Developmemntal Trauma Disorder (DTD)

Notes from Dr Bessel A van der Kolk ...

Many people who ..... “experience multiple forms of trauma / abuse experience developmental delays across a broad spectrum, including cognitive, language, motor, and socialization skills, they tend to display very complex disturbances, with a variety of different, often fluctuating, presentations.”

“Mastery is most of all a physical experience,” writes Van der Kolk “ the feeling of being in charge, calm, and able to engage in focused efforts to accomplish goals. Children who have been traumatized experience the trauma-related hyperarousal and numbing on a deeply somatic level.

Their hyperarousal is apparent in their inability to relax and in their high degree of irritability.

Single Diagnosis needed for Complex Childhood Trauma History

http://pn.psychiatryonline.org/content/42/3/20.full

In recent years, leaders in the treatment of childhood trauma—including Ford, van der Kolk, and Robert Pynoos, M.D., who is director of the National Child Traumatic Stress Network (NCTSN)—have spearheaded a project with colleagues nationwide to support the introduction of a new diagnosis in DSM that more completely accounts for the wide range of childhood developmental trauma.

They say that in the absence of a diagnosis that accurately captures the pervasive nature of disturbances related to early childhood trauma, children tend to receive a hodgepodge of labels for any number of symptoms—PTSD and attention deficit, conduct, and mood disorders—that are treated as separate conditions.

“Approaching each of these problems piecemeal, rather than as expressions of a vast system of internal disorganization, runs the risk of losing sight of the forest in favor of one tree,” said van der Kolk.“ What you call someone has large implications for how you treat someone, even though you may be describing the same phenomenology [using different terms].”

He noted, for instance, that because of the emotional dysregulation that traumatized children frequently display—as well as self-harming behaviors they may adopt as a coping mechanism—they are too often diagnosed with bipolar disorder and treated exclusively with drugs and behavior management.

But van der Kolk and other leaders in the field say that such an approach is an example of how an overly simplified diagnosis can lead to inadequate treatment and a poor outcome.

“Looking at developmental trauma can help us to think more realistically about both the complexity of presenting problems and the depth or extent of clinical services that need to be in play, not only in the consulting room but in the work with parents and teachers,” Marans told Psychiatric News. “It makes a big difference whether you base a diagnosis solely on the presentation of particular symptoms or on a more complex view of how the symptoms are affecting development over time.”

In his article “Developmental Trauma Disorder: A New Rational Diagnosis for Children With Complex Trauma Histories,” in the May 2005 Psychiatric Annals, van der Kolk argued the case for a new diagnostic entity and described implications for treatment.

“The diagnosis of PTSD is not developmentally sensitive and does not adequately describe the effect of exposure to childhood trauma on the developing child,” he wrote. “

Because infants and children who experience multiple forms of abuse often experience developmental delays across a broad spectrum, including cognitive, language, motor, and socialization skills, they tend to display very complex disturbances, with a variety of different, often fluctuating, presentations.”

At the Trauma Center in Boston, van der Kolk said, treatment of severely traumatized children can involve theater groups, yoga, and breathing and sensory integration exercises aimed at enhancing self-regulation. A focus of therapy is improving heart rate variability, which reflects disruption of the body's sympathetic-parasympathetic balance caused by chronic trauma.

In the Psychiatric Annals article, he explained that treatment of chronically traumatized children should focus on three primary areas: establishing the child's capacity to regulate his or her internal states of arousal, learning to negotiate safe interpersonal attachments, and integration and mastery of the body and mind.

“Mastery is most of all a physical experience,” he wrote,“ the feeling of being in charge, calm, and able to engage in focused efforts to accomplish goals. Children who have been through this kind of traumatized experience typically display trauma-related:

1. hypo-arousal and numbing on a deeply somatic level.

2. hyperarousal - inability to relax and or a high degree of irritability.”

Repeated Trauma in Childhood - repeated Trouble in Adulthood

The name for this group of problems is still not standardised. Psychiatrists, psychotherapists and counsellors are still coming to terms with the profound realisation that continued or regular traumatic experiences during childhood produce a wide range of symptoms in adulthood that may appear to be separate and are often diagnosed as different disorders, but are in fact linked to the same common cause.

Current terms being used include:

Developmental Trauma Disorder

Childhood Developmental Trauma.

Complex Childhood Trauma

Repeated Childhood Trauma

Early Relational Trauma

Can I suggest you go to Google and type “DTD Trauma” to see the latest findings on this still relatively new understanding?

The bottom line for self awareness and self empowerment work and voice dialogue is that so much of what we discover about ourselves and our inner selves and what those selves do, all goes back to the time when we were “copping” regular or continued traumatic experiences in those early years from age 0 to 10.

Repeated childhood trauma is a polite term for any form of abuse that a child experiences again and again during the vital life skill developmental stage between age 0 to 10

Hyper-arousal – states of extreme rage and aggression is more common

But what we often see is

Hypo-arousal – in which a person disengages and dissociates under stress - In that state the brain’s ‘red phone’ compelling the mind to take action, is dead.

FROM http://www.somaticpsychotherapy.com.au/

“Where there is early relational trauma – where the caregiver has failed to adequately provide attuned and regulating parenting – a series of maladaptive physiological and behavioural responses will directly shape the child’s ability to cope in future life. Ultimately, Schore said, the child exposed to ongoing trauma – whether abuse or neglect - is at risk of developing a response to stressors of either hyperarousal or hypoarousal.

Schore suggested that the therapeutic community has put far too much emphasis on how to manage states of hyperarousal – in which clients may display states of extreme rage and aggression. But that in his view, the state of hypoarousal – in which a person disengages and dissociates under stress – is far less frequently identified, despite it being the more difficult state to work with.

Dissociation, Schore said, in which the body enters a parasympathetic state including reduced heart rate and blood pressure, is simply a “primitive strategy of right brain auto-regulation for coping with intense emotional arousal and pain”.

In the state of dissociation, the right brain’s ‘red phone’ compelling the mind to take action, is dead. Instead, it would seem that the right brain cortical sub-cortical system is unable to recognise or process either external or internal stimuli in this state. ))

EMDR is proving useful in helping reprocess Developmental childhood trauma symptoms

In non-psychological terms that repeated childhood trauma:

1. Damages or destroys a number of skills we need to operate as a functional adult.

2. Stops us learning other life skills that would help us “master” the kinds of everyday problems that life serves up to us

3. Results in a wide range of behaviour symptoms than may be misdiagnosed as classic psychiatric disorders but are actually more like a “collection of missing life skills”

TYPES OF REGULAR OR REPEATED CHILDHOOD TRAUMA /ABUSE

Physical, Mental, Verbal, Emotional, Spiritual, Sexual, Violence, Shaming, Distorted Reality, Abandonment, Engulfment, Hidden secrets, Excessive control or negativity

FEELINGS CONNECTED WITH REGULAR CHILDHOOD TRAUMA /ABUSE

Lonely, hurt, sad, angry, fear, shame, guilt, worthless, frustration, pain, betrayed, defeated, helpless, hopeless, lost, shut down, devastated, embarrassed, smothered, annoyed, enraged

ADULT BEHAVIOUR RESULTING FROM REGULAR CHILDHOOD TRAUMA /ABUSE

Hyper-arousal – either excessively busy, unable to relax, hyper-vigilant, excessive agitation or irritability, regular states of extreme rage and or aggression,

But what we often see as well is

Hypo- arousal – in which a person disengages and dissociates under stress - In this state the brain’s ‘red phone’ compelling the mind to take action, is dead. (Dr. Allan Schore UCLA Psychiatry Department and Bessel van der Kolk)

Loss of the life skill called “mastery” the feeling of being in charge, calm, and able to engage in focused efforts to accomplish goals.

Physical pain and body discomfort

Addictive cycles

Black and white thinking or flipping between two opposite positions. Either “I love him or I hate him” with nothing in between

RSDP Repeated self defeating patterns (click link at the bottom of this page to go to the RSDP pages)

What can you do about it ? Click here

RSDP Repeated self defeating patterns (click here to go to the RSDP pages)

Links -

This is a very informative site on childhood abuse

http://www3.sympatico.ca/m.armstrong/9.htm

Vietnam veterans

http://www.dontforgetvietnamvets.net