Post Traumatic Stress Disorder (PTSD) is the diagnosis given to individuals who experience clinical distress after a traumatic experience. However, some experts have signaled the need for a new diagnosis that better describes and encompasses the effects of multiple childhood traumatic experiences. Consequently, the diagnosis of developmental trauma has been proposed by mental health experts.
What is Developmental Trauma?
Professionals have recently recommended that the term ‘developmental trauma’ be used for individuals with a history of multiple childhood traumas. This suggestion has been put forth as a means of more accurately addressing the distinct issues that can manifest as a result.
Part of the reasoning behind the proposed new diagnosis is that those who have undergone multiple childhood traumas do not always meet the criteria needed for a PTSD diagnosis, thus potentially slipping through the cracks in the treatment system.
Addressing the Diagnoses Gap and Avoiding Misdiagnosis
There are many consequences to misdiagnosis as a result of this gap in diagnoses. Without a proper diagnosis it is possible that some traumatized children will not get the help they need. This can happen by not receiving a diagnosis at all and subsequently not having access to services. On the other hand, traumatized children may receive an inaccurate, non-trauma related diagnosis, e.g., Autistic Spectrum Disorder (ASD) or Conduct Disorder, thereby receiving services that do not adequately meet their needs.
In order to address this gap, clinicians sought to include Developmental Trauma Disorder in the latest edition of the Diagnostic and Statistical Manual, a tool used by professionals to guide diagnosis and treatment.
The Diagnostic and Statistical Manual (DSM)
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and seeks to quantify and define a widely accepted body of mental disorders as agreed upon by leading experts. The DSM is the worldwide gold standard for clinicians, researchers and academics, as it defines the agreed-upon categories and descriptions of mental health disorders. Since research is always evolving, the DSM is updated consistently as a means of staying current.
Developmental Trauma Disorder: The Definition
Developmental Trauma Disorder was proposed as a distinct clinical entity based on data produced by Bessel van der Kolk of the National Child Traumatic Stress Network. There are several criteria that define the proposed Developmental Trauma Disorder, including:
- Exposure to trauma
- Affective and physiological dysregulation
- Attentional and behavioral dysregulation
- Self and relational dysregulation
- Post-traumatic spectrum symptoms
Other Criteria for Proposed Developmental Trauma Disorder
An individual would have to have experienced the above symptoms for a duration of 6 months or more in order to be diagnosed with Developmental Trauma Disorder. Additionally, the symptoms would need to impose a clinically significant level of impairment on the individual’s overall functioning.
Unfortunately, despite the hopes of many mental health professionals, Developmental Trauma Disorder was not included in the DSM-5, published in 2013. Experts are not in agreement on the validity of Developmental Trauma Disorder so it isn’t certain whether the diagnosis will be re-considered in the future.
Advantages and Disadvantages of a Diagnosis Such as Developmental Trauma Disorder
An accurate diagnosis is crucial for optimal therapeutic treatment services. Thus the most compelling reason for the introduction of a new diagnoses, like Developmental Trauma Disorder, is the subsequent establishment of needed resources and services.
Specifically, the proposal to recognize developmental trauma as a mental health disorder came on the heels of data which showed that those in the foster care system and/or the adopted population often experience childhood trauma leading to increased risk for poor psychosocial outcomes. Unfortunately, this date was accompanied by government reports indicating that this cohort is often denied needed resources and services since they don’t always meet the criteria for currently established mental health diagnoses.
There is another key, nonclinical reason for recognizing developmental trauma as a distinct entity. When we attach a label to something it becomes recognizable, and thus more real to some. Consequently, implementing a distinct Developmental Trauma classification could be immensely helpful for those who seek to understand and relate to their own, or a loved one’s, trauma-related issues. However, it must be mentioned that labels can also lead to stigma. Pathologizing a behavior runs the risk of turning normal behavior into abnormal behavior.
Diagnostic Labels Are a Product of the Current Times We Live In
Over the years, the professionals that sign off on the DSM have eliminated certain diagnoses, added categories of abnormal behavior, and altered categories of dysfunction, as a means of staying current with new research and decreasing the risk associated with over pathologizing.
For instance, decades ago homosexuality was listed as abnormal behavior in the DSM. As research gained an increased understanding of homosexuality, however, it was subsequently eliminated from the abnormal behavior category. Another example is that of today’s so-called ‘maladaptive online behavior.’ While this concept was not recognized in the past, it is now being evaluated for addition to future versions of the DSM.
Highlighting the fluid, and often difficult nature of elucidating and agreeing upon the definitions of mental health disorders, the current version of the DSM is the fifth edition since its inception in 1952.
Don’t Hesitate to Get the Help You Need
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