Psychiatric comorbidity of developmental trauma disorder and posttraumatic Stress disorder: findings from the DTD field trial replication (DTDFT-R)

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; 1 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) C 2: Impaired self-protection (either C2.a. extreme risk-taking or recklessness; or, C2.b. intentional provocation of conflict or violence) C 3: 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, 5 items; 2 required for DTD) D1: Self-loathing, including view of self as irreparably damaged and defective D 2: Attachment insecurity and disorganization (either D2.a. parentified over-protection of caregivers; or D2.b. difficulty tolerating reunion following separation from primary caregiver(s)) D 3: 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. Demographic correlates of DTD, PTSD, and positive screens for probable child psychiatric disorders

Variable	DTD	PTSD	Depression	Bipolar Disorder	Psychosis	Panic Disorder	SAD
Full Sample	27%	39%	62%	15%	9.5%	10%	44.5%
Age (Pre-teen)	26%	36%	53*%	12%	7.5%	6.5%*	49%
Age (Teen)	29%	43%	73%*	19%	12%	15%*	39%
Gender (Female)	25%	44%	59.5%	20%	11%	12%	44.5%
Gender (Male)	30%	36%	55%	11%	8%	8.5%	45%
Ethnicity (Black, Latino/Hispanic)	24%	40%	57%	16%	13%	11%	47%
Ethnicity (White)	32%	40%	65%	15%	8%	10%	44%
Non-Birth Family	31%	43.5%	64%	18.5%*	11%	11%	47.5%
Birth Family	21%	31.5%	59%	8.5%*	6.5%	8.5%	39%
Variable	Phobia	OCD	Eating Disorder	ADHD	ODD	Conduct Disorder	SI
Full Sample	23.5%	10%	5.5%	54%	50%	24%	26.5%
Age (Pre-teen)	26%	4.5%*	1%	48%	52%	22%	21.5%*
Age (Teen)	21%	16.5%*	11%	59%	48%	26%	33%*
Gender (Female)	24%	10%	6%	44%*	43%*	24%	27%
Gender (Male)	18%	10%	5%	62%*	57%*	210%	25%
Ethnicity (Black, Latino/Hispanic)	21.5%	10%	5%	53%	43%	22.5%	21.5%
Ethnicity (White)	25%	10%	6%	54.5%	55%	24.5%	29%
Non-Birth Family	24%	9%	5.5%	60%*	55%*	28.5%*	27%
Birth Family	23%	12%	5.5%	39%*	40%*	15%*	26%

DTD = Developmental Trauma Disorder; PTSD = Posttraumatic Stress Disorder; SAD = Separation Anxiety Disorder; OCD = Obsessive Compulsive Disorder; SUD = Substance Use Disorder; ADHD = attention deficit hyperactivity disorder; ODD = oppositional defiant disorder; SI = Suicidality. * p < .05.

Table 3. Unadjusted relationship of DTD and PTSD with probable psychiatric diagnoses

	DTD	PTSD
Comorbid Diagnosis	OR [95% CI]
Major Depression	9.05 [4.03–19.13]	4.86 [2.72–8.71]
Bipolar Disorder	4.80 [2.39–5.23]	4.71 [2.28–9.73]
Psychosis	3.28 [1.44–7.48]	3.94 [1.65–9.44]
Panic Disorder	3.23 [1.45–7.17]	2.23 [1.01–4.92]
Separation Anxiety Disorder	5.25 [3.01–9.18]	5.19 [3.06–8.80]
Phobia	3.29 [1.84–5.89]	2.19 [1.09–3.37]
Eating Disorder	1.06 [0.35–3.20]	2.42 [0.84–7.00]
Obsessive Compulsive Disorder	2.99 [1.33–6.70]	1.75 [0.79–3.88]
Attention Deficit Hyperactivity Disorder	5.09 [2.83–9.15]	2.63 [1.58–4.37]
Oppositional Defiant disorder	9.00 [4.78–16.96]	3.00 [1.81–5.00]
Conduct Disorder	4.12 [2.30–7.40]	2.17 [1.23–382]
Suicidal Ideation	4.04 [2.29–7.14]	4.36 [2.46–7.72]

OR = Odds Ratio; CI = Confidence Interval; p < .05 indicated in bold format.

Table 4. Multivariate logistic regression analyses

Outcome: PTSD	Beta	S.E.	Wald F	df	p	OR	95%	CI
Age	.088	.060	2.129	1	.145	1.092	.970	1.229
Gender	−.621	.331	3.523	1	.061	.537	.281	1.028
White	−.175	.328	.286	1	.593	.839	.442	1.595
Intact Family	−.291	.342	.727	1	.394	.747	.383	1.460
Depression	.689	.395	3.035	1	.081	1.992	.917	4.323
Bipolar Disorder	.595	.467	1.626	1	.202	1.813	.727	4.525
Psychosis	.597	.562	1.127	1	.288	1.816	.603	5.465
Panic Disorder	−.699	.545	1.649	1	.199	.497	.171	1.445
Separation Anxiety	1.320	.339	15.115	1	.000	3.742	1.924	7.279
Phobia	−.303	.385	.618	1	.432	.739	.347	1.572
ADHD	.071	.378	.035	1	.852	1.073	.511	2.254
ODD	.293	.394	.553	1	.457	1.340	.620	2.899
Conduct disorder	−.187	.397	.223	1	.637	.829	.381	1.804
OCD	−.261	.537	.237	1	.626	.770	.269	2.205
Eating Disorder	.821	.665	1.524	1	.217	2.273	.617	8.370
DTD	1.340	.379	12.470	1	.000	3.818	1.815	8.033
Outcome: DTD	Beta	S.E.	Wald F	df	p	OR	95%	CI
Age	.033	.070	.218	1	.641	1.033	.900	1.186
Gender	.403	.383	1.111	1	.292	1.497	.707	3.168
White	.477	.393	1.472	1	.225	1.612	.745	3.484
Intact Family	−.038	.390	.009	1	.923	.963	.448	2.070
Depression	1.056	.516	4.189	1	.041	2.875	1.046	7.902
Bipolar Disorder	.343	.495	.481	1	.488	1.410	.534	3.720
Psychosis	−.078	.624	.016	1	.901	.925	.273	3.141
Panic Disorder	.837	.590	2.011	1	.156	2.310	.726	7.346
Separation Anxiety	.835	.395	4.477	1	.034	2.305	1.063	4.997
Phobia	.674	.411	2.691	1	.101	1.963	.877	4.394
ADHD	.425	.424	1.005	1	.316	1.529	.666	3.509
ODD	1.245	.444	7.861	1	.005	3.473	1.455	8.293
Conduct disorder	.649	.419	2.403	1	.121	1.914	.842	4.349
OCD	.864	.594	2.111	1	.146	2.371	.740	7.601
Eating Disorder	−.354	.772	.211	1	.646	.702	.155	3.185
PTSD	1.443	.383	14.193	1	.000	4.232	1.998	8.965

All disorders other than PTSD and DTD are probable diagnoses based on K-SADS screeners. ADHD = Attention Deficit Hyperactivity Disorder; PTSD = posttraumatic stress disorder; DTD = Developmental Trauma Disorder; S.E. = standard error, OR = Odds Ratio; CI = Confidence Interval; p < .05 indicated in bold format.

Data availability statement

The data is available in a repository on this link: https://www.complextrauma.org/resources/other-resources/.