Developmental Trauma: Why It’s a Political Game Changer in the Mental Health Profession
The March/April 2010 issue of the Psychotherapy Networker magazine contained a lead article written by Dr. Mary Sykes Wylie. Her hard-hitting article, “The Long Shadow of Trauma,” describes a struggle within the mental health community regarding the validity of childhood trauma, specifically developmental trauma, that has polarized the profession into two factions—one seeing developmental trauma as insignificant, the other seeing it as life-changing and game-changing.
Wylie’s article described in great detail the long-term efforts of Dr. Bessel van der Kolk and many of his colleagues to make changes related to the PTSD diagnosis in both the DSM-IVR and the DSM-5 editions. Van der Kolk’s clinical work indicated that the criteria for a diagnosis of PTSD did not fit the child clients he and his colleagues were treating. It also identified an underlying political differences between factions within the mental health community that can only be described as a conflict of values and beliefs.
Wylie’s recount of the emergence of developmental trauma as a new clinical category is riveting. She describes how this new complex trauma syndrome spurred van der Kolk and his collaborators to push their agenda even harder to add Developmental Trauma Disorder as a new diagnostic category to the DSM-5.
In June 2013, she says, the APA issued the DSM-5 edition without including the DTD diagnostic category. In his denial letter, the DSM subcommittee chair Matthew Friedman, executive director of the National Center for PTSD, highlighted the issues. He wrote that “the consensus is that it is unlikely that DTD can be included in the main part of DSM-5 in its present form because of the current lack of evidence in support of the diagnosis and the lack of prospective testing of your proposed diagnostic criteria.”
The DSM subcommittee members consisted primarily of epidemiologists and other researchers who worked in university psychiatry settings rather than with real people in clinics. Chair Matthew Friedman also said, “the consensus is that it is unlikely that DTD can be included in the main part of DSM-5 in its present form because of the current lack of evidence in support of the diagnosis and the lack of prospective testing of your proposed diagnostic criteria.” Yes, they agreed that the data cited by the DTD task force showed that chronically abused children had more symptoms than others, but so what? That didn’t mean they were inappropriately diagnosed or treated under the current system, or that this new diagnosis was required to fill a “missing diagnostic niche.”
There was just no consensus in the child trauma field that DTD would be clinically useful. According to Wylie, the complex trauma group responded with a polite,but barbed, rebuttal. They were hardly addressing a “diagnostic niche,” they replied but a substantial proportion of the one million children who are confirmed every year to be abused and neglected, plus the half-million living in foster care.
There was also a great deal of consensus, thank you very much, from thousands of clinicians who treat chronically traumatized children—if the DSM subgroup liked, the NCTSN task force estimated that it could assemble a petition to DSM in favor of such a diagnosis signed by 10,000 clinicians.
Had DTD been included in the DSM-5, its supporters believe it would be a game changer. Just as the creation of PTSD “transformed the health care system for individuals exposed to traumatic stress and led to an explosion of specialized research and practice,” said psychologist Bradley Stolbach, “the inclusion of [DTD] in DSM-5… will be a powerful catalyst for transformation of the systems that serve children.”