Beyond PTSD: Client Presentations of Developmental Trauma Disorder From a National Survey of Clinicians

Objective: The emergence of updated Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013) criteria for posttraumatic stress disorder (PTSD), which includes modified criteria for young children, raises questions regarding the need for developmentally appropriate standalone psychiatric diagnosis encompassing complex trauma presentations in children. The present study addresses these questions by examining how DSM-5 PTSD and proposed developmental trauma disorder (DTD) diagnoses relate to functional impairment and trauma exposure using clinician-report surveys. Method: We surveyed psychotherapists across the United States, and asked them to report on the symptom characteristics, functional impairment, and trauma exposure of children, adolescents, and young adults under their care (n = 210; age range = 2-21). We fit symptom data to the draft criteria for (1) DTD, a proposed trauma diagnosis for children and (2) existing criteria for adult and child/preschool PTSD. Results: Results indicated that comorbidity between DTD and PTSD was high (52.4% and 59.9% for adult and child/preschool criteria, respectively). Comorbid DTD/PTSD and DTD-alone groups had more functional domains impacted and greater exposure to some types of trauma relative to the other groups. Conclusions: These findings speak to the relationship between trauma complexity and wide-ranging symptom presentations, provide support for research and clinical emphasis on a developmentally informed diagnosis, and may support existing treatment approaches. Clinical Impact Statement Findings from clinician surveys suggest the developmental trauma disorder and its co-occurrence with full posttraumatic stress disorder (PTSD) is associated with greater functional impairment and trauma exposure burden than PTSD alone. These findings suggest broadening the diagnostic picture may more accurately capture the complex relationship between trauma exposure and symptom presentation. Clinicians should be aware of evidence-based treatment approaches for complex trauma-related presentations in children and adolescents and assess for symptoms over and above Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013) PTSD criteria.