disruptive behaviour disorders. They also have a range of symptom characteristics that are unique to DTD and not associated with PTSD such as impaired mentalizing, which is the ability to understand your own needs, strengths and limitations and that others might have worldviews different to your own.

Despite the prevalence of these difficulties, people who have suffered trauma often do not receive a diagnosis or are given alternative diagnoses such as Autism Spectrum Disorder or Conduct Disorder. As a result, they can be denied access to support services, are at greater risk of poor outcomes and stigmatisation and have less opportunity to find the help they need. The DTD lens could help avoid over-pathologising these individuals by giving them a broader diagnostic framework for the many complex symptoms they have to face. It would also make it easier for professionals to identify the root causes of their distress and provide effective treatment.

A key feature of DTD is dissociation, which is our body and mind’s natural way to anaesthetise ourselves against overwhelming experiences and emotions. It is an adaptive and vital survival mechanism but in children who have experienced trauma it can lead to long-term psychological problems if not addressed. This is one of the key reasons why DTD is so difficult to treat and why it is important that those who are suffering from it are given the correct support and care they need.

While DTD is most prevalent in people who have experienced severe interpersonal trauma, it can be found in those who have a variety of other conditions such as depression, anxiety and substance use disorders. As well as the physiological and attachment based disturbances that are seen in DTD, it is often linked to socio-economic factors such as poverty, low levels of education, violence exposure and parental alcohol or drug use. This makes it a significant issue for the most vulnerable members of our society, such as looked after and adopted children. In addition, DTD can be exacerbated by the impact of other life events such as loss of relationships, bereavement and family breakdown. This can lead to a vicious cycle of repeated trauma, lack of treatment and poor outcomes for these vulnerable people.

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