Developmental trauma

What is developmental trauma?

Developmental trauma (Dutch: ontwikkelingstrauma) is trauma that arises in childhood, usually over a long period and within the relationship with caregivers, and that affects developing attachment, emotion regulation and self-image. It is not about one shocking event, but about what repeated lack of safety does to a child who is still fully developing.

What developmental trauma looks like in practice

A common picture: a child grows up with a caregiver who is unpredictable, sometimes warm and sometimes frightening. The child learns to stay constantly alert, because the environment that should provide safety is itself the source of threat. That alertness does not go away once the child is grown. As an adult, closeness in particular can trigger the same alertness: the body reacts to intimacy as if there is danger, while nothing is wrong. This is not unwillingness and not making a fuss, but a system that learned early that coming close means risk.

How developmental trauma carries through

Early, persistent threat keeps the stress system in the highest gear. Where the fight-or-flight response is meant as a brief emergency mode, in a child in chronic insecurity it stays on far too long, in a phase where the brain, attachment and emotion regulation are still forming. Bessel van der Kolk, Julian Ford and Joseph Spinazzola describe developmental trauma as the result of repeated, usually interpersonal trauma in childhood, with symptoms that reach further than those of ordinary post-traumatic stress disorder. Daniel Cruz and colleagues summarize in Frontiers in Psychiatry that it is not about a single event, but about the influence of chronic, often relational stress on development itself. What a child normally learns, namely to calm itself and to trust others, comes about with more difficulty or differently as a result.

Developmental trauma, PTSD and complex PTSD

There is a lot of confusion here, and it is worth keeping apart. Van der Kolk and colleagues proposed including Developmental Trauma Disorder as a separate diagnosis for children in the DSM-5. That proposal was not adopted, which means the DSM has no diagnosis that fully covers this picture. The World Health Organization took a different route and included complex PTSD in the ICD-11 in 2019. Andreas Maercker and colleagues describe in The Lancet that this diagnosis, on top of the symptoms of PTSD, has three extra problems: difficulty regulating emotions, a negative self-image with shame or guilt, and difficulty holding on to relationships and closeness. So developmental trauma refers to the early cause and the influence on development, while complex PTSD is the recognized diagnosis that describes the adult picture. Only a professional can assess what is exactly going on.

What I see of it

As a psychotherapist with twenty-five years of experience, I recognize the pattern behind this concept. Some women who write to me notice that touch and closeness stir something in them they cannot place: a tension, an urge to withdraw, right at the moment when it should feel good. What I can mean in that is limited and it is explicitly not treatment. You do not work through trauma during a date. What I can do is take the time, impose no pace, and force nothing, and at the same time say honestly that real help with trauma belongs with an expert, not with me.

What you can do

• See this as a concept, not a diagnosis you give yourself. Whether this applies is assessed by a professional, not a page and not you.
• Go to your family doctor if early insecurity still affects your life or your relationships now. Your doctor can refer you to mental health services or to trauma-focused help.
• Ask for someone who works with trauma. For this picture there are targeted forms of treatment; a care provider trained in them is the right address.
• Don’t force closeness. That your body is on edge during intimacy is not a failure. Building up calmly in a safe situation helps more than forcing yourself.

More reading on developmental trauma

Within this glossary, complex trauma explains the recognized diagnosis complex PTSD, and attachment style explains how early experiences shape the pattern of closeness and distance.

Beyond this site, the review article by Cruz and colleagues in Frontiers in Psychiatry gives an accessible framework, and Bessel van der Kolk describes the subject extensively in his book The Body Keeps the Score.

Where this fits on this site

I do not treat trauma and I don’t pretend to. What I do is meet a woman at her own pace, without pressure, and that can be pleasant alongside real help, never instead of it. What a meeting looks like when you are mainly seeking calm and attention is at intimate togetherness. Talking calmly first is always an option.

Sources

• Complex post-traumatic stress disorder. Andreas Maercker, Marylene Cloitre, Rahel Bachem et al., The Lancet, 2022. Backs up that the ICD-11 includes complex PTSD, with, on top of the PTSD symptoms, problems with emotion regulation, a negative self-image with shame and guilt, and difficulty with relationships and closeness.
• Comorbidity of developmental trauma disorder (DTD) and post-traumatic stress disorder. Bessel van der Kolk, Julian D. Ford & Joseph Spinazzola, European Journal of Psychotraumatology, 2019. Backs up that DTD stands for the consequences of repeated, interpersonal trauma in childhood, with symptoms that reach further than those of PTSD.
• Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Daniel Cruz, Matthew Lichten, Kevin Berg & Preethi George, Frontiers in Psychiatry, 2022. Provides the framework that developmental trauma is about the influence of chronic, often relational stress in childhood on development itself, and that the proposal for DTD was not included in the DSM-5.

Related terms

Developmental trauma is about the early cause. The terms below are about how that carries through.

• Fight-or-flight response. The body’s emergency mode that stays on far too long after early insecurity.
• Complex trauma. The recognized diagnosis complex PTSD, which describes the adult picture.
• Attachment style. The pattern of closeness and distance that is partly formed in childhood.
• Anxious attachment. One of the patterns that can arise after early insecurity.
• Self-regulation. The ability to calm yourself, which developmental trauma makes harder to develop.