Developmental Trauma: What You Can’t See…

Bessel van der KolkWhat you can’t see, can hurt you.

Dr. Bessel van der Kolk, MD (left) and leaders in brain science and attachment are calling for a hard look at developmental trauma.  Developmental Trauma Disorder (DTD) was identified by van der Kolk in 2005, but the psychiatric Powers That Be deny it exists. [FN1]

“Clearly our field would like to ignore social realities,” Dr. van der Kolk said recently, “and study genes…”

He’s also shown it’s at the root of borderline personality disorder and bipolar disorder. He implies (I’m sure it’s true) that it’s at the root of most cases mis-diagnosed as  ADHD/ADD.  See van der Kolk video: http://www.acesconnection.com/clip/bessel-van-der-kolk-childhood-trauma-affect-regulation-and-borderline-personality-disorder-69-min

I dubbed it “trauma since the sperm hit the egg” when I realized I had it.  Dr. Allan Schore calls it “trauma in the first 1000 days, conception to age two.”  It used to be called “complex PTSD” (C-PTSD) or “Early Trauma” (ET).

Developmental trauma starts in utero when we don’t have much more than a brain stem, and goes on during the pre-conscious years. It can continue until 24 or 36 months depending on when the thinking brain (frontal cortex) comes on line.  That’s up to 45 months living in general anxiety to non-stop terror — before age 3.  A very long time to an infant.

DTD occurs as a continual process, not discrete incidents, while a baby has not developed a thinking brain able to recall incidents.  Frequently it occurs before there are any discrete incidents.

“No one can see it” means “it never happened.”  As I’ve said, “No one beat me or raped me. What’s wrong with me?”  Try getting that treated.

Neuroscientists Dr. Daniel Siegel, MD, Dr. Bruce Perry MD and others detail how attachment failures cause developmental trauma in this video: www.youtube.com/watch?v=jYyEEMlMMb0 [FN2]

Insecure Attachment as the Cause

Allan Schore 2DTD is a “Relational Trauma, trauma in the context of a relationship” as Dr. Allan Schore (left), father of attachment theory in the U.S., identified it in the 1990s. [FN3] Only relational processes can explain DTD, not incidents.

Yet all the American Psychiatric Association (APA) can fathom is Post-Traumatic Stress Disorder (PTSD) — since it’s caused by a visible incident such as war injury or rape. Developmental trauma has no incident. It’s ingrained in brain and visceral tissue, with no obvious “big bang,” so some call it “little ‘t’ trauma,” as opposed to visible PTSD “Big ‘T’ Trauma.”

Insecure attachment and attachment disorder generally are the cause of developmental trauma, not vice versa, Dr. van der Kolk details in his May 2005 Psychiatric Annals pdf  noted above and in FN1.  He emphasized this again in a terrific May 10, 2013 speech at Yale on child trauma, borderline personality disorder and bipolar disorder (click for video).  He lists DTD’s symptoms as relational and chronic: inability to concentrate or regulate feelings, chronic anger, fear and anxiety; self-loathing; aggression, self-destructive behavior. [FN4A]

Working with the National Center for Child Traumatic Stress Complex Trauma Network (NCTSN), van der Kolk reports that he ran a survey of 40,000 children nationally being treated for multiple traumas. Most of them  “do not meet the criteria for PTSD… (as) the majority of issues are not specific traumas, but issues in their attachment relationships,” he says.

Van der Kolk describes studies by his colleague Dr. Marylene Cloitre, on attachment problems as the cause of DTD.  “Marylene looked at chronic complex trauma symptoms, then she did child attachment interviews, Dr. Mary Main’s interviews, in which I hope all of you have been trained, because they are very very helpful to see what were peoples’ experiences of their childhoods,” he said [referring to the Adult Attachment Interview (AAI)]. [FN4B]

Dr. Cloitre found “that pure PTSD symptoms are a function of specific traumatic incidents, but the other symptoms she identified – affect dysregulation, mood regulation, anger expression, chronic suicidality, self-injury, disturbance in relations with self and others… do not occur in PTSD.  They are rather a function of a disturbed attachment relationship,” van der Kolk repeated.

Yet psychiatry, he says, “is not good at treating attachment difficulties. There is very little treatment” of it.  Innovative somatosensory healing programs at van der Kolk’s Trauma Center in Boston using “theater programs, yoga, martial arts for kids, etc. — to get them inter-personally attuned — are not standard treatment even though we do statistical research and publish it,” he notes.

The Body Keeps the Score

Bessel Book bodykeepsscoreBecause DTD happens before we have a thinking brain, the body is forced to store all the memories as somatic trauma. “There is somatization. The body keeps the score,” he says, the title of his latest book, “this is a somatic experience, and you become a terrified organism. Your immune system changes, your stress hormone system changes and your perception of your body changes.”

PTSD’s existence was hard to get recognized at first, too. It took Dr. van der Kolk and friends a chunk of the 1970s and ’80s to get the government to stop insisting that war trauma didn’t exist. Doctors finally established the diagnosis PTSD by showing that Vietnam vets were re-living discrete terrifying incidents from the past.

But “in fact there was no basis for any opinion about the prevalence” of any childhood trauma, even of childhood sexual abuse, before the 1995-1998 Adverse Childhood Experiences (ACE) Study,  study co-director Dr. Vincent J. Felitti, MD, notes. “That’s because such information is almost completely protected by shame and secrecy, by families, and by individuals.  Doctors also have been inhibited by our own ignorance and major gaps in our training, from asking into certain areas of patient history.” [ FN5]

In 1995 Felitti ran an obesity program at Kaiser Permanente in San Diego. But he had a 50% drop-out rate, just when those quitting were losing up to 100 pounds.  “As we interviewed almost 300 of the dropouts, every other person spoke of having childhood sexual abuse; most of them seemed to have been waiting to tell someone after hiding it for years,” Felitti said. “They also often mentioned verbal and physical abuse and other traumatic experiences such as watching their mother being beaten.

“We were amazed. I thought, ‘This can’t be true. People would know if that were true. Someone would have told me in medical school.’  [FN6]

“We wanted to know: to what degree does this happen in the whole population?  That’s how we created the ACE Study.  We took at first 8 and later a total of 10 categories of traumatic childhood experiences which we’d heard about from our obese patients, then found 17,421 average, middle-class adults who agreed to interviews.

“We were astonished to find that the percent of the general public who suffer from traumatic experiences in childhood and adolescence is far higher than imagined… Two-thirds (64-67%) of middle class subjects had one or more types of childhood trauma, and 38-42% had two or more types. One in six had an ACE Score of 4 or more; one in nine had an ACE Score of 5 or more.”  In less privileged populations the numbers are far higher.

Similarly, Dr. van der Kolk describes a patient in the 1980s who could not recall if she were sexually abused, yet drew portraits of her family with menacing genitals. “So we went to the textbook — Freedman,  Kaplan, & Sadock’s  ‘Comprehensive Textbook of Psychiatry’ — with which I sat for my board exam in psychiatry.  It said:  ‘Incest is very rare; it happens in 1 out of 1.1 million women.’   At the time there were about 200 million Americans, so I thought, ‘Hmm… About 100 million women, 110 women are incest victims; how come 47 of them are in my office?’/” [FN4 Yale video.]

“The text says it is also very benign,” he went on quoting it: ‘There’s no agreement about the role of father-daughter incest as a source of psychopathology. The act offers an opportunity to test a fantasy whose consequences are found to be gratifying and pleasurable…In many cases it allows for a better adjustment to the external world.  The large majority of them are none the worse for the experience ’. ”  [FN7]

Developmental Trauma: Psychiatrists Still in Denial

Shrink knitting my brainBut even today, until DTD is in the APA’s official Diagnostic and Statistical Manual of Mental Disorders (DSM), most mental health professionals will not diagnose or treat it, and no insurance company will cover it.

So in 2012 Dr. van der Kolk’s NCTSN network submitted data on 200,000 children around the world to the APA to document DTD.  He spoke on DTD before the National Association of State Mental Health Directors, which treats 6.1 million patients a year with a $29 billion budget, and they wrote to the APA urging that DTD be included in the next DSM-5 in 2013.

But the APA refused and in June 2013, issued DSM-5 without mention of developmental trauma. Van der Kolk in his Yale video ridicules the APA for asking only two questions on child trauma in preparing DSM-5: “1. Can we assume life was pretty good growing up? and  2. Was anyone in your family a drug addict or an alcoholic?”

“Clearly our field would like to ignore social realities,” van der Kolk responds, “and study genes or biological functions — because for us to actually find out how the environment shapes the brain, would get us into very difficult situations.”

The APA refusal letter actually made a veiled dig against the Adverse Childhood Experience (ACE) Study and denied that “childhood adverse experiences” are a “substantive” problem – which is outrageous.  Dr. van der Kolk read that letter at Yale in May 2013 and let ’em have it:

APA:  “The consensus was there was just too little evidence to include DTD in the DSM-5. There have not been any published accounts about children with this disorder.”
Dr. vdK aside: “No, because it’s not in the textbooks!”

APA: “The notion that childhood adverse experiences lead to substantive developmental reduction is more clinical intuition than a research-based fact. “
Dr. vdK aside: “We submitted research data on 200,000 children from around the world to substantiate our diagnosis.”

APA: “The statements made cannot be backed up by prospective studies.”
Dr. vdK aside: “Actually, they can.”

Dr. van der Kolk could make a lot more money as a TV comedy star, after dealing with this idiocy for a lifetime. Despite the tragedy, his psychiatrist audience also had a good laugh — the APA is that absurd.

Developmental trauma is the “invisible” part of “the Silent Epidemic of Attachment Disorder.” [FN8]. DTD can happen as a by-product when a mother or her child are beaten or sexually abused – but it also happens on a wide-spread basis with no visible incident.

Perhaps 20-40% of our population goes through life never knowing they even have DTD. That’s why many of them go on to become leaders of industry and government. That’s why Dr. van der Kolk has said that the US Congress is “dissociated,”  or they’d feel the simple human compassion to know that sending youth to war brings back a flood of PTSD suicides.  (To me that means more than 50% of Congress has attachment problems, which is why they made a career of trying to control others. ) [FN9]

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  van der Kolk, Bessel, MD, “Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories,” Psychiatric Annals 35:5, 401-408, May 2005   www.traumacenter.org/products/pdf_files/preprint_dev_trauma_disorder.pdf
This article also details how developmental trauma is attachment-based:  “Early patterns of attachment inform the quality of information processing throughout life [11]. Secure infants learn to trust both what they feel and how theyunderstand the world…. (more),” he reports.
But “When caregivers are emotionally absent, inconsistent, frustrating, violent, intrusive, or neglectful, children are liable to become intolerably distressed and unlikely to develop a sense that the external environment is able to provide relief. Thus, children with insecure attachment patterns have trouble relying on others to help them, while unable to regulate their emotional states by themselves. As a result, they experience excessive anxiety, anger and longings to be taken care of. These feelings may become so extreme as to precipitate dissociative states or self-defeating aggression…”
Dr. van der Kolk has been Medical Director of The Trauma Center in Boston for 30 years (www.traumacenter.org).

FN2  Daniel Siegel, MD, et.al, “Trauma, Brain & Relationship: Helping Children Heal,” www.youtube.com/watch?v=jYyEEMlMMb0
Introductory video on Attachment Disorder and how development of the mind-body system can cause trauma. Copies at www.postinstitute.com/dvds.

FN3  Schore, Allan N., PhD, “Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, & Infant Mental Health,” 2001, www.trauma-pages.com/a/schore-2001b.php

FN4A  van der Kolk, Bessel, MD: Video, Yale University, May 10, 2013, “Childhood Trauma, Affect Regulation, and Borderline Personality Disorder,” http://acesconnection.com/video/bessel-van-der-kolk-childhood-trauma-affect-regulation-borderline

FN4B  Cloitre, Marylene, et. al, (NYU Child Study Center, Department of Psychiatry, New York University Medical College,  marylene.cloitre@nyumc.org), “Attachment organization, emotion regulation, and expectations of support in a clinical sample of women with childhood abuse histories,”   Journal of Traumatic Stress, 2008 Jun;21(3):282-9. doi: 10.1002/jts.20339.  Abstract: Despite the consistent documentation of an association between compromised attachment and clinical disorders, there are few empirical studies exploring factors that may mediate this relationship. This study evaluated the potential roles of emotion regulation and social support expectations in linking adult attachment classification and psychiatric impairment in 109 women with a history of childhood abuse and a variety of diagnosed psychiatric disorders. Path analysis confirmed that insecure attachment was associated with psychiatric impairment through the pathways of poor emotion regulation capacities and diminished expectations of support. Results suggest the relevance of attachment theory in understanding the myriad psychiatric outcomes associated with childhood maltreatment and in particular, the focal roles that emotion regulation and interpersonal expectations may play. http://www.ncbi.nlm.nih.gov/pubmed/18553408

FN5   Vincent J. Felitti, MD;  Robert F. Anda, MD, MS;  “The Lifelong Effects of Adverse Childhood Experiences,” Chapter 10 of Chadwick’s “Child Maltreatment,” Sexual Abuse and Psychological Maltreatment, Encyclopedic Vol 2 of 3, STM Learning, Inc., Saint Louis, p.203-215; March, 2014

FN6   Stevens, Jane, “The Adverse Childhood Experience Study” — the largest, most important public health study you never heard of — began in an obesity clinic,”  ACEsTooHigh.com

FN7  Freedman, Alfred M., Kaplan, Harold I., & Sadock, Benjamin J.,  “Comprehensive Textbook of Psychiatry,” 2nd Edition, Williams and Wilkins Co., Baltimore, 1975; 2609 pages.  Now in 9th edition; known since 4th edition as “Kaplan and Sadock’s.”

FN8  Lanius, Ruth A., MD; Vermetten, Eric; Pain, Claire; Editors, “The Impact of Early Life Trauma on  Health and Disease: The Hidden Epidemic,” Cambridge University Press, 2010. “Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician,” American Academy of Pediatrics,  2012 (New York Times 1-7-12), and many more.

FN9  van der Kolk, Bessel, MD, “What Neuroscience Teaches Us About the Treatment of Trauma,” June 6, 2012 webcast, National Institute for the Clinical Application of Behavioral Medicine  (NICABM) : Most of Congress is “dissociated,” van der Kolk told this 2012 globally-televised webcast, or they’d feel the simple human compassion to know that sending youth to war brings back a flood of PTSD suicides. We already knew from Korea and Vietnam that “for every solider that will die on the battlefield, there will be 30 suicides, as is happening right now,” van der Kolk said.  But “society dissociates from the reality of it and then Congress says, ‘Oh, gosh, isn’t that amazing!’  No it’s not amazing, that’s what happens!”
Short promo clip: http://www.nicabm.com/nicabmblog/how-trauma-traps-survivors-in-the-past/
Link to buy video, mp3 audio, transcripts: http://www.nicabm.com/trauma-2012-new/
On Congress, see also http://www.theatlantic.com/politics/archive/2014/06/why-it-matters-that-politicians-have-no-experience-of-poverty/371857/

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45 responses to “Developmental Trauma: What You Can’t See…

  1. Pingback: Who am I? More than your Average Therapist-Jessica Lang, LMFT - Jessica Lang

  2. Hi, Kathy. I’ve read your site off and on for over a year now. I’ve had an addiction since I was 4 years old or so. I’m 34 now. I gave up the addiction last year. I’ve been doing Somatic Experiencing since May and it has helped immensely. But now I have a neurofeedback session next Friday. I’m excited and scared too. I literally live dissociated. Always have. Just didn’t know it. I have three children and one on the way, yet I’m terrified of my children. I pray that these sessions help with the dissociation and fear centers in my brain while the somatic experiencing helps discharge the bodily trauma. God bless you, Kathy

  3. DEAR CATHY,This paper is even more fundamental to how most of us suffer from attachmeny disorders.It is entitled”THE ORIGINS OF HUMAN LOVE AND VIOLENCEhttp://www.violence.de/prescott/pppj/article.html I/ve been a psychiatrist for 58 years,there is always a moral dilemma in PTSD<simple or complex. Everyone deep down knows something was wrong in what they endured,and life,or lives, are spent trying to make it right.Love Andy Ferber MD aka Swami Anand Bodhicitta

  4. I’m so happy to have found this article and its resources. I could cry. It’s so very validating. I’ve been reading, and working for years to shed light on DTD within the adoptee and preemie populations. I was born premature and poly drug addicted in 1990. I was 1lb 8oz, and at least two months premature, then shuffled through three family caregivers before I was legally adopted. I have felt for a long time that this is why I’ve had such self destructive tendencies. (Eating disorders, self harm) Every therapist I’ve ever seen and every article I’ve ever read doesn’t find that your formative years (bring born premature) or adoption or even being born addicted can cause trauma. In fact many articles specifically only pay attention to the fact that the parents are under stress. Epigenetics was a forefront for DTD that I was introduced to, this was after I read “The primal wound” by Nancy Verrier. Which the first piece of literature I came across that acknowledged trauma caused by disrupted bonding…

    • I am SO sorry for your pain, but glad you found my website. Nancy Verrier was one of my first inspirations. What you wrote about “Every therapist I’ve ever seen” is so sad. I had the same problems, that’s why I started my own website. However as you can see from all my blogs, science has now realized that Dr. Verrier and you are correct, and most of the therapists are wrong. They all need re-training. Please read as much as you can on my website. I welcome all your comments. Forgive me that my software problems currently are limiting comments to 1030 characters, so don’t put spaces between paragraphs…Please let me know if you’d like to write a Guest Blog on your experiences?

  5. Click for key update: Neurofeedback Works – Van der Kolk. Trauma expert Bessel van der Kolk, MD posted a webinar 8-9-16 which changes the map. He says Sebern Fisher introduced him to neurofeedback. “She showed me drawings that traumatized kids did (stick figures), how they developed after 20 weeks of neurofeedback (real people), after 40 weeks (an attached group). I was blown away,” he says. “Nothing I know of can do that.”

  6. Pingback: Adult Survivor Developmental Trauma – Chat Live

  7. i formed my own philosophy about this years ago. so glad to see doctors are actually studying it. doing shamanic work for 25 years, especially soul retrievals, i could see and feel not just events but the overall energy. a week ago i journeyed back and saw my twin in utero who died before anyone knew there were twins. my twin was filled with terror and i absorbed that terror. please continue this work. it is SO important.

  8. Thank you all for sharing and spreading the word. Vital stuff!

  9. Pingback: Developmental Trauma: What you Can’t See ...

  10. Are there any attachment disorder healing therapists connected with Kaiser Permante Los Angeles or Orange County?

  11. Hi Kathy, I just now saw this site and wish to say that it feels very validating–thank you for that!
    I am a survivor of sexual abuse by my stepfather beginning after we moved from New Jersey to Maine when I was 7. My mom and dad divorced when I was 3 but even before that, I didn’t see him a lot because he had a gambling addiction. My earliest memory of my mom is at around 1 or 2 years old. I remember climbing onto her lap to use my little hands to wipe her tears. After the divorce, she met a guy who beat her. This was before she met my stepfather who abused me. The guy that beat on her got her pregnant. The baby died a few days after birth; I was 4 or 5. Around then I “got into” a bottle of baby aspirin, was rushed to hospital. Later I was bouncing a ball and a light fixture fell on my head. It required stitches. My mom was NEVER abusive but seems I was the parent a long time!
    Several years ago, I found my therapist after being hospitalized for depression. I work over the phone and via email with her. She is not local and also, I have difficulty going outside due to anxiety. She was the one that I finally dared confide in regarding strange new symptoms such as feeling young, wanting to be held, rocked, having an inexplicable yearning for a soft blanket and to be bottle fed or nursed. I was so ashamed and felt like a freak! She feels it is attachment disorder. She has expertise in this but I have not yet been able to afford to go to where she is. She doesn’t feel it can be done successfully by phone. Do you agree developmental trauma might be a factor even though I had a loving mom present at home? Thanks for a great site! Anxious to get your book!

  12. Pingback: thinking out of the box goes neonatal….. | seeking spirit

  13. I’m interested in attachment disorder/dev trauma therapists in the Portland OR area. A psychiatrist I saw years ago after a suicide attempt asked about my birth. My mother was in labor with me more than a day, could not breastfeed and didn’t want to. My MD said that the release of oxytocin that normally occurs in a woman after giving birth doesn’t always happen.
    When I was 15 months old I was hospitalized for 28 days in two surgeries, sent home in a heavy plaster diaphragm-to-ankle cast and spent weeks in my crib. My mother was not present with me. I was isolated from the family, from meals, from interaction. I could hear them but I could not see them.
    I suffer from developmental trauma. This is is a daily suffering, an injury of the self, an obsessive sadness coupled with dissociation and a deep and irrational fear that grips me every morning and is constant throughout the day. It’s a pain that is so absolute it doesn’t have a physical corollary. It’s not that I hurt “everywhere”. I am Hurt and Fear of Hurt. I don’t know which is worse: blank nothingness without thought or organization – or vagus full alert in which heart and lungs and mind veer wildly and I am paralyzed in a physiological maelstrom I can’t escape most mornings.
    I have researched trauma steadily since the early 80s and I’ve worked in therapy for many years with several providers. In the last couple of years, finally, there is some good literature.
    What I have learned is that kinship – friends, family, community – is the most important asset. Having even one meaningful relationship can make the difference in self perception. Physical and social isolation makes developmental trauma intolerable beyond words. Your article on developmental trauma is very good. I purchased and started reading the Porges’ book.

    • Your story breaks my heart as I have something similar. Developmental trauma is earth-shattering as you describe.
      Your most important statement has been my only salvation: “friends, family, community – is one of the most important assets to a person with this condition. Having even one meaningful relationship can make the difference” YES. Getting with human mammals for “fur” is mission critical.
      I use meditation to find out even what the heck I am feeling (difficult). Once I find out what I’m feeling, I go sit with other human mammals who are safe for me (who don’t want to get anything from me) and tell my feelings, especially my “bad” feelings, and see that they can listen and not make me bad for my feelings. Then my bad feelings about me, start to become good feelings about me. (Check Dr. Allan Schore’s 9-28-14 Oslo speech “The Most Important Years… the right brain and its importance,” on the neuroscience of in utero and neonatal attachment (real meat starts at minute 8) : https://www.youtube.com/watch?v=KW-S4cyEFCc Also: Meditation Can Hold Feelings, But Only Other People Heal Our Pain http://www.huffingtonpost.com/josh-korda/meditation-can-hold-feeli_b_7840596.html
      * What’s new is that we can also add Neurofeedback ( see http://attachmentdisorderhealing.com/neurofeedback/ and/or EMDR (see http://attachmentdisorderhealing.com/emdr-sandra-paulsen-developmental-trauma/
      IF it’s geared to developmental trauma specifically, to our treatment. These are not thinking “head talk.” These are emotional training!
      There are links on my page “find a therapist” to therapists all over the country (some global). Maybe try the neurofeedback finder or the EMDR finder and then look at the profiles of who comes up to see if they have developmental experience? Or call the offices of the developmental experts mentioned (Dan Siegal, Allan Schore) and ask for referrals in your area, or similarly call offices of (Kristin Hall added in comments here): “Other attachment focused-therapists include (1) Dr. Dan Hughes (danielhughes.org) for Dyadic Developmental Psychotherapy, (2) Dr. Phil Shaver (shaver.socialpsychology.org) focus is on attachment in adult relationships.

  14. I live in the Greater Los Angeles area and would like your list of attachment-based therapists in Orange County. Do you know only of one’s in Orange County, or by any chance, do you also know of some in Los Angeles County? Thanks.

    • Please could you tell me a bit about yourself: What is your approximate age? Do you think you have developmental (infant) trauma? Have you had therapy before? Are you a therapist or had any training in psychology? I need to know a little bit about people before I release private info on therapists’ offices, I’m sure you understand.

      • I’m in my early 50’s. Yes, I think I have developmental trauma – I’ve been reading Bessel Van Der Kolk’s ‘The Body Keeps the Score’ and Pete Walker’s (therapist in the San Francisco area) book about Complex PTSD. Yes, I have had therapy before, but none of it has seemed to have helped much. I am not a therapist in training; I had some instruction in Psychology as an undergraduate as apart of my major, but that was many years ago. I look forward to hearing back from you.

        • Thank you. I’ve send the OC list by email. Please when calling say you were referred by Kathy Brous in Orange County who runs the website AttachmentDisorderHealing.com. See new info on LA Attachment-based therapists here: Find an Attachment-based Psychotherapist: http://attachmentdisorderhealing.com/resources/attachment-therapists-directory/

        • Hi MEM. I am in a similar situation to yours. I am 32, live in northern L.A. County (Santa Clarita) and need an attachment-based therapist badly. Were you able to get any referrals or was there a list of attachment therapists in L.A. County? Thank you for any information you can provide. I have read a lot about psychology over the last 10 years and even came out to California from DC seeking help. I was involved with a nonprofit mental health center in the Valley, which had a good theory and insight about attachment and childhood trauma, so I trusted them to a great extent, for about a year but then was essentially cut off from them, since last October. I have some concerns about how they operate and am not sure if that is just my fear and avoidance, or whether my concerns are legit. In any case, I want to try to find another attachment therapist bc I know I have major attachment trauma and need help. I have been hardcore struggling for at least 10 years. Thank you and thank you again Kathy (I left a comment on your “Find a Therapist/Therapist Directory” page earlier today). Peace & love

  15. I am very moved; please, please stick with a therapist. If your current one is not a loving, compassionate attachment-based therapist, find another. See Find an Attachment-based Psychotherapist: http://attachmentdisorderhealing.com/resources/attachment-therapists-directory/ and also “How to Hire a Therapist” http://attachmentdisorderhealing.com/resources/z-under-construction/
    I’m sorry but developmental trauma is likely given an alcoholic mother until age 6; that’s terrifying to an infant & child. Later orphanage and other experiences would compound the fear.
    I have developmental trauma and I too am terrified of my mom tho’ all she did was lock me in a room alone starting at birth. The infant mind reads these kind of experiences as a survival threat; it floods the infant brain with stress chemicals. I also lived “in a constant state of hyper-vigilance and activity driven by enormous amounts of nervous energy” with horrible nightmares.
    Most of all, “inner child” work was terrifying to me; see my autobio: http://attachmentdisorderhealing.com/what-inner-child/
    That’s because any “going within” was completely terrifying to me. It used to be that I couldn’t even meditate without being totally overwhelmed with washes of sheer terror.
    I say “was” because there IS treatment for developmental trauma and it DOES work! But as the title of my book says: “Don’t Try This at Home.” Please do NOT do it yourself. Do it under therapist supervision. Here’s what I did to heal: http://attachmentdisorderhealing.com/featured-topics/healing-body-work/

  16. I am a 52 year old incest survivor from South Africa. My mother was an alcoholic before I was born and abandoned me and my 2 brothers when I was 6. I was raped at 6 and hospitalized due to the damage. I recalled the rape at 30 when I gave birth to my daughter and it was confirmed by the gynecologist. We spent 2 years in an orphanage then my father got custody; he was emotionally disconnected and seldom around. We spent weekends at mom’s and after she passed out drinking my stepfather molested me every night until I was 16.
    Strangely, I am FAR more terrified of my MOTHER than stepfather. I live in a constant state of hyper-vigilance and activity driven by nervous energy and suffer nightmares. I take on a job all out for 6-8 hours without a break then crash.
    Body therapy has helped me. However any ‘delving’ into my ‘inner child’ fills me with total terror. I had some Hypnotherapy 20 years ago, and it took me to such a dark, terrifying place, where my entire body would shake uncontrollably and my teeth chatter…the fear was overwhelming so I stopped.
    I have had a wonderful marriage for over 25 years, but find intimacy to be terrifying. I have ‘associates’ in fact I know many people as I owned a vintage shop for years, but I have no friends other than my husband. I do take meds to prevent and stop constant panic attacks. So, yes, I definitely have PTSD, but the Developmental Trauma is something I gave not read about. I have extreme difficulty forming close relationships. I will speak to my therapist about this. Thank you for a most interesting blog.

  17. I’m glad this article and comments addressed how the lack of an accepted “diagnostic construct” precludes getting treatment paid by insurance. In my testimony before the Vermont Legislative Trauma Commission in 2000 I raised the issue of a childhood incest survivor having to endure 90 days of sexual abuse to meet diagnostic criteria of “PTSD” before being eligible for treatment or legal protection from an abuser.

  18. Thanks to all of you working on child abuse, especially Dr. Felitti and the ACE Study. I want to add an important clarification to one statement above: “in fact there was no basis for any opinion about the prevalence” of any childhood trauma, even of childhood sexual abuse, before the 1995-1998 Adverse Childhood Experiences (ACE) Study, co-director Dr. Vincent J. Felitti, MD, notes… Doctors also have been inhibited by our own ignorance and gaps in training from asking into certain areas of patient history.” But: there are caregivers who understood this long ago. I was first helped to deal with my childhood sexual abuse in 1982 by a psychiatrist, Dr. Roberta Batt in Ithaca, NY. I moved to Madison, WI, in 1984 and began the OASIS Program, which helped people with childhood sexual abuse in their histories. My therapist Lloyd Sinclair had his MSW, as did most OASIS therapists.
    But yes, MDs, especially psychiatrists, have long denied the adverse effects of childhood abuse even when presented with the evidence by patients. See “The Assault on Truth” by Jeffrey Mousaieff Masson re Freud’s cowardly betrayal of his patients. But there have been others who have been listening for decades.

    • Thank you so much and you are right; when I finally found a good attachment-based therapist, he’d known about it for years. Just as Dr. Bessel van der Kolk asked himself in the 1970s: “If only 1% of American women suffer sexual abuse, about 101 women, how come 47 of them are in my office?” (I’m quoting from memory but exact quote is in the blog.) The best doctors have known for a long time. The problem is that most are not trained.

  19. I wondered whether attachment difficulties and subsequent Developmental Trauma Disorder have been studied in micro-premature babies? I gave birth to twin at 24 weeks gestational age; weighing 1lb 7oz and 1lb 9oz respectively. They subsequently spent 4.5 long months in a level 3 NICU, followed by discharge home on continuous oxygen therapy. In addition, the lack of in-home, community mental health supports left me struggling with depression, anxiety, and PTSD. Are my children at a higher risk for developing DTD? Your insight is greatly appreciated! – Christine

    • Severe stress to the mother during pregnancy can cause DTD. Sonograms of babies in utero when carrying mother is smoking show stress to the fetus, as when mother is drinking. Even the most careful mother who imbibes nothing, but is under stress while carrying, for ex with an alcoholic husband, can give birth to babies who become alcoholics because they’re born with an over-stressed nervous system.
      I was an unwanted pregnancy, my mother was nearly borderline, hysterical. When I first heard the above research in 2009 I could feel that I must have been flooded with stress chemicals as a fetus in utero. I have DTD pretty bad.
      Please contact my friend Dr. Joanne Loewy (below), who specializes in treating premature babies to mitigate and heal the stress. She follows my blog and will know what’s been done to heal babies in the situation you describe below.
      Remember: there IS healing! There ARE remediation measures!
      Contact: Dr. Joanne V. Loewy DA, LCAT, MT-BC
      Director, The Louis Armstrong Center for Music & Medicine
      Mount Sinai Beth Israel Hospital
      16th and 1st Avenue, 6 Silver 21, New York, NY 10003
      (212) 420-3484 Fax (212) 420-2726
      Associate Professor Albert Einstein College of Medicine
      Co-Editor-in-Chief, “Music and Medicine”www.sagepub.com/journals/Journal201929 http://www.musicandmedicine.org and http://www.facebook.com/ArmstrongMusicandMedicine

  20. Dear Bob, Thank you! As you see from Dr. vd Kolk’s struggles in my blog, we’ve all had the problem you describe. As Dr. Vincent Felitti always says, all the professions have always assumed there’s really no such thing as child trauma, except in extreme cases (“one percent of women” as van der Kolk waxed angry over).
    But each of us thinks we’re the only one hurting, so we soldier on in silence and nobody ever discusses it. That sure was horrible.

  21. About 15 years back, a resident physician (dual residency in Internal medicine and Psychiatry) had a computer PTSD screening tool at my then Family Physician’s practice, and some of the questions didn’t even come close to some traumatic incidents I’ve had, or were not “framed” to elicit a positive forth-coming reply., but none of them as I recall dealt with the Developmental Traumas or ACEs. Nor were such items on my list of questions when I participated in a Veterans Administration’s PTSD research study of Non-Veterans, but that may have taken place before the CDC/Kaiser ACE study was completed…This article was most helpful, though!

  22. Thanks for the great article. Dr. Marylene Cloitre works on this. I watched the last 5 yrs of Dr. van der Kolk’s annual Boston Trauma Conference on DVD… He is spot on… It’s outrageous the APA doesn’t listen to the Association of State Mental Health Providers; they get the Community Mental Health dollars. There is no drug to treat DTD, but the drugs they give for bipolar, or schizophrenia, etc are just chemical paralytics that society forces on people, rather than get to the bottom of the real problem which usually is DTD. I and many others could have avoided years of stupidity from junk psychiatry if not for pharmaceutical companies steering for profits.

    • I concur with you, “in whole and in part” on this one, Tina!
      Kathy’s paragraph about the APA’s ‘dig” at the CDC/Kaiser-Permanente ACE study, would seem to indicate the APA is in DENIAL, since the World Health Organization has adopted the ACE screening tool, and uses it to assess the health of the world’s children, or at least the developing world’s children! If I am not mistaken, the 2013 WHO survey found the Netherlands’ children the healthiest in the world, …the U.S. 25th, and Canada 26th.

  23. Pingback: Allan Schore: What is the “Self”? | "Don't Try This at Home"

  24. *Is* there a “father of attachment theory”? First I ever heard of attachment parenting was through Dr. Sears, and he was inspired by Jean Liedloff who wrote The Continuum Concept. I think a lot of people were pretty much going in the same direction from the 70s onward. Which makes the experts snubbing this concept even worse, because it’s not just one guy they were ignoring.

  25. Pingback: Music Therapy and Child Trauma | "Don't Try This at Home"

  26. Pingback: +HEALING KID TRAUMA: RHYTHM AND SINGING | Stop the Storm

  27. 🙂 That’s great! They are coming to Pittsburgh in Sept to do a retreat. We are looking fwd to it! Will be looking fwd to your book also. Suggestion: Consider enabling in your settings the option(s) for readers of your blog: “email me when there are new blog posts” AND “email me when there are new comments on this post”.

  28. http://www.howwelove.com? I love Kay and Milan! I did a lot of work with the audios and books of Dr. Henry Cloud and Dr. John Townsend, authors of “Boundaries.” They’re top attachment-based therapists and co-thinkers of Kay and Milan.

  29. I will look at it, thanks! So glad to have found your website.
    Another resource that helped to integrate the C-ptsd/developmental trauma info was marital attachment work through http://www.howwelove.com. Their book is best when using some of the supplemental CDs with it – specifically the ACPT materials. (ACPT stands for “Attachment Core Pattern Therapy”.)

  30. I have experienced some healing because of these concepts too. Thank you for this informative blog.
    You may also be interested in the recent interview Dr. van der Kolk did with Krista Tippett of On Being. You can listen online here: http://www.onbeing.org/program/restoring-the-body-bessel-van-der-kolk-on-yoga-emdr-and-treating-trauma/5801

    • Thank you! I had 3 incompetent therapists who re-traumatized me nearly to suicididality. Then I did research and found healing with an attachment-based therapist who agreed to add somato-sensory body work for the pre-conscious first 36 months trauma. Check my book for what happened: “A New Book

  31. Kathy, Are you familiar with Dr. Daniel Hughes work with Dyadic Developmental Psychotherapy? Interesting stuff I think! Also, there are some women working together on CPP Child-Parent Psychotherapy-I think working to get it down to a science, they have a couple of pages on FB, I’ll invite you.

    • Sorry I hadn’t heard of Dyadic Developmental Psychotherapy but I’m no specialist, just trying to get well. But it looks good in Wikipedia at least. I like like the “playful” idea of creating what Dr. Shonkoff at Harvard calls “serve and return” healing.
      But whether it works with RAD kids, or the criticisms in Wikipedia should be taken seriously, I have no info.

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