Relation of Interpersonal Conflict Behaviors to Emotion Dysregulation and PTSD in Adolescents with a History of Betrayal Trauma

Posttraumatic stress disorder (PTSD) is a disorder that develops in response to exposure to a traumatic stressor. Although this is the most well known diagnosis for individuals who have difficulties after a traumatic event, research documents numerous difficulties and psychopathology that can result from traumatic events, many of which do not fit the DSM-IV criteria of PTSD. Specifically, severe, chronic, interpersonal trauma tends to have a different pattern of effects on individuals than does acute, non-interpersonal trauma. This is particularly true for children (e.g., van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005). Because of this, the construct of Developmental Trauma Disorder (DTD) was introduced, although it is not currently recognized in the DSM 5. Emotion regulation skills and interpersonal dysfunction are two core components of this disorder. Trauma perpetrator (i.e., betrayal trauma) has also been found to be an important trauma characteristic when determining the clinical trajectory following traumatic experiences. The current study examined whether adolescents who have experienced betrayal trauma exhibit more negative communication behavior during a stressful interpersonal task, and report more emotion regulation deficits, than adolescents with non-betrayal trauma histories. The study also examined whether emotion regulation mediates the relation between betrayal trauma and negative communication. Finally, analyses were conducted to determine if PTSD or betrayal trauma best predicts negative communication behavior. Adolescents with a history of betrayal trauma reported more emotion regulation difficulties, and exhibited significantly more aggressive, negative non-aggressive, and fewer positive behaviors when engaged in a stressful interpersonal task with their mothers. Although PTSD symptom severity was related to experiencing a betrayal trauma, neither PTSD severity nor PTSD diagnosis predicted interpersonal difficulties as well as betrayal trauma history or emotion regulation difficulties. Finally, emotion regulation difficulties were found to mediate the relation between betrayal trauma and negative communication behavior. These results lend support for adding DTD to the next version of the DSM, illustrating that clinically significant problems related to trauma may not look PTSD-like.