Developmental Trauma Disorder
A new, rational diagnosis for children with complex trauma histories.
Childhood trauma, including abuse and neglect, is probably the single most important public health challenge in the United States, a challenge that has the potential to be largely resolved by appropriate prevention and intervention. Each year, more than 3 million children are reported to authorities for abuse or neglect in the US; about 1 million of those cases are substantiated(1). Many thousands more undergo traumatic medical and surgical procedures and are victims of accidents and of community violence (see Spinazzola et al., page xxx). However, most trauma begins at home; the vast majority of people (about 80%) responsible for child maltreatment are children’s own parents.
Inquiry into developmental milestones and family medical history is routine in medical and psychiatric examinations. In contrast, social taboos prevent obtaining information about childhood trauma, abuse, neglect, and other exposures to violence. Research has shown that traumatic childhood experiences not only are extremely common but also have a profound impact on many different areas of functioning. For example, children exposed to alcoholic parents or domestic violence rarely have secure childhoods; their symptomatology tends to be pervasive and multifaceted and is likely to include depression, various medical illnesses, and a variety of impulsive and self-destructive behaviors. Approaching each of these problems piecemeal, rather than as expressions of a vast system of internal disorganization, runs the risk of losing sight of the forest in favor of one tree.