The Fallout from Childhood Adversity

Current psychiatric diagnoses fail to serve those who suffered adversity during childhood. The Diagnostics and Statistics Manual (DSM V) does not yet outline a category that recognizes the uniquely devastating nature of trauma during vulnerable years and well-characterized downstream effects. 

Instead, those with history of formative hardship are diagnosed with Post Traumatic Stress Disorder (a category initially formulated to address wartime trauma experienced by adult soldiers), Borderline Personality Disorder (a term that has acquired pejorative connotations and implies someone who reacts with alternating idealization and rage to those who try to get close), Bipolar Disorder (which picks up on the intense moodiness that often follows early adversity but misses many other important sequelae), Attention Deficit Hyperactivy Disorder (ADHD), or various other anxiety, mood, conduct, personality, and thought disorders.

Because of the lack of specificity of these classifications, it is not uncommon for people who endured adverse upbringings to be burdened with multiple psychiatric labels, which often serve to worsen already low self-regard. Rather than aiding healing, they lead sufferers to feel misunderstood and criticized.

Trauma experts are advocating a new diagnosis for inclusion in the DSM: Developmental Trauma Disorder1, which will unify the classification and management of those who suffered early mistreatment. The new category captures a number of maladjustments: poor self-concept, emotional reactivity, social unease, feelings of emptiness, problems with focus, and stress-induced bodily symptoms, among others.

This list of difficulties can sound discouraging, but once we recognize the symptom aggregate as a coherent adaptive response to formative trauma, we can set aside judgment and begin to engage our challenges in constructive ways.

1. Developmental trauma disorder: Towards a rational diagnosis for children with complex trauma histories.  BA van der Kolk, MD, Psychiatric Annals, 2005.

 

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