Understanding the impact of psychological trauma is critical for future health care providers, as we inevitably will treat patients with psychologically traumatic backgrounds. To effectively treat patients, providers need to understand the life situations that may be contributing to the patient’s current physical status. It is a monumental act of trust by patients to disclose their traumatic backgrounds. The sharing of such privileged information is to be honored with an informed and supportive response.
An initiative focused on such “trauma informed care” was the topic of a recent conference I had the opportunity to attend. The Central Iowa ACEs 360 Coalition also will host an event on Friday, Oct. 14, at the Iowa Events Center in Des Moines that will focus on building resilience in individuals, families and communities in response to findings of the latest Iowa report on adverse childhood experiences (ACEs) released in July 2016.
What is trauma informed care?
Trauma informed care is a treatment approach that includes understanding, recognizing and responding to the effects of all types of trauma and post-traumatic stress disorder in children and teens. It emphasizes physical, psychological and emotional safety for both children and providers and helps survivors rebuild a sense of control and empowerment. The Trauma Informed Care Project (TIC), sponsored by Orchard Place in Des Moines, has as its mission to examine policies, practices and organizational structures to help prevent the re-traumatization of survivors. Trauma informed care challenges providers to stop asking “What’s wrong with you?” and begin asking “What happened to you?”
Trauma and physical symptoms
Most DMU students have exposure to the Adverse Childhood Experiences study. This study provides tremendous insights into the physical manifestations of the emotional duress. Key findings of this study indicate that ACEs are common, with almost two-thirds of participants having at least one ACE and one-fifth having experienced three or more. As the number of adverse trauma experiences increases, so does the risk for numerous physical manifestations, including chronic pain, myocardial infarction, asthma, disability, coronary heart disease, stroke, and diabetes.
Knowing that ACEs can increase the risk of many of the big health problems in our country, it is important to integrate this knowledge into our conceptualization of a patient’s case. Detrimental behaviors causing poor health conditions are commonly initiated as a coping mechanism as a result of the childhood experience. These coping strategies will remain in place until the trauma is addressed or the patient finds a coping mechanism that works better. Patients are likely aware of the negative implications of destructive behaviors and may carry immense shame regarding their behavior. Thus instead of focusing on what is wrong with the patient, you may consider investigating what has happened to the patient to originate the behavior, and the ways in which the behavior has actually helped the patient to cope with their life circumstances. Things may not be as they seem on the surface.
Trauma and triggers
People who have experienced traumatic life events are often very sensitive to situations that remind them of the people, places or things involved in their traumatic event. Often, trauma survivors can be re-traumatized by well-meaning providers and community service providers. Unfortunately, triggers may cause a patient to relive the trauma and view a health care setting as a source of distress rather than a place of healing and wellness.
Triggers can include any of the senses: the sight of a white lab coat, the smell of rubbing alcohol, the touch of a doctor, the sounds of a door shutting. Medical settings may be distressing for individuals with trauma experiences because the invasive procedures, removal of clothing, personal questions and vulnerable physical positions may re-enact times when the patient was deliberately harmed or degraded by someone else.
Touch can be very healing and executed with the best of intentions; however, touch can also be very triggering. If a patient has been touched in the past in ways that were extremely painful or degrading, and then if a health care provider touches that same part of the patient’s body or otherwise reminds the patient of the traumatic touch in some way, it may trigger intense memories of the traumatic episode, even to the point where the patient feels like the traumatic experience is happening again.
The challenge is that our patients won’t wear a cautionary sign around their necks and may not be comfortable disclosing such personal information. Therefore, when performing a physical on any patient, it is very important to ask for permission (particularly for exposing any new parts of the body or before touching any intimate parts of the body) and to watch for non-verbal cues, such as flinching, drawing back, grimacing or stiffening.
Reactions to the trigger can present in multiple ways. A patient may have an emotional (crying or fear) or physical reaction (blood pressure changes or stomachaches) as well as a behavioral reaction (uncooperative, restlessness, non-adherence). Understanding the impact of trauma is an important first step in becoming a compassionate and supportive health care provider, but this conference indicated to me that understanding local resources for patients can also prove to be critical as we look toward a holistic way of healing.
Autumn Brunia is a second-year osteopathic medical student at DMU.