Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach

Figures & data

Table 1. Probable DSM-IV psychiatric disorders, and symptoms of PTSD and DTD.

Psychiatric disorders	N (%)
PTSD only	86 (17.0)
DTD only	72 (14.2)
Comorbid PTSD and DTD	90 (17.8)
Depression	299 (59.0)
Bipolar disorder	84 (16.6)
Psychosis	63 (12.4)
Panic disorder	51 (10.1)
Separation anxiety disorder	216 (42.6)
Phobia	113 (22.3)
Generalized anxiety disorder	270 (53.3)
Attention deficient hyperactivity disorder	283 (55.8)
Oppositional defiant disorder	249 (49.1)
Conduct disorder	137 (27.0)
Obsessive compulsive disorder	29 (18.2)
Any internalizing disorder	438 (86.4)
Any externalizing disorder	346 (68.2)
PTSD symptoms	N (%)	DTD symptoms	N (%)
PTSD B1	194 (38.3)	DTD B1	335 (66.1)
PTSD B2	161 (31.8)	DTD B2	169 (33.3)
PTSD B3	197 (38.9)	DTD B3	95 (18.7)
PTSD B4	191 (37.7)	DTD B4	149 (29.4)
PTSD B5	161 (31.8)	DTD C1	210 (41.4)
PTSD C1	229 (45.2)	DTD C2	44 (8.7)
PTSD C2	180 (35.5)	DTD C3	217 (42.8)
PTSD C3	161 (31.8)	DTD C4	46 (9.1)
PTSD C4	138 (27.2)	DTD C5	207 (40.8)
PTSD C5	184 (36.3)	DTD D1	134 (26.4)
PTSD C6	125 (24.7)	DTD D2	140 (27.6)
PTSD C7	83 (16.4)	DTD D3	135 (26.6)
PTSD D1	197 (38.9)	DTD D4	124 (24.5)
PTSD D2	258 (50.9)	DTD D5	77 (15.2)
PTSD D3	220 (43.4)	DTD D6	119 (23.5)
PTSD D4	179 (35.3)
PTSD D5	152 (30.0)

Note: PTSD = Posttraumatic stress Disorder, DTD = Developmental Trauma Disorder

Table 2. Fit indices for the latent class models with one to six classes.

Number of classes	LMR (p-value)	Entropy	AIC	BIC	SSABIC	BLRT (p-value)
1	–	–	19,346.385	19,481.697	19,380.126	–
2	3043.219 (<.001)	.937	16,354.36	16,629.213	16,422.895	–9641.192 (<.001)
3	726.082 (<.001)	.926	15,690.746	16,105.14	15,794.077	–8112.18 (<.001)
4	398.264 (<.001)	.93	15,356.544	15,910.479	15,494.67	–7747.373 (<.001)
5	208.349 (.56)	.909	15,213.211	15,906.687	15,386.132	–7547.272 (<.001)
6	216.04 (.21)	.904	15,062.00	15,895.016	15,269.715	–7442.546 (<.001)

Note. LMR = Lo–Mendell–Rubin likelihood ratio test, AIC = Akaike information criterion, BIC = Bayesian information criterion, SSABIC = Sample size adjusted Bayesian information criterion.

Figure 1. Profile plot from latent class analysis of PTSD and DTD symptoms.

Table 3. Distribution of gender and race across the four latent classes.

Demographics	DTD + PTSD (C1)	Predominantly PTSD (C2)	Predominantly DTD (C3)	Minimal symptoms (C4)	X^2
	N/Standardized residuals
Female	80 (.8)	78 (.3)	15 (–2.2)	73 (.2)	10.906*
Male	70 (–.8)	78 (–.3)	39 (2.1)	74 (–.2)
White	71 (–.8)	92 (1.2)	31 (.6)	68 (–.9)	6.691
Non-White	79 (.8)	64 (–1.3)	23 (–.6)	78 (.9)
Black	41 (1.1)	27 (–1.6)	14 (.4)	36 (.3)	4.96
Non-Black	107 (–.6)	128 (.9)	40 (–.2)	109 (–.2)
Hispanic	17 (–.6)	24 (.7)	2 (–1.9)	24 (1.1)	6.69
Non-Hispanic	131 (.2)	131 (–.3)	52 (.8)	121 (–.4)

Note. Bold font = trauma type over-represented (standardized residual ≥ 2.0) or under-represented (standardized residual ≤ –2.0).

*p < .05.

Table 4. Distribution of trauma/adversity types across the four latent classes.

Trauma/\ Adversity types	DTD + PTSD (C1) N = 150	pPTSD (C2) N = 156	pDTD (C3) N = 54	Minimal symptoms (C4) N = 147	X^2(3)
	N/Standardized residuals
Physical violence	36 (1.6)	30 (.7)	29 (.3)	18 (–.6)	20.415***
Family violence	35 (1.8)	29 (.8)	23 (–.6)	21 (.2)	20.661***
Sexual trauma	16 (1.8)	11 (.4)	12 (.5)	4 (–1.4)	10.674*
Community violence	22 (.6)	22 (.9)	19 (–.1)	18 (.8)	11.38*
Traumatic loss	39 (1.4)	38 (1.4)	28 (–.6)	24 (.0)	26.67***
Non-interpersonal trauma	115 (.3)	66 (.1)	19 (.5)	54 (–.5)	9.297
Emotional abuse	24 (2.6)	20 (1.7)	12 (–.6)	6 (–1.5)	26.916***
Neglect	34 (2.6)	26 (1.1)	19 (–.6)	13 (–.9)	28.016***
Caregiver impairment	34 (1.6)	32 (1.5)	24 (–.6)	20 (.1)	25.471***
Poly-victimization	13 (1.8)	12 (1.5)	8 (.0)	3 (–1.3)	15.69**
		Mean (SD)			F(3, 502)
Cumulative interpersonal trauma/adversity	4.29 (2.41)	3.75 (2.24)	3.70 (2.40)	3.46 (2.32)	3.204* C1 > C4

Note. pPTSD = Predominantly PTSD, pDTD = Predominantly DTD.

Bold font = trauma/adversity type over-represented (standardized residual ≥ 2.0).

*p < .05, **p < .01, ***p < .001.

For pairwise comparisons, Bonferroni's correct term was applied (α = 0.05/6 = .01).

Table 5. Latent class differences and comparisons across child psychiatric disorders.

Psychiatric disorders	DTD + PTSD (C1) N = 150	pPTSD (C2) N = 156	pDTD (C3) N = 54	Minimal symptoms (C4) N = 150	X^2(3)
	N (Standardized residuals)
1 + internal disorder^a	149 (1.7)	139 (.3)	47 (.0)	103 (–2.0)	52.52***
1 + external disorder	129 (2.6)	110 (.3)	47 (1.7)	60 (–4.0)	82.02**
	Mean (SD)				F(3, 503)
Number of diagnoses^a	5.59 (2.13)	3.42 (2.15)	4.02 (2.02)	1.67 (1.86)	91.93*** C1 > C2, C3 > C4
Diagnosis	N (Standardized residuals)				X^2(3)
PTSD	70 (2.5)	36 (–1.9)	24 (–2.0)	44 (–1.0)	17.32***
DTD	59 (1.6)	36 (–1.9)	24 (1.7)	42 (–.7)	14.10**
Depression	131 (4.5)	87 (–.5)	40 (1.4)	41 (–4.9)	114.31***
Bipolar disorder	44 (3.8)	26 (.0)	8 (1–.3)	6 (–3.7)	34.38***
Psychosis	34 (13.6)	18 (–.3)	6 (–.3)	5 (–3.1)	25.66***
Panic disorder	30 (3.8)	14 (–.4)	4 (–.6)	93 (–3.1)	27.45***
SAD	112 (6.0)	56 (–1.3)	21 (–.4)	27 (–4.5)	101.55***
Phobia	54 (3.6)	24 (–1.8)	10 (–.6)	25 (–1.4)	23.39***
GAD	125 (5.0)	78 (–.6)	28 (–.1)	39 (–4.4)	97.393***
ADHD	104 (2.2)	89 (.2)	38 (1.4)	52 (–3.3)	40.76***
ODD	105 (3.7)	70 (–.8)	41 (2.8)	33 (–4.6)	84.66***
CD	64 (3.7)	38 (–.6)	21 (1.7)	14 (–4.1)	45.86***
OCD	14 (.8)	9 (–.9)	5 (.4)	11 (–.1)	1.68

Note. PTSD = DSM-IV TR Posttraumatic stress disorder, DTD = Developmental trauma disorder, SAD = Separation anxiety disorder, GAD = Generalized anxiety disorder, ADHD = Attention deficit hyperactivity disorder, ODD = Oppositional defiant disorder, CD = Conduct disorder, OCD = Obsessive compulsive disorder, pPTSD = Predominantly PTSD, pDTD = Predominantly DTD.

Bold font = trauma type over-represented (standardized residual ≥ 2.0) or under-represented (standardized residual ≤ –2.0).

For pairwise comparisons, Bonferroni's correct term was applied (α = 0.05/6 = .01).

^a Comorbidity results do not include the PTSD or DTD diagnoses because the latent classes were based on their symptoms

*p < .05. **p < .01. ***p < .001.

Table 6. Latent class differences on PTSD symptom count scores.

Total scores	DTD + PTSD (C1)	pPTSD (C2)	pDTD (C3)	Minimal symptoms (C4)	F(3, 503)	Class comparison
	Mean (SD)
PTSD total	11.79 (2.94)	7.79 (3.13)	1.35 (1.79)	.42 (.89)	610.237***	C1 > C2 > C3, C4
Reexperiencing	3.67 (1.25)	2.52 (1.51)	2.479 (.157)	.036 (.036)	292.90***	C1 > C2 > C3, C4
Avoidance	4.36 (1.49)	2.74 (1.60)	.26 (.48)	.13 (.44)	344.764***	C1 > C2 > C3, C4
Hyperarousal	3.75 (1.11)	2.53 (1.20)	.65 (.91)	.17 (.43)	376.762***	C1 > C2 > C3, C4
PTSD impairment	2.09 (1.09)	1.26 (1.19)	.15 (.49)	.03 (.22)	147.972***	C1 > C2 > C3, C4

Note. PTSD = DSM-IV TR Posttraumatic stress disorder, pPTSD = Predominantly PTSD, pDTD = Predominantly DTD. Bonferroni's correct term was applied (α = 0.05/30 = .002).

***p < .001.

Data availability statement

Per the conditions of Human Subjects Research (IRB) approval, encrypted study data are available upon request from the first author, [email protected].