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Developmental Trauma Disorder

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.

  1. Witnessing or experiencing multiple adverse interpersonal events involving caretaker(s) for at least one year.
  2. Affective and physiological dysregulation.
  3. Attentional and behavioral dysregulation.
  4. Self and relational dysregulation.
  5. Chronically altered perception and expectations.
  6. At least two post-traumatic symptoms.
  7. Functional impairment- at least two of the following areas: academic, family, peers, legal, health.
  8. 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.

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trusting perception + trauma is trauma

unknown artist

unknown artist

For many years, I have lived with a massive confusion in me over how to view my past, and therefore, who I am in the present. whether I am over-dramatizing or minimizing the dysfunction I grew up with, and the adverse events that have happened in my life. I believe this indecision is at the heart of my confusion around identity, personality, status, and whether or not I can trust my own perceptions.

A person I had been dating for a couple of weeks told me last night that they had suffered through “way worse” experiences than me. In the context of our conversation around living together, which felt absolutely ridiculous for me to consider at this point, I took this to mean that he was telling me I should be able to get over my past to be able to live with him. I felt my blood beginning to boil, and in that moment of sudden, acute and brilliant clarity, exited the vehicle immediately, and walked away.

I am, growing more than I have in many years, feeling more joy, spontaneity, laughter and playfulness. I realized last night that this person had been telling me very subtly and indirectly, whenever I expressed needing to move slowly in relationship, that I am putting my own walls up, somehow limiting myself, not being as much as I can be. It is amazing how loving and caring a totally dysfunctional person can appear, seeming spiritual and evolved and enlightened and self-sufficient, meanwhile failing to follow through with any plans or intentions or promises; getting lost, injuring himself, and depending on others for many things. What I realized was that my involvement with this person was like going around in circles. In one moment, he would proclaim that he never got angry, in the next, he would say how angry he was; one moment, he would say he wasn’t dependent on anyone, in the next, he would proclaim that he needed to get his license so he could be more independent. ! And on, and on, and on. It was another opportunity for me to practice reading between the lines and listening to what my inner gut was telling me, even if it was the exact opposite of all the words I had been longing to hear, or of all the things I felt were really going on, deep in my gut. Words can lie, actions cannot.

And that is the link to the source of the confusion epicenter in me and my original trauma of invalidation. That people and situations are not what they seem, or appear to be. The experience of perceiving something that no one else is perceiving, such as abuse, emotions, or relationship dynamics. Because I was a child at the time of the original trauma, instead of judging everyone else as being blind, I developed a chronic confusion, a chronic state of doubt towards my ability to perceive reality. My caregivers and eventually the entire community surrounding me simply denied my truth by inaction – a lack of response to an unhealthy situation–and I became the crazy one. It was this experience that caused the loss of stability in my sense of inner self. And here I was, experiencing it again. Another chance to trust and act on my own perceptions, despite the appearance or the insistence of others that they are wrong.

There is nothing in my past that fits the American Psychological Association’s description of trauma (“… an emotional response to a terrible event like an accident, rape or natural disaster”). I wasn’t raped or bombed, starved, bullied or beaten, and my parents weren’t alcoholics or drug addicts. So why do I exhibit symptoms of a survivor? What can I possibly have to complain about, when so many others have had it seemingly so much worse than me? What is wrong with me? Why can’t I just get my shit together?

My therapist at VIHA recently presented me with a definition of trauma echoing the one I found on the free online dictionary: “An emotional wound or shock that creates substantial, lasting damage to the psychological development of a person, often leading to neurosis. An event or situation that causes great distress and disruption.”

“…leading to neurosis.” According to Dr. George Boeree, effects of neurosis can involve:

“…anxiety, sadness or depression, anger, irritability, mental confusion, low sense of self-worth, etc., behavioral symptoms such as phobic avoidance, vigilance, impulsive and compulsive acts, lethargy, etc., cognitive problems such as unpleasant or disturbing thoughts, repetition of thoughts and obsession, habitual fantasizing, negativity and cynicism, etc. Interpersonally, neurosis involves dependency, aggressiveness, perfectionism, schizoid isolation, and socio-culturally inappropriate behaviors, etc.”

Wikipedia defines trauma as:

“… a single experience, or an enduring or repeating event or events, that completely overwhelm the individual’s ability to cope or integrate the ideas and emotions involved with that experience. …

“There is frequently a violation of the person’s familiar ideas about the world and of their human rights, putting the person in a state of extreme confusion and insecurity. This is also seen when people or institutions, depended on for survival, violate or betray or disillusion the person in some unforeseen way.”

Helpguide.org defines trauma as “[a] severely disturbing experience that leads to lasting psychological or emotional impairment,’ and lists the following events as “[c]ommonly overlooked causes of psychological trauma”:

  • Falls or sports injuries
  • Surgery (especially in the first 3 years of life)
  • The sudden death of someone close
  • A car accident
  • The breakup of a significant relationship
  • A humiliating or deeply disappointing experience
  • The discovery of a life-threatening illness or disabling condition

The HelpGuide website states that “[t]rauma can also stem from ongoing, relentless stress …” and goes on to say:

“Not all potentially traumatic events lead to lasting emotional and psychological damage. Some people rebound quickly from even the most tragic and shocking experiences. Others are devastated by experiences that, on the surface, appear to be less upsetting. People are more likely to be traumatized by a stressful experience if they’re already under a heavy stress load or have recently suffered a series of losses.”

Silvano Arieti’s Interpretation of Schizophrenia, originally published in 1955, also sheds some interesting light on the definition of trauma:

layered vogue covers

layered vogue covers

“… conditions of obvious external danger, as in the case of wars, disasters, or other adversities … do not produce the type of anxiety that hurts the inner self and do not themselves favor schizophrenia. Even extreme poverty, physical illness, or personal tragedies do not necessarily lead to schizophrenia unless they have psychological ramifications that hurt the sense of self. Even homes broken by death, divorce or desertion may be less destructive than homes where both parents are alive, live together, and always undermine the child’s conception of himself.”

The fact is, that saying others have suffered more than me and that I am not justified to need healing has simply not served me well in my life. In fact, it has eaten me from the inside out like a termite. How many years and how much energy did I waste trying to pretend to be “normal” and “okay” because there was no obvious reason for me to not be okay? There was no reason to not be okay, so I must be okay, and if I’m not okay, then I am horribly defective and I should rot in hell.

That was the prison I lived in. That is the prison I am letting myself out of by adopting a more inclusive understanding of what trauma is.

'light in her eyes' by Lucy Lumis

'light in her eyes' by Lucy Lumis

A very many of the symptoms of trauma are the same as those of Borderline Personality Disorder, which is said to stem from a combination of external events and personal character traits–specifically, intensity of emotions and emotional sensitivity. In other words, an event may not be experienced as traumatic by one individual, but extremely traumatic by another person who possesses the emotional intensity and sensitivity.

I am starting to understand that I have traits of a survivor because trauma is a subjective experience.  The events in my life are subtle in comparison to others, but my emotional responses are not. I am an emotionally intense and sensitive person who has experienced several of the definitions of trauma cited here in this article. Whether my official diagnosis is trauma or Borderline Personality Disorder, my sense of inner self has been damaged from very early on by the false faces of denial – the disparity between what is spoken and what I feel. Subsequent traumas have deepened the wound and created new ones with prolonged periods of extreme stress, depression and pressure. My life in the last 2 years covers pretty much every category under the DSM-IV’s Axis IV, which is used for, “…reporting psychosocial and environmental stressors that may affect the diagnosis, treatment, and prognosis of mental disorders”:

  • Problems with primary support group
  • Problems related to the social environment
  • Educational problems
  • Occupational problems
  • Housing problems
  • Economic problems
  • Problems with access to health care services
  • Problems related to interaction with the legal system/crime
  • Other psychosocial and environmental problems

When I exited the vehicle last night, I validated myself in my perceptions and in my recovery. I chose not to remain in the confusion and chaos of that relating. I honored my needs as a survivor, for compassion, clarity, honesty and understanding as a matter of life or death. I deemed the absence of these things as being unsafe. I cannot expect myself to toughen up and bear it. The costs outweigh the benefits.

Whether there is diagnosis or not, I believe that everyone has traumas – places in which we struggle to trust and act on our perceptions because of a lack of clarity or resolution about past events. It is how much they affect our ability to live well that pushes us onto the path of healing. Everyone’s tipping point is different, but suffering is suffering; dysfunction is dysfunction, and trauma is trauma.