Physical and Behavioral Health Services

Individuals with complex traumatic stress disorders can demonstrate:

• “Learned helplessness” … they feel unable to protect themselves from harm or threats, so they feel unable change their lives in a positive way.
• Dissociation … they use psychological and emotional distancing or numbing to protect themselves from fear and emotional pain. They appear to be zoned or spaced out, and emotionally shut down. They feel what’s happening isn’t real. They often have a lower heart rate.
• Hyper-arousal … they need to be always ready to protect themselves or others, they’re on edge, hyp

Helplessness and isolation are the core experiences of trauma. Power and reconnections are the core experiences of recovery.

Judith Herman, M.D., author of Trauma and Recovery

Health-risk behaviors are used as coping mechanisms.

To alleviate or numb the pain of trauma, children and adults can resort to eating unhealthy food or overeating, using tobacco, abusing drugs or alcohol, or engaging in risky sexual activities. When childhood traumatic stress goes untreated, the individual can experience anxiety and shame, and their coping mechanisms can contribute to social isolation, and result in chronic diseases such as hypertension, diabetes, cancer, substance-use disorders, depression and other behavioral health challenges.

90% of clients in public behavioral health-care settings have experienced trauma

SAMHSA-HRSA Center for Integrated Health Solutions

Understanding triggers can avoid re-traumatizing patients:

Massive secretions of neuro-hormones at the time of the trauma may deeply imprint traumatic memories in the amygdala, causing “fear conditioning” where sensory information — smells, sounds, touch, sights, etc. — from past harmful or threatening events get coded and stored, causing the individual to experience these same sensory experiences as harmful or threatening.

Health and behavioral health care providers who are not trauma-informed may inadvertently re-traumatize patients by triggering memories of past abuse and feelings of fear, which can lead to angry, disruptive patient behavior, loss of trust, failure to comply with recommended medication, treatment or follow-up appointments.

Common types of triggering events include:

• Invasive procedures
• Removal of a patient’s clothing
• Physical touch
• Personal questions that may be embarrassing/distressing/triggering
• Power dynamics of relationship
• Gender of healthcare provider
• Vulnerable physical positions during an exam or procedure
• Loss of, and lack of, privacy

Childhood trauma and toxic stress impact the brain and the body.

Conditions that have been linked to trauma exposure include chronic lung and heart disease, viral hepatitis, liver cancer, autoimmune diseases, sexually transmitted infections, depression and other mental health conditions and higher rates of suicide. Many studies, including the original CDC adverse childhood experiences (ACEs) study in 1998 and the Philadelphia Urban ACEs study in 2013, have shown correlations between childhood trauma and lifelong health problems.

Using a “trauma lens” may lead to better outcomes.

Patients with complex needs are often hard to engage and have high no-show rates. They may not take their medications consistently, or follow through with recommended lifestyle changes. They may avoid preventive care, show anxiety about medical procedures, or complain of chronic unexplained pain. Considering the impact of trauma on physical and emotional health, may explain certain behaviors, enabling more effective communications, and help build relationships and trust.