Some kids grow up in what psychologists call “high-threat zones,” where they see and hear things that terrify them. They’re small, they’re confused and often they don’t have a big person to guide, protect or comfort them. The traumas they experience might include a combination of neglect, emotional abuse and family or community violence. They might struggle to learn in school. They might become addicted to drugs or alcohol, and their lives can be shattered when they get into trouble with the law. Some end up in foster care, and some don’t make it through childhood.
These kids suffer from what psychologists call complex trauma, or C-PTSD. They have a difficult time maintaining their self-worth and forming healthy relationships. They’re often emotionally numb, they have a hard time trusting others and they struggle to control their behavior. They’re not the kind of children we want to see in our classrooms, hospitals and neighborhoods. Almost everyone has seen or heard something in their lifetime that they might consider traumatic, but only some of us have a traumatic past that interferes with our lifelong sense of health and well-being.
It’s not surprising that people with unresolved childhood trauma have many psychiatric problems, but there are some who experience symptoms of far more serious disorders than others. These individuals might have a PTSD diagnosis but also suffer from other mental health issues like anxiety, depression and suicidal ideations, as well as physical symptoms such as chronic pain or gastrointestinal problems. Their identities and lives are organized around surviving rather than developing a flexible, adaptive sense of self.
Researchers who have studied the impact of C-PTSD and DTD have suggested that they are distinct from one another, in part because DTD developmental trauma disorder in adults includes symptom domains that are related to mood disturbances, externalizing behavior problems and somatic disregulation that may not be included in PTSD (Espejo-Siles et al., 2020). Dissociation is one of the defining features of DTD and might be seen as a last-ditch survival mechanism that prevents individuals from experiencing the reality of their experiences.
In addition, DTD symptoms are likely to involve impaired reflective functioning, which refers to the ability to understand one’s own needs and strengths, as well as to perceive that others have different worldviews and perspectives from our own. Early interpersonal trauma and insecure attachment correlate with low reflective functioning, which could explain why adults who experienced a traumatic childhood often have DTD symptoms (Fox & van der Kolk, 2022).
A growing group of psychologists and psychiatrists is studying the merits of DTD as an alternative to PTSD for trauma-impacted children, adolescents and young adults. They argue that it better addresses the timing of adversity, the disruptions in development caused by it and the impact on relationship capacities. It also helps to limit over-pathologizing these individuals, who might receive multiple psychiatric diagnoses and treatments that don’t always align with their needs and outcomes. In this way, DTD can facilitate more accurate assessments; targeted and effective symptom management; improved adherence to treatment; and better long-term outcome for these trauma-impacted individuals.