Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach

Abstract

Background: Developmental Trauma Disorder (DTD) is a proposed childhood psychiatric diagnosis for psychopathological and developmental sequela of victimization and attachment trauma extending beyond posttraumatic stress disorder (PTSD). Objective: To determine whether a sub-group of trauma-impacted children is characterized by symptoms of DTD that extend beyond, or co-occur with, the symptoms of PTSD. Method: Person-centred Latent Class Analyses (LCA) were done with data from 507 children (ages 7-18 years, (M = 12.11, SD = 2/92); 49% female) referred to the study by mental health or paediatric clinicians. Results: A four class solution was optimal (LMR = 398.264, p < .001; Entropy = .93): (1) combined DTD + PTSD (n = 150); (2) predominant DTD (n = 156); (3) predominant PTSD (n = 54); (4) minimal symptoms (n = 147). Consistent with prior research, the DTD + PTSD class was most likely to have experienced traumatic emotional abuse and neglect (X 2 (3) = 16.916 and 28.016, respectively, p < .001), and had the most psychiatric comorbidity (F(3, 502) = 3.204, p < .05). Predominant DTD class members were most likely to meet criteria for Oppositional Defiant Disorder (ODD) (X 2 (3) = 84.66, p < .001). Conclusion: Symptoms of DTD may occur with, or separately from, PTSD symptoms. Children with high DTD|+PTSD symptoms had extensive psychiatric comorbidity, while those with high DTD symptoms and minimal PTSD symptoms were highly likely to meet criteria for ODD. In clinical and research assessment and treatment of children with complex psychiatric comorbidity or disruptive behaviour problems, symptoms of DTD should be considered, both along with, and in the absence of, PTSD symptoms.

Exploring networks of complex developmental trauma symptomatology among children and adolescents involved in child welfare

“…Boys, on the other hand, were found to exhibit more behaviors indicative of dismissive‐avoidant attachment (emotionally withdrawn, avoidant, and not reciprocating in social and emotional exchanges) and emotional dysregulation resulting in self‐harming behaviors. The nonreciprocal interpersonal behaviors exhibited by boys, if not conceptualized from an attachment theory perspective, may be erroneously diagnosed as oppositional defiance and as an early indication of antisocial traits (Ford et al., 2022 ). Such an interpersonal style may not only arise from violent victimization—which occurs more frequently in boys and can be related to higher levels of surgency and hyperactivity—but may be interpreted as intentional displays of opposition, contributing to future physical violence in high‐risk contexts (Fallon et al., 2022 ; Finkelhor et al., 2015 ; Moody et al., 2018 ).…”

“…Children exposed to traumatic experiences exhibit symptom profiles that do not fit internalizing–externalizing dimensions and often do not meet full criteria for PTSD (Ford et al., 2022 ; Spinazzola et al., 2018 ). Relatedly, common measures of trauma for children and adolescents fail to capture the unique symptoms expressed by children who have experienced maltreatment, including those involved in out‐of‐home care and child protection services (Denton et al., 2017 ; Tarren‐Sweeney, 2013a ).…”

Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis

“…The descriptive classification of mental disorders has been challenged since its introduction by the question of how to best conceptualize the impact of childhood maltreatment on mental disorders Teicher & Samson, 2013;van der Kolk et al, 2009). Continuing debate revolves around how the latent vulnerability due to maltreatment can be related to distinct subtypes of specific mental disorders, debate also continues on how such complex psychopathology is developmentally appropriately assessed within the disorder category of PTSD and the newly introduced complex PTSD diagnoses (Ford et al, 2022;Maercker et al, 2022;Spinazzola et al, 2021;Teicher et al, 2022). More recently transdiagnostic approaches to mental health, as the general p-factor theories, the hierarchical taxonomy of psychopathology (HiToP), or the Research Domain Criteria (RDoC), have gained prominence mainly in research (Caspi et al, 2014;Cuthbert & Insel, 2013;Dalgleish et al, 2020;Kotov et al, 2017).…”

Exploring gender differences in complex developmental trauma symptomatology among children and adolescents involved in child welfare

“…However, the studies relied on PTSD diagnostic criteria, which fail to capture the full breadth of symptoms expressed by children and adolescents who have experienced complex developmental trauma (repeated and/or multiple exposures to interpersonal violence and attachment disruptions; Cook et al, 2005;D'Andrea et al, 2012;van der Kolk, 2005van der Kolk, , 2009. Children exposed to traumatic experiences exhibit symptom profiles that do not fit internalizing-externalizing dimensions and often do not meet full criteria for PTSD (Ford et al, 2022;Spinazzola et al, 2018). Relatedly, common measures of trauma for children and adolescents fail to capture the unique symptoms expressed by children who have experienced maltreatment, including those involved in out-of-home care and child protection services (Denton et al, 2017;.…”

“…Boys, on the other hand, were found to exhibit more behaviors indicative of dismissiveavoidant attachment (emotionally withdrawn, avoidant, and not reciprocating in social and emotional exchanges) and emotional dysregulation resulting in self-harming behaviors. The nonreciprocal interpersonal behaviors exhibited by boys, if not conceptualized from an attachment theory perspective, may be erroneously diagnosed as oppositional defiance and as an early indication of antisocial traits (Ford et al, 2022). Such an interpersonal style may not only arise from violent victimization-which occurs more frequently in boys and can be related to higher levels of surgency and hyperactivity-but may be interpreted as intentional displays of opposition, contributing to future physical violence in high-risk contexts (Fallon et al, 2022;Finkelhor et al, 2015;Moody et al, 2018).…”