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INTRODUCTION

Recognizing and addressing trauma offers a powerful opportunity to improve the experience and outcomes of primary care for both patients and clinicians. For clinicians, understanding that trauma underlies and perpetuates many common health conditions helps clarify why certain conditions often remain refractory to standard medical treatment. This understanding, in turn, can lead to deeper and more compassionate connections with patients and more effective treatment plans. For patients, understanding the connection between the experience of trauma and their current health issues can lead to greater self-acceptance, engagement in care, healthier coping mechanisms, and improved health outcomes.

WHAT IS TRAUMA?

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects.” Examples of these events and circumstances include childhood and adult physical, sexual, and emotional abuse; neglect; loss; intimate partner violence; community violence; war; and structural violence such as racism, sexism, xenophobia, homophobia, and transphobia, among many others. Repeated exposure to trauma (e.g., witnessing the ongoing physical abuse of one’s mother, experiencing serial sexual abuse) is known as “complex trauma” and is associated with particularly harmful consequences to physical and emotional health and well-being.

HEALTH IMPACT OF TRAUMA

Childhood and adult trauma are associated with many common causes of adult illness, death, and disability in the United States. The seminal Adverse Childhood Experiences (ACE) study documented remarkably high rates of serious childhood physical and sexual abuse, neglect, and household dysfunction among 17,000 predominately white, middle-class adults. The study calculated an ACE score (0–10) based on how many categories of childhood events adults had experienced: 64% reported at least one ACE category, and one in six reported four or more. Notably, 25% of women and 16% of men reported having experienced childhood sexual abuse. The study revealed a strong dose–response relationship between childhood trauma and adult heart, lung, and liver disease; depression; substance abuse; obesity; diabetes; sexually transmitted infection risk; and intimate partner violence (IPV). Individuals who reported four or more ACE categories had 2 times the rates of lung and liver disease, 3 times the rate of depression, 3 times the rate of alcoholism, 11 times the rate of intravenous drug use, and 14 times the rate of attempting suicide than those who reported ACE scores of 0.

Similarly, trauma in adulthood is common and associated with poor health outcomes. It is also frequently undiagnosed. More than one-third of U.S. women experience stalking, physical violence, and/or rape from an intimate partner during their lifetimes. One in five men experiences sexual violence in their lifetimes. Adult experiences of trauma are also strongly correlated with many of the same illnesses and unhealthy coping strategies as childhood trauma. In addition, these data are likely to underestimate the impact of trauma, since ...

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