Trauma-Informed Care
Many of you, like we who support in various ways the CPTSD Foundation, have survived one or more traumatic events. By traumatic events I offer the following definition I found on the Healthline website:
“A traumatic event is an incident that causes physical, emotional, spiritual, or psychological harm. The person experiencing the distressing event may feel threatened, anxious, or frightened as a result.”
In this series of articles, we are going to explore several topics vital to understanding the effect traumatic events have on survivors.
The Effects of Trauma on Adults
Trauma can occur at any age and to anyone.
In fact, there is no one alive who will escape having some trauma occur in their lifetime. All of us will experience the death of a loved one, a disappointment from a friend, or perhaps losing a job to layoffs.
While these are all valid traumatic events, they are commonplace and are not ordinarily life-long in their toxicity to the lives of those experiencing them.
However, traumatic events where we felt threatened and frightened with no escape leave us living with residual anxiety and fear. These events are highly toxic violations of our bodies, minds, and souls.
As adults, these traumatic occurrences may occur in the form of any of the following:
- Rape
- Domestic violence
- Being mugged or robbed
- Natural disasters
- Severe illness
- Serious injury in an accident
- Living in a war zone
- Participating in war
Unfortunately, adults often experience not one traumatic event but several concurrently. Clearly, horrific and highly traumatizing events such as rape cause significant harm to the mental and physical health of their victims.
I felt it essential to include adult victims of trauma in this piece because often when we tend to discuss childhood trauma and its effects on adult lives. However, it is vital for us to also keep in mind that adult survivors of trauma may also develop one of the many mental health disorders such as major depression, anxiety, and complex post-traumatic stress disorder.
Below is a short list of some of the long-lasting effects adults can experience long after their ordeal has ended.
- Shock, denial, or disbelief
- Confusion, difficulty concentrating
- Anger, irritability, mood swings
- Anxiety and fear
- Guilt, shame, self-blame
- Withdrawing from others
- Feeling sad or hopeless
- Feeling disconnected or numb
The Effects of Trauma on Children
As with adults, most children will experience at least one traumatic event before the age of eighteen. These could be the loss of a pet, the death of a grandparent, or being snubbed by a school friend. However, there are traumas children live through that are so out of the ordinary that they stunt their development. These experiences include any type of abuse or neglect.
What is now termed adverse childhood experiences (ACEs) cause changes in the brain, social isolation, health problems, and even death for these unfortunate little ones.
All the negative consequences these children experience are the result of toxic stress.
The following is the definition of toxic stress that appears in a paper funded by the National Institute of Mental Health that states:
“Toxic stress has been defined as exposure to chronic, severe and prolonged stress, occurring in the absence of protective factors. Excessive stress in early childhood is a particular risk because it can disrupt developing brain circuits and increase levels of stress hormones, both of which can lead to problems lasting into adulthood.”
The Adverse Childhood Experiences (ACEs) Study
We have covered the adverse childhood experiences (ACEs) study in-depth in a recent piece. However, ACEs are so crucial to our discussion that it is worth a reminder so we can better understand toxic childhood stress.
While there have been reams of paper, and thousands of words written dealing with the research of how toxic events impact children, the most influential and important of these studies was completed by Dr. Robert Anda and Dr. Vincent Felitti from 1995 to 1997.
The experiment began in the early 1990s to answer the question of why patients who successfully lost weight dropped out of a weight loss program. Doctor Vincent Felitti, who conducted the study, could not make sense of the data until he personally interviewed the participants individually.
It was then that he learned weight loss made the patients feel vulnerable. Digging deeper, Doctor Felitti found that a large proportion of the previous patients of the weight loss program he interviewed also reported experiences of childhood sexual abuse.
The results of the interviews prompted the now famous research known as the adverse childhood experiences (ACEs) study.
Doctor Felitti was joined by doctor Robert Anda to survey 17,000 adults about their exposure to ten categories of abuse, neglect, and household dysfunction during their childhoods.
The categories on the survey included:
- Any form of abuse
- Substance abuse in the childhood home
- Incarcerated family member
- A family member living with a mental health issue
- Separated or divorced parents
After questioning their subjects, the doctors did physical exams and began tracking the volunteer’s health.
The ACEs Follow-Up Study
In 2009, a paper published in the American Journal of Preventative Medicine of a follow-up study to the ACEs study was conducted beginning in 2006. The purpose of the experiment was to determine if adverse childhood experiences were associated with an increased risk of premature death in adulthood.
Their findings were stunning.
When following up with the subjects who took part in the original ACEs study, the researchers found a strong correlation between the trauma these adults had endured in childhood and poor health outcomes decades later.
The researchers observed that people who reported six or more adverse childhood experiences died close to twenty years earlier than those without these life-altering events.
The participants who had reported six or more adverse childhood experiences were nearly three times more likely to die before or at age 75, and nearly five times more likely to die at or before age 65 than the average population of the United States.
These results show conclusively that people who experienced childhood abuse will have their lives cut short.
However, why? What was killing these people?
Effects of ACEs on the Body and Mind in Adulthood
An excellent resource on how ACEs affect adults is found on the Substance Abuse and Mental Health Association (SAMHSA) website. SAMHSA lists several studies conducted to determine how adverse childhood experiences affected the body and mind after reaching adulthood.
The studies report higher incidences of the following:
- Diabetes
- Heart attacks
- Obesity
- HIV infections
- Suicidal ideation
- Completed suicides
- Significantly increased risk of experiencing a severe mental health issue
- Divorce or separation
- Never married
- Lower Incomes
- Lower education
The effects above are only a partial list of the potentially horrific consequences of childhood trauma on children later in life.
In short, people who survived childhood abuse are sicker both physically and emotionally, less affluent, and have poorer relationships. The reason is simple to define. They are living with less support than those of the same age in their communities.
How Trauma-Informed Care Can Help
Until recently, most people had no idea what the definition of trauma and no understanding of how to treat it. While efforts to prevent childhood trauma are ongoing, treating children and adults who are already affected by it has become a national concern.
Because of the long-lasting impact and prevalence of adverse childhood experiences, trauma-informed care is applied now in a wide range of settings. These include mental health and substance abuse treatment facilities, child welfare systems, schools, and criminal justice institutions.
The first step in treating this problem has been making professionals in medicine, law enforcement and other vital areas aware of trauma and to become informed. They need to know how to handle affected individuals they may encounter in their various occupations.
Once again, SAMSHA gives the best description of what trauma-informed care should look like:
“A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.”
The ultimate goal of trauma-informed care is to mitigate the effects of trauma on survivors by addressing head-on the fact it occurred, and that the expectation of is a full recovery.
The Six Key Principles of Trauma-Informed Care
In trauma-informed care, six guiding principles allow for the healing of individuals and families who have been impacted by trauma. These include empowerment and collaboration between those impacted and those who would help them to overcome the effects of trauma on their lives.
The six fundamental principles of trauma-informed care are safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, voice and choice, cultural, historical and gender issues.
Significant advancements have been made to promote the concepts of recovery and practice. A variety of state and community behavioral health service providers have received training to promote recovery from trauma using guidelines set forth by the Substance Abuse and Mental Health Services Administration.
Also, General Practitioners, teachers, and others are receiving training to help them identify those who may be suffering from the effects of complex trauma.
All the training offered is based on research, practice and the personal experiences of recovering individuals within the context of health reform. SAMSHA states that these techniques will, “lead efforts to advance the understanding of recovery and ensure that vital recovery supports and services are available and accessible to all who need and want them.”
The Future Articles in This Series
I hope this article has made you hungry to learn more about trauma-informed care. New knowledge is being discovered every year about how trauma and toxic stress affect the lives of those who experience them. Trauma-informed care is changing the face of treatments offered to aid in recovery.
These new treatment options give new life and hope to the millions of people who live with the life-altering effects of trauma every day.
Future articles on this subject will cover resiliency, neuroplasticity, and how you can apply these to your life to recover from any trauma that is holding you back from enjoying your life