What is developmental trauma disorder?

Bessel van der Kolk, MD,1 and colleagues are pioneers in developing DTD philosophy and diagnostic criteria, and they have shared their knowledge globally with the intent to improve the identification, treatment, and prognosis for children who have suffered traumatic experience. Van der Kolk describes DTD as a distinct condition affecting children, adolescents, and adults who have been repeatedly subjected to various forms of childhood maltreatment, including neglect and/or physical, emotional, and sexual abuse, during specific periods of their neurophysiological development.1 Child maltreatment is particularly traumatizing if it was committed by a significant caretaker, such as a parent.

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Other causes of DTD include witnessing acts of violence, permanent loss of an essential caregiver, institutionalization, and experiencing inconsistent custodians, such as multiple and abusive foster parents.1 Among other numerous examples, exposure to poverty, serious illness, multiple surgeries, warfare, or a life-threatening natural disaster or motor vehicle accident can traumatize a child’s psyche.1 

Van der Kolk has proposed that DTD is manifested in various ways that negatively affects a victim’s capacity to relate to oneself and others.1 The following sections address some of the adverse consequences of DTD, including impaired cognitive, emotional, and social functioning, and common somatic symptoms. 

Cognitive, emotional, social, and somatic effects 

Children are critically dependent on the quality of their relationship with caregivers for normal development, and when they are repetitively traumatized, their psyche becomes damaged.1 They naturally internalize a caregiver’s facial expressions, emotions, and actions that serve as a “mirror” reflecting to a child his or her personal worth and identity. If caretakers are deficient or inconsistent in areas of sensitivity and emotion, or if they are violent or negligent, children endure tremendous stress. This stress is often exhibited in victims as persistent psychological states of hyper-arousal, nervousness, and agitation, and/or hypo-arousal or feeling emotionally numb.1,4 

Dissociation or tainted consciousness is a characteristic defense mechanism and survival skill that DTD victims use to escape overwhelming emotion and the impact of abuse.1,4 Dissociation includes “thought suppression, minimization, and outright denial.”5 Depersonalization or feeling disengaged from oneself and the world are other described symptoms of dissociation.4,5 As a result, children learn to ignore their authentic emotions, while missing important opportunities to develop the capacity for introspection and self-managing abilities.1,6 They also learn not to trust their thoughts and feelings, causing self-perception and discernment of others to be confusing or distorted.1,6

Due to a lack of self-protection and unable to escape their plight, traumatized children develop other defenses, or maladaptive personalities, described as fight, flight, freeze, and fawn types (4-Fs).6 Fight responders possess a considerable need to control their environment, are typically disruptive or argumentative, and may display violent or aggressive behavior toward others, such as bullying.1,6 Flight personalities will flee or avoid their chaotic life, as seen in children who run away from home, become overactive, develop a compulsive or obsessive nature, or strive for perfectionism.1,6 Freeze types isolate themselves, engaging in dissociative activities such as excessive sleeping or constant use of the television or computer.1,6 Fawn responders are considered submissively co-dependent, sacrificing self-identity and healthy personal boundaries to sustain relationships or avoid rejection.6 Behaviors resulting from the 4-Fs often unjustifiably cause a child to be characterized as difficult, disobedient, rebellious, withdrawn, lazy, shy, or hyperactive.1,6 Within a traumatized and defenseless environment, the 4-Fs may be used interchangeably and serve as a child’s primary coping skills, while causing intellectual, social, sensory, and/or motor developmental delay or arrest.1,6 

In an attempt to avoid abuse, children become hypervigilant of their surroundings, which further creates anxiety and tension.1,6 When caregivers are unable to provide a predictable and safe environment for their children, or offer relief to their stress, victims develop a limited capacity for emotional self-regulation and impulse control, their ability to experience healthy interpersonal bonds is restricted, and the process of learning from experience becomes fragmented and indistinct.1 These consequences are the primary origins of DTD.1 Other reactions to interpersonal trauma include high-risk and self-destructive behaviors, emotional instability, attention deficit, depression, and eating disorders.1 Deficient school or work performance, a proneness to accidents, and decreased sensitivity to pain are other signs of childhood trauma.1,7 Unexplained and persistent backache, abdominal or pelvic pain, headache, and insomnia are frequent somatic-related symptoms,4,6-7 and these may alert a health provider to identify a psycho-traumatic cause.

Ultimately, many perpetrators consistently induce intense emotions within their victims, including fear, humiliation, and unnecessary remorse resulting in poor self-esteem, or self-hatred. Above all, these children learn not to rely on themselves and others and lack a broader interpretation of life apart from their trauma-induced version. As a result, victims may develop a host of physical and psychological impairments affecting their health and ability to interact successfully with themselves and others.1,6,8