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Complex trauma disorder among youth needs recognition, experts say

Mandy Habib, center, is co-director of the Institute

Mandy Habib, center, is co-director of the Institute for Adolescent Trauma Treatment and Training in Adelphi University's School of Social Work. Credit: Adelphi University

Mental health experts are pressing for greater recognition of complex trauma disorder, a common condition among mistreated children and adolescents, with some practitioners asserting it should be included in the leading diagnostic manual of psychiatry.

Mandy Habib, a clinical psychologist and co-director of the Institute for Adolescent Trauma Treatment and Training at Adelphi University, said the condition occurs among youths who have suffered repeated episodes of any one or several types of trauma: physical battery, neglect, verbal insults, threats, and sexual and emotional abuse.

The trauma often is perpetrated by an adult and leaves distinct psychological scars that can have lifelong consequences. Alcoholism, drug abuse, sexual promiscuity, food addiction, violent behavior and crime can have their roots in complex trauma that began in childhood, Habib and other experts said.

“It is such an underrecognized phenomenon,” Habib said, emphasizing that the disorder should be a stand-alone diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which is in its fifth edition.

She is joined in that belief by colleagues at Northwestern University in Illinois, the National Child Traumatic Stress Network and The Trauma Center at Justice Resource Institute, a Massachusetts-based nonprofit.

The stress network, established by Congress in 2000, is federally funded through an agency of the U.S. Department of Health and Human Services and jointly coordinated by UCLA and Duke University. Its mission is to work with scores of local grantees across the country to raise the standard of care and improve access to services for traumatized children, their families and communities.

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Habib and her collaborators, as part of efforts to spread the word, also served as the mental health professionals involved in a YouTube video aimed at teens to help them recognize the condition and seek help.

“When people hear the word trauma, they think of PTSD,” Habib said of post-traumatic stress disorder. “But with complex trauma, it is the difference between experiencing a traumatic event and having a traumatic life.”

PTSD, an official mental health diagnosis in the DSM, can emerge after a horrific event — often because of direct experience, but also because of being a witness. PTSD symptoms can include recurring nightmares, depression, anxiety, flashbacks and ongoing thoughts about the event.

Complex trauma disorder is marked by a broad constellation of problems, which have been cataloged by mental health experts.

Many youths with complex trauma have relationship problems with family members and peers. Most have low self-esteem and are plagued by shame and guilt. Thinking and learning are impaired and some young people are affected by depersonalization, a sense of being detached from or “not in” one’s body, according to data collected on the condition.

As one example, Habib described the case study of a young woman who had experienced a life of neglect and abuse. Her earliest memories centered on her sixth birthday, when her angry father knocked her unconscious and tainted what should have been a happy occasion. The event was part of a pattern of abuse that occurred over many years.

Having an official diagnosis in the DSM would help eliminate the misdiagnosis of children and teens who are affected by complex trauma disorder. Many are diagnosed as being bipolar or as having attention deficit hyperactivity disorder, or ADHD.

Kids diagnosed with those conditions are prescribed potent medications. But those drugs not only fail to treat complex trauma, Habib and other experts said, they allow trauma symptoms to smolder unattended.

Alan Steinberg, associate director of the National Center for Child Traumatic Stress at UCLA, said proven therapies — group and/or one-on-one counseling — effectively address complex trauma disorder. Far more mental health professionals and laypeople need to be made aware of those treatments, he said.

Nearly 700,000 children are abused annually in the United States, according to the National Children’s Alliance, a nonprofit advocacy organization. Three-quarters of those cases involve neglect, 17.2 percent are physical mistreatment and 8.4 percent are sexual abuse. Some children are “polyvictimized,” which means they suffer more than one form of maltreatment.

“There are evidence-based interventions that help; recovery programs. They are effective and they should be put in place,” Steinberg said. “We have been doing this for a long time.”

Children who live in communities plagued by gang violence and those exposed to incessant bullying also can develop complex trauma disorder, he said.

Steinberg added that mental health researchers nationwide are amassing the data that are required to qualify complex trauma as an official diagnosis.

“What is happening with these children is not fully captured in the definition of PTSD,” Steinberg said, although aspects of PTSD — such as flashbacks and nightmares — may be a part of complex trauma for some youths.

The American Psychiatric Association, which publishes the DSM, now considers the manual a “living document” and not just a physical book. That means changes and updates can be made online.

“Proposed changes would be considered based on new scientific evidence or clinical developments in mental health care,” Dr. Philip Wang, director of research at the American Psychiatric Association, told Newsday in an email.

“This new process also means changes to the DSM can be completed in a timely and transparent manner due to advancements in digital communication platforms,” Wang said.

Habib, meanwhile, said she hopes young people will become acquainted with the condition through the video titled “Never Give Up,” which was posted last week on YouTube.

The documentary-style production, which runs about 14 minutes, features youths who have experienced complex trauma.

“It’s about what they’ve been through, how they dealt with it and how they are choosing better coping strategies,” Habib said.

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