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3.4 Developmental trauma disorder
Aim . To understand the impact of a single versus repetitive sexual abuse .
KEY TO KNOW
It is important to distinguish between children who have been exposed to trauma repetitively or regularly during childhood from children who have been exposed to one or two traumatic events . Children exposed to repetitive trauma do not display the symptoms of classic post-traumatic stress disorder ( PTSD ). They tend to suffer instead from developmental trauma disorders ( DTD ). This diagnosis has not yet been accepted in diagnostic manuals , but it is widely used by researchers and clinicians . DTD is characterised by lack of regulatory capacity in three areas : 1 . Lack of capacity to regulate emotions and bodily states . Children shift rapidly between affective states ; have low moods ; are excited ; are hypersensitive ; lack affect awareness ; have sleeping problems ; have eating disturbances ; lack temperature awareness ; have delayed motor responses .
2 . Lack of capacity to regulate attention and behaviour . Children are impulsive , attracted to tension and danger , prone to have misconceptions , and focus on possible threats to them .
3 . Poor capacity to regulate closeness and distance in relationships . Children have poor socio-emotional functioning ; do not trust others ; are constantly prepared for rejection ; do not trust themselves with changes in cognition and identity .
Due to the pervasive character of these symptoms , clinicians often misinterpret the symptoms of children with DTD and diagnose them as having bi-polar disorder , anxiety disorder , depression , attention deficit and hyperactivity disorder ( ADHD ), or borderline disorders .
3.5 Sexual abuse and trauma
Survivors of sexual abuse have many symptoms that resemble the symptoms of other traumatised children , but they have some specific reactions due to the relational and sexual aspects of this particular trauma .
A child who is sexually assaulted by an adult will not easily distinguish between bad things being done to them and bad things being done by them . This affects their view of themselves . “ The dirty things done to me make me a dirty person .” Many children will blame themselves for their assault and tell themselves “ I am a bad person ”, “ I am dirty , disgusting ”, “ I am to blame ”.
Their reactions are sometimes difficult to understand for the child . They include :
• Extremely low self-esteem , even self-hate .
• Children tend to take the blame themselves , believing they are guilty for what happened . Perpetrators are also responsible for this response if they call the children they abuse bad , naughty , unlovable , etc .
• Lack of trust , constant expectation of betrayal .
• Especially when the perpetrator is a trusted person , such as a relative , a teacher , or a religious leader , the child feels betrayed . This response also occurs if the child does not feel protected by adults , or adults have not believed the child .