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Developmental Trauma Disorder proposed to DSM-V


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News News News. The DSM editors are planning to expand the definition of PTSD to include childhood PTSD as a new disorder, Developmental Trauma, as part of a broader definition including Complex Trauma.

"The traumatic stress field has adopted the term
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News News News. The DSM editors are planning to expand the definition of PTSD to include childhood PTSD as a new disorder, Developmental Trauma, as part of a broader definition including Complex Trauma.

Just to be Very Precise, the referenced article does NOT say that this new terminology is going to be included in the DSM V as a new diagnosis.

The author stated that a particular group specializing in childhood trauma is 'proposing" the development of a new trauma diagnosis.

It is very risky to make statements about what will be included in the next DSM unless they come from the managment committee.

a.m. It is interesting to see new models developed to replace the vague set presently in use.

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Just to be Very Precise, the referenced article does NOT say that this new terminology is going to be included in the DSM V as a new diagnosis.

Yes, I know. I got that information from a paper of another doctor, Paula Thomson Psy.D. I am asking her persmission via email to repost the paper here, so bear with me...

;)

OH, she is contributor to this online trauma center. Check out the site here: http://www.traumaresources.org/

There is an awesome set of videos there regarding developmental trauma.

Alex

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...The DSM editors are planning to expand the definition of PTSD to include childhood PTSD as a new disorder, Developmental Trauma, as part of a broader definition including Complex Trauma.

Okay. Correction. I researched a little about DSM-V, and found a good page for it here:

http://www.psych.org/research/dor/dsm/dsm_faqs/faq81301.cfm

Two of the interesting Q&A points are:

Q1:

What does it mean if a diagnosis is not included in the DSM?

A1:

It only means that, as of 1994, there was not sufficient data to justify its inclusion in the DSM-IV. Just because a category is not included in DSM-IV does not necessarily mean that it is invalid, or not worthy of being a focus of research or treatment.

...

... purpose of the early versions of the DSM [i & II] was to standardize ... the diagnostic makeup of these early versions represented a consensus of those disorders ... in the 1950's and 1960's. Starting with DSM-III, with the explosion of research in psychiatry, attempts have been made to make the DSM as empirically-based as possible...

...

...As the DSM has become increasingly more informed by research, so has the basis for inclusion of new categories in the DSM. As stated above, originally categories were included because they were felt to represent what psychiatrists were treating [in the '50s and '60s].

Q2:

How can I get involved in the DSM-V revision process?

A2:

The DSM-V revision process will not formally begin until the DSM-V workgroups are selected, which should probably occur sometime in 2005 or 2006. At that point, suggestions for change and other proposals can be forwarded to the appropriate work group members. In the meantime, since the DSM-V revision process will continue to be empirically-based, any proposed changes will be more favorably considered if there is evidence to back it up. Therefore, you might want to start now the process of putting together a persuasive evidence-based case for your suggestions. This could consist of conducting an ongoing literature review that could be used as the basis for your proposal, or if no published literature exists, collecting data and then submitting the work to a peer-reviewed journal for publication. While of course this will not guarantee that your proposal makes it into DSM-V, the most common reason for proposals to be rejected is the paucity of data available to back it up.

--------------------------

So, I was a bit excited when starting the thread and jumped the gun. It is almost 100% certain there is going to be major changes in PTSD due to the advent of trauma research. Trauma researchers are already using a wide variety of terms that should be standardized. All of this talk of SID (self-id disorder), complex PTSD, DTD or CDTD (child developmental trauma disorder), and, of course BPD, are going to have to be rehashed. And, it looks like we can help! According to the Q&A above, it looks like an open process, where any person can put together the data and theories of others and forward it to the appropriate comittee (bolded, above).

Upon closer reading, Dr. Thomson's paper does say the theory is "proposed," so it's in very early stages from the DSM perspective. However, from the perspective of the trauma community, the term is already widely used. So, while it might not end up being DTD, it will probably be considered some form of PTSD, not a the very generalized personality disorder cluster (BPD) we know today.

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Guest Guest_Alex_*

I am asking her persmission via email to repost the paper here...

Okay. Permission granted. Dr. Thomson said it was okay to repost as long as I gave her credit for it as well as kept the references. I had to OCR the doc back into Word, and then convert to HTML, so, things may look a little unaligned here and there, and many of the page numbers of the original document are still indented on the right side.

This is the outline for Dr. Thomson's UCLA extension course. It's 49 pages (printed) and very well worth the read if you are interested in modern trauma theory & treatment. It includes psychological, physiological, and psycho-biological theories for things such as self-injury, intrusive thought, detachment, estrangement, etc. Most of the things we know today as "Borderline" can be better explained as complex PTSD through her paper.

Also included in the paper is ways to assess & intervene in forms of PTSD including child abuse, spouse abuse, elder abuse, and suicidality. She refers to some of this as "psychological first aid," and it will certainly come in handy if anyone needs an emergency guide for supporting someone in such a situation.

Here it is:

http://www.cosmicdust.org/self/UnderstandTreatPTSD/

Alex

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i agree that people can have life-long issues from trauma in childhood resulting in complex symptoms and that this understanding can aid in treatment and so this could certainly benifit people.

i don't, however, think this is the same thing as borderline. borderline refers to a specific set of maladaptive coping mechanisms and and patterns of thought and behavior impacting personal interaction and sense of self. many borderlines probaly would qualify for this new diagnosis if it was added to the DSM. however, not all people who would hypothetically recieve this new diagnosis also fit the diagnostic criteria for borderline, nor would all borderlines fit the criteria for this new diagnosis.

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{some disorder is a...}

specific set of maladaptive coping mechanisms and and patterns of thought and behavior impacting personal interaction and sense of self.

There are so many things mentioned in the Understanding & Treating PTSD paper that seem to account for a variety of different BPD effects. I guess I should start a new thread on a few, since the paper has so many.

Let me just site this interesting one, and then I'll shut up ;) :

---------

Abusive or Neglecting Care giver

The abusive caregiver not only shows less play with her infant but also induces traumatic states of enduring negative affect in the child. This caregiver is inaccessible and reacts to her infant's expressions of emotions and stress inappropriately and/or rejectingly and therefore shows minimal or unpredictable participation in the various types of arousal regulating processes. Instead of modulating she induces extreme levels of stimulation and arousal, very high in abuse and/or very low in neglect (Schore).

Kestenberg (1985) refers to this experience as dead spots in the infant's subjective experience and Winnicott described it as a failure of "going on being"; an "unthinkable agony". This dyadic relationship [caregiver-infant] is implicated in the development of dissociative behavior

--------

Okay I'm NOT saying your parent's didn't love you or anything. Parents are people too, and they did their best. Oh I know about parents. I think a lot of us do.

I'm just saying there are lots of different answers in the paper. Probably too many for one thread. I just wanted you all to know, since "BPD" is now about 12 yrs old (DSM-IV is 1994), a lot of new things have been put together since then. It's good to be on the forefront of developments.

Remember, I'm just trying to help & contribute. That can often mean debate, and that's fine. I hope I didn't upset anyone. I live with someone who I'm pretty sure is BPD (or something), so it's imporant for me to find out what this thing might be. He is at a place where I cannot even try to tell him he might have something. He is that touchy about "self".

Okay, as always...hope it helps. Keep on Threadin'

Alex

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i agree with penny century in acknowledging that many people with traumatic childhoods go on to have borderline but this is not the sole cuase of borderline and for many people with borderline this is not an issue myself included.

as penny stated i like many boardlines have "a specific set of maladaptive coping mechanisms and and patterns of thought and behavior impacting personal interaction and sense of self." these for me were not brought on by childhood trauma and there are many cases similar to mine were people who have come from relatively stable non-traumatic childhoods have grown up to develop borderline personality.

once again i state my position that labelling illness does little to help anyone. instead of being interested in labels i like to focus on my illness, what ever they call it, what ever the reasons for it and work on getting better. where it sits in the DSM-V will not impact my illness one bit.

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