'Developmental Trauma’

Bessel van der Kolk

Trauma Center Boston

I have spent my career studying how children and adults adapt to traumatic experiences, and have tried to translate emerging findings from pharmacology, neuroscience and attachment research to develop and study potentially effective treatments for traumatic stress in children and adults. In 1984 I set up one of the first clinical/research centers in the US dedicated to study and treatment of traumatic stress in civilian populations which has trained numerous researchers and clinicians specializing in the study and treatment of traumatic stress, and which has been continually funded to research the impact of traumatic stress and effective treatment interventions. I did the first studies on the effects of SSRIs on PTSD; was a member of the first neuroimaging team to investigate how trauma changes brain processes and did the first research linking BPD and deliberate self-injury to trauma and neglect in early childhood. Much of my research has focused on how trauma has a different impact at different stages of development, and that disruptions in care-giving systems have additional deleterious effects that need to be addressed for effective intervention. In order to promote a deeper understanding of the impact of childhood trauma and to foster the development and execution of effective treatment interventions I initiated the process that led to the establishment of the National Child Traumatic Stress Network (NCTSN), a Congressionally mandated initiative that now funds approximately 150 centers specializing in developing effective treatment interventions, and implementing them in a wide array of settings, from juvenile detention centers to tribal agencies, nationwide. Based on data on 20,000 children followed within the Network we proposed to include a diagnosis Developmental Trauma Disorder within the DSM5. While that effort failed, we continue to systematically study the differential adaptation to trauma in children, in the expectation that this will eventually lead to a more precise diagnostic system that incorporates the effects of early experience on RDoC-related neurocircuits, and provide more precise targets for intervention. Following in the footsteps of Abram Kardiner who called traumatic stress a “physioneurosis” I have focused on studying treatments that stabilize physiology, increase executive functioning and help traumatized individuals to feel fully alert to the present. This has included an NIMH funded study on EMDR and NCCAM funded study of yoga, and, in recent years, the study of neurofeedback to investigate whether attentional and perceptual systems (and the neural tracks responsible for them) can be altered by changing EEG patterns. Having an well-trained clinical team that specializes in the treatment of children and adults with histories of child maltreatment, a treatment model that already is widely taught and implemented nationwide, a research lab that studies the effects of neurofeedback on behavior, mood, and executive functioning, and numerous training opportunities nationwide to a variety of mental health professional, educators, parent groups, policy makers, and law enforcement personnel, puts us in an excellent position to lead the treatment and dissemination parts of this effort.

Abstract

Prior to 1980, hundreds of thousands of veterans returned from Vietnam with symptoms that did not fit into an existing diagnosis. The introduction of the PTSD diagnosis in the DSM III made it possible for their condition to be recognized and treatments to be developed. Today we are in a similar situation. Every year, there are ten times as many children in the US reported to be victims of domestic violence, neglect and abuse than combat soldiers from Iraq and Afghanistan diagnosed with PTSD. However, these children live in a diagnostic void because the current DSM-IV conceptualization of PTSD does not reflect the symptoms experienced by the vast majority of these children. For when trauma occurs within the context of what is supposed to be a safe interpersonal attachment, the trauma picture takes on a profoundly different shape and has profound effects on brain development and the formation of the self. So, instead, abused and neglected children receive such widely disparate diagnoses as bipolar disorder, conduct disorder, ADHD, and other anxiety disorders. All of these diagnoses are etiologically unrelated to trauma and lead to pharmacological and behavioral control at the expense of dealing with the fear, shame, terror and rage that derive from real threats to these children’s survival. The lack of proper diagnosis also has profound implications on insurance reimbursement, treatment development and clinical research. Thus these children are condemned to receive treatments that are likely to be ineffective and therefore put them at risk to grow up to be unproductive, expensive, potentially dangerous, and long-suffering members of our society. In response to this neglect of our nation’s greatest public health threat, the National Child Traumatic Stress Network’s DSM-V Task Force has proposed a new clinical syndrome, Developmental Trauma Disorder, based on a literature review of about 100,000 chronically traumatized children and direct systematic observations of 20,000 traumatized children. This diagnosis describes the five clusters of symptoms that characterize many children who have suffered repeated trauma in an interpersonal context: (1) affect and impulse dysregulation; (2) disturbances of attention, cognition, and consciousness; (3) distortions in self-perception and systems of meaning; (4) interpersonal difficulties; and (5) somatization and biological dysregulation. This presentation will review the development of DTD as a diagnosis and give an overview of the field trial for DTD for eventual inclusion in the DSM-V.

Session

KN-5 » Keynote (13:30 - Monday, 2nd October, King Willem Alexander Compact)

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