Before one discusses the nuances and intricacies of trauma, there must be a basic understanding of what trauma is and how it impacts our health and psychophysiology (Clarke et al., 2019; Gray, 2021). Many people live by the adage “time heals all wounds,” but does it? What about wounds from trauma? The experience of trauma is complex and involves many systems in our brain, influencing our body in numerous ways (Schemitsch & Nauth, 2020; Schweizer et al., 2018). Pop-culture references to trauma would often have us believe that it is simply an event that occurs to people and perhaps there is a prescribed number of days we have to get through it. Rather, trauma is a response to overwhelmingly stressful situations that exceed one’s ability to with cope that experience. The effects of trauma can cause ripples through people’s lives, leading to physical and mental health issues. (Clarke et al., 2019; Gramlich et al., 2021; Gray, 2021; Schemitsch & Nauth, 2020; Schweizer et al., 2018).
Classification of Trauma
Trauma can be classified multiple ways, each with its unique characteristics and impacts. Acute trauma results from a single distressing event, such as a car accident or a violent assault, natural disaster, witnessing violence or other life-threatening event (Calhoun et al., 2022; Schemitsch & Nauth, 2020). Chronic trauma, on the other hand, refers to repeated and prolonged forms of exposure, such as ongoing domestic violence or bullying, long-term exposure to violence such as what a nurse, police officer, or first responder might experience (Clarke et al., 2019; Gray, 2020; Gray, 2021). Complex trauma is a type of trauma experienced by individuals exposed to varied and multiple traumatic events. This is often of an invasive, interpersonal nature, leading to a wide range of immediate and long-term impacts (Calhoun et al., 2020; Clarke et al., 2019; Gray, 2021; McLaughlin et al., 2014; Price et al., 2014; Schemitsch & Nauth, 2020).
Another classification is based on the nature of the traumatic event – whether it was directly experienced or witnessed, or whether it was learned about indirectly (McLaughlin et al., 2014; Price et al., 2014). Direct trauma is experienced first-hand and has immediate psychological effects (Clarke et al., 2019; Gray, 2020; Gray, 2021). Indirect trauma, also known as vicarious or secondary trauma, affects individuals who hear about first-hand traumatic experiences from others. Their reactions and symptoms are often like those who have had direct trauma.
Impacts on Health and Psychophysiology
Trauma impacts the body and mind, disrupting normal physiological and psychological functioning. The acute stress response to traumatic events can have immediate health consequences (Clarke et al., 2019; Gray, 2021; Price et al., 2014; Schweizer et al., 2018). These include increased heart rate, hypervigilance, and sleep disturbances. If the trauma is unresolved or repeated, the chronic stress response can lead to long-term health issues, including cardiovascular disease, irritable bowel syndrome, adrenal fatigue, and chronic pain (Calhoun et al., 2020; Clarke et al., 2019; Gray, 2021; Price et al., 2014; Schweizer et al., 2018).
Trauma responses can significantly influence the brain’s structure and function. The amygdala, which is the fear center of the brain, becomes hyperactive (Clarke et al., 2019). This leads to a heightened state of fear and anxiety. Meanwhile, the prefrontal cortex, responsible for executive functions like decision-making and impulse control, can become impaired (Clarke et al., 2019). This disruption can lead to issues with memory, attention, and emotional regulation (Calhoun et al., 2020; Clarke et al., 2019; Gramlich et al., 2021; Gray, 2021; Price et al., 2014; Schweizer et al., 2018).
Mental health is also heavily impacted, with trauma being a significant risk factor for conditions such as posttraumatic stress disorder (PTSD), depression, anxiety disorders, and substance use disorders (McLaughlin et al., 2014; Price et al., 2014; Schweizer et al., 2018). The psychological impact can extend to a person’s social and interpersonal functioning, affecting their relationships, self-perception, and world view (Clarke et al., 2019; Calhoun et al., 2022; Gray, 2021; Schemitsch & Nauth, 2020; Schweizer et al., 2018).
Diversity and Inclusion in Trauma Experiences
The experience and impact of trauma are not monolithic; they vary considerably across individuals and communities due to factors like age, gender, race, socioeconomic status, temperament, family history, and cultural background. People from marginalized communities, for example, often experience unique forms of trauma, such as racial trauma, that are not widely recognized or proclaimed to not be understood (Gray, 2020). LGBTQIA individuals experience identity trauma, which is also not widely recognized. This population may be in constant fear of someone causing them physical harm or taking their life (Calhoun et al., 2020; Gray, 2020; Price et al., 2014). Additionally, not everyone has the same access to resources and support to cope with trauma, leading to disparities in outcomes in recovery.
Inclusion and diversity must be prioritized in trauma research, intervention, and policy to ensure that all individuals’ experiences are understood, validated, and addressed. Some professionals, such as Doctors of Behavioral Health (DBH), have “health equity” as one of the pillars of their population-based healthcare (Nundy et al., 2022). Encouraging health equity by more professionals allows for more trauma informed healthcare.
Intervention, Prevention, Advocacy, Integrated Healthcare and Therapeutic Help
Trauma intervention and prevention can come from various resources. There are many techniques and methods that are used to help individuals reduce their symptoms from trauma or recover completely (Magruder et al., 2017; Menschner & Maul, 2016). Advocacy is one of the most common ways that individuals can receive help. Whether it is from a primary care physician, a DBH, a nurse practitioner, or a medical social worker, there are individuals who are trained to advocate for the needs of victims (Menschner & Maul, 2016; Nundy et al., 2020). They have unique specializations designed to improve care (Nundy et al., 2020). In integrated healthcare, medical professionals collaborate with mental healthcare professionals as part of improving care.
Integrated healthcare is especially useful for individuals with trauma. Since people with trauma have both physical and mental health effects, a person versed in integrated healthcare treatments and solutions will be able to provide efficient and effective care (Magruder et al., 2017; Menschner & Maul, 2016; Nundy et al., 2020). Trauma patients are all unique. Treatments and interventions are tailored to treat the specific needs a person may have. An individual may have a need for long-term therapeutic care (Magruder et al., 2017). Individuals who are qualified to treat trauma may help an individual in a few sessions, or it may take a lifetime. Either way, therapeutic practitioners versed in trauma can help an individual manage their psychological and physiological symptoms, exacerbated by negative and traumatic experiences (Magruder et al., 2017). Trauma, in all its forms and classifications, significantly impacts our health and psychophysiology (Clarke et al., 2019; Gray, 2021).
Recovery from trauma requires comprehensive and diverse approaches (Clarke et al., 2019). Recognizing the diversity in trauma experiences and ensuring inclusion in trauma research and interventions is key to addressing this pervasive issue effectively. As society becomes more aware of the severe effects of trauma, it is the collective responsibility of society to foster environments that support healing and promote policy and procedural changes in dealing with psychophysiological health. So while it is not true that time heals all wounds, efficient and improved quality care tailored to each trauma survivor can assist in the healing process.
Calhoun, C. D., Stone, K. J., Cobb, A. R., Patterson, M. W., Danielson, C. K., & Bendezú, J. J. (2022). The role of social support in coping with psychological trauma: An integrated biopsychosocial model for posttraumatic stress recovery. Psychiatric Quarterly, 93(4), 949–970. https://doi.org/10.1007/S11126-022-10003-W
Clarke, D., Schubiner, H., Clark-Smith, M., & Abbass, A. (2019). Psychophysiologic disorders: Trauma informed, interprofessional diagnosis and treatment. Psychophysiologic Disorders Association.
Gramlich, M. A., Smolenski, D. J., Norr, A. M., Rothbaum, B. O., Rizzo, A. A., Andrasik, F., Fantelli, E., & Reger, G. M. (2021). Psychophysiology during exposure to trauma memories: Comparative effects of virtual reality and imaginal exposure for posttraumatic stress disorder. Depression Anxiety, 38, 626– 638. https://doi.org/10.1002/da.23141
Gray, A. (2020). United States and Canada. In K. G. Nadeau & S. Rayamajhi (Eds.), Women and Violence: Global Lives in Focus (pp. 1-33). ABC-CLIO Solutions, Inc.
Gray, A. (2021). Violence, and adverse childhood experiences: The psychophysiologic effects of witnessing abuse. Gray’s Trauma-Informed Care Services Corp. https://gettraumainformed.com/2021/09/22/violence-and-adverse-childhood-experiences-the-psychophysiologic-affects-of-witnessing-abuse/
Lishak, V., Scott, K. L., Dyson, A., & Milovanov, A. (2021). General criminality as a marker of heterogeneity in domestically violent men: Differences in trauma history, psychopathology, neurocognitive functioning, and psychophysiology. Journal of Interpersonal Violence, 36(17–18), NP9623–NP9648. https://doi.org/10.1177/0886260519858065
Magruder, K. M., McLaughlin, K. A., & Elmore Borbon, D. L. (2017). Trauma is a public health issue. European journal of psychotraumatology, 8(1), 1375338. https://doi.org/10.1080/20008198.2017.1375338
Menschner, C., & Maul, A. (2017). Key Ingredients for Trauma-Informed Care Implementation. Center for Health Care Strategies. https://www.chcs.org/resource/key-ingredients-for-successful-trauma-informed-care-implementation/
McLaughlin, K. A., Sheridan, M. A., & Lambert, H. K. (2014). Childhood adversity and neural development: Deprivation and threat as distinct dimensions of early experience. Neuroscience & Biobehavioral Reviews, 47, 578–591. https://doi.org/10.1016/J.NEUBIOREV.2014.10.012
Nundy, S., Cooper, L. A., & Mate, K. S. (2022). The quintuple aim for health care improvement: A new imperative to advance health equity. JAMA, 327(6), 521–522. https://doi.org/10.1001/JAMA.2021.25181
Price, M., Kearns, M., Houry, D., & Rothbaum, B. O. (2014). Emergency department predictors of posttraumatic stress reduction for trauma-exposed individuals with and without an early intervention. Journal of Consulting and Clinical Psychology, 82(2), 336–341. https://doi.org/10.1037/a0035537
Schemitsch, C., & Nauth, A. (2020). Psychological factors and recovery from trauma. Injury, 51, S64–S66. https://doi.org/10.1016/j.injury.2019.10.081
Schweizer, T., Renner, F., Sun, D., Kleim, B., Holmes, E. A., & Tuschen-Caffier, B. (2018). Psychophysiological reactivity, coping behaviour and intrusive memories upon multisensory Virtual Reality and Script-Driven Imagery analogue trauma: A randomised controlled crossover study. Journal of Anxiety Disorders, 59, 42–52. https://doi.org/10.1016/J.JANXDIS.2018.08.005