Developmental Trauma Disorder Diagnosis

In his article Developmental Trauma Disorder - Towards a rational diagnosis for children with complex trauma histories,  Bessel van der Kolk and a group of practitioners describe a proposed a new diagnostic criteria for Developmental Trauma. Although their recommendations were not adopted for DSM-V, their proposal is available for review. Table 1 is a summary of their proposed set of criteria. You can read an explanation for the proposal in the Appendix of The Body Keeps The Score. And I have prepared a simplified version of the proposal that you can view. Developmental_Trauma_Disorder_Overview.doc

You can find out more about  the Adverse Childhood Experience (ACE) assessment here.

Table 1 : Developmental Trauma Disorder

A. Exposure

  1. Multiple or chronic exposure to one or more forms of developmentally adverse interpersonal trauma (abandonment, betrayal, physical assaults, sexual assaults, threats to bodily integrity, coercive practices, emotional abuse, witnessing violence and death).
  2. Subjective Experience (rage, betrayal, fear, resignation, defeat, shame).

B. Triggered pattern of repeated dysregulation in response to trauma cues

Dysregulation (high or low) in presence of cues. Changes persist and do not return to baseline; not reduced in intensity by conscious awareness.

  • Affective
  • Somatic (physiological, motoric, medical)
  • Behavioral (e.g. re-enactment, cutting)
  • Cognitive (thinking that it is happening again, confusion, dissociation, depersonalization).
  • Relational (clinging, oppositional, distrustful, compliant).
  • Self-attribution (self-hate and blame).

C. Persistently Altered Attributions and Expectancies

  • Negative self-attribution
  • Distrust protective caretaker
  • Loss of expectancy of protection by others
  • Loss of trust in social agencies to protect
  • Lack of recourse to social justice/retribution
  • Inevitability of future victimization

D. Functional Impairment

• Educational • Familial • Peer • Legal • Vocational

Social Engagement Solutions – Building Communities For Human Flourishing