Developmental trauma disorder: Pros and cons of including formal criteria in the psychiatric diagnostic systems

BMC Psychiatry (Impact Factor: 2.21). 01/2013; 13(1):3. DOI: 10.1186/1471-244X-13-3
Source: PubMed

ABSTRACT

Background
This article reviews the current debate on developmental trauma disorder (DTD) with respect to formalizing its diagnostic criteria. Victims of abuse, neglect, and maltreatment in childhood often develop a wide range of age-dependent psychopathologies with various mental comorbidities. The supporters of a formal DTD diagnosis argue that post-traumatic stress disorder (PTSD) does not cover all consequences of severe and complex traumatization in childhood.

Discussion
Traumatized individuals are difficult to treat, but clinical experience has shown that they tend to benefit from specific trauma therapy. A main argument against inclusion of formal DTD criteria into existing diagnostic systems is that emphasis on the etiology of the disorder might force current diagnostic systems to deviate from their purely descriptive nature. Furthermore, comorbidities and biological aspects of the disorder may be underdiagnosed using the DTD criteria.

Summary
Here, we discuss arguments for and against the proposal of DTD criteria and address implications and consequences for the clinical practice.

Download full-text

Full-text

Available from: Franz Petermann
    • "letzten Jahre belegen , dass frühe und lang anhaltende Traumatisierungen in der Kindheit aus entwicklungspsychologischer Sicht von fundamentaler Bedeutung sind (Schmid et al. 2013). Frühere epidemiologische Studien berichteten von einer 20 %igen Rate der sexuellen Missbrauchserfahrungen in der Kindheit unter der Allgemeinbevölkerung (Felitti et al. 1998). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The psychological long-term effects of sexual abuse in childhood are typically associated with diverse symptoms. To date, these symptoms may be best conceptualized as complex posttraumatic stress disorder (PTSD). Objectives Based on a prototypal case, we overview multiple facets of complex PTSD during child- and adulthood, as well as associated diagnostic challenges particularly regarding symptom overlap with borderline personality disorder and current evidence-based psychotherapeutic options. With the present work, we aim to sensitize clinicians to trauma-related disorders. Methods Case report, narrative review of the current literature, and comparable analysis of the diagnostic criteria in the different classification systems. Results and conclusions Although epidemiological studies report high rates of childhood sexual abuse, the symptoms of a subsequently developing complex PTSD are still frequently unidentified or falsely diagnosed by practitioners. Therefore, the specific trauma history should be reviewed if multiple, diverse, or varying symptoms and diagnoses are on hand. Trauma- and confrontation-oriented psychotherapeutic approaches might prevent further chronic manifestations of the symptoms.
    No preview · Article · Sep 2015 · Psychotherapeut
  • Source
    • "403). This level of symptom complexity that is linked to childhood cumulative trauma and expressed as self-regulatory disturbances is commonly viewed as difficult-to-treat (Cloitre, Stolbach, Herman, Van der Kolk, Pynoos, Wang, & Petkova, 2009; Schmid, Petermann, & Fegert, 2013). However, this " developmental heterotopia of trauma " (p. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Youth behavioral disorders are not only considered widespread and costly in terms of financial, human, and societal impact into adulthood, but also resistant to interventions, especially when related to childhood trauma and accompanied by continued social distress and comorbid conditions such as personality, mood, and substance use disorders. Mode Deactivation Therapy (MDT), a third wave contextual therapy approach derived from cognitive therapy principles, was developed in recognition of the need for this population. The MDT theoretical framework and methodology contains elements of mindfulness, Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT), but it is the unique Validation-Clarification-Redirection process (VCR) step that sets it apart from other contextual approaches. VCR is considered to be the core process component in MDT to affect therapeutic change by validating core beliefs as reasonable responses to past experiences, but exploring functional alternative beliefs. The main objectives of this study is to review evidence of the effectiveness of family-based MDT (FMDT) compared to standard treatment, and provide a preliminary randomized controlled group study of the mediation effects that VCR and other components have on the overall treatment mechanisms and outcomes. Recommendations for further study conclude the current scope.
    Full-text · Article · Apr 2014
  • Source
    • "403). This level of symptom complexity that is linked to childhood cumulative trauma and expressed as self-regulatory disturbances is commonly viewed as difficult-to-treat (Cloitre, Stolbach, Herman, Van der Kolk, Pynoos, Wang, & Petkova, 2009; Schmid, Petermann, & Fegert, 2013). However, this " developmental heterotopia of trauma " (p. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Youth behavioral disorders are not only considered widespread and costly in terms of financial, human, and societal impact into adulthood, but also resistant to interventions, especially when related to childhood trauma and accompanied by continued social distress and comorbid conditions such as personality, mood, and substance use disorders. Mode Deactivation Therapy (MDT), a third wave contextual therapy approach derived from cognitive therapy principles, was developed in recognition of the need for this population. The MDT theoretical framework and methodology contains elements of mindfulness, Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT), but it is the unique Validation-Clarification-Redirection process (VCR) step that sets it apart from other contextual approaches. VCR is considered to be the core process component in MDT to affect therapeutic change by validating core beliefs as reasonable responses to past experiences, but exploring functional alternative beliefs. The main objectives of this study is to review evidence of the effectiveness of family-based MDT (FMDT) compared to standard treatment, and provide a preliminary randomized controlled group study of the mediation effects that VCR and other components have on the overall treatment mechanisms and outcomes. Recommendations for further study conclude the current scope.
    Full-text · Article · Apr 2014
Show more