Diagnosing trauma in adolescence : investigating appropriate diagnostic constructs to explain complex attachment and trauma related symptomatology in a sample of adolescents in out-of-home care.

Abstract

Experiencing maltreatment in the early developmental years has consistently been shown to impact brain development and attachment relationships, thus leading to a range of functional impairments in the adolescent years. Complex attachment and trauma related symptomatology is presently not well conceptualised within diagnostic classification systems. Three diagnostic constructs encompass some of this complexity, namely Borderline Personality Disorder (BPD), Complex Post-Traumatic Stress Disorder (C-PTSD) and Developmental Trauma Disorder (DTD). The aim of the present study was to test the validity and coherence of these three constructs among a sample of 230 adolescents residing in out- of-home care. The present study analysed data from the CICS adolescent survey. ACA and CBCL items were used to derive new Complex Post-Traumatic Stress Disorder (C-PTSD) and Borderline Personality Disorder (BPD) scales. A scale for Developmental Trauma Disorder (DTD) was unable to be created due to limitations within the construct. Results showed 19 adolescents met BPD case-ness, and 3 adolescents met C-PTSD case-ness, furthermore, 2 of the C-PTSD cases also met criteria to be a BPD case. Concerns regarding working with singular diagnostic constructs and applying the diagnostic framework to this population are discussed, as are implications for clinical practice and recommended research directions.