The Voices section is a place for physicians, staff and community leaders to share their perspectives on all things healthcare. Dr. Carmela Sosa works to combat the social drivers that impact the overall well-being of kids throughout the Central Valley.
MADERA, Calif. – “What is wrong with you?!” We’ve all been there – someone makes a mountain out of the proverbial mole hill. Their reaction is out of proportion to the situation, completely over the top – and sometimes, we might be the ones who are “overreacting”. But did you ever stop to think that, perhaps, the question we should be asking is not, “What is wrong with you?” but rather, “What happened to you?” Did you ever consider that an individual may have a history of trauma driving their reaction?
Why might we wonder about a history of trauma? When a person experiences a potentially life-threatening event or emotionally harmful circumstance, they appropriately move into a fight-or-flight mode. This is a normal response to a dangerous situation – one that is rooted in self-preservation. But when individuals are exposed to repeated trauma, or if they experience significant stressors without protective supports in their life, they may begin to exist in survival mode. Their brains and bodies are chronically activated, always weary of that looming threat, and may respond out of proportion to mildly stressful or even typical situations. Their previous survival mechanisms, such as becoming combative (fight) or withdrawing (flight) kick in. But instead of being protective, they are potentially harmful.
Let’s take a step back. In 1998, a landmark Kaiser/CDC study identified 10 adverse childhood experiences, also known as ACEs. The original 10 ACES were comprised of forms of abuse, neglect, and household dysfunction. From this study, we learned that one in six adults has experienced at least one ACE, regardless of socioeconomic status or educational achievement. Sixteen percent have experienced four or more ACEs, with women, racial/ethnic minorities, low-income individuals, and other marginalized populations being at much higher risk. There is a dose-dependent response, which means the more ACEs one has experienced, the higher the risk for adverse health outcomes such as heart disease, obesity, cancer, and depression. In fact, the odds ratio for a suicide attempt in an individual with an ACE score of four or more is 37:1 relative to someone who experienced no ACEs.
Now imagine – no less than one in six people you interact with each day – friends, family, colleagues – has experienced some form of trauma. You may even be one of them. We all bring our emotions, experiences and coping mechanisms to our encounters with each other, and most often, those experiences are often unknown to others. How we interact with one another could either trigger a response or be a positive support. Trauma is widespread, so it is important that we approach our patients, families, co-workers and each other through a trauma-informed lens.
What does “trauma-informed” mean? Until more recently, the concept of trauma-informed care existed primarily in the mental health world. The earliest roots of trauma-informed services came from research on survivors of captivity and war in the 1960s. It is now well-understood that an individual is more likely than not to have experienced some sort of trauma, which can have a significant impact on not only emotional and psychological well-being, but also physical health. Being trauma-informed means approaching our interactions with one another in a manner that builds trust, empowers others, and strengthens collaboration. It requires a paradigm shift and reframing how we view the actions, behaviors, and interactions of those around us.
Since the original study, we have come to recognize that other community and environmental factors, such as experiencing poverty, discrimination, or being unhoused, can lead to the same structural and physiological changes as the original ACEs. Stressors that go unbuffered become toxic stress and can lead to maladaptive behaviors, a weakened immune system, impaired metabolism, as well as structural changes in the brains of young children that lead to poor self-regulation and disrupted higher-order thinking.
Let’s work together to support one another by being mindful of the path others walk or have walked. Those paths are more likely than not to have been fraught with trauma. By learning how to appropriately identify and respond to someone who has experienced trauma or is triggered, we can decrease the likelihood of re-traumatization and increase the chances that our interactions will help build resilience.
To learn more about adverse childhood experiences, or to get training to screen for ACEs, visit ACEs Aware.
