Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis.

D'Andrea, Wendy; Ford, Julian; Stolbach, Bradley; Spinazzola, Joseph; van der Kolk, Bessel A.

doi:10.1111/j.1939-0025.2012.01154.x

Cited by 703Child Abuse and TraumaPosttraumatic Stress Disorder ResearchChild and Adolescent Psychosocial and Emotional Development

Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis.

D'Andrea, Wendy, Ford, Julian, Stolbach, Bradley, Spinazzola, Joseph, van der Kolk, Bessel A.·2012·American Journal of Orthopsychiatry

DOI 10.1111/j.1939-0025.2012.01154.x

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Abstract

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 undertreatment and overtreatment. 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.

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Chronic interpersonal trauma has been associated with high-risk behaviors that appear to be reactions to underlying despair and unspeakable terror.
“Chronic interpersonal trauma has been associated with high-risk behaviors that appear to be reactions to underlying despair and unspeakable terror (Cook et al., 2005; D' Andrea et al., 2012).”
From Development of a Differential Assessment Guide to Improve Engagement with Youths & Families Living with Chronic Trauma (2023) · cites this paper as D' Andrea et al., 2012
The effects of neglect, abuse, impaired or disengaged caregivers and family violence on development have been well-documented for young children.
“The effects of neglect, abuse, impaired or disengaged caregivers and family violence on development have been well-documented for young children (Briere et al., 2017; D'Andrea et al., 2012; Perry, 2002; Puetz et al., 2020; Spinazzola et al., 2018).”
From Development of a Differential Assessment Guide to Improve Engagement with Youths & Families Living with Chronic Trauma (2023) · cites this paper as D'Andrea et al., 2012
DTD includes symptoms that closely parallel most of the symptoms of adult BPD and cPTSD/DSO as well as symptoms that are developmentally specific to childhood and related to children's adaptations to traumatic victimization and disrupted attachment bonding that could be precursors of adult cPTSD or BPD.
“Thus, DTD includes symptoms that closely parallel most of the symptoms of adult BPD and cPTSD/DSO as well as symptoms that are developmentally specific to childhood and related to children’s adaptations to traumatic victimization and disrupted attachment bonding [25] that could be precursors of adult cPTSD or BPD.”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [25]
Developmental trauma disorder (DTD) was formulated as a pediatric variant of cPTSD based on research on childhood sequelae of maltreatment and poly-victimization, an international survey of clinicians, and a field trial study with children.
“Based on research on the childhood sequelae of maltreatment and poly-victimization [25] on an international survey of clinicians [45], and results from a field trial study with both clinical and non-clinical samples of children [160, 174], developmental trauma disorder (DTD) was formulated as a pediatric variant of cPTSD.”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [25]
DTD addresses the core domains of both cPTSD and BPD, potentially serving as a precursor to either disorder.
“DTD addresses the core domains of both cPTSD and BPD, potentially serving as a precursor to either disorder.”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [25]

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Segmented Hippocampal Volume in Children and Adolescents with Posttraumatic Stress Disorder
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“Studies by Cicchetti and colleagues (Cicchetti & Rogosch, 2007; Maughan & Cicchetti, 2002; Rogosch & Cicchetti, 2005; Shields & Cicchetti, 2001), as well as other investigators (Cloitre, 2005; Noll, Trickett, Harris, & Putnam, 2009; Pollak, Messner, Kistler, & Cohn, 2009), have been instrumental in…”
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Increased prevalence of electrophysiological abnormalities in children with psychological, physical, and sexual abuse
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Cortisol, Dehydroepiandrosterone, and Estradiol Measured Over 24 Hours in Women With Childhood Sexual Abuse-Related Posttraumatic Stress Disorder
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Perceived neighborhood disorder, community cohesion, and PTSD symptoms among low-income African Americans in an urban health setting.
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Psychological trauma and PTSD symptoms as predictors of substance dependence treatment outcomes.
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Caregiver traumatization adversely impacts young children's mental representations on the MacArthur Story Stem Battery
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Does Out-of-Home Placement Mediate the Relationship Between Child Maltreatment and Adult Criminality?
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In their own words: Trauma and substance abuse in the lives of formerly homeless women with serious mental illness.
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Social perspective-taking skills in maltreated children and adolescents.
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Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy
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AOne-Year Open-Label Trial of Risperidone Augmentation in Lithium Nonresponder Youth with Preschool-Onset Bipolar Disorder
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Complex Trauma Among Psychiatrically Impaired Children
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The association between PTSD symptoms and salivary cortisol in youth: The role of time since the trauma
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The Economic Burden of Hospitalizations Associated With Child Abuse and Neglect
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Is tonic immobility the core sign among conventional peritraumatic signs and symptoms listed for PTSD?
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Cognitive and emotional differences in young maltreated children: A translational application of dynamic skill theory
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Risky Behaviors and Depression in Conjunction With—or in the Absence of—Lifetime History of PTSD Among Sexually Abused Adolescents
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Morphologic Alterations in the Corpus Callosum in Abuse-Related Posttraumatic Stress Disorder
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Child Physical Abuse and Self-Perceived Social Isolation Among Adolescents
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NEUROBEHAVIORAL SEQUELAE OF CHILD SEXUAL ABUSE
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Dissociation predicts later attention problems in sexually abused children
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Variations in Behavior Problems of Preschoolers Exposed to Domestic Violence: The Role of Mothers’ Attunement to Children’s Emotional Experiences
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Genotype and Childhood Sexual Trauma Moderate Neurocognitive Performance: A Possible Role for Brain-Derived Neurotrophic Factor and Apolipoprotein E Variants
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Treatment Processes and Outcomes Among Adolescents With a History of Abuse Who Are in Drug Treatment
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Prevalence and correlates of physical abuse in Hong Kong Chinese adolescents: a population-based approach
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The Relationship Between PTSD Symptoms and Attention Problems in Children Exposed to the Bosnian War
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Child Abuse and Aggression Among Seriously Emotionally Disturbed Children
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Attributions and Coping in Sexually Abused Adolescents Referred for Group Treatment
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Post-Treatment Outcomes Among Adjudicated Adolescent Males and Females in Modified Therapeutic Community Treatment
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A Child Trauma Treatment Pilot Study
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ADHD and posttraumatic stress disorder
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The relationship between executive attention and dissociation in children
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The Silent Epidemic of Neurodevelopmental Injuries
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Motivation-Adaptive Skills-Trauma Resolution (MASTR) Therapy for Adolescents with Conduct Problems
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Object Relations and Interpersonal Problems in Sexually Abused Female Patients: An Empirical Study With the SCORS and the IIP
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A Preliminary Study of a Cartoon Measure for Children's Reactions to Chronic Trauma
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Mental Health Care in the African-American Community.
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Adult Attention Deficit Hyperactivity Disorder, the Family, and Child Maltreatment
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Dissociative Experiences in Children with Abuse Histories: A Replication in Puerto Rico
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Assessment of the sequelae of complex trauma: Evidence-based measures.
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Trauma-related predictors of deontic reasoning: A pilot study in a community sample of children
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Factors Related to Outcome in a School-based Intensive Mental Health Program: An Examination of Nonresponders
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Mental Health Care in the African-American Community
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Behavioral competence of maltreated children in child care
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Behavioral and Emotional Characteristics of Abused Children
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The Traumatic Impact of Growing up in Community Violence: How that Impact Compares to the Impact on Children Growing up in War-Torn Countries.
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Commentary: The language of diagnosis – reflections on Rutter (2011)
Taylor, E. A. (2011) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2011.02383.x · Cited by 2 · see citing works
Poverty, Special Education, and ADHD
Gibson, P. A. (2013) · Routledge eBooks · doi:10.4324/9780203050972-19 · Cited by 2 · see citing works

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Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities
Dvir, Y., Ford, J. D., Hill, M., & Frazier, J. A. (2014) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000014 · Cited by 698 · see citing works
Self-citation
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Authors: D'Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van der Kolk, B. A.
Affiliations: The New School (US)
La Rabida Children's Hospital (US)
Justice Resource Institute (US)
ORCID: D'Andrea, Wendy
Venue: American Journal of Orthopsychiatry
Publisher: American Psychological Association (APA)
Published: 2012
Volume: 82
Issue: 2
Pages: 187-200
ISSN: 0002-9432 (ISSN-L)
1939-0025
DOI: 10.1111/j.1939-0025.2012.01154.x
OpenAlex: W2114620191
Cited by: 703
References: 173
Citations by year: 2026: 39 · 2025: 41 · 2024: 36 · 2023: 58 · 2022: 45 · 2021: 84 · 2020: 45 · 2019: 60 · 2018: 52 · 2017: 62 · 2016: 63 · 2015: 47 · 2014: 29 · 2013: 37 · 2012: 3
FWCI: 5.39
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Orthopsychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: Affective Neuroscience Foundation
Topics: Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords: childhood trauma, interpersonal victimization, trauma diagnosis, psychiatric comorbidity, emotional dysregulation, behavioral dysregulation, cognitive disorders, post-traumatic stress disorder, treatment outcomes
MeSH terms: Mental Disorders, Child, Child Abuse, Humans, Interpersonal Relations, United States, Comorbidity, Prevalence, Crime Victims

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Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis.

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