DEVELOPMENTAL TRAUMA DISORDER

A new “research stream” (actually two) has opened up to address “Developmental Trauma Disorder.”  This diagnosis doesn’t come from being in battle or surviving a terrifying incident like a fire or assault, but rather tries to understand the deficits or digressions that come from the prevention or damaging of the normal steps of development from conception to adulthood.  This is rich territory for stories of what caused which deficits, how the child coped, how adults reacted, and how it all worked out.  (Think Dickens.) 

Our interest in people who are wrenched out of their previous contexts, or weighed down by increasing burdens related to poverty or drugs, is very strong.  Ordinary misery, not so much. The media loves the dramatic and shocking dimensions or gets very sentimental, which doesn’t always lead to helpful reflection.  Our media is also suffering from DTD.   But quietly, behind the scenes, we seem to be learning more about how to be human and how to raise human children.

In the past, such bottlenecks in the development of creatures -- remember that we're in the midst of one of the six mass extinctions on this planet -- have triggered mutations and evolutions, both physical and cultural.  Without deliberately meaning to, we may be creating the next kind of human beings.  It appears that the developments already beginning — that is, new characteristics that contribute to survival — may be along the lines of empathy, the ability to understand each other.  “Mirror cells” may be only a beginning, one cell at a time, that could develop into an organ.  But there are always several streams of development at once and one stream seems to be surviving by callousness, emptiness, bullying, greed, and unconsciousness.

On the other hand, statistical changes like smaller penises and earlier menses may mean that our out-of-control use of estrogen-like molecules are saturating the world.  I’m told that our sewage lagoon might be required to filter certain human-changing molecules along with the shit that our bacteria eat now.  But what bacteria will eat insulin and estrogen?  They say this will be extremely expensive.

How much of developmental troubles have nothing to do with chemistry, but are produced by the way we raise children?  Or more accurately, neglect to properly raise them.

Here’s a rather exhaustive list of characteristics from a down-loadable document:

http://www.traumacenter.org/products/pdf_files/preprint_dev_trauma_disorder.pdf

This paper is written by Bessel A. van der Kolk, MD who is a major leader in the field.  The sub-title is “Towards a Rational Diagnosis for Children with Complex Trauma Histories”:

Complex disruptions of affect regulation

Disturbed attachment patterns

Rapid behavioral regressions

Shifts in emotional states

Loss of autonomous strivings

Aggressive behavior against self and others

Failure to achieve developmental competencies

Loss of bodily regulation in the areas of sleep, food and self-care

Altered schemas of the world

Anticipatory behavior and traumatic expectation

Multiple somatic problems from gastrointestinal distress to
    headaches

Apparent lack of awareness of danger and resulting self-
    endangering behaviors

Self-hatred and self-blame

Chronic feelings of ineffectiveness

Here’s another set from “Trauma and Attachment: The John Bowlby Memorial Conference Monograph 2006”  edited by Sarah Benamer, Kate White

When trauma emanates from within the family, children experience a crisis of loyalty and organize their behavior to survive within their families.  Being prevented from articulating what they observe and experience, traumatized children will organize their behavior around keeping the secret, deal with their helplessness with compliance or defiance, and acclimatize in any way they can to entrapment in abusive or neglectful situations.  (Piaget, 1954)

Bessel van der Kolk

Boston University Medical Center psychiatrist Bessel van der Kolk, MD seems to be the main investigator.   Van der Kolk has published extensively on the effect of trauma on development of mind, brain and body. He has found connections to dissociative problems, borderline personality disorder, self-mutilation, and a wide range of other issues.  Some suggest oppositional defiance.

This article was on the APA.org website.

A new diagnosis for childhood trauma?

Some push for a new DSM category for children who undergo multiple, complex traumas.

By Tori DeAngelis

March 2007, Vol 38, No. 3

“There are two research streams:  Children who experience interpersonal trauma show a disrupted ability to regulate their emotions, behavior and attention.  This does compare to animals deprived of caregiving, which means they are anxious, highly reactive to stressors, and as adults less likely to explore their environments.”  This sounds very much like many low-income rez kids, who try to create a defensive cocoon that is familiar, if painful.  To them that’s the only thing that feels like reality.  Or safe.

“The other research area shows that much of children’s later ability to think clearly and solve problems in a calm, non-impulsive way stems from their experiences in the first five to seven years of life.”  Check out the general tumult over political issues: highly emotional and totally without evidence.  This is endemic in the whole United States.

This is not Teddy Roosevelt.

Who raised this man?

In addition, the team is including the latest findings on the neurobiological consequences of traumatic interpersonal stress. For instance, studies show that women abused as children who recall memories of abuse or are confronted with stressful cognitive challenges have strong reactions in brain areas that signal threat, but reduced mobilization of brain areas related to focusing attention and categorizing information, Ford's notes in his paper.

Finally, the group is piecing together information on how complex interpersonal trauma can differentially impact each stage of development, says Pynoos. It also is incorporating the fact that effects of early trauma can spill over into other stages, even if those traumas have stopped occurring, he notes.

In 2007, in broad brush form, here is what children must show to be considered to have the disorder, according to a May 2005 article in Psychiatric Annals (Vol. 35, No. 5, pages 401-408) by Boston University Medical Center psychiatrist Bessel van der Kolk, MD, a leader of the National Child Traumatic Stress Network interest group that is spearheading the effort:

Exposure: Exposure to one or more forms of developmentally adverse interpersonal traumas such as abandonment, betrayal, physical or sexual abuse and emotional abuse. May also experience subjective feelings in relation to this trauma, such as rage, betrayal, fear, resignation, defeat and shame.

Dysregulation: Dysregulated development in response to trauma cues, including disturbances in emotions, health, behavior, cognition, relationships and self-attributions. Behavioral manifestation could be self-injury, for example; cognitive manifestation might appear as confusion or dissociation.

Negative attributions and expectations: Negative beliefs in line with experience of interpersonal trauma. May stop expecting protection from others and believe that future victimization is inevitable.

Functional impairments: Impairment in any or all arenas of life, including school, friendship, family relations, and the law.

Henri Nouwen

Helpers are probably not very effective if they learn these lists and characteristics by reading or classwork without identifying these elements in their own identities. (They are universal, but vary in strength and compensation.)  But people who are too deep in struggle with their own developmental issues may not be helpful yet because it takes so much energy.  See "The Wounded Healer" a classic and beloved book by Henri Nouwen, who discusses this in a non-punishing way.

If people come in from one culture context and try to address these issues according to what works “at home,” they are likely to fail until they can construct some internal map of the people they are “helping,” a map of emotion and meaning rather than academic study or even observation close-up.  "Nice" educated people who try to help kids with complex and intense DTD issues will not "get" this and yet they are often the ones assigned to do this task, whether or not the kid wants it.