Types of Trauma: Type 1 and Type 2 Trauma

• A traumatic event involves significant actual or threatened physical or psychological harm to oneself or others, ranging from miscarriage to murder. Examples include divorce, death, disasters, violence, rape, torture, accidents, injuries, illnesses, and actions violating one's moral code.

Type 1 Trauma

• Type 1 trauma, also known as simple, single incident, or acute trauma, is a single, well-defined event, like natural disasters or accidents. It often leads to PTSD

Type 2 Trauma

• Type 2 trauma, also known as complex, chronic, developmental, or attachment trauma, involves a series of related, sequential traumas, such as neglect, maltreatment, or sexual abuse, usually by people close to the individual.
• Type 2 trauma results in impaired personality development and issues like dissociation, low self-efficacy, impaired emotional regulation, somatization, and a disturbed perception of self and others

Types of Trauma

• Acute trauma is from a single event like a car accident or assault.
• Chronic trauma involves multiple events, like ongoing domestic violence.
• Secondary trauma results from hearing about others' first-hand trauma experiences.
• Complex trauma includes the exposure to and impact of events like early childhood abuse/neglect.
• Historical trauma is multi-generational trauma experienced by communities facing oppression and disempowerment.
• Complex trauma has a complex impact on emotional regulation, cognitive function, and belief systems, unlike chronic trauma.

ACES (Adverse Childhood Experiences)

• Childhood maltreatment and household challenges are common and often co-occur and include abuse (physical, emotional, sexual) and neglect (physical, emotional).
• Household dysfunction includes mental illness, incarcerated relatives, substance abuse, a mother being treated violently, and divorce.
• ACE-IQ added peer violence, exposure to war, marriage and parental death, to reflect global childhood experiences.
• ACEs lead to behavioral outcomes like lack of physical activity, smoking, alcoholism, drug use, and missed work, as well as physical health issues such as obesity, diabetes, STDs, cancer, and stroke. They can also lead to mental health issues like depression and suicide attempts.

Trauma-Related Disorders

• Trauma-related disorders stem from direct or indirect experiences of traumatic events, leading to distressing emotional, cognitive, and physiological reactions, and an inability to cope with these reactions effectively.
• These disorders can manifest as mood disorders, conduct disorders, psychosis, and personality disorders.

Childhood PTSD Diagnosis

• Childhood PTSD diagnosis is based on intrusion, avoidance, negative alterations in mood and cognition, and hyperarousal (fight/flight).
• The majority of children experience at least one traumatic event by adulthood, though only a minority develop PTSD.
• Symptoms may manifest differently in children, such as intrusions appearing in play in the form of trauma re-enactment, or distressing dreams/nightmares, with less focus on describing subjective experience.
• Risk of PTSD varies with the type of trauma, with interpersonal violence carrying the highest risk (30-70%), followed by exposure to war and conflict (46%), and being a child refugee (35-97%).

Contextual Factors of Trauma

• Trauma is influenced by systemic, relational, and contextual elements like the child’s age and developmental stage, temperament, relationship with involved people, reactions of others, cultural and societal context, power dynamics, nature of the trauma/threat, and the meaning the child ascribes to it.

Child and Family Characteristics

• Girls are 2-3 times more likely to develop PTSD.
• Children with pre-existing mental health difficulties are more susceptible to PTSD.
• Poor family functioning is a risk factor for PTSD, with a significant association between parent and child PTSD.
• Strong social support reduces the likelihood of a child developing PTSD.

Developmental Trauma

• Individuals with multiple traumas might not meet PTSD criteria and may receive alternative diagnoses like ASD or conduct disorder.
• There is an Overlap between neurodevelopmental and trauma clusters
• 'Developmental trauma' specifies the impact of multiple childhood traumas, differing from single-event trauma.
• In 2009, a proposal was made to add developmental trauma disorder to the DSM, adding clusters to existing PTSD symptoms, including emotional and physiological dysregulation/dissociation; problems with conduct and attention regulation; and difficulties with self-esteem/managing social connections, resulting from type 2 traumas.

Sequential Development

• Infancy manifests as regulatory disorder.
• Preschool age manifests as attachment disorders.
• School age manifests as hyperkinetic conduct disorder.
• Adolescence manifests as combined conduct and emotional disorders.
• Young adulthood manifests as personality disorder.

Why Developmental Trauma Disorder Rejected by DSM-4

• It challenged the tradition of purely descriptive diagnostic categories and overlapped with existing diagnoses like borderline personality disorder (BPD).
• There was an assumption of monocausality without proven evidence.
• People can have symptoms of DTD without experiencing trauma.
• There was a lack of age specificity/developmental specificity.

Current Status

• The concept has been influential and is widely used by CAMHS and social care.
• The ICD-11 was published with complex PTSD included.
• Trauma-informed approaches are seen as important (Triesman).