Meanwhile, van der Kolk's own commitment to DTD is as much moral as scientific and clinical. "There are 10 times as many kids getting abused in America than there are soldiers fighting in Afghanistan and Iraq," he says, "and their maltreatment is strongly correlated with our huge jail population, high crime rates, poverty, and school dropouts, not to mention suicide, depression, obesity, and a host of other issues. But none of this is in people's purview—the connection between these vast social problems and the way we raise our kids isn't being made." Van der Kolk would like to see a massive public crusade against child maltreatment based on the model of the anti-smoking campaign begun by Surgeon General C. Everett Koop in 1982. "We need someone important in public life to have the courage to stand up and take a very visible stand on something like this—it has a huge impact on both science and society."

Unfortunately, the issue remains an uphill fight. Politically and socially, child abuse continues to be a taboo subject. Van der Kolk recalls sitting at a dinner next to former Surgeon General David Satcher in 1999, who told him about a new plan to address the adolescent suicide epidemic in the United States. "That's just great," van der Kolk replied, and began telling him about the Trauma Center's interventions to stem an adolescent suicide epidemic in South Boston. Mentioning the ACE studies and the astonishing correlation between child abuse and suicide, van de Kolk added, "I'm so glad you'll be making this connection publicly, so that the issue of child maltreatment will get more attention." Satcher responded, "Well, no, we left that out of the report—it's way too sensitive a topic."

We've come a long way in our understanding of trauma. No one any longer denies the fact that wars can ruin the lives of soldiers and their families. But when it comes to physical and emotional violence within the family, advocates like van der Kolk insist that society continues to avoid the grim evidence. As he puts it, "We don't seem ready to acknowledge that the largest danger to our women and children isn't Al-Qaeda, but the people who are supposed to love and take care of them."

Mary Sykes Wylie, Ph.D., is a senior editor of the Psychotherapy Networker. Tell us what you think about this article by e-mail at letters@psychnetworker.org, or at www.psychotherapynetworker.org. Log in and you'll find the comment section on every page of the online Magazine section.

If you want to send your comments regarding the need for a developmental trauma disorder diagnosis (DTD) to the American Psychiatric Association, you can access the DSM-V website at: www.dsm5.org/Pages/Default.aspx.

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Joel4th  - Whole-Hearted Agreement -From a patient's view   |Registered |2010-09-05 22:45:20 I am not a Psychiatrist or Psychologist, but a 46 year old that has recently become disabled by the long-term result of Child-hood Trauma from a Vietnam Veteran Father who abused my sisters and abandoned myself and my brothers. Also, complicating the dysfunction was the Army's Protection of the Abuser and the furious pace of constantly moving. Begining in my 30's My Mental Health was brought to a breaking point as a result of "Work-Place Bullying" so prevalent in Civil Engineering. Eventually PTSD like symptoms and Panic attacks completely disabled me 2 years ago. Obtaining a Diagnosis was nearly imposible because I have Multiple Problems and Doctors would not put anything in writing to support my case. An MHMR Psychologist diagnosed me as having "P.D.D. or A.S.D., but I belive your Diagnosis fits better. - I recommend specific study of Children in Military Families,who are Moved too often. jfreess   |2010-06-29 13:16:26 Very good article, well-written and thought-provoking.

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