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What is Developmental Trauma?



Imagine a life where you're always scared, unsure, and in pain. This is the tough reality for many children facing developmental trauma, and it doesn’t stop in childhood. The impacts of developmental trauma follow you into adulthood. 


If you're here, you probably have questions. What is developmental trauma? How does it affect a child's mental and physical health? How does it manifest in adult life?

This blog will answer all these questions. We'll learn about its causes and effects and why it's crucial to understand, diagnose, and treat it correctly.


Defining Developmental Trauma


In their first years, infants and toddlers need caregivers who provide a secure, consistent, and affectionate environment. The brain can undergo healthy and normal growth under these conditions.


The brain's development follows a bottom-up sequence. Lower brain regions manage survival and stress responses, while upper regions handle executive functions, like interpreting experiences and making moral judgments. 


The upper parts of the brain require the lower parts to develop first, creating a ladder-like progression from the bottom up. However, repeated stress responses from persistent neglect or abuse can disrupt this sequential development. The ladder still forms, but crucial steps are missing, leading to various issues.


For many, this can lead to Development Trauma (DT) or reactive attachment disorder. It manifests in the form of sensory processing disorder, ADHD, oppositional defiant disorder, bipolar disorder, personality disorders, PTSD, cognitive impairment, speech delay, learning disabilities, and more.


Developmental Trauma Disorder (DTD) was introduced to the Diagnostic and Statistical Manual by experts working on Complex Trauma in children in 2009. The goal was to better capture the challenges faced by kids and teens exposed to prolonged traumatic stress. 

They didn't fit the criteria for Post-Traumatic Stress Disorder (PTSD), with symptoms pointing to various unrelated diagnoses like Oppositional Defiance Disorder and Autism Spectrum Disorders. Despite these diverse diagnoses, their issues originated from trauma and disruptions in development.


The Trauma Center at JRI has dedicated a decade to researching "Disorders of Extreme Stress" in children. Alongside the National Child Traumatic Stress Network, they proposed including Developmental Trauma Disorder in the DSM-5, set to be published in 2012. The disorder hasn't been added to the manual drafts yet since it's still under consideration with ongoing research trials.


Causes of Developmental Trauma


A child's life can be deeply affected by ongoing mistreatment, abuse, or disturbances in their bond with primary caregivers during childhood. This inevitably leads to emotional and neurological harm. These traumas can disrupt the natural growth of the brain, possibly resulting in mental disorders like autism spectrum disorders.


DT is caused by one or more of these factors:


  • Physical, emotional, or sexual abuse

  • Exposure to violence

  • Separation from a primary caregiver or frequent changes in caregiving figures

  • Neglect

The impact of developmental trauma, including complex trauma, can last a lifetime. It can shape a child's entire existence. Understanding the roots of developmental trauma is crucial if you want to help affected children and support their families.


Criteria for Developmental Trauma Disorder


According to JRI, the consensus proposed criteria for DTD include:


Exposure


The child or teen has faced multiple, prolonged adverse incidents for at least one year in their childhood or adolescence. For most, this looks like experiencing or witnessing severe interpersonal violence repeatedly. 


Children with DTD may also have had varying caregivers, separation from their primary caregiver, or exposure to severe and repeated emotional abuse by their caregiver. This leads to disruptions in consistent, protective caregiving. 


Affective and Physiological Dysregulation


The child does not have normal developments related to arousal regulation. That could include the inability to control or recover from feelings of fear, anger, or shame, leading to extreme tantrums, prolonged reactions, or even immobilization. 


Other than that, the regulation of their bodily functions, especially sleeping, eating, and elimination, may be disturbed. They may over-react or under-react to touch and sound or become disorganized during routine transitions. DTD can also manifest as a lack of awareness or dissociation from their bodily states, emotions, and sensations. 

Lastly, they may also have trouble describing their bodily state or emotions.


Attentional and Behavioural Dysregulation


The child does not sustain attention, learn, or cope with stress in a normative way. This manifests at two ends of the spectrum: being preoccupied with threat or unable to perceive threat at all. The child may misread crucial safety and danger cues.


The child may also be impaired at self-protection due to risk-taking or thrill-seeking behaviours. Instead, they attempt maladaptive patterns for comfort, such as rocking, compulsive masturbation, or other rhythmic movements. 


Another criterion for DTD is reactive and habitual self-harm, whether that's intentional or automatic. Lastly, they may not be able to initiate or sustain goal-oriented behaviour.


Self and Relational Dysregulation


The child may not have a normative sense of identity and involvement in relationships. They may be intensely preoccupied with the safety of their caregiver or have trouble reuniting with them after separation. They would have persistent feelings of self-loathing, defectiveness, or worthlessness. 


Most evidently, children with DTD show little to no reciprocation in their relationships with adults or caregivers, clouded by feelings of defiance and destruct. Instead, they may be verbally or physically aggressive to adults as well as peers. 


On the other end of the spectrum, it can look like excessive and inappropriate attempts at sexual or physical intimacy or relying on adults for constant reassurance. Lastly, self and relational dysregulation can manifest as a lack of empathy for others' displays of distress. 


Functional Impairment


Functional impairment due to DT causes distress and impairment in various aspects of their life. In academics, they may have issues like under-performance, lack of discipline, non-attendance, drop-out, conflict with school personnel, or learning disabilities unexplained by neurological factors. Meanwhile, familial impairment can look like running away, avoidance, non-fulfilment of responsibilities, and attempts to hurt family members in one way or another.


In the legal landscape, their DT could lead to frequent arrests, incarceration, convictions, violation of court orders, and contempt for the law and conventional morals. They may also have ongoing health issues, with unexplainable illnesses, chronic pain, fatigue, or frequent headaches. 


DTD can also affect how you perform at work. Developmentally traumatized teenagers may be disinterested in work and unable to keep a job or meet realistic demands. Lastly, they may have issues such as isolation, age-inappropriate affiliations, and avoidance in relation to their peers.


The criteria for developmental trauma disorder also outline the duration of disturbance. The child must have at least six months of dysregulation and post-traumatic symptoms. 


How Developmental Trauma Affects Mental Health


The effects of DT stem from a person's childhood, but they last well into their adult years, impacting their mental health, emotional regulation, and relationships. Let's break down the long-term effects of developmental trauma on a child's mental health.


Psychiatric Disorders


Developmental trauma is associated with various psychiatric disorders. That includes borderline personality disorder (BPD), anxiety disorders, post-traumatic stress disorder (PTSD), substance use disorders, mood disorders, and dissociative disorders. Children who have experienced DT are more likely to develop these disorders. 


They're also more vulnerable to depression, anxiety, and substance abuse. Later in life, adults with DT may struggle with eating disorders or personality disorders.


Since they are at a higher risk of developing these psychiatric disorders, early intervention is absolutely crucial for children with DT. Addressing the trauma at a younger age can help them adopt healthier coping mechanisms in adult life.


Emotional Regulation Difficulties

Children with developmental trauma do not have a normative sense of emotional regulation. They may experience frequent mood swings, anger, persistent sadness, and difficulty controlling their emotions. These issues can lead to other mental disorders if left unaddressed.


This is especially true for oppositional defiant disorder, which leads to irritable and angry behaviour. It's crucial to address these problems early on to help manage their emotions in a better way.


Interpersonal Relationship Issues

DTD can make it harder for children to develop and sustain healthy relationships due to trust issues or a misunderstanding of social cues. This can also make them more vulnerable to certain psychiatric disorders. 


In this scenario, trauma-informed care, cognitive-behavioural therapy, and mindfulness are the best courses of action to help them develop healthier relationships. 


Diagnosis and Treatment

Getting an accurate assessment and diagnosis for DTD is vital for giving the right treatment and support to affected children. There are a few different ways to treat developmental trauma disorder. That includes trauma-informed care and evidence-based interventions, which may help them develop healthier coping mechanisms for complex trauma.

The diagnosis and treatment for developmental trauma disorder will involve:


  • DSM Criteria: The criteria for diagnosing DTD according to the Diagnostic Manual of Mental Disorders is still under development. 

So, we must separate DTD from PTSD and complex PTSD during the diagnosis and treatment. This is the only way to better understand the unique needs of children with DT. DTD symptoms strictly relate to intense emotions like fear, anger, or shame. 

While standardized interviews and assessments may still be part of the diagnosis, DTD isn't officially recognized in the DSM-5.


  • Trauma-Informed Care: In trauma-informed care, creating a secure environment is a priority. It also focuses on techniques for self-control, self-reflection, and processing traumatic memories. This approach recognizes how trauma can impact a person's physical, mental, and emotional well-being.

  • Evidence-Based Interventions: Using evidence-based interventions like play therapy and cognitive-behavioural therapy helps children with DTD build healthier responses and coping strategies. These interventions have undergone thorough testing in relation to specific DTD issues. More specifically, cognitive-behavioural therapy may help by identifying negative thought patterns, trauma processing, behavioural changes, and skill-building. 

Meanwhile, play therapy opens doors for non-verbal expression and simple emotional regulation. It creates a safe and consistent environment for the child to process their trauma, improve their communication skills, and work on attachment issues.


Conclusion


Developmental trauma starts young and at home. For those suffering, it can feel like a lifelong battle that dictates every decision. But trauma-focused therapy can help you resist the programming of your childhood, finding new ways to feel safe within your own body and mind.


Therapy helps you understand how developmental trauma has shaped your life. The good news is that only you can take ownership of your new journey. Consider personalized, individualized treatment today to break free from maladaptive patterns resulting from developmental trauma. You deserve a chance at happiness! 


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