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Clinical Significance of a Proposed Developmental Trauma Disorder Diagnosis: Results of an International Survey of Clinicians

Julian D. Ford, PhD; Damion Grasso, PhD; Carolyn Greene, PhD; Joan Levine, MPH; Joseph Spinazzola, PhD; and Bessel van der Kolk, MD

Published: August 15, 2013

Article Abstract

Objective: Maltreatment, family violence, and disruption in primary caregiver attachment in childhood may constitute a developmental form of trauma that places children at risk for multiple psychiatric and medical diagnoses that often are refractory to well-established evidence-based mental health treatments. No integrative diagnosis exists to guide assessment and treatment for these children and adolescents. This study therefore assessed clinicians’ ratings of the clinical utility of a proposed developmental trauma disorder diagnostic framework.

Method: An Internet survey was conducted with an international convenience sample of 472 self-selected medical, mental health, counseling, child welfare, and education professionals. Respondents made quantitative ratings of the clinical significance of developmental trauma disorder, developmental trauma exposure, and symptom items and also posttraumatic stress disorder (PTSD) and other Axis I internalizing and externalizing disorder symptom items for 4 clinical vignettes. Ratings of the discriminability of each developmental trauma disorder item from PTSD, other anxiety disorders, affective disorders, and externalizing behavior disorders, and of each developmental trauma disorder item’s amenability to existing evidence-based treatments for those disorders, also were obtained.

Results: Respondents viewed developmental trauma disorder criteria as (1) comparable in clinical utility to criteria for PTSD and other psychiatric disorders; (2) discriminable from and not fully accounted for by other disorders; and (3) refractory to existing evidence-based psychotherapeutic treatments.

Conclusions: The exposure and symptom criteria proposed for a developmental trauma disorder diagnosis warrant clinical dissemination and scientific field testing to determine their actual clinical utility in treating traumatized children with complex psychiatric presentations.

J Clin Psychiatry 2013;74(8):841-849

Submitted: July 19, 2012; accepted January 17, 2013 (doi:10.4088/JCP.12m08030).

Corresponding author: Julian D. Ford, PhD, University of Connecticut Health Center, Department of Psychiatry MC1410, 263 Farmington Ave, Farmington, CT 06030 (

Volume: 74

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