Progress and Limitations in the Treatment of Complex PTSD and Developmental Trauma Disorder

Abstract

Purpose of review This review describes treatments that have been developed (or adapted from treatment models for posttraumatic stress disorder [PTSD]) for Complex PTSD (cPTSD) in adulthood and developmental trauma disorder (DTD) in childhood. The nascent research evidence-base is reviewed and future directions are discussed. Recent findings Numerous psychotherapy treatments are in the early stages of clinical testing and dissemination for symptoms of cPTSD (emotion dysregulation, interpersonal detachment, altered self-perception) and the additional symptoms of DTD (interpersonal, somatic, and behavioral dysregulation and dissociation). There is indirect evidence, primarily based on reductions in depression and anxiety symptoms (but not cPTSD or DTD symptoms specifically), of efficacy for varied approaches to trauma-focused cognitive behavior therapy (CBT) in randomized controlled trials with adults and children with histories of developmentally adverse traumatic childhood experiences (e.g., abuse, violence). No approaches to pharmacotherapy have been systematically developed or tested for adult cPTSD or childhood DTD. Summary Despite a rapidly growing array of promising approaches to psychotherapy for cPTSD and DTD, the absence of formal diagnostic criteria for cPTSD and DTD has limited efforts to conduct scientific evaluations of the efficacy of these treatments. As treatment models continue to be created, refined, and disseminated, the recent development and validation of psychometric assessment measures for cPTSD (the International Trauma Questionnaire; ITQ) and DTD (the Developmental Trauma Disorder Semi-structured Interview; DTD-SI) is a crucial catalyst for rigorous outcome research that can lead to a robust cPTSD and DTD treatment outcome evidence-base and a precision health approach to treatment.