Comorbidity of developmental trauma disorder (DTD) and post-traumatic stress disorder: findings from the DTD field trial

Figures & data

Table 1. Developmental trauma disorder (DTD) criteria.

Criterion A: lifetime contemporaneous exposure to both types of developmental trauma A1: interpersonal victimization: victim of or witness to physical or sexual assault or abuse, or witness to domestic/adult intimate partner violence; A2: primary caregiver attachment disruption: prolonged separation from or neglect or verbal/emotional abuse by a primary caregiver. Criterion B (current emotion or somatic dysregulation, 4 items; 3 required for DTD) B1: Emotion dysregulation (either B1.a. extreme negative affect states; or B1.b. impaired recovery from negative affect states) B2: Somatic dysregulation (either B2.a. aversion to touch; or B2.b. aversion to sounds; or B2.c. somatic distress/illness that cannot be medically explained/resolved) B3: Impaired access to emotion or somatic feelings (either B3.a. absence of emotion; or B3.b. physical anaesthesia that cannot be medically explained/resolved) B4: Impaired Emotion or Somatic Verbal Mediation/Expression (either B4.a. alexithymia; or B4.b. impaired ability to recognize/express somatic feelings/states) Criterion C (current attentional or behavioural dysregulation, 5 items; 2 required for DTD) C1: Attention bias towards or away from threat (either C1.a. threat-related rumination; or C1.b. hyper- or hypo-vigilance to actual or potential danger) C2: Impaired self-protection (either C2.a. extreme risk-taking or recklessness; or, C2.b. intentional provocation of conflict or violence) C3: Maladaptive self-soothing C4: Non-suicidal self-injury C5: Impaired ability to initiate or sustain goal-directed behaviour Criterion D (current relational- or self-dysregulation, 6 items; 2 required for DTD) D1: Self-loathing, including self viewed as irreparably damaged and defective D2: Attachment insecurity and disorganization (either D2.a. parentified over-protection of caregivers; or D2.b. difficulty tolerating reunion following separation from primary caregiver(s)) D3: Betrayal-based relational schemas (either D3.a. expectation of betrayal; or D3.b. oppositional-defiance based on expectation of coercion or exploitation) D4: Reactive verbal or physical aggression (including proactive instrumental aggression that is motivated primarily by preventing/responding to harm/injury) D5: Impaired psychological boundaries (either D.5a. promiscuous enmeshment; or D5.b. craving for reassurance) D6: Impaired interpersonal empathy (either D6.a. lacks empathy for, or intolerant of, others’ distress; or D6.b. excessive responsiveness to the distress of others

Table 2. Unadjusted relationship of developmental trauma disorder (DTD) and post-traumatic stress disorder (PTSD) with probable psychiatric diagnoses.

	DTD	PTSD
Comorbid diagnosis	OR (95% CI)	OR (95% CI)
Major depression	3.30 (1.86–5.87)	3.08 (1.66–5.71)
Bipolar disorder	2.67 (1.36–5.23)	2.56 (1.29–5.05)
Psychosis	3.55 (1.71–7.35)	3.15 (1.53–6.46)
Panic disorder	3.75 (1.52–5.43)	2.01 (0.83–4.83)
Separation anxiety disorder	3.81 (2.18–6.65)	2.37 (1.34–4.19)
Phobia	1.94 (1.02–3.66)	3.03 (1.58–5.82)
Eating disorder	1.32 (0.29–6.04)	1.85 (0.40–8.50)
Substance use disorder	1.53 (0.50–4.72)	1.55 (0.49–4.93)
Generalized anxiety disorder	3.30 (1.89–5.75)	2.79 (1.55–5.02)
ADHD	3.48 (1.92–6.30)	1.33 (0.75–1.38)
Oppositional defiant disorder	3.30 (1.89–5.75)	1.50 (0.86–2.64)
Conduct disorder	2.94 (1.66–5.22)	1.74 (0.96–3.15)
DSM-5 dysregulation disorder	2.65 (1.08–6.54)	3.35 (1.33–8.41)

ADHD, attention-deficit hyperactivity disorder; DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; OR, odds ratio; CI, confidence interval.

p < .05 indicated in bold.

Table 3. Multivariate logistic regression analyses.

							95% CI
	β	SE	Wald F	df	p	OR	Lower	Upper
Outcome variable: PTSD
DTD	.892	.351	6.457	1	.011	2.441	1.226	4.858
Major depression	.733	.372	3.884	1	.049	2.082	1.004	4.318
Bipolar disorder	.314	.432	0.531	1	.466	1.422	0.618	3.192
Psychosis	.540	.435	1.341	1	.247	1.730	0.732	4.091
Panic disorder	−.315	.540	0.340	1	.560	1.776	0.616	5.124
Separation anxiety disorder	−.057	.376	0.023	1	.880	2.132	1.071	4.246
Phobia	.679	.412	3.015	1	.351	0.681	0.916	4.242
Generalized anxiety disorder	.908	.382	5.645	1	.018	2.479	1.172	5.243
ADHD	−.508	.377	1.601	1	.074	2.116	0.274	1.322
Oppositional defiant disorder	−.144	.367	0.127	1	.228	1.555	0.393	1.909
Conduct disorder	−.121	.373	0.092	1	.547	1.252	0.406	1.935
DSM-5 dysregulation disorder	.644	.465	1.918	1	.281	1.905	0.765	4.470
Outcome variable: DTD
PTSD	.888	.350	6.442	1	.01	2.430	1.224	4.825
Major depression	.235	.361	0.421	1	.515	1.265	0.624	2.555
Bipolar disorder	.352	.425	0.687	1	.407	1.422	0.618	3.270
Psychosis	.548	.439	1.560	1	.212	1.730	0.732	4.091
Panic disorder	.574	.541	1.130	1	.288	1.776	0.616	5.124
Separation anxiety disorder	.757	.351	4.643	1	.031	2.132	1.071	4.246
Phobia	−.385	.412	0.871	1	.351	0.681	0.303	1.527
Generalized anxiety disorder	.209	.365	0.329	1	.566	1.233	0.603	2.519
ADHD	.750	.377	3.950	1	.047	2.116	1.010	4.433
Oppositional defiant disorder	.442	.367	1.451	1	.228	1.555	0.758	3.190
Conduct disorder	.225	.373	0.363	1	.547	1.252	0.603	2.600
DSM-5 dysregulation disorder	.509	.472	1.160	1	.281	1.653	0.659	4.195

All disorders other than post-traumatic stress disorder (PTSD) and developmental trauma disorder (DTD) are probable diagnoses based on Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) screeners.

ADHD, attention deficit hyperactivity disorder; DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; OR, odds ratio; CI, confidence interval.

p < .05 indicated in bold.