Developmental Trauma - In DSM5?
Jul 12, 2012
Great news, on at least a couple of fronts today.
"Last night" I received the following from Wendy D'Andrea, author of this important study "A naturalistic study of the relation of psychotherapy process to changes in symptoms, information processing, and physiological activity in complex trauma." -- [LINK], as well as the latest article on the diagnosis "Developmental Trauma Disorder" -- "Understanding interpersonal trauma in children: why we need a evelopmentally appropriate trauma diagnosis" -- [LINK]:
"The good-ish news with the DSM-V situation is that, as I understand it, they plan to release continuous updates, like software. So they are encouraging us that while it won't likely be there now, it may be in version 5.1 or something. The other good news is that the revised PTSD diagnosis includes a lot of the self- and relational-dysregulation symptoms we'd like to see in DTD. The best news of all is (if you ask me) that the DSM-V process has been so problematic across the board that it seems like it will eventually implode.
I'm happy to share that, with my colleague Greg Siegle, I've just gotten a really big grant from the NIH to study trauma's effects on the body across diagnoses through a new grant mechanism called RDoC. The grant mechanism makes a point of being "agnostic to the DSM." This type of grant, which is not tied to a given diagnosis but rather to trauma as a risk factor, is an unprecedented step in the right direction for the NIH, as it is looking more to commonalities in mechanism and life history rather than concrete, limited diagnostic constructs."
On another, LOCAL, front we have news that Kate Scott has had an important article published -- [LINK] -- in the British Journal of Psychiatry: "Childhood maltreatment and DSM-IV adult mental disorders: comparison of prospective and retrospective findings". Professor Scott is an Associate Professor in the Department of Behavioral Medicine / Psychiatry at the University of Otago. This is an important and valuable contribution, this time by local researchers, to the field. As the article's abstract begins, to define the problem:
"Prior research reports stronger associations between childhood maltreatment and adult psychopathology when maltreatment is assessed retrospectively compared with prospectively, casting doubt on the mental health risk conferred by maltreatment and on the validity of retrospective reports."
The abstract concludes:
"Prospectively and retrospectively assessed maltreatment elevated the risk of psychopathology to a similar degree. Prospectively ascertained maltreatment predicted a more unfavourable depression course."
In fact, as Scott notes in the article, for various methodological reasons, the findings were "conservative" the strength of the association was less strong than might exist "in reality" -- and the childhood abuse - adult disorder association not limited to mental disorders such as depression, alone -- other studies have found such forms of childhood adversity as neglect, and physical abuse, are contributors such alcohol use disorders as heavy, episodic drinking -- [LINK] -- and (personal communication) Scott advises that a similar effect is discernible in the local data, consistent with the other studies findings.
For far too long, the assumption has been made that these associations are made only by "personality disorder" self--interested unstable individuals. The research data in fact argue that this is in fact contrary to the truth -- victims of abuse who suffer disorders, and victims generally, may UNDER play the significance of such abuse factors in accounting for their problems -- this would be consistent with the effects of shame and "flawed self" perspective of abuse victims.
It is too early, for us oldies, who have been forced to suffer the consequences of psychiatric maltreatment in the past, to get excited by these developments, but hopefully it will mean that, for those "newly diagnosed" children and young adults, the long misunderstood nature of trauma-related disorders will become better understood as such, trauma-related disorders, and not as "personality disorders", and that "adequate and appropriate" treatment will be forthcoming, and that the stigma such oldies as I have suffered, and that adult victims of sexual abuse, and other forms of abuse, have suffered, will also come to an end.
Further information on the "RDoC" -- Research Domain Criteria -- research scheme can be found here: -- [LINK]
As usual, contact me if you'd like copies of the articles cited.