Children who have problems resulting from complex, multiple traumas such as child abuse, neglect, death of loved ones or traumatic medical experiences currently receive a variety of imperfect diagnoses in the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders that do not always adequately describe their mental health needs, maintains a working group of child experts developing a diagnosis called “developmental trauma disorder” or DTD.
"There is no diagnosis for children that more than partially addresses the symptoms associated with these impairments in self-regulation," says University of Connecticut psychologist Julian Ford, PhD, a member of the group, which is under the umbrella of the federally funded National Child Traumatic Stress Network.
Some of those diagnoses, and where the group thinks they fall short, include:
Pervasive Developmental Disorders capture some of the problems children have with attachment and information processing, but involve more severe problems with reality orientation, communication and stereotypic behaviors, Ford says. In addition, PDDs do not usually involve the pronounced anxiety and depressed mood seen in DTD.
Oppositional Defiant Disorder and Conduct Disorder, like DTD, involve intense anger, distrust and conflict in relationships, as well as distorted beliefs about people and the world, Ford says. But they don't include the guilt, shame, anxiety, dissociation and depressed mood seen in children with DTD.
Reactive Attachment Disorder is similar in symptoms and impairments to DTD, but is limited to early childhood and must occur in the context of "pathogenic care," such as neglect or abandonment. By contrast, children with DTD can be traumatized but not face neglect or abandonment, Ford notes.
Affective disorders capture the sadness, loss of interest, physical complaints and social dependency and withdrawal involved in DTD, says Ford. But they don't include DTD-related anxiety, reactive anger, shame, guilt, dissociation and disorganized feelings about trust and relationships.
Anxiety disorders, including Post Traumatic Stress Disorder, capture the fearfulness, worry and avoidance involved in DTD, but not the intensely changeable emotional states, negative self-beliefs and disorganized attachment feelings and behaviors that DTD does.
Borderline personality disorder captures the changeable emotional states and disturbed relationships of DTD-related dysregulation and attachment problems, but it is an adult diagnosis that is not appropriate for children whose personalities are still forming, Ford says. In addition, it does not address these children's dissociation, physical complaints or extreme dysregulation in response to trauma reminders or memories, he says.