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Developmental Trauma Disorder - A Provisional Diagnosis
Developmental Trauma Disorder - A Provisional Diagnosis
To cite this article: Corey M. Teague (2013) Developmental Trauma Disorder: A Provisional Diagnosis,
Journal of Aggression, Maltreatment & Trauma, 22:6, 611-625, DOI: 10.1080/10926771.2013.804470
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Journal of Aggression, Maltreatment & Trauma, 22:611–625, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 1092-6771 print/1545-083X online
DOI: 10.1080/10926771.2013.804470
COREY M. TEAGUE
Department of Psychology, Middle Tennessee State University,
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611
612 C. M. Teague
That is, DTD can be understood as the experince of severe betrayals (i.e.,
multiple sufferings) in a percieved trusting intimate childhood or adolescent
relationship that interferes with functioning.
Developmental trauma can consist of single or multiple traumas.
However, most children experiencing developmental trauma experience
multiple traumas. In a study completed by Spinazzola et al. (2003), 77.6%
of the children experiencing trauma had experienced multiple traumas.
These findings support the argument affirming the complexity and sever-
ity of childhood trauma. Green et al. (2000) explored symptom severity
associated with multiple and single exposures to trauma. This study not
only reassessed the outcomes of trauma but also assessed the severity of
these outcomes based on the number of trauma exposures experienced.
Green et al. found that individuals exposed to multiple traumas, exclud-
ing interpersonal trauma, had significantly more severe trauma symptoms.
These findings support the argument affirming the debate that developmen-
tal trauma can have more devastating effects on children than the current
mental health classifications can characterize. Margolin and Vickerman
(2007) went on to say that the ongoing nature of family violence expo-
sure for children can complicate the mental health diagnosis process due
to the multiple problems that emerge and the severity of those prob-
lems. When there is no classification that comprehensively characterizes
this issue, it forces treatment to focus on the identified behavior and not
underlying developmental impairments. Blaustein et al. (2007) argued the
following:
The studies and literature mentioned support the complexity and diver-
sity of the outcomes related to developmental trauma. Multiple and single
traumas seem to have complex and diverse outcomes if that trauma involves
primary relationships or environments. Much progress has been made
toward a new DTD diagnosis. However, there seem to be some factors
that have halted this progress. According to Weinhold and Weinhold (2010)
and Wylie (2010), these factors are (a) the perception that the symptoms of
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DTD are too broad and possibly displaces current disorders, (b) the present
gap between academic research (quantitative) and clinical practice (qualita-
tive), and (c) the lack of funding to complete academic research specifically
related to DTD. Wylie went on to argue that the DTD research that has
already been done is more substantial compared to most provisional disor-
ders that have been proposed, accepted, and included in the Diagnostic and
Statistical Manual of Mental Disorders (American Psychiatric Association,
2000).
Several studies and theoretical and practical literature have been
reported that support the need for a new diagnosis that captures the effects
of developmental trauma on children (Briere & Spinazzola, 2005; Courtois,
2004; Luxenberg, Spinazzola, & van der Kolk, 2001). The contructs of
attachment, cognition, affect regulation, self-concept, behavior regulation,
dissociation, and maturation/biological development have been described,
understood, and influenced for many years. However, research is defin-
tely continuous in these areas and in the area of being able to predict
the normative and nonmormative (i.e., unexpected) development of each.
Nevertheless, it is very important for clinicians to understand the complexity
and diversity of developmental trauma when attempting to assess or treat
children and adolescents who have experienced this type of trauma. The
official recognition of DTD will allow mental health professionals to assess
and treat the underlying issues of developmental trauma and avoid provid-
ing treatment that only scratches the surface (Wylie, 2010). In the effort to
endorse or not endorse DTD, mental health professionals might benefit from
a continuous review and elaboration on studies and theoretical literature
published that address the impairments related to DTD in general and in
relation to trauma. This is an effort to review those studies and literature to
increase understanding of the seven impaired domains related to DTD, elab-
orate on the effects of developmental trauma exposure on each domain, and
state the importance of describing and understanding developmental trauma
as it relates to mental health professionals.
614 C. M. Teague
ATTACHMENT
COGNITION
AFFECT REGULATION
SELF-CONCEPT
children can manifest alterations in their sense of self as early as early child-
hood (Blaustein et al., 2007). The family is the initial agent of socialization
for the child and therefore provides the child with sense of who he or she
is socially. These early relationships have a profound influence on a child’s
development of a coherent sense of self (Blaustein et al., 2007). An adverse
nature in these relationships could interfere with how children perceive
themselves and their abilities. Developmental trauma is definitely an adverse
situation for a child that could negatively alter his or her global self-concept
(e.g., powerlessness, incompetence). A study was conducted with trauma-
tized and nontraumatized toddlers to examine their self-concept, and it was
found that traumatized toddlers were more likely to respond with negative
emotion toward a self-recognition task (Blaustein et al., 2007). Problems in
this “self” domain have been implicated in the development of dysfunction
in social and life skills.
BEHAVIOR REGULATION
(Henricsson & Rydell, 2006). Belsky (2007) went on to say that internalizing
tendencies involve intense fear, social inhibition, and often behaviors seen
in depressed individuals. Nevertheless, internalized or externalized behavior
regulation allows for action inhibition where action inhibition is appropriate
for the situation. Inhibitory control involves the ability to plan and suppress
inappropriate behaviors toward themselves or the environment (Batum &
Yagmurlu, 2007). There have been many studies on the history of trauma in
children and how it affects the ability regulate behavior.
Developmental trauma is associated with children’s inability to plan
and suppress inappropriate behaviors toward themselves or the environ-
ment (Blaustein et al., 2007; van der Kolk, 2005). It is a human phenomenon
that behavior thoughts and plans are evoked in many situations. Children
experiencing developmental trauma find it hard to “put on the brakes”
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when inappropriate behavior plans and thoughts are evoked. These behav-
iors take on different patterns and sometimes seem to be a comfort for the
child. According to Blaustein et al. (2007) and Briere and Spinazzola (2005),
children experiencing developmental trauma will exhibit rigidly controlled
behavior patterns, including compulsive compliance with adult requests,
resistance to changes in routine, inflexible bathroom rituals, and rigid control
of food intake. They can also exhibit behaviors that are not controlled, such
as aggression, oppositional defiance, and even conduct disorder. However,
these behaviors, controlled or not controlled, seem to be coping strategies
for the children. Blaustein et al. (2007) called the dysregulation of behavior
in traumatized children defense responses to extreme stress. The absence of
healthy and the aforementioned unhealthy coping strategies could lead to
more unhealthy coping strategies such as cutting or drugs use.
DISSOCIATION
a defense mechanism that protects people from experiences that have been
perceived and judged as being too overwhelming (Briere & Spinazzola,
2005; Liotti, 2004; Thomas, 2005). These characteristics of dissociation
suggest that overwhelming, distressful, and overpowering experiences
interfere with the structure and function of consciousness. These types of
experiences are generally related to traumatic events.
Developmental trauma can lead to the overdevelopment of avoidance
activities such as dissociation (Briere & Spinazzola, 2005; Lawson, 2009).
Dissociation runs along a continuum from normal kinds of experiences, such
as getting lost in thoughts while driving (mild), to peritraumatic dissociation
during traumatic exposures (transient), to dissociative disorders (extensive;
Blaustein et al., 2007; Courtois, 2004). The progression of dissociation can
lead to problems for the child in the face of negative experiences as well
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MATURATION
TABLE 1 Central Nervous System Brain Structures That are Affected by Trauma and Prenatal
Alcohol Exposure
Attachment
Neurotransmitters Chemical messengers that allow different brain structures
to communicate
Hypothalamic–pituitary– Multiorgan network that allows the organism to respond
adrenal (HPA) axis swiftly and proficiently to perceived threat (fight/flight/
freeze response)
Amygdala Primary role in emotion and threat detection-initiates the
fight/flight/freeze response
Hippocampus Involved in new memory acquisition and learning;
involved in emotional regulation and smoothly
integrating the two halves of the brain
Fusiform face area (FFA) Necessary for facial recognition (e.g., infant recognition of
caregiver)
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DISCUSSION
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