2010 Plenary Speakers

Developmental Trauma Disorder: A New Diagnosis for Childhood Interpersonal Trauma

Prior to 1980, hundreds of thousands of veterans returned from Vietnam with symptoms that lacked an adequate diagnosis in DSM-II. This lack of diagnostic precision prevented these veterans from receiving proper treatment, a situation that could not be addressed until PTSD was finally incorporated into DSM-III. Today we are in a similar situation as the clinicians and researchers who tried to help that traumatized population. While there are ten times as many children in the US who are victims of domestic violence, neglect and abuse than there are combat soldiers in Iraq and Afghanistan, they live in a diagnostic void, and hence are condemned to receive treatments that are likely to be ineffective, and therefore are likely to condemn them to grow up to be unproductive and long-suffering members of our society.

When the issue of interpersonal attachment is considered as a factor in the genesis of psychopathology the trauma picture takes on a profoundly different shape. Lack of interpersonal safety and rhythmical attunement has profound effects on brain development and the formation of the self. Research from the DSM IV field trial showed that interpersonal trauma causes more severe symptomatology than does impersonal trauma such as accidents or natural disasters. The current DSM-IV conceptualization of PTSD is an inadequate representation of the symptoms experienced by the vast majority of chronically traumatized or abused children. In response this serious threat to our nations public health the National Child Traumatic Stress Network proposed a new clinical syndrome: Developmental Trauma Disorder, based on a literature review of bout 100,000 chronically traumatized children and direct systematic observations of a sample of 20,000 traumatized children, to more precisely capture the problems that require clinical intervention in this population.

When a diagnostic system does not include a diagnosis that captures the actual symptoms of a vast population of disturbed human beings, people with these symptoms are forced to receive inappropriate diagnoses. Currently, abused and neglected children  receive such disparate diagnoses as bipolar disorder conduct disorder, ADHD, phobic anxiety, reactive attachment disorder, and separation anxiety. All of these diagnoses are etiologically unrelated to trauma, and lead to pharmacological and behavioral control at the expense of dealing with fear, shame terror and rage that are derived from real threats to these children’s survival. The creation of a new diagnosis is an essential precondition for the development of effective treatment interventions that focus on affect regulation, disorders of attention and consciousness and  the capacity to have harmonious relations with oneself and others.

Proposed by the National Child Traumatic Stress DSM-V Task Force, Developmental Trauma Disorder accurately and comprehensively describes the five clusters of symptoms that characterize many children who have suffered repeated trauma or abuse: (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.

Dr. Van der Kolk has been centrally involved in(a) the DSM IV field trial that first organized the differential impact of trauma depending on attachment status and level of developmen (b) the process of developing criteria for Developmental Trauma Disorder, (c) designingand raising funds for  the field trial for Developmental Trauma Disorder, and (d) advocating that Developmental Trauma Disorder be included in DSM V. In his lecture, Dr. van der Kolk will “tell the story” of Developmental Trauma Disorder. He will describe Developmental Trauma Disorder’s scientific and political odyssey along the road to DSM-V.

Bessel van der Kolk, MD

Bessel A. van der Kolk, M.D. has been the Medical Director of The Trauma Center in Boston for the past 25 years and is Professor of Psychiatry at Boston University Medical School.  He is Director of the National Child Traumatic Stress Network Community Program in Boston and past President of ISTSS. Though he identifies himself primarily as a clinician, he has published well over 100 peer reviewed scientific articles on various aspects of trauma, including his current projects:
1) yoga for treating PTSD,  funded by the National Institutes of Health;
2) the use of theater for violence prevention in the Boston public schools, funded by the CDC;
3) the mechanisms of EMDR;
4) sensory integration; and
5) the use of neurofeedback in PTSD.

He participated in the first neuroimaging study of PTSD, in the first study to link Borderline Personality Disorder with childhood trauma; was co-principal investigator of the DSM IV Field Trial for PTSD and is chair of the NCTSN DSM V workgroup on Developmental Trauma Disorder.  He has written extensively about using neuroscience research to identify appropriate treatments for PTSD and completed the first (and sadly, only) NIMH-funded study of EMDR. He has taught at universities and hospitals around the world, including most European countries, Israel, Russia, South Africa, China, Japan, Indonesia, Turkey, India, Argentina and Australia.