Experiencing trauma at any age leaves a lasting impact, whether it is the result of a single event or years of neglect or abuse. However, facing trauma as a child can compound the effects of the trauma throughout one’s developmental years, distorting interpersonal relationships and self-worth.

Though developmental trauma disorder (DTD) is similar to post-traumatic stress disorder (PTSD), the former compounds multiple traumatic experiences over time, rather than just one event. As a result, DTD creates a false narrative about one’s sense of self and worth that is consistently reinforced over time without proper recognition and treatment.

Embark Behavioral Health hosted the webinar Developmental Trauma and its Relationship to PTSD. During the webinar, Embark’s Clinical Officer Rob Gent, MA, LPC, described his personal experience with DTD and PTSD, their differences and similarities, and several evidence-based options for treating trauma.

Understanding PTSD

PTSD is a psychiatric disorder that occurs in people who have experienced or witnessed a traumatic event or who have been threatened with death, sexual violence, or serious injury. Traumatic events that can lead to the development of PTSD include but are not limited to natural disasters, serious accidents, terrorist acts, war or combat, or sexual assault.

According to Gent, PTSD symptoms last more than four weeks and include three main criteria: re-experiencing details of the event through intrusive thoughts, memories, or dreams; avoiding thoughts, people, or places associated with the event or isolating from others entirely; and alterations in mood such as irritability, isolation, difficulty concentrating, and distorted beliefs about oneself or others.

Symptoms of PTSD typically develop within three months of the traumatic event but can persist for months and often years. Affected individuals not only continue to remember the event, but sometimes relive it through flashbacks that can be debilitating and affect day-to-day life.

Although PTSD can affect people of any age, the lasting effects are especially profound among children. Experiencing trauma during developmental years affects the narrative children create about themselves as they grow. Repeated exposure to trauma, or experiencing multiple traumas at once, leads to the development of DTD and sparks a belief that they are inherently bad and deserve the bad things happening to them.

Developmental Trauma and PTSD

DTD has the same profile as PTSD, but the symptoms and resulting effects continue over a longer period of time and are usually tied to an interpersonal relationship. Because infants are completely dependent on their caregivers, a negative or harmful relationship with their caregiver can create compounded trauma over time.

According to Gent, children who are abused or neglected by a primary caregiver (75%) are more likely to develop DTD and PTSD than children who are abused by a trusted adult (25%) or a stranger (10%). “The closeness of a relationship has a lot to do with our potential for developing DTD and PTSD,” he said. “The younger we are, the less coping skills we have. When we’re an infant, we’re 100% reliant on our caregiver to take care of us.”

As infants, we experience sensations based on our needs, such as feeling hungry and needing food or feeling disconnected and needing comfort. Because infants lack a rational brain and the ability to communicate, they cry, expecting their caregiver to identify and meet their needs. If their caregiver promptly resolves the issue, and consistently does so, the infant is hardwired to expect that they will continue to be taken care of and that the world is generally a safe place.

However, if the infant’s needs are not met, the situation remains unresolved, and this pattern continues over time, the infant remains in a state of hypervigilance. The body constantly feels as though there is an imminent threat and enters a fight, flight, freeze, or fawn response. Anytime the infant’s needs are not met, this trauma is compounded, and they eventually develop the belief that certain people, situations, and/or the world at large is unsafe.

The Body’s Reaction to Trauma

As trauma is experienced, the memory is stored in the amygdala, a mass of gray matter inside the brain involved with the experiencing of emotions. Over time, experiences that trigger or mimic the initial traumatic memory – even if they aren’t themselves traumatic — pile on, creating a narrative that instructs the body on how to react. When people are consistently cared for as children, the narrative built in the amygdala is one of safety – they know that if they cry for food, they will be fed; if they ask to be comforted, they will be held.

However, when needs are continuously left unmet, the narrative supported by the amygdala is tainted by trauma. Every time an individual cries or asks for help, and the situation isn’t resolved, the narrative that they are unsafe is reinforced. When this trauma is experienced in developmental years, the result is hard-wired neural pathways sending a message through emotional responses and behaviors that the world is unsafe, and they are in constant danger.

For infants and children who lack rational thought, it can be extremely difficult to have this expectation while watching others receive the care they desperately want. Experiencing neglect while witnessing peers have their needs met also adds to one’s inner narrative, and in developmental years especially impacts the story an individual creates about themselves.

Over time, this narrative lays the foundation for one’s actions, causing them to avoid anything that may trigger those feelings of trauma, neglect, or abuse. As a result, people with DTD and/or PTSD tend to withdraw from others, eventually buying into the belief that they can’t expect safety and sometimes, that they don’t deserve it. “Trauma breeds isolation,” Gent said. “Shame is lonely.”

According to Gent, shame is a big driver in DTD and PTSD. These neural pathways are created before the rational brain is, so by the time logic and self-awareness is developed, individuals have already been hardwired to believe this narrative as an absolute truth. People may not even recognize that they experienced trauma or neglect as a child, making it difficult to identify the underlying cause of the problem and especially any possible treatments.

As they grow, people with DTD and PTSD are guided by this false narrative, believing that negative events are essentially earned punishment. As a result, many people who struggle with DTD and PTSD develop poor coping skills, such as substance use, in an attempt to manage the overwhelming emotions associated with trauma, including shame. The effects of substance use then compound with the trauma, creating a vicious cycle that can be difficult to break free from without support and behavioral changes.

Treating DTD and PTSD

There are several therapies that work to address DTD and PTSD. However, it’s important that individuals seeking treatment first have a trusting relationship with a provider as well as a coping method to process their trauma. Diving into traumatic memories without a solid foundation of trust and safety can exacerbate the problem, compounding more triggers within the amygdala and along neural pathways, resulting in more frequent or harmful flashbacks, memories, or feelings of shame.

One way to help store and navigate trauma is the container method, in which a patient with DTD or PTSD works with a therapist to create an imaginary container from which traumatic memories can be safely accessed and processed. Patients are encouraged to visualize a container, whether it be a padlocked safe, a transparent box, a family heirloom trunk, etc. Over time, with the help of their therapist, patients practice “opening” the container, accessing a particular traumatic event, memory, or feeling, processing the truths surrounding the trauma, and safely locking it back up in the container when complete.

The container method offers a way to store trauma yet still feel in control and aware of it, rather than continuing to repress it. This provides the patient with a tool to “put away” difficult thoughts or feelings related to the trauma when triggers arise, offering a safe coping method that simultaneously works to rewrite the false narrative that’s been created. Focusing on the truths of the event each time the memory is accessed, such as recognizing that their basic needs were unmet as a child, allows patients to better understand their trauma and its origins and begin chipping away at feelings of shame.

Once a patient with DTD or PTSD has established a trusting relationship with their mental health provider and developed a tool for processing trauma, therapy can be an effective form of treatment. Several types of trauma therapy take different approaches to rewiring the neural pathways. As a result, triggers are processed and disconnected from the narrative stored in the amygdala.

Eye Movement Desensitization and Reprocessing (EMDR) therapy is a structured therapy that encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (such as eye movements). Rather than focus on altering the emotions and their responses, EMDR therapy focuses directly on the memory and changes the way the memory is stored, reducing problematic symptoms such as triggers.

Narrative exposure therapy (NET) takes a different approach, focusing instead on the emotions related to the trauma and their role in the patient’s narrative of their life. With guidance from the therapist, patients establish a narrative of their traumatic experiences with positive events incorporated. By contextualizing the network of both traumatic and positive memories, the patient fills in details to develop a coherent story. This helps “rewrite” the false narrative created over time by compounded trauma, especially with regards to DTD.

Various types of cognitive therapy (CT), including cognitive behavioral therapy (CBT), are also used to treat trauma disorders, as well as related responses. CBT focuses on the relationship between thoughts and behaviors and works to improve functioning in other domains. Over time, CBT strengthens the ability to emotionally regulate — changing the association between triggers and emotional responses — leading to the development of healthier behaviors.

Because trauma affects an individual’s brain, body, and behaviors, it is important to identify and begin treating early on to reduce its severity. Caregivers of children especially are encouraged to recognize warning signs of trauma and prioritize mental health as well as physical health throughout their children’s developmental years.

Embark Behavioral Health operates a network of treatment and therapy programs across the country, specializing in preteens, teens, and young adults struggling with mental health and substance use. To learn more about available services, call 866.479.3050 or visit https://www.embarkbh.com/.

Additional resources:

Embark Behavioral Health – YouTube

National Center for PTSD – Support for Providers Treating PTSD

National Center for PTSD – Understanding PTSD and Finding Treatment

SAMHSA – PTSD Treatment Basics

SAMHSA – PTSD and Children

Better Help – Developmental Trauma Disorder