Developmental Trauma Disorder

In working on a previous post about developmental trauma disorder, I came across this paper by Bessel van der Kolk, who I consider the world’s foremost expert in trauma.  Therapists who work with traumatized people have been trying to get “developmental trauma disorder” into the DSM, the big book of diagnoses.  But those in charge refuse to consider it something different from PTSD.  I don’t know why.  If the trauma occurs before the brain and nervous system have fully developed, it will interfere with that development.  This has been my experience, and I can tell you I have struggled my whole life to heal what happened to me.  From believing I was defective, to understanding that the things I was trying to fix were what I had learned from my alcoholic parents, and could be unlearned, to finally getting on anti-depressant medication and realizing that I had been severely depressed my whole life…  I had identified with the soldiers coming back from Vietnam with PTSD, but I thought I was just trying to make myself special which is what my mother taught me I did.  My parents were alcoholic, but they had never been physically abusive, so I couldn’t understand how I could have been traumatized.  I thought trauma only happened through violence.  It wasn’t until I read in Waking the Tiger that an infant could be traumatized by being left alone in a cold room, that I began to understand.  The other thing that convinced me was that Waking the Tiger was full of warnings like “if you start to feel uncomfortable, anxious, etc. put the book down and go find a therapist.”  While I was reading about hypervigilance, I went into a spiral into terror and didn’t come down until I started seeing a Somatic Experiencing practitioner.  That finally convinced me.

Developmental trauma disorder     Bessel van der Kolk

Chronic trauma interferes with neurobiological development (see article by Ford, this issue) and the capacity to integrate sensory, emotional and cognitive information into a cohesive whole.    p3

Children learn to regulate their behavior by anticipating their caregivers’ responses to them. This interaction allows them to construct what Bowlby called “internal working models”. A child’s internal working models are defined by the internalization of the affective and cognitive characteristics of their primary relationships. Because early experiences occur in the context of a developing brain, neural development and social interaction are inextricably intertwined. As Don Tucker (p.199) has said: “For the human brain, the most important information for successful development is conveyed by the social rather than the physical environment. The baby brain must begin participating effectively in the process of social information transmission that offers entry into the culture.”

Early patterns of attachment inform the quality of information processing throughout life. Secure infants learn to trust both what they feel and how they understand the world. This allows them to rely both on their emotions and thoughts to react to any given situation. Their experience of feeling understood provides them with the confidence that they are capable of making good things happen, and that if they do not know how to deal with difficult situations they can find people who can help them find a solution.p4

When caregivers are emotionally absent, inconsistent, frustrating, violent, intrusive, or neglectful, children are liable to become intolerably distressed and unlikely to develop a sense that the external environment is able to provide relief. Thus, children with insecure attachment patterns have trouble relying on others to help them, while unable to regulate their emotional states by themselves. As a result, they experience excessive anxiety, anger and longings to be taken care of. These feelings may become so extreme as to precipitate dissociative states or self-defeating aggression. Spaced out and hyperaroused children learn to ignore either what they feel (their emotions), or what they perceive (their cognitions).p5

If children are exposed to unmanageable stress, and if the caregiver does not take over the function of modulating the child’s arousal, as occurs when children exposed to family dysfunction or violence, the child will be unable to organize and categorize its experiences in a coherent fashion. p6

These statements all helped me to put what I was feeling into a context that made sense.  Confused?  Unable to “organize and categorize” my experience?  Learning to ignore my emotions and my perceptions?  Yes, I have had all those experiences often, even recently.

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