JANILEE: Welcome friends! You found just Janilee at the corner of “Am I crazy?” And “No, you're not. Here's the research to prove it.” These are miniature episodes that occur in between the main ones where we talk about specific topics and really delve into the research. This week we are talking about Developmental Trauma Disorder known by its abbreviation as DTD. This is a diagnosis that was put forth by someone named Bessel Van der Kolk. I'm a big fan of his work. Probably most certainly going to be mentioning him again. In this episode, I will be only quoting from one paper as opposed to multiple papers, as per usual. In this episode I will only be referring to Bessel van der Kolk's diagnosis proposition for DTD that he made back in 2009. Now, this is a bit older of a resource than what I tend to use. The reason that I am choosing to stick with this though, is because it is a very good explanation of a broad terminology that is more commonplace now in psychiatric circles than it has ever been before. I will be going through the paper and I won't be quoting all of it, but a link to the full paper will, of course, be provided in the show notes. So feel free to click in there and follow along if you want, or just listen. And if something stands out to you, or something sounds interesting and you want to look into it more, the link will again still be in the show notes.

Van der Kolk starts with some stats that I think are really interesting. So let's dive into those. First one: each year, more than 3 million children are reported to authorities for abuse or neglect in the US, and about 1 million of those cases are substantiated. (That means that it's been proven to be true with actual facts that have been seen and verified by third party sources.) In addition to that, there are thousands of people who undergo traumatic medical and surgical procedures, there are victims of accidents and community violence. And keep in mind, this is a paper from over a decade ago. And unfortunately, with the way the world is, these numbers are most likely higher. Now, what's interesting, though, is after quoting these kind of broad stats, is Van der Kolk narrows in on the purpose of this diagnosis. He says the vast majority of people, about 80% that are responsible for child maltreatment are children's own parents. Why is that important? Because most trauma begins at home.

And so this is an interesting thing to look into.  Van der Kolk addresses some of the things that make this a bit more challenging, talking about social taboos and as well as like family medical history and just social norms of how it can be a hard thing to look into and to research. What are you supposed to do? Go up to a parent and say, “Hey, do you abuse your child?” Of course I'm not going to say yes, right? And so it's a harder thing to look into. And so how even did this diagnosis of developmental trauma disorder come to be? Well, as people grow up, they tended to be diagnosed with comorbid issues. Now comorbidity, as we've talked about in the past, is just a fancy word to say you're diagnosed with more than one thing at the same time. Now the sort of comorbidities that are listed we'll get into in just a second. But when, but when people who had multiple comorbidities grew up, very often when looking at their past as an adult, looking back into their childhood, there was a lot of children that were exposed to alcoholic parents or domestic violence. There was an actual study that was done called the ACE study, the Adverse Childhood Events that I also find interesting and we'll get into in a later episode. But going on from that, Van der Kolk has this quote and this now I'm quoting directly from the article.

“Approaching each of these problems piecemeal rather than as expressions of a vast system

of internal disorganization runs the risk of losing sight of the forest in favor of one tree.”

 And I love the way that that's explained, right? You have a forest, but you're so focused on staring in on one tree, this one diagnosis, and maybe the tree next to it, this other comorbid diagnosis, that you lose sight of the fact that you're in a forest and this tree isn't standing by its own and it's part of something bigger. So if we take a step back and we look at the bigger picture, we're introduced to something called complex trauma, which is also something you've probably heard of before. It has, in recent years become a little more common to talk about. So, what does complex trauma mean? Well, in the traumatic stress field, right, most of the time, it's used to describe

“the experience of multiple chronic and prolonged developmentally adverse traumatic events, most often of an interpersonal nature.”

Interpersonal meaning between two or more people.  So complex trauma, the way that I like to think of it is… a simple way to describe it to people who maybe don't have the experience of complex trauma or necessarily the language to talk about it. Complex trauma is when trauma is a daily norm, whereas a traumatic event is when it's not so common. I think it was Van der Kolk who said this. I will verify and note it in the show notes. {Editor’s Note: It was an example used by Nadine Burke Harris} But use an example of: let's say you run into a bear in the forest. That's a traumatic event because you don't really see a bear ever. And when you see the bear, your fight or flight response is activated. All of that stuff happens. You leave, and then you can say, “Whoa, guys, look, I saw this bear once.” Complex trauma is when you live with the bear, when every day that you go home, you're confronted by the bear, and the bear is constantly around you, and you can't escape it, and you are retraumatized every day to the point where you wake up, you see a bear staring at you, and you're not surprised. 

Okay, so continuing on in this article, Van der Kolk addresses Adverse Childhood Experiences (the ACE - I said events earlier, I meant experiences.)  The study that was done by Kaiser and the CDC, it followed almost 18,000. The exact number here is 17,337 adults and looked back at their life and the things that they had experienced. There is:

30% reported physical abuse,

19.9% sexual abuse,

23.5% family alcohol abuse,

18.8% mental illness,

12.5% witnessed their mothers being beaten,

4.9% reported family drug abuse,

and so on. And again, we'll get more into the ACE study later in a different [episode]. But you remember those comorbidities I talked about before? Those trees that we're seeing, that we lose sight of the fact that we're in a forest? Here's a list of some of the comorbidities that were found in the ACE study and that Van der Kolk used to come up with this new developmental trauma sort of diagnosis.  We have depression, suicide attempts, alcoholism, drug abuse, sexual promiscuity, domestic violence, cigarette smoking, obesity, physical inactivity, sexually transmitted diseases.  Those don't really sound like great, fun, happy things. Well, they're not. Right?  Continuing on with all of these things, when you have isolated traumatic incidences, you tend to be diagnosed with Post-Traumatic Stress Disorder. Right. And so Van der Kolk goes on to say that  in contrast to the regular PTSD, you have “chronic maltreatment” or “inevitable repeated traumatization” - remember, we're living with the bear. Vander Kolk doesn't mention it in his paper, but that has more commonly been known recently as cPTSD or complex post traumatic stress disorder.  These have a pervasive effect on the development of a mind and a brain. Think about all of the stats and all of this research that has been done about how drinking alcohol before a certain age can actually hinder the brain development, right. If we're thinking back to a child's brain, if you've ever taken a developmental psychology class, you know that the child's brain is very malleable and very adept at interpreting environments and working in a way to help the child survive. So when you have chronic trauma and in such a young child, it interferes with neurological and biological, (or neurobiological) development. And so what happens with that is that your ability - and by your I mean the child's - ability to perceive their surroundings is actually lessened. So Van der Kolk gets into this, um oh, one more thing that Van der Kolk quenches that I thought was an interesting thing to point out is people with childhood histories of trauma, abuse, and neglect, they make up almost the entire criminal justice population in the US. That is staggering.  It's just staggering. Like just sitting on that and thinking for just a moment about how it's so easy to think of the “other”, to think of the “they” to classify, oh, ‘That's that.” like “That's them, that's their problem.” But realizing that when almost an entire population is made up of people [who have childhood trauma], this is some that should be addressed. 

Moving on with the article, Van der Kolk, I'm looking now for those following along: I'm under the title Trauma Caregivers and Affect Tolerance.  Under this section, Van der Kolk talks about how children learn to regulate their behavior by anticipating their caregivers’ responses to them. So that would be the people mainly responsible for taking care of the child most of the time, that is the biological birth parents. So this interaction, it allows children to develop in their head a way that they should be responding to the world and allows the children to assess the proper way to respond when things get a little tricky. So we have a child's “Internalized Working Model” is what this is called, by a researcher named Bowlby. Here's another quote:

“It's defined as the internalization of the active and cognitive characteristics of their primary relationships.”

A lot of words. What it means is how a child's inner world develops is entirely dependent on their external relationships to others. So how a child interacts with a human is going to change how the child's internal world works. So we have children whose brains are extraordinarily malleable, and they can be shaped and they can be formed as the experiences that this child has as they're growing up. Van der Kolk then defines that there are two types of children those who are securely attached and those who are insecurely attached. Securely attached is a good, healthy, normal way to be attached. Insecurely attached is what leads to problems later on in life. So let's start with securely attached children.

“Secure children learn a complex vocabulary to describe their emotions such as love, hate, pleasure, disgust, and anger. This allows them to communicate how they feel and to formulate efficient response strategies. They states such as hunger and thirst, as well as emotional states than do maltreated children.”

So this is basically - it's a lot of boringness almost, but it's essentially just saying that this child experiences life and is able to describe how life is affecting them. So under most conditions, parents are able to help their distressed children restore a sense of safety and control. Again, this is still securely attached children.

“The security of that attachment bond mitigates against trauma induced terror. When trauma occurs in the presence of a supportive, even if helpless caregiver, the child's response is likely to mimic that of the parent. The more disorganized the parent, the more disorganized the child.”

So even if a child is found in a situation where their parent is helpless, if their parent is able to be there for the child, even if the parent is flummoxed and doesn't know what to do and is kind of losing their cool and not sure how to handle or process this trauma; if the child is securely attached to the parent, child's going to get out okay. The child's going to be able to explain and say, “Hey, I'm feeling this way. Oh parent, you are too? Cool.”  So this is just a normal, healthy way that securely attached children develop.

Now we're switching over into the insecurely attached, which these are the people who would have developmental trauma disorder. This is a lot and it's a little scary to read. It was a little scary for me to read at first because I felt I felt like the technical terms were describing my experience and that was a scary thing to experience.  But it also helped me understand that the way I was experiencing life was not problematic. It was just something that was different than the normal, healthy, securely attached child. It so if anything in this next insecurely attached children section rings true with you, remember, this doesn't mean that anything's wrong with you. It just means that you're different than the norm and that you're part of a group of people who haven't really spoken up or said anything up to this point. All right, let's dive into the research again.

“At the core of any traumatic stress is a breakdown in the capacity to regulate internal states.”

Remember in the example before, even if the parent is dysregulated, the child's going to be dysregulated, but the child's going to be able to express that, and that's the difference. Okay, so when caregivers are not only absent and not securely attached to their children, but when they are emotionally abusive or absent or inconsistent, frustrating, violent, intrusive, neglectful, any of the above, children are likely to become intolerably distressed, and “unlikely to develop a sense that the external environment is able to provide relief.” Meaning the external environment happens. “I have no effect on it. What I do doesn't matter.”

“Children with insecure attachment patterns have trouble relying on others to help them, and they are unable to regulate their emotional states by themselves.”

Remember, parents aren't there. Parents aren't showing a proper way to regulate emotions children's going to suffer.

“As a result. They experience excessive anxiety, anger, and longings to be taken care of. These feelings may become so extreme as to precipitate dissociative states or self-defeating aggression. Spaced out or hyper aroused, children learn to ignore either what they feel their emotions or what they perceive their cognitions.”

See, these insecurely, attached children literally do not have the ability, the neurobiological or psychological ability to perceive both their internal world and their external world. They can't perceive how they're feeling and what's actually happening to them. They can't find the balance between the two because there's no way to experience both at the same time. So what does this lead to? Well, good news. There's more science to help us out here.

“When children are unable to achieve a sense of control and stability, they become helpless. If they are unable to grasp what is going on and unable to do anything to change it, they go immediately from fearful stimulus to fight, fight, freeze response, without being able to learn from the experience.”

Right? Think of the experience we talked about before. If you encounter a bear, you can look back on that. If it's singular instance that happens and say, “Maybe I should have put my trash up, maybe I should have done this or that different.” Once the cortisol is out of our system and once the fight or flight adrenaline has run its course, we can look back on that and learn from it. But insecurely attached children, right? Remember, we're still talking children here. They don't have that ability. They don't learn anything from this. Their body's just taken on a ride, their cortisol is triggered, their adrenaline runs, and at the end of all of it, they're in a fight or flight response that came from a fearful stimulus. And this is just the hell that their life is, back and forth and back and forth. There’s sensations it talks about being exposed to reminders of the trauma. There's sensation, there's physiological states, images, sounds, situations. It can also be people. If it's a person that tends to be the instigator of these events, they behave, these children, they behave as if they're being traumatized all over again and it is a catastrophe. Have you ever heard about overreacting to a tiny little stimulus? Yeah. This is why. Because the body isn't able to learn from it. The body isn't able to say, “Well, I was in the forest and I didn't put the trash up and then a bear came”, right? The body only remembers “I was in a forest and a bear came.” That middle step is gone. That ability to learn is gone. It's literally you're just on a roller coaster ride of emotions that your body is taking you on because of all of the hormones that are coursing through your veins. So a lot of problems, continuing on with article

“many problems of traumatized children can be understood as efforts to minimize objective threat and to regulate their emotional distress.”

So thinking through that right, minimize objective threat. Remember objective being how the child is perceiving this this is a threat to me. Ish. It's a threat to you ish because it feels real and your body reacts as if it's real and that is a threat. But from the unhealthy perspective or an outside perspective, we can see how it doesn't have to be A leads to B. But it is at this moment, right? And that intervening in that middle stage is crucial to getting your body to understand that there's more than one way to respond to these triggering stimuli. And that's something that we can get into later if we are wanting to.

So insecure children really don't have a lot going for them. And that sounds really sad to say, but they don't! When you aren't able to grow up in a situation where your parent is able to experience emotions and reflect them back to you in a healthy way, you're not going to be able to experience emotions, you're not going to be able to reflect them back, you're not even going to understand them. You're not going to learn from anything and your entire life instead of learning and growing up, and all of that healthy stuff, you're just going to be frozen in time. As a child who is unable to protect themselves from big, bad, scary things. Have you ever heard of the phrase “healing the inner child” or “inner child work” or “write a letter to your younger self”? {Editor’s Note: another phrase often used is “reparenting”.} This is the science that those sort of treatment plans are based on.  It's this. It’s your insecurely attached child self not being able to regulate what is happening to you. 

RE-PARENTING/INNER CHILD WORK EXAMPLE

I just want to share an example of something I was going through when I was in therapy that really brought this science to mind and helped how understanding the science helped me through. I recalled back to when I was younger and my best friend had died. And after my best friend had died, I felt very alone and I was sitting in a corner of my room and it was this corner where the wall was at a 90 degree angle, and then on the other side was a bookcase. And so it was just this really small area and I just really cozied up to the bookcase and the wall and I grabbed a really big stuffed bunny I had and I just tried to get comfort from those things. Now, as a child, I had no idea what I was doing. I didn't understand that I was trying to get comfort. I just knew I missed my friend. I didn't have anyone I could talk to about it because I wasn't in therapy and I didn't feel safe going to anyone in my life and asking them for a hug or telling them that I was sad. Did I know how to put it in all of those words? No. All I knew is that I didn't feel safe and this is what made me feel safe. Viewing that as an adult, it makes a lot more sense and I can have a lot more compassion and understanding for that younger version of myself.

CONTINUING ON WITH RESEARCH PAPER

Children depend on caregivers for their very survival. Literally. Without caregivers, they die.  And this happens and it's sad and it's terrible *breathes* had to take a breath there, but it happens. What happens to those who don't die? Those who do survive well, they learn that their survival is predicated on those causal actions, on what Van der Kolk describes as “a crisis of loyalty.”  When a child is traumatized very often they will be told “You can't say anything. That's a family secret. Don't air our dirty laundry. That's not anything to share.” The reason for that… So the abuse doesn't get discovered. I know that's, simply put, but that is most often the reason. What happens to the child and their experience when this occurs? Let's read a quote from Van der Kolk

“Being prevented from articulating what they observe and experience, traumatized children will organize their behavior around keeping the secret, deal with their helplessness with compliance or defiance, and acclimate in any way they can to entrapment in abusive or neglectful situations.”

All right, let's use some of these more mainstream phrases we've used before. “The hell you know versus the heaven you don't.” That is this last part. They'll acclimate in ways that they can to entrapment in abusive or neglectful situations. They're going to stay there because that's what they know. The hell they know versus a heaven that they don't. Because this is all they know.  When we're talking about organizing their behavior around, keeping a secret, that's literally the child's job. The child's job is to not let mom get in trouble. There is a really awesome TEDx talk that I have listened to countless times, and it has changed a lot of language I use when talking about not just Developmental Trauma Disorder and my own experience, but also in any advocation that I do for specifically foster care and fostering teens. (I will link it in the show notes, so don't worry.)

But in there, the person giving the TEDx talk talks about how everything was the world's fault, that the world was out to get them, that the world was against his mom and his family. And the only way that he could survive was to keep that secret, to keep all of the things that mom did to stave off the world, to keep those things secret. So if we have children who are being emotionally neglected, they're insecurely attached, they can't learn from anything, there's no predictability. Their entire lives are built around keeping secrets and staying in the hell that they know. What happens? Well, you have chronically traumatized children. This is going to result in deficits and emotional self-regulation. It's going to be problems with self-definition. It's going to be reflected in a poor sense of self.  It's going to show in “poorly modulated affect and impulse control, including aggression against themselves and others.” There's going to be “uncertainty about reliability and predictability of others.” Just because a person's nice now doesn't mean they're going to be nice later. And that is often expressed as “distrust, suspiciousness and problems with intimacy.” Often all of these things build up and they result in social isolation. 

So chronically traumatized children, they tend to suffer from all of the social isolation and not being able to interact in any meaningful social way, this can actually lead to “distinct alterations in states of consciousness.”  Fancy word, Van der Kolk helps us out, gives us some examples.

“Amnesia, hypermnesia, disassociation, depersonalization and derealization flashbacks and nightmares of specific events, school problems, difficulties in attention regulation, disorientation in time and space, and sensorimotor developmental disorders.”

So children often are literally out of touch with their feelings, and they have no language to describe their internal states. Referring back to that Ted Talk I mentioned earlier, a phrase that stood out to me was when this person did start to realize that maybe something was up, pointing out the fact that as a child, you don't have the knowledge to say, “I'm being abused per this state law code, blah, blah, blah.” No, all you have the knowledge to say is, “This is my experience, and it doesn't make sense.”, and a lot of people cannot understand. I remember for me, I often had to say, “My mom makes me do chores.” … That doesn't sound like abuse, but I didn't have the terminology then to explain my situation and my reality and the things I was living for. I was literally out of touch with my feelings and with my environment.  Van der Kolk helps us. He goes on and says,

“As a result they [meaning these insecurely attached children], they lack a good sense of cause and effect of their own contribution to what happens to them.”

Without healthy development, these children, they act instead of plan. They show what they want through behaviors, rather than just discussing it. I'm sure you've heard something along the lines of “the problem child is acting out for attention.” There can be a really negative way to perceive and discuss that, but that is kind of true. It's not because they want attention. It's because they want something. And they haven't been paid enough attention prior to this for anyone to understand how they communicate. They want a certain thing, and the only way they know to communicate that they want this thing is behavior. Because no one's ever taught them how to use their words literally.

Van der Kolk goes on: “These children have difficulty appreciating novelty.” Quick definition “novelty” is new things that have never happened before. “Without a map to compare and contrast, anything new is potentially threatening. What is familiar tends to be experienced as safer, even if it is a predictable source of terror.”

We're back to this whole hell you know versus heaven you don't. If it's familiar, it wins. Who cares about good or bad? Who cares about happy or sad? Can I handle it? Do I know how to interact and deal with it in a reliable way, or do I not?  That's all that matters.

All right, for those of you following along, we are now under the heading Childhood Trauma and Psychiatric Illness. Van der Kolk helps us out at the beginning here by talking about “numerous studies of traumatized children finding problems with unmodulated aggressions and impulse control.” Additionally, “attentional and dissociative problems and difficulty negotiating relationships with caregivers, peers, and later in life, intimate partners.” Well, good golly, that sounds just about every person that we ever have to interact with. 

Going forward, we are reminded about the fact that this is a diagnosis, this Developmental Trauma Disorder, it is a diagnosis for children. As Vander Kolk reminds us, the results of the DSM Five sorry, the DSM Four field trial suggested that

“trauma has its most pervasive impact during the first decade of life and becomes more circumscribed with age.”

Circumscribed? There meaning more like pure PTSD. So if we're thinking about all of the examples of how we even know that developmental trauma happens, it's by having adults who have these comorbidities looking back on their lives and being able to identify these things.  The reason that they are comorbidities when they're adults is because it's that more, quote unquote, pure PTSD or cPTSD, because that is what is able to be diagnosed. [in the DSM 4] Without looking at any sort of causal big picture. Is it just a tree, or are we in a forest scenario? 

So we're moving to the part of this article here where Vander Kolk is starting to describe why we need DTD as a diagnosis separate from PTSD or even cPTSD. It is explained that PTSD is not developmentally specific, it doesn't have to happen to children, it doesn't have to happen to adults. It can happen to anyone at any point in their life. It talks about how there's a broad spectrum of how this diagnosis can impact a person's life cognitive skills, language skills, motor skills, socialization, et cetera.  However, at this time, when DTD is not a diagnosis, there's no other diagnosis to actually explain these comorbid diagnoses. It's just you have PTSD, and somehow, somewhere else, independently, you had another comorbid diagnosis. That's not what is happening. That's not the full picture.

In order for this to become an actual diagnosis that makes it into the DSM, you need to show that there is a benefit to treating this diagnosis differently than you would treat another diagnosis such as regular PTSD. So Van der Kolk explains the reasoning for that by saying,

“By relegating the full spectrum of trauma related problems to seemingly unrelated comorbid conditions, fundamental trauma related disturbances may be lost to scientific investigation, and clinicians may run the risk of applying treatment approaches that are not helpful.”

So let's get into this. Let's get into how understanding there's a difference between PTSD and DTD. PTSD being brought up up to this point because it is the most similar diagnosis that exists in the DSM four, which is the current DSM as of this paper. So Van der Kolk helps us. He gets into we're now at the heading for those following along A New Diagnosis, Developmental Trauma Disorder. So let's kind of take a step back. We've kind of gone into the story and the history of leading up to why this diagnosis is even needed. Let's just say that we have this straight from the DSM. Let's look at what we have listed here.

I find that one of the best sections that describes what DTD is. … It contrasts PTSD yet again. But this time, instead of explaining what PTSD is, it explains everything. PTSD is not and DTD is. So, I'm going to read it. It's a little bit longer, but bear with me because it's a very important section that we need to listen to. 

“Moreover, the PTSD diagnosis does not capture the developmental effects of childhood trauma. The complex disruptions of affect regulation, the disturbed attachment patterns, the rapid behavioral regressions and shifts in emotional states, the loss of autonomous strivings, the aggressive behavior against self and others, the failure to achieve developmental competencies, the loss of bodily regulation in the areas of sleep, food and self-care.  The altered schemas of the world, the anticipatory behavior and traumatic expectations, the multiple somatic problems from gastrointestinal distress to headaches, the apparent lack of awareness of danger and resulting self-endangering behaviors, the self-hatred and self-blame and the chronic feelings of ineffectiveness.”

*takes deep breath*

Does anyone else feel that with me? The first time I read that paragraph, I felt like my entire life had been described.  There's a lot of things in there that we could go through bit by bit and piece by piece. I just want to focus on the rest of this section for this episode of VILIFIED, because it talks about so many different experiential things in a very scientific way that I find can be really hard. I tend to turn to intellect, and I want to understand things when I'm confused.  I have been told multiple times on multiple occasions by multiple people that I tend to intellectualize my emotions, and that is completely true. So if you're someone like me, know that's not a bad thing. Sometimes understanding the science of why we are the way we are, it can help us, us develop that language that is needed to express our internal realities.  So I'm going to go through the rest of the section to give us some language to use if we need to.

Van der Kolk mentions in the DSM Four there is something called Criterion A, which is basically, what is the criteria required for something to be considered a traumatic event. So this criteria requires, in part, an experience involving, quote, “actual or threatened death or serious injury or threat to the physical integrity of self or others.” Unquote.  Van der Kolk goes on that children exposed to these common types of interpersonal adversity wouldn't be diagnosed with PTSD. Remember, interpersonal is between people? It's that lack of self. It's not able to understand cause and effect. It's the emotional abuse and neglect. Those things don't qualify as PTSD under that definition. Van der Kolk continues:

“Non criterion A forms of childhood trauma exposure, such as psychological or emotional abuse and traumatic loss have been demonstrated to be associated with the PTSD symptoms and self-regulatory impairments in children and into adulthood.”

What does that all mean? It's saying if you want to look at the PTSD symptoms, that is the same as these DTD symptoms, but according to the definitions already put forward and even the treatment plans in place, they're not the same thing, and they should be treated differently. Similar to how you can have a headache because you're dehydrated, because you're hungover, because you're on your period, because you hit your head. It's still a headache, but the causal factors are not the same.  So being able to define this Developmental Trauma Disorder is helpful. Moving forward in the article, Van der Kolk goes on to say,

“the proposed diagnosis,” [remember that's Developmental Trauma Disorder] “is organized around the issue of triggered dysregulation in response to traumatic reminders, stimulus generalization, and the anticipatory organization of behavior to prevent the recurrence of trauma effects.”

These are things we've all talked about before. Remember explaining them as we lead up to this whole diagnosis and how it differs from PTSD. So this DTD diagnosis, it's all about dysregulation. It's all about not being able to understand reality or effectively interact with reality. The next point made talks about how, according to this definition of PTSD if we were to diagnose these people who have DTD with PTSD instead, we would be saying that, “Hey, all of these things, they've experienced interpersonal trauma, abandonment, betrayal, physical abuse, sexual abuse, witnessing domestic violence, that all of those things would have consistent and predictable consequences.”  But that's not actually the case. What actually happens is

“the experiences engender intense effects such as rage, betrayal, fear, resignation, defeat, shame and efforts to ward off the recurrence of those emotions which oftentimes includes avoidance of experiences that precipitate them or engaging in that convey a subjective sense of control in the face of potential threats.”

Trying to control the external world to the best of our ability to prevent things from happening because again, not understanding that there is not that causal factor because we're unable to learn from experiences and unable to actually understand the causal impact that we and others have on our external world. 

So, when you have that kind of experience as a child, often your physiological dysregulation leads to multiple somatic problems. Somatic being “experienced in the body”. That can be headaches, stomachaches in response to the being fearful. I mentioned headaches before and those were just more of those physically caused, physically experienced things. There's a connection between the mind and the body. Which, yes, is a book, also written by Van der Kolk that we can get into later if wanted.  But understanding that these like long term emotional dysregulations they have huge effects on behavior. Not because someone isn't trying or someone isn't doing their best, but because someone cannot interact reliably with their environment. And even once the environment is reliable it doesn't make it safe and it doesn't mean that this person is able to flip a switch and just be happy because their environment got better. No, it requires learning and growing and changing and insurmountable odds really of being able to eventually hope to function somewhat normally.

A quote that I like says “Insight and understanding about origins of their reactions seems to have little effect.” Now, I know that I basically just said the opposite thing. But realizing that the difference between what I said and what that quote was referencing here in this article is that quote is referencing people who … who are still in that space. People who genuinely can't find any reason to care what's happening external to themselves. Because if they stop caring about their internal world for a second, their internal world will collapse and fall apart. And that doesn't mean they're weak. Doesn't mean that they're not trying. It means that right now things aren't lining up in a way for them to learn. I didn't understand these things until I had someone walk me through it and until I started learning and not quite understanding and going to people - and by people, I mainly mean a trauma informed therapist - and saying, “How is my trauma in this? Is this a thing? Am I making this up? What is happening?” And having that therapist be able to explain to me, “Yeah, this is how your specific situation is showing up in this research.” Doesn't mean that it was easy. Doesn't mean that it was something that I could just walk on by and fix overnight. Doesn't mean that there are not things that  I'm not still working on. 

I want to end with just two more points from this article, and then I just wanted to share one quick story that helps put a point on what I've been explaining. Talking about people who are now adults who have grown up with this DTD, this Developmental Trauma Disorder. Article states “they easily misinterpret events in the direction of a return to trauma and helplessness.” Of course, because it always happens before. Why would it not happen again? “This causes them to be constantly on guard, frightened and overreactive.” And the last quote from the article here “They tend to lose the expectation that they will be protected and they act accordingly.”

And how could they not? How can we really blame them after going through this entire article that just talks about how from the time that they're a child, they're not able to develop in a normal way? How can we genuinely blame or not have any sympathy for the life and the way that these people have had to live? If you are like me and you have lived through these things, it’s a lot and it's really hard. 

I want to share this experience that I had. And it happened over months, if not years. When I started the first time, when I was first exposed to this information, I didn't really know what to do with it. And at the time, I was seeing a trauma informed therapist, and I go in and we talked about this kind of thing, and I don't remember exactly what was said, but I know that I left that session of therapy with this image in my head. And we haven't talked a lot about neurological physiology… All we need to understand is that we have habits and we're trying to form new habits. So the way that we've always done things I pictured…  I pictured a football field with two people and  they're just waiting on the line of scrimmage for the ball to snap. And for those of you who aren't sporty at all, picture two people waiting at a line for the starting shot at the beginning of a race. Now, you have one person who's an athlete, who's done this before and who knows exactly what's happening. And you have what I pictured in my head is like a super scrawny nerd because that was my jam. I'm a nerd. Still am, clearly, because I'm doing this podcast, right?

So in my head, there's these two people, very much an athlete and very much a newbie at this whole thing. And the gun goes off or the ball is snapped on the line of scrimmage, and instantly this little nerd person just crumbles and falls on their face. And the athlete makes it look like the easiest thing in the world.  And every time - and again, this happened over months or years. Every time I experienced a stimulus, I pictured that in my head.  Even if it wasn't in the moment, even if it was just like a day later or an hour later or five minutes later, until I could eventually, in the moment, visualize this. And all I did was visualize it. It didn't change what I did, but I was able to visualize, “Hey, okay. So I just had a stimulus, and that was the ball being snapped. That was the gun going off at the beginning of the race. And I'm this little nerd who's never done this before, and my habit just took over and made this look super easy.”  Well, I realized that there was a second choice. Even though I physically and physiologically was not able to make said choice, I realized that there was a second option. And over time, and I really, really want to stress that this is not a day or even a month. It took me probably months to realize that I had another choice and that this nerd could have a chance.

But it took me years to be able to change the outcome every time that gun went off, every time that the ball was snapped. And all it did… and all it started as was  keeping the athlete frozen for half a second and then the athlete still ran over to the nerd, but the nerd got two steps in before falling on their face. And then it starts again because it's a new situation, a new stimulus happens. The gun goes off, the ball is snapped, and the athlete's frozen for a full second this time and the nerd gets three steps in before the habit takes over. And that has to do with myelinated neural pathways that we'll get into later because definitely going to be an episode where I talk about that that is so fascinating to me. All of that to be said though, don’t discount being able to understand things in a different way as not being growth, because it is because being able to actually visualize things or see things or conceptualize of things in a different way is huge and it's important. And don't for a second think that it's not worthwhile.