THE CONCEPT OF CUMULATIVE TRAUMA IN TIMES OF COVID-19: COULD KHANS THEORY BECOME USEFUL AGAIN?

"The paper discusses whether the psychoanalytic concept of Cumulative Trauma could be a valuable theoretical contribution in understanding possible traumatization’s of children in the course of the Covid-19 pandemic, as they may quite often face a multiple stressed parent during a lockdown, who’s parental function is on the verge breaching. This concept of trauma as established by British Psychoanalyst Masud Khan in 1963 was hardly taken into account in recent trauma research and it has seen little discussion in psychodynamic literature; if at all, it has been used as a merely descriptive category, without considering the suspension of the parental care function, which was identified as the decisive traumatogenic factor for the child’s traumatization. The paper begins with a recapitulation of the original theory and then moves on to linking the Cumulative Trauma to current research contexts (attachment, mentalization, developmental trauma disorder). Finally, the relevance of the concept for parenting in times of the Covid-19 pandemic is explored on the basis of a short clinical case example."

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

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.

Bullying Victimization and Trauma

Bullying victimization and trauma research traditions operate quite separately. Hence, it is unclear from the literature whether bullying victimization should be considered as a form of interpersonal trauma. We review studies that connect bullying victimization with symptoms of PTSD, and in doing so, demonstrate that a conceptual understanding of the consequences of childhood bullying needs to be framed within a developmental perspective. We discuss two potential diagnoses that ought to be considered in the context of bullying victimization: (1) developmental trauma disorder, which was suggested but not accepted as a new diagnosis in the DSM-5 and (2) complex post-traumatic stress disorder, which has been included in the ICD-11. Our conclusion is that these frameworks capture the complexity of the symptoms associated with bullying victimization better than PTSD. We encourage practitioners to understand how exposure to bullying interacts with development at different ages when addressing the consequences for targets and when designing interventions that account for the duration, intensity, and sequelae of this type of interpersonal trauma.