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OBJECTIVES

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  • Define trauma.

  • Describe the risk and protective factors for trauma.

  • Review the effects of trauma on health.

  • Review how childhood trauma results in adulthood disease and poor outcomes.

  • Describe ways of addressing trauma in health care.

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INTRODUCTION

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Marta is a 23-year-old woman who brings her healthy 3-year-old child in for a check-up with her new family practice provider. She presented to her prior provider’s office with severe headaches many times and has had an extensive workup. Today, she appears depressed and overwhelmed and says she cannot concentrate due to the headaches. When her new provider asks compassionately why Marta thinks she has headaches, Marta wonders if it could be that her father used to slam her head against the table if she did not know the answers to questions. Upon further questioning, Marta’s provider learns that Marta’s mother died when she was a baby. She was the youngest of six children in a poor family in Mexico. Her father was particularly abusive to her. When she was 16 she was taken to an older man’s house and told that she was now married to him. She fled across the Mexico–US border. She does not want to talk about the journey across the border. Marta reveals to her new provider that she is worried that she does not know how to be a good mother.

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Trauma is a leading cause of morbidity and mortality worldwide. Traumatic experiences refer to everything from being in a car accident to witnessing terrible events, being abused, or living through a natural disaster or a war. Traumatic events are more disruptive and likely to overwhelm a person’s ability to adapt than the normal stresses and vicissitudes of life. Trauma’s risks also multiply: being exposed to one traumatic event increases both individual and community risks for future traumatic events. The impacts of trauma are dependent on individual and community vulnerabilities, resources, and protective factors. Trauma, especially in childhood, causes health disparities. It is a root cause of adult disease and high-risk behaviors. Trauma also disproportionately affects the most vulnerable people and populations. Trauma prevention and treatment are evolving and improving. Addressing trauma in the health-care setting holds the potential to more effectively improve health, decrease suffering, and promote the achievement of health equity.

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DEFINITION OF TRAUMA AND TYPES OF TRAUMATIC EVENTS

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Defining trauma is challenging. The term “trauma” is often used interchangeably and inconsistently to refer to events and to the outcomes of the events. Defining an event as traumatic depends on the totality of circumstances. Each person may respond to a similar event differently based upon the circumstances surrounding the event and the interplay between genetic, epigenetic, biological, psychological, environmental, family, community, societal, historical, and other factors. Thus, most experts now understand that trauma is a process that involves the interaction between an event or series of events and the individual ...

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