I have been pointed towards the effects of trauma before, by my old counselor a year or so ago, who pointed out that the symptoms of trauma are very similar to Borderline Personality Disorder. My recent experience of attachment with my therapist caused me to research Attachment Disorder today, and found me at the website of Attachment Disorder Maryland.
My jaw dropped and I nearly gasped several times reading their page on Developmental Trauma Disorder (DTD). It’s been a while since I’ve had the experience of immense relief to read about parts of myself that hadn’t yet been reflected to me externally. I am feeling immense relief and hope that this has been written about.
Most-striking excerpts from the website of Attachment Disorder Maryland — their page on Developmental Trauma Disorder (DTD):
Definition : Developmental Trauma Disorder is a diagnostic proposal for DSM-5, authored by Bessel van der Kolk and colleagues. The concept of DTD is based on a wide array of research data that comprises tens of thousands of children across multiple research studies. DTD results from growing up in an interpersonal context of ongoing danger, maltreatment, unpredictability, and/or neglect. 80% of all child maltreatment is at the hands of children’s own parents. Maltreatment embeds “hidden traumas” in infant – caregiver interactions that are neglectful, intrusive, unpredictable, threatening, aggressive, rejecting, or exploitive. These interactions convey that the world is a dangerous, unreliable, and/or indifferent place that offers little or no safety. Given the highly limited capacities of infants / young children to assess risk, this lack of physical and/or emotional safety quickly rises to the level of a subjective survival threat (annihilation anxiety) even though the objective nature of the event may not actually be at that level. For this reason, such events do not warrant a diagnosis of PTSD because the events are not “imminently life threatening”, a criteria for PTSD. However, it is subjective perception, and not objective lethality, that determines trauma. Using PTSD criteria, the element of trauma gets missed, and the erroneous diagnostic process has begun.
Major diagnostic criteria for DTD: There are seven major diagnostic criteria for DTD.
- Witnessing or experiencing multiple adverse interpersonal events involving caretaker(s) for at least one year.
- Affective and physiological dysregulation.
- Attentional and behavioral dysregulation.
- Self and relational dysregulation.
- Chronically altered perception and expectations.
- At least two post-traumatic symptoms.
- Functional impairment- at least two of the following areas: academic, family, peers, legal, health.
- Duration of disorder is at least 6 months.
(#7 of Developmental impacts:)
Fragmentation / disorganization: We know from object relations theory that whatever is communicated as being off limits to an infant’s caretaker is also off limits to the Self. Infants quickly pick up implicitly, what their caretakers do not want to see, will reject, are afraid of, will retaliate against… These elements become “off limits” which lays the groundwork for fragmenting the child’s Self construct. This fragmentation of the Self produces a pervasive state of internal disorganization that causes further fragmentation as time moves forward, and so the disorganization is both effect and then cause. This internal disorganization impairs integrative processing such that the integration of sensory, cognitive, emotional, and behavioral experience into a congruent picture does not occur and so children with DTD can appear very different across time and situations. This, in turn causes significant confusion for the adults interacting with these children on an ongoing basis. Given their confusion, the adults are prone to respond inconsistently to the child, thereby validating the child’s view of the world as unpredictable. Now the original traumatic context is being replicated in the present in a dizzying escalating spiral that carries profound implications for attachment….
DTD vs. Post Traumatic Stress Disorder (PTSD): PTSD stems from discrete, traumatic incidents rather than an ongoing pattern of embedded trauma. It manifests as specific responses to stimuli that are reminders of the traumatic incident. In the absence of traumatic triggers, PTSD symptoms may be minimal to wholly absent. PTSD lacks the pervasive developmental sequelae of DTD. Since PTSD can’t account for all the symptoms of DTD, other diagnoses are often added to PTSD to cover the additional symptoms. This produces fragmented diagnostic thinking and the partial diagnosis phenomenon. Once again, it’s the Blind Men and the Elephant story. The part is mistaken for the whole, leading to a lack of understanding about the whole (systemic dysregulation resulting from developmental trauma) and a partially effective, clinical response at best.On the other hand, the “hidden traumas” of DTD do not meet the DSM-4 definition of a “traumatic event” as they are not imminently life threatening. Evidence based treatments for PTSD do not adequately address the pervasive developmental impairments and attachment difficulties that come with DTD.