We recently released our course on Trauma-Informed Care. We’ve already gotten great feedback on it. We want to take a few blog posts to explore Trauma and Trauma-Informed Care. Let’s Start with talking about; Trauma, Types of Trauma, and Trauma Prevalence.
What is Trauma?
The American Psychological Association narrowly defines trauma as exposure to actual or threatened death, serious injury, or sexual violence (APA, 2013). Some have criticized the APA’s limiting definition and suggest that events may still be traumatic even if one’s own, or someone else’s, physical integrity is not threatened (Briere & Scott, 2006). The Substance Abuse and Mental Health Services Administration (2012) broadens the definition of trauma and states that trauma can be “an event or set of circumstances experienced by an individual that is emotionally or physically harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being” (SAMHSA, Trauma and Justice Strategic Initiative, 2012, p. 2). In their research among the homeless population, Hopper, Bassuk, and Olivet (2010) further expand the definition by stating,
Trauma is an experience that overwhelms a person’s resources for coping and thus disrupts an individual’s sense of safety, ability to self-regulate, and perception of control” (p. 80).
Furthermore, Hopper et al. (2010) elaborate on the trauma victim’s sense of loss of control: following a traumatic event, many individuals fear that they are losing control over their lives. Harris and Fallot (2001) speak to the identity-defining nature of trauma on an individual level and state that trauma should not be viewed as a single discreet event but rather as a defining and organizing experience that forms the core of an individual’s identity.
Types of Trauma
Symptoms of trauma vary between individuals. Some victims recover quickly from a traumatic event, and others develop long-lasting emotional, mental, or physical maladies such as depression and Post-Traumatic Stress Disorder (PTSD) (Ursano, Benedek, & Engel, 2012). The literature identifies many types of trauma, including neglect, psychological abuse, physical abuse, sexual abuse, community violence, combat-related trauma, domestic violence, accidents, disasters, adverse childhood experiences (ACE), and historical trauma. These types of trauma are self-explanatory save, perhaps, Adverse Childhood Experiences and historical trauma.
The Adverse Childhood Experiences (ACE) study was groundbreaking research that examined the associations between childhood trauma and health conditions later in life (Felitti et al., 1998). The ACE study broadens and expands the types of trauma usually considered as part of the trauma definition to and include experiences such as verbal abuse, physical neglect, and emotional neglect. The study also expands the definition of trauma to include experiences that occur within a family and to its members, such as having a parent who is an alcoholic, a mother who is a victim of domestic violence, a family member who has been or is currently incarcerated, a family member diagnosed with a mental illness, and the absence of a parent through divorce, death, or abandonment.
Historical trauma is defined as the experience of past generational trauma being experienced in the current generation of a cultural group. Fonagy (1999) researched this phenomenon with the descendants of Holocaust survivors. Dr. Maria Yellow Horse Braveheart (1998) observed in Native American populations similar occurrences of current generations suffering traumatic reactions because of past generational atrocities.
The statistics on trauma and its effects in the United States are staggering. Approximately 7.7 million American adults age 18 and older, or about 3.5 percent of people in this age group in a given year, have PTSD. Over 51% of the general population has experienced trauma in childhood, and over 98% of people served by behavioral health services have experienced trauma (Kilpatrick et al., 2013). Hodas (2006) points out that the prevalence of trauma in child welfare services is so high and widespread that welfare workers employ a Universal Precautions approach, which assumes that everyone they serve has a trauma history.
Having a fundamental understanding of trauma can be a significant help in understanding the needs of our clients or patients. Trauma’s prevalence demands that we take steps and measures to provide care that is empathetic and compassionate. It isn’t necessarily what we do for an individual as much as it is what we become. We must become caring and compassionate providers of care understanding that trauma can negatively impact emotional, physical, mental, and spiritual well-being across the lifespan of an individual.
Briere, J. N., & Scott, C. (2006). Principles Of Trauma Therapy: A Guide To Symptoms, Evaluation, And Treatment. Centers for Disease Control and Prevention. Atlanta: CDC; 2006 [cited 2014 September 5]. Adverse Childhood Experiences Study Retrieved from http://www.cdc.gov/nccdphp/ace/index.htm.
Felitti, V. J., & Anda, R. F. (2010). The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior: Implications for healthcare. The impact of early life trauma on health and disease: The hidden epidemic, 77-87.
Harris, M. and Fallot, R. D. (2001), Envisioning a trauma-informed service system: A vital paradigm shift. New Directions for Mental Health Services, 2001: 3–22. doi: 10.1002/yd.23320018903
Hodas, G. R. (2006). Responding to childhood trauma: The promise and practice of trauma informed care. Pennsylvania Office of Mental Health and Substance Abuse Services, 1-77.
Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma- informed care in homelessness services settings. The Open Health Services and Policy Journal, 3(2), 80-100.
Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD Prevalence Using DSM‐IV and DSM‐5 Criteria. Journal of Traumatic Stress, 26(5), 537-547.
Substance Abuse and Mental Health Services Administration, Trauma and Justice Strategic Initiative (2012). SAMHSA’s working definition of trauma and guidance for trauma-informed approach. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Ursano R.J., Benedek D.M., Engel C.C. Trauma-informed care for primary care: The lessons of war. Annals of Internal Medicine. 2012;157:905-906. doi:10.7326/0003-4819-157-11-201212040-00542