Developmental trauma disorder: pros and cons of including formal criteria in the psychiatric diagnostic systems

Traumatized individuals are difficult to treat, but clinical experience has shown that they tend to benefit from specific trauma therapy. A main argument against inclusion of formal DTD criteria into existing diagnostic systems is that emphasis on the etiology of the disorder might force current diagnostic systems to deviate from their purely descriptive nature. Furthermore, comorbidities and biological aspects of the disorder may be underdiagnosed using the DTD criteria.Here, we discuss arguments for and against the proposal of DTD criteria and address implications and consequences for the clinical practice.Inclusion of post-traumatic stress disorder (PTSD) in psychiatric diagnostic systems represents an important milestone since a clear connection between traumatic experiences and mental disorders have not been established previously [1-3]. Clinicians in the field of child and adolescent psychiatry and clinical psychology have to face acute traumatized children and victims of different shades and forms of chronic child abuse, maltreatment and neglect.In the clinical setting, the effects of neglect, maltreatment, and abuse are noticeable which has prompted the need for a diagnosis capable of creating the connection between developmental and psychopathological aspects.In children and adolescents, the usefulness of diagnostic criteria of PTSD is limited because the characterization of the condition is based on symptoms in adults. Because most symptoms are subjective and require verbal description by the patient, the diagnosis of PTSD in younger children remains challenging. In the presence of distinct, well-defined traumata and their effects, the diagnosis of PTSD can be readily made; childhood traumatization and neglect tend to be more complex and may entail a multitude of psychosocial risk factors. Therefore, various proposals for diagnostic criteria have been published which include developmental psychology factors [4-7].Most traumatic experiences in children and