Up Close With Dr. E

Childhood trauma is unique


Get ready to view your world through the lens of psychological trauma. What’s it like to suffer from an undiagnosed trauma disorder? To answer that question, here are the words of a woman named Eva. (Eva is not a real patient — she is a character used to illustrate key aspects of trauma.)

“Hello, I’m Eva, and I’m 29 years old. I live under a dome of fear. Like a shipwreck survivor tossed into a stormy sea, I’m swimming in danger: Over 1 million COVID deaths in America, war and a threat of nuclear holocaust, mass shootings and gun violence, strange weather patterns and storms and droughts and wildfires. Yet somehow, I manage to go to work, raise my kids and love my husband.”

“But, like rolling a boulder up a steep mountain slope, I have days when extreme stress overwhelms me, and the boulder rolls back and crushes me. On these unbearable days, black thoughts rise: There is no point living; my family would be better off without me; I’m alone and forsaken; I’ve always hated myself; Like a walking dead person, I’ve lost the feeling of being alive.”

“Even on my better days, I can’t live in the moment, the ‘now,’ the ‘present.’ I play this silly game of ‘Do-over.’ It goes like this: I have the power to go back in time and — with all the knowledge I have right now — start my life all over again. A Do-over. So, I go back. But this time I make better choices. Study harder in school, go to college, stay away from bad friends and hurtful lovers. But then my mind hits the wall of reality.”

“So, I rocket forward into my future, where I play another game called ‘what-if.’ What if I quit smoking and drinking, work out, lose weight, get buff and become a better person? Like a ping pong ball, I bounce back and forth between Do-over and What-if? Unable to live in the now, I can’t enjoy the simple joys of living: the colors of a rainbow, the smile on my children’s faces, the smell of apple pie baking in my oven. What’s wrong with me?”

What’s wrong with Eva? Is she depressed or suffering from anxiety? Is it Post Traumatic Stress Disorder (PTSD)? Close, but no. Eva is suffering from an undiagnosed condition called Developmental Trauma Disorder (DTD). A disorder that develops in childhood and, unfortunately, is not accepted by current diagnostic textbooks. DTD is what I will label “Little T” trauma, as contrasted to “Big T” trauma, or Adult PTSD.

There is an overlap of symptoms shared by both Little T traumas and Adult PTSD, and children and adolescents can have a PTSD diagnosis. But most of the children I’ve treated for early onset trauma (Little T’s) do not have PTSD.

Adults can experience events that cause trauma. These events include assault, rape, domestic violence, shootings, medical illness, car accidents, death of loved ones, wars, natural disasters or fires.

Little-t traumatic events- those occurring in childhood-have an additional feature which makes them extremely potent: Loss of their caregivers. For that reason, childhood traumas also include the following: Loss of primary caregivers, constantly changing caregivers, high-stress divorces, and parental abuse.

Here are some symptoms of DTD:

• Emotional and physiological dysregulation — the child can’t control powerful emotions such as fear, anger or shame.

• Disturbed body functions — problems with sleeping, eating and elimination.

• Attention problems — inability to start and sustain goal-directed behavior.

• Impaired relationships — inability to trust others.

To see why Little-t traumas are so powerful, you need this model of child development. Picture a spiraling staircase with 100 steps. Each step represents a skill that must be mastered before the child can ascend to the next, more difficult level. Some steps are physical skills — the ability to crawl, walk, then run.

Other skills are cognitive — thinking abilities that allow the child to master concepts, such as cause and effect, or how to manage time. Childhood traumas act like hand grenades, exploding the staircase, destroying steps. This leaves gaps in development, which in turn, causes problems as the child grows into adulthood.

Children interpret adverse events — domestic violence, abuse — in a highly personal way. Because children lack the cognitive skills to accurately interpret traumatic events, they use this formula: “It’s my fault, I must be bad, all bad, and bad forever.” This belief robs the child of a positive self-image, causes social isolation, and cuts off the child’s sense of having a future.

At the beginning of this article, Eva talked about the state of the world and how she is living under a dome of fear. Does this worsen a person’s traumatic injuries? All our modern-day struggles press down on us and yes, can worsen a person’s traumatic injuries. But the real damage is their potential to separate us from each other. The single most powerful medicine to heal trauma is the heart-to-heart connections between us — healthy human relationships.

The best source of information on DTD symptoms is the book, “The Body Keeps the Score,” by Bessel Van Der Kolk, MD, published in 2014.

The content of this article is for educational purposes only and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.


Dr. Richard Elghammer contributes his column each week to the Journal Review.