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Papers by Bessel van der Kolk

Springer eBooks, 1995

Terrifying experiences that rupture people’s sense of predictability and invulnerability can prof... more Terrifying experiences that rupture people’s sense of predictability and invulnerability can profoundly alter the ways that they subsequently deal with their emotions and with their environment. The syndrome of Post Traumatic Stress Disorder (PTSD) can follow such widely different stressors as war trauma, physical and sexual assaults, accidents, and other natural and man-made disasters. Mirroring the confusion and disbelief of people whose basic assumptions are shattered by traumatic experiences, the psychiatric profession periodically has been fascinated by trauma, followed by sudden disbelief in the importance of trauma in the genesis of psychopathology. Over the past decade our profession has experienced the third intense wave of efforts to grasp the reality of trauma on body and soul, after the first at the Salpetriere during the closing decades of the 19th century, and the second, spearheaded by Abram Kardiner (1941), in the 1940s. The findings about the consequences of trauma and what constitutes effective treatment have been extraordinarily consistent over these 120 years.

PubMed, 1994

Secure attachments with caregivers play a critical role in helping children develop a capacity to... more Secure attachments with caregivers play a critical role in helping children develop a capacity to modulate physiological arousal. Loss of ability to regulate the intensity of feelings and impulses is possibly the most far-reaching effect of trauma and neglect. It has been shown that most abused and neglected children develop disorganized attachment patterns. The inability to modulate emotions gives rise to a range of behaviors that are best understood as attempts at self-regulation. These include aggression against others, self-destructive behavior, eating disorders, and substance abuse. The capacity to regulate internal states affects both self-definition and one's attitude toward one's surroundings. Abused children often fail to develop the capacity to express specific and differentiated emotions: Their difficulty putting feelings into words interferes with flexible response strategies and promotes acting out. Usually, these behaviors coexist, which further complicates diagnosis and treatment. Affective dysregulation can be mitigated by safe attachments, secure meaning schemes, and pharmacological interventions that enhance the predictability of somatic responses to stress. The ability to create symbolic representations of terrifying experiences promotes taming of terror and desomatization of traumatic memories.

Acta Psychiatrica Scandinavica, Mar 13, 2022

OBJECTIVE Developmental Trauma Disorder (DTD) is a childhood psychiatric syndrome designed to inc... more OBJECTIVE Developmental Trauma Disorder (DTD) is a childhood psychiatric syndrome designed to include sequelae of trauma exposure not fully captured by PTSD. This study aimed to determine whether assessment of DTD with an independent sample of children in mental health treatment will replicate results from an initial validation study. METHODS The DTD semi-structured interview (DTD-SI) was administered to a convenience sample in six sites in the United States (N=271 children in mental health care, 8-18 years old, 47% female, 41% Black or Latinx) with measures of trauma history, DSM-IV PTSD, probable DSM-IV psychiatric diagnoses, emotion regulation/dysregulation, internalizing/externalizing problems, and quality of life. Confirmatory Factor (CFA) and Item Response Theory (IRT) analyses tested DTD's structure and DTD-SI's information value. Bivariate and multivariate analyses tested DTD's criterion and convergent validity. RESULTS A three-factor solution (i.e., emotion/somatic, attentional/behavioral, and self/relational dysregulation) best fit the data (CFI = 0.91; TLI = 0.89; BIC = 357.17; RMSEA = 0.06; SRMR = 0.05). DTD-SI items were informative across race/ethnicity, gender, and age with three exceptions. Emotion dysregulation was the most informative item at low levels of DTD severity. Non-suicidal self-injury was rare but discriminative in identifying children with high levels of DTD severity. Results supported the criterion and convergent validity of the DTD construct. CONCLUSION This replication provides empirical support for DTD as a construct and potential psychiatric syndrome, and the DTD-SI's validity as a clinical research tool.

European Journal of Psychotraumatology, 2021

ABSTRACT Background: Developmental Trauma Disorder (DTD) has extensive comorbidity with internali... more ABSTRACT Background: Developmental Trauma Disorder (DTD) has extensive comorbidity with internalizing and externalizing disorders distinct from posttraumatic stress disorder (PTSD). Objective: To replicate findings of DTD comorbidity and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable DSM-IV psychiatric disorders were identified with KSADS-PL screening modules, in a multi-site sample of 271 children (ages 8–18 years old; 47% female) in outpatient or residential mental health treatment for multiple (M = 3.5 [SD = 2.4]) psychiatric diagnoses other than PTSD or DTD. Results: DTD (N = 74, 27%) and PTSD (N = 107, 39%) were highly comorbid and shared several DSM-IV internalizing and externalizing disorder comorbidities. Children with DTD with or without PTSD had more comorbid diagnoses (M = 5.7 and 5.2 [SD = 2.4 and 1.7], respectively) than children with PTSD but not DTD (M = 3.8[SD = 2.1]) or neither PTSD nor DTD (M = 2.1[SD = 1.9]), F[3,267] = 55.49, p < .001. Further, on a multivariate basis controlling for demographics and including all potential comorbid disorders, DTD was associated with separation anxiety disorder, depression, and oppositional defiant disorder after controlling for PTSD, while PTSD was associated only with separation anxiety disorder after controlling for DTD. Both DTD and PTSD were associated with suicidality. Conclusions: DTD is associated with psychiatric comorbidity beyond that of PTSD, and DTD warrants assessment for treatment planning with children in intensive psychiatric services.

Psychological Trauma: Theory, Research, Practice, and Policy, Oct 1, 2022

OBJECTIVE The emergence of updated Diagnostic and Statistical Manual of Mental Disorders (5th ed.... more OBJECTIVE The emergence of updated Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013) criteria for posttraumatic stress disorder (PTSD), which includes modified criteria for young children, raises questions regarding the need for developmentally appropriate standalone psychiatric diagnosis encompassing complex trauma presentations in children. The present study addresses these questions by examining how DSM-5 PTSD and proposed developmental trauma disorder (DTD) diagnoses relate to functional impairment and trauma exposure using clinician-report surveys. METHOD We surveyed psychotherapists across the United States, and asked them to report on the symptom characteristics, functional impairment, and trauma exposure of children, adolescents, and young adults under their care (n = 210; age range = 2-21). We fit symptom data to the draft criteria for (1) DTD, a proposed trauma diagnosis for children and (2) existing criteria for adult and child/preschool PTSD. RESULTS Results indicated that comorbidity between DTD and PTSD was high (52.4% and 59.9% for adult and child/preschool criteria, respectively). Comorbid DTD/PTSD and DTD-alone groups had more functional domains impacted and greater exposure to some types of trauma relative to the other groups. CONCLUSIONS These findings speak to the relationship between trauma complexity and wide-ranging symptom presentations, provide support for research and clinical emphasis on a developmentally informed diagnosis, and may support existing treatment approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Journal of Traumatic Stress, Apr 1, 2000

American Journal of Psychiatry, Aug 1, 1994

British Journal of Psychotherapy, Mar 1, 1996

Abstract Since trauma is an inescapably stressful event that overwhelms,people&amp;amp;#x... more Abstract Since trauma is an inescapably stressful event that overwhelms,people&amp;amp;#x27;s coping mechanisms it is uncertain to what degree the results of laboratory studies of ordinary events have relevance to the understanding of traumatic memories. This paper first revie ws the literature on the differences between recollections of stressful and of traumatic events. It then reviews the evidence implicating dissociative processes

Psychiatric Annals, May 1, 2005

Psychiatric Clinics of North America, Dec 1, 1994

European Neuropsychopharmacology, Sep 1, 1997

Journal of Traumatic Stress, Oct 1, 1995

PsycEXTRA Dataset, Feb 23, 2013

CNS Spectrums, 1998

The aim of this meeting was to obtain a consensus on what constitutes good research practice in p... more The aim of this meeting was to obtain a consensus on what constitutes good research practice in posttraumatic stress disorder (PTSD). Objectives were to review relevant parameters of trials, such as the patients recruited, the means of assessing PTSD at baseline, and the change in symptomatology in response to treatment, and to reach a consensus on the most appropriate parameters to use in future research. The bases for the discussion were the 1995 National Institute of Mental Health (NIMH) and the National Center for PTSD consensus on the assessment of PTSD, results of drug treatment trials, and information on the assessment scales used in PTSD research.