When Childhood Trauma Hijacks a Survivor’s Life

Exposure to psychological trauma in childhood—while the brain and mind are rapidly developing—can cause not only posttraumatic stress but also alterations in development that may change the entire course of a child’s life. Such “developmental traumas” appear to shift the pattern of brain activation from one based on creatively exploring the world (what I call the “learning brain”) to one based on chronic hypervigilance (the “survival brain”).¹

Survival-oriented changes in the brain are necessary for the severely traumatized child’s initial coping and self-protection. But, when the brain stays in survival mode too long, 3 key self-regulation systems in the brain are impacted: the reward/motivation system (centered on midbrain areas responsive to the neurotransmitter dopamine), the distress tolerance system (centered on limbic brain areas responsive to the neurotransmitters serotonin and adrenaline), and the executive system for emotion and information processing (centered on the medial and dorsolateral prefrontal cortices).

The result is that the child grows up with a brain that has been hijacked by its own alarm system.² This can lead to serious problems including alcohol and substance use, health risks (such as smoking and obesity), mental health outcomes (such as depression and suicidality), and social risks (such as violent relationships, teen pregnancy, and delinquency). These problems often are considered distinct comorbid disorders and behaviors, but, when they stem from the person being stuck in survival mode after childhood trauma, they may be better understood and treated as a single, albeit complex, “developmental trauma disorder” (DTD). DTD is not recognized as a psychiatric diagnosis in the DSM-5 but may warrant inclusion in the future if research demonstrates its clinical utility as a syndrome.

A step toward that goal was taken in a recent study³ that used an international Internet survey to ask 472 child-serving clinicians (including psychiatrists as well other mental health, social work, medical, and nursing clinicians) their views on childhood developmental trauma. They rated the clinical significance of assessment and treatment of DTD symptoms of emotion dysregulation, dissociation, somatoform problems, self-harm, disorganized attachment, risky and impulsive behavior, and aggression in addition to symptoms of PTSD and other existing psychiatric disorders. Overwhelmingly, the clinicians said that developmental alterations were crucial to understanding and treating their traumatized child clients and that these symptoms could not be accounted for or treated adequately using existing psychiatric diagnoses. They viewed the DTD symptoms as distinct from but comparable in clinical utility to symptoms of PTSD and other psychiatric disorders. And, of particular importance, they viewed existing evidence-based psychotherapeutic treatments as, at best, partially effective—and often ineffective—in treating DTD symptoms.

DTD thus may fill a crucial gap in the clinician’s toolkit and in scientific research as we continue to work toward understanding the dilemmas of and providing effective treatment to developmentally traumatized children and adults who suffered developmental trauma in their childhoods. These patients otherwise may be burdened by a long list of psychiatric diagnoses. DTD will not replace any existing diagnosis, including PTSD, but it may serve as the basis for a more consolidated and less stigmatizing diagnostic summary and approach to treatment for children and adults whose brains, and lives, have been hijacked by complex trauma.

Financial disclosure:Dr Ford has received grant/research support from the National Institute for Justice and the Substance Abuse and Mental Health Services Administration and is co-owner of Advanced Trauma Solutions.

References

1. Courtois CA, Ford JD, eds. Treating Complex Traumatic Stress Disorders: Scientific Foundations and Therapeutic Models. New York, NY: Guilford Press; 2009.

2. Ford J, Wortmann J. Hijacked by Your Brain: How to Free Yourself When Stress Takes Over. Naperville, IL: Sourcebooks; 2013.

3. Ford JD, Grasso D, Greene C, et al. Clinical significance of a proposed developmental trauma disorder diagnosis: results of an international survey of clinicians. J Clin Psychiatry. 2013;74(8):841–849. Abstract