Wednesday, May 16, 2012

The Invisible Wounds of Trauma

May is Mental Health Awareness Month.  The American Psychological Association is sponsoring a blog party today, Wednesday, May 16, 2012 to help promote discussion.*

Mental Health America announced two themes for this year's Mental Health Awareness Month. Do More for 1 in 4 is a call to action to promote awareness, reduce stigma, and get help for the 25% of the American population believed to have a diagnosable, treatable mental health condition. 

Healing Trauma's Invisible Wounds is the second theme, which focuses on the impact of traumatic events on the mental health of individuals and communities.  
A Program of Mental Health America
According to the National Child Traumatic Stress Network (NCTSN), over 25% of American youth have experienced at least one serious traumatic event by the age of 16 and over 25% of teens who have suffered traumatic events develop post-traumatic stress disorder (PTSD). The Substance Abuse & Mental Health Services Administration (SAMHSA), reports that more than 60% of youth age 17 and younger have been exposed to crime, violence and abuse either directly or indirectly.** NCTSN noted that when left untreated, traumatic stress can impede child development and cause prolonged problems with behavior, emotional regulation, relationships, school performance and the ability to enjoy life. In addition:

As the number of traumatic events experienced during childhood increases, the risk for the following health problems in adulthood increases: depression; alcoholism; drug abuse; suicide attempts; heart and liver diseases; pregnancy problems; high stress; uncontrollable anger; and family, financial, and job problems. (NCTSN, Understanding Child Traumatic Stress, 2005).  Treatment from a mental health professional who has training and experience working with traumatized children can reduce child traumatic stress and minimize physical, emotional, and social problems (NCTSN Treatments That Work, 2012).***

 The above statistics demonstrate the degree to which trauma is pervasive in our society and the huge potential impact on mental health.  However, if you look through the Diagnostic and Statistical Manual of Mental Disorders (DSMIV), you wouldn't know how prevalent traumatic stress is. It is only mentioned as a significant factor in a few disorders in the entire manual even though many of the diagnoses listed could occur as a result of trauma.

Bessel van der Kolk, MD, who is an internationally recognized leader in the field of psychological trauma, proposed a new diagnostic category, Developmental Trauma Disorder,**** which would begin to address this discrepancy. The proposed criteria include: 

A. Exposure
1. Multiple or chronic exposure to one or more forms of developmentally adverse interpersonal trauma (abandonment, betrayal, physical assaults, sexual assaults, threats to bodily integrity, coercive practices, emotional abuse, witnessing violence and death).
2. Subjective Experience (rage, betrayal, fear, resignation, defeat, shame).

B. Triggered pattern of repeated dysregulation in response to trauma cues
Dysregulation (high or low) in presence of cues. Changes persist and do not return to baseline; not reduced in intensity by conscious awareness.
•Somatic (physiological, motoric, medical)
•Behavioral (e.g. re-enactment, cutting)
•Cognitive (thinking that it is happening again, confusion, dissociation,
•Relational (clinging, oppositional, distrustful, compliant).
• Self-attribution (self-hate and blame).

C. Persistently Altered Attributions and Expectancies
•Negative self-attribution
•Distrust protective caretaker
•Loss of expectancy of protection by others
•Loss of trust in social agencies to protect
•Lack of recourse to social justice/retribution
•Inevitability of future victimization

D. Functional Impairment
At the 2010 annual conference of the International Society for the Study of Trauma and Dissociation,  Bessel van der Kolk spoke about his attempts to get Developmental Trauma Disorder (DTD) included in DSMV. At one point, he received a rejection letter from the committee evaluating his proposal, which stated that the proposed diagnosis would effectively encompass most other childhood disorders.  As Dr. van der Kolk said in his plenary address, "No Shit!!" 

According to the website of the Trauma Center at Justice Resource Institute in Brookline, Massachussetts, founded by Bessel van der Kolk, who serves as its medical director, we can help make a difference by supporting the research studying the validity of the DTD diagnosis (

It is exceedingly rare that we have the opportunity to effect far-reaching change to society. This is your opportunity to take direct action. You can personally help transform medical knowledge and quality of care for all those impacted by maltreatment and neglect by contributing a tax-deductible donation to the "DTD Field Trial, JRI TraumaCenter" as soon as you possibly can. Your continued support beyond the target fund is appreciated because there will no doubt be additional work to do beyond this phase.
  What do you think of the proposed Developmental Trauma Disorder diagnosis?