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Trauma-Informed Care and Why It Matters

How we’re falling short in treating trauma victims and what we can do to fix it.

It is sometimes said that traumatic reactions are normal reactions to abnormal situations. As true as this statement is, it’s also true that individuals’ coping reactions post-trauma remain poorly understood, even by many of the people who are in the best positions to offer support and treatment to trauma victims. It is important for everyone to understand that victims of traumatic events, such as human trafficking, will not always react or behave in the way that we might expect.

A woman’s experience of trauma impacts every area of functioning, including physical, mental, behavioral, and social. According to the U.S. Department of Health and Human Services Office on Women’s Health, 55 percent to 99 percent of women in substance use treatment and 85 percent to 95 percent of women in the public mental health system report a history of trauma, with the abuse most commonly having occurred in childhood.

The Adverse Childhood Experiences (ACE) study conducted by the U.S. Centers for Disease Control and Prevention and Kaiser Permanente assessed associations between childhood trauma, stress, and maltreatment, and health and well-being later in life. Almost two-thirds of the participants (both men and women) reported at least one childhood experience of physical or sexual abuse, neglect, or family dysfunction, and more than one of five reported three or more such experiences.

Women were significantly more likely than men to report more traumatic experiences in childhood. ACE scores were found to be highly correlated with serious emotional problems, health risk behaviors, social problems, adult disease and disability, mortality, high health care and other costs, and worker performance problems. Higher scores were also significantly correlated with liver disease, chronic pulmonary obstructive disease, heart disease, autoimmune disease, lung cancer, depression, attempted suicide, hallucinations, the use of antipsychotic medications, the abuse of substances, multiple sex partners, and an increased likelihood of becoming a victim of sexual assault or domestic violence.

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Public education, prevention, early identification and intervention, and effective trauma treatment are all necessary to break the cycle of violence. We need to intensify educational efforts to expand the availability of trauma-informed care. Trauma-informed care means treating a whole person, taking into account past trauma and the resulting coping mechanisms when attempting to understand behaviors and treat the patient.

To illustrate why trauma-informed care is so important, take a few examples. Sometimes people only believe victims of rape when they are incredibly emotional when describing the details of the assault, because that reaction is perceived to be the normal reaction to such trauma. But many victims speak matter-of-factly and without affect or visible emotion about these traumatic events. This doesn’t mean that a victim is lying or exaggerating claims. Rather, the stoicism is often tied to a victim’s desperate attempt to cope with trauma through detachment.

There are many other situations in which the lens of trauma-informed care can help outsiders to better understand a trauma victim’s behaviors. The general public has little understanding of the ramifications of trauma. The result of this lack of understanding goes beyond an empathy gap or the lack of appropriate response for victims of trauma. It can result in judgmental attitudes and even re-victimization of those who have survived trauma.

For example, when people say that they don’t understand why women in abusive relationships “choose” to stay, they must acknowledge that they are not coming from a place of being the trauma victim, and so their understanding about the reasons behind this may be limited. Adhering to stereotypical beliefs about the “appropriate” behaviors for rape victims is called rape myth acceptance. In societies with high levels of rape myth acceptance, victim-blaming is more common, and perpetrators may suffer few consequences.

Another example is substance abuse. With substance abuse, a compassionate, trauma-informed approach is one that starts by acknowledging that people may use substances, such as drugs or alcohol, as a survival skill as the result of trauma. Without considering that perspective, health-care providers will not be able to effectively provide help.

This limited line of thinking can also influence general policy decisions that affect millions. Past traumas and their physical and psychological effects can become preexisting conditions, which can exclude people from access to affordable health care. The current Republican-proposed health bill’s lack of protection for people with preexisting conditions (which includes rape and domestic abuse) opposes efforts to better address trauma and treat the whole person. It’s essentially punishing individuals for recognizing and trying to overcome types of trauma and stigmatizing them further.

To begin to address this issue, training in trauma-informed care is necessary for health-care providers and law enforcement. This training is important to build the capacity among providers to deliver holistic patient care, being sensitive to how a range of experiences over the life course may relate to a person’s current health behaviors and health status.

Law enforcement officials must be aware of the range of unexpected potential reactions they might receive from victims, so that if they’re called out to situations of abuse, they can understand that an apparent lack of emotion doesn’t mean that a person has not been abused. Shattering that myth and other limiting, dismissive narratives means making an effort to broaden our understanding of what people have been through in their lives, how these “preexisting conditions” have affected their personalities, and what help they need with that bigger picture in mind.

And everyone should practice empathy and tolerance, because you never know what others have gone through.

More from Mellissa Withers, Ph.D., M.H.S
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