Understanding Interpersonal Trauma in Children: Why We Need a Developmentally Appropriate Trauma Diagnosis

• Published in: American journal of orthopsychiatry 2012-04, Vol.82 (2), p.187-200
• Main Authors: D'Andrea, Wendy, Ford, Julian, Stolbach, Bradley, Spinazzola, Joseph, van der Kolk, Bessel A.
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Attention deficit disorders. Hyperactivity; attention‐deficit hyperactivity disorder; Biological and medical sciences; Child; Child Abuse - psychology; Child Abuse - statistics & numerical data; child abuse and neglect; Child clinical studies; Child health; childhood victimization; Children; Children & youth; Cognition & reasoning; Comorbidity; Consciousness; Crime Victims - psychology; Diagnosis; Distress; Human; Humans; Interpersonal Influences; Interpersonal Relations; interpersonal trauma; Literature Reviews; Medical sciences; Medical treatment; Mental Disorders; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Mental health care; Mental stress; Pediatrics; Post traumatic stress disorder; Posttraumatic Stress Disorder; Prevalence; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Social psychiatry. Ethnopsychiatry; Symptoms; Trauma; Treatment Outcomes; United States - epidemiology; Victimization; Victimology; Victims
• ISSN: 0002-9432; 1939-0025
• DOI: 10.1111/j.1939-0025.2012.01154.x

Childhood exposure to victimization is prevalent and has been shown to contribute to significant immediate and long-term psychological distress and functional impairment. Children exposed to interpersonal victimization often meet criteria for psychiatric disorders other than posttraumatic stress disorder (PTSD). Therefore, this article summarizes research that suggests directions for broadening current diagnostic conceptualizations for victimized children, focusing on findings regarding victimization, the prevalence of a variety of psychiatric symptoms related to affect and behavior dysregulation, disturbances of consciousness and cognition, alterations in attribution and schema, and interpersonal impairment. A wide range of symptoms is common in victimized children. As a result, in the current psychiatric nosology, multiple comorbid diagnoses are necessary-but not necessarily accurate-to describe many victimized children, potentially leading to both under-treatment and over-treatment. Related findings regarding biological correlates of childhood victimization and the treatment outcome literature are also reviewed. Recommendations for future research aimed at enhancing diagnosis and treatment of victimized children are provided.