What Is Trauma-Informed Care?
There is not one single way to be a trauma-informed healthcare provider, just as there is not one single way to practice medicine.
The goal is NOT to uncover every hidden trauma a patient has experienced.
Instead, trauma-informed care means understanding that trauma may influence a person's health, behaviors, relationships, healthcare experiences, lifestyle choices, and overall life story.
It means approaching patients with curiosity rather than judgment.
In this post, I discuss five strategies that have helped me become a more trauma-informed healthcare provider. I also share several de-identified patient interactions where listening differently led to a greater understanding of the patient's health and experiences.
All patient identities and identifying information have been changed or removed to protect privacy.
5 Strategies for Becoming a Trauma-Informed Healthcare Provider
1. Develop a relationship founded on trust
2. Demonstrate a judgment-free approach
3. Become comfortable with the expression of emotions
4. Understand different forms of trauma and how they can affect health
5. Collaborate with an interprofessional team
1. Develop a Relationship Founded on Trust
Trust is one of the most difficult—and most important—parts of any relationship.
It is especially important between patients and healthcare professionals.
For someone who has experienced trauma, trust may have previously been violated by a parent, partner, caregiver, healthcare professional, institution, or society.
Before someone can feel comfortable sharing vulnerable parts of their story, they often need to feel emotionally and physically safe.
Trust Can Begin Within Minutes
You do NOT necessarily need to know someone for months or years to begin developing trust.
Small interactions during the first few minutes of an encounter can demonstrate that you are listening and that what the patient says matters.
Simple statements may include:
"I hear you."
"I can't imagine what you're going through."
"That sounds incredibly painful."
"I appreciate you telling me that."
These statements may seem small, but they communicate:
I am listening.
I believe your experience matters.
I am not rushing past what you just told me.
Humanizing the Patient-Physician Relationship
Sometimes sharing an appropriate common interest, background, or experience can help humanize the healthcare relationship.
That does NOT mean every healthcare professional should disclose personal information.
Self-disclosure should always be thoughtful, professionally appropriate, and centered on whether it benefits the PATIENT.
But sometimes reducing the rigid power difference between "doctor" and "patient" can help someone feel safer.
For trauma survivors, that sense of safety may make it easier to participate in care and share information that is important to their health.
Trust Is Fragile
Trust can take time to build and seconds to damage.
Be patient.
Be transparent.
Explain what you are doing.
Ask permission when appropriate.
If you tell someone you will return in ten minutes, try to return in ten minutes.
If you do not know the answer, say so.
If something uncomfortable needs to happen during an examination or procedure, explain it beforehand.
Small acts of predictability can be incredibly meaningful for someone whose previous experiences involved a loss of control.
2. Demonstrate a Judgment-Free Approach
You can tell someone:
"This is a safe space."
But your BODY LANGUAGE may communicate something completely different.
Actions speak louder than words.
Someone with a history of trauma may be especially attentive to facial expressions, tone, posture, and other nonverbal cues.
If a patient notices you repeatedly looking at the clock, typing without acknowledging them, crossing your arms, appearing impatient, or turning your entire body toward the computer, they may interpret that as:
"You don't have time for me."
"You don't believe me."
"You are judging me."
And they may stop sharing.
Use Open Body Language
Small changes can communicate that you are present.
When possible, sit down, face the patient, maintain culturally appropriate eye contact, keep an open posture, nod to demonstrate that you are listening, and use brief verbal acknowledgments such as "mm-hmm" or "I understand."
You do not need to dramatically perform empathy.
You simply need to communicate:
I am here.
I am listening.
Curiosity Instead of Judgment
Trauma-informed care asks us to shift our thinking from:
"What's wrong with this person?"
toward:
"What might have happened to this person?"
And sometimes:
"What is happening in this person's life right now?"
A behavior that initially appears irrational may make much more sense once you understand the person's experiences.
That does not mean every behavior is caused by trauma.
It means we remain curious enough to ask.
3. Become Comfortable With the Expression of Emotions
Medical illness and trauma can bring up many emotions: sadness, anger, fear, shame, frustration, guilt, anxiety, grief, and sometimes emotional numbness.
A trauma-informed healthcare professional needs to become comfortable allowing patients to HAVE those emotions.
Our instinct is often to immediately fix discomfort.
Sometimes we reach for a tissue.
Sometimes we change the subject.
Sometimes we start talking because silence feels uncomfortable.
But sometimes the most therapeutic thing we can do is simply remain present.
You Do Not Have to Stop Someone From Crying
Crying does not mean the encounter is going badly.
Anger does not automatically mean the patient is angry at YOU.
Silence does not mean you need to fill the room with words.
People who have experienced trauma may have intense emotional reactions when they feel vulnerable, frightened, powerless, or reminded of previous experiences.
As healthcare professionals, our job is not always to make those emotions disappear.
Sometimes our job is simply to tolerate them without becoming defensive or uncomfortable ourselves.
Trauma Can Affect the Brain's Threat Response
Traumatic and chronic stress experiences can affect neural systems involved in fear, threat detection, emotional regulation, and executive functioning.
The amygdala plays an important role in detecting and responding to emotionally significant or threatening stimuli, while areas of the prefrontal cortex participate in higher-order regulation, interpretation, and decision-making.
Research has demonstrated changes in amygdala-prefrontal circuitry associated with chronic stress and trauma.
This helps us understand why someone may intellectually recognize that they are safe while their body still reacts as though danger is present.
It is not as simple as telling someone:
"Calm down."
Their nervous system may be responding before conscious reasoning has had an opportunity to catch up.
Be a Stable Presence
When someone is experiencing intense emotion, you can help by remaining calm, slowing down the interaction, allowing silence, offering tissues, acknowledging what they are experiencing, and asking what would help them feel more comfortable.
If physical comfort such as holding someone's hand seems appropriate, ASK first.
For someone with a trauma history, unexpected touch may be uncomfortable or triggering.
Permission matters.
4. Understand the Different Types of Trauma
There are MANY types of trauma.
Medicine historically placed significant emphasis on Adverse Childhood Experiences, commonly referred to as ACEs.
The original ACE framework helped demonstrate associations between childhood adversity and later health outcomes.
But trauma does not end when childhood ends.
Trauma Can Occur Across the Lifespan
Traumatic experiences may include childhood abuse or neglect, sexual violence, intimate-partner violence, community violence, war, natural disasters, housing instability, poverty, serious illness, medical trauma, loss, displacement, discrimination, and other experiences involving threat, helplessness, or loss of safety.
People may also experience repeated discrimination related to race, ethnicity, language, sexual orientation, gender identity, disability, immigration status, socioeconomic status, or other identities.
Trauma can be interpersonal, structural, acute, chronic, or cumulative.
Trauma Can Affect Physical and Mental Health
Higher exposure to adversity and chronic stress has been associated with multiple long-term health outcomes.
Trauma may influence mental health, sleep, substance use, eating patterns, chronic stress physiology, healthcare engagement, relationships, and other behaviors that affect health.
This does NOT mean every person who experiences trauma will develop a medical or psychiatric condition.
It means trauma is one of many important factors that may shape someone's health.
You Do Not Need to Ask Everyone to Disclose Their Trauma
Being trauma-informed does NOT mean asking every patient:
"What trauma happened to you?"
People are allowed to keep their experiences private.
You can provide trauma-informed care even if you never know whether someone has experienced trauma.
You can explain procedures, ask permission, provide choices when possible, avoid unnecessary judgment, respect boundaries, and communicate transparently with EVERY patient.
That is one of the benefits of trauma-informed care:
You do not need someone's trauma history to treat them with dignity.
5. Collaborate With an Interprofessional Team
Trauma can affect many aspects of someone's life, so one healthcare professional rarely has every resource a patient needs.
An interprofessional team may include a Primary Care Provider, medical specialists, psychiatrists, therapists, social workers, occupational/physical/speech therapists, behavioral therapists, dietitians, case managers, counselors, community organizations, and chaplains or religious leaders when desired by the patient.
The specific team depends on the person's needs and preferences.
Share Only What Is Necessary
Not everyone on a patient's care team needs to know the details of someone's trauma.
Information should be shared according to clinical relevance, privacy requirements, and the patient's preferences whenever possible.
The goal is not to repeatedly make someone retell a painful story.
The goal is to coordinate care.
Trauma-Informed Care in Practice
The following are examples from de-identified patient encounters that helped shape how I think about trauma-informed medicine.
These interactions reminded me that the chief complaint is not always the entire story.
Sometimes a conversation that begins with weight, sleep, abdominal pain, or chronic disease eventually reveals a much larger context.
Patient Example #1: A Teenager Presenting for a Well-Child Visit
One patient was a teenage girl with obesity and a history of an ovarian cyst who presented for a routine visit.
At first glance, this might seem like a straightforward pediatric primary-care encounter.
But over the course of approximately an hour, the clinical picture became much more complicated.
We discussed school, friendships, sleep, diet, menstrual history, sexual health, mood, and safety.
After speaking with the parent, I also asked the parent to step out so I could speak privately with the patient.
Following the Patient's Story
The conversation developed naturally.
We talked about her difficulty sleeping, long naps after school, eating patterns, menstrual irregularity, birth-control options, sexual orientation and identity, and current sexual activity.
Then I showed her the growth chart.
There had been a significant increase in her weight around age ten.
Instead of simply saying:
"You gained a lot of weight."
I became curious.
I asked what had been happening in her life around that time.
That question changed the visit.
When Trauma Entered the Conversation
As we continued talking about mood, eating, sleep, and her life around the time her weight changed, she disclosed a history of childhood sexual abuse.
She had never told anyone before.
I did not begin the visit intending to uncover trauma.
The conversation led there because we were trying to understand her WHOLE story.
I gave her tissues, allowed her time to cry, and stayed present with her.
Then I involved my supervising resident and attending so we could develop an appropriate safety and treatment plan.
One Medical Complaint Can Reveal Multiple Needs
By the end of the encounter, we were no longer only discussing weight.
The visit raised concerns involving depression, possible trauma-related symptoms, sleep disturbance, suicidal thoughts without an active plan, hypertension, metabolic health, menstrual irregularity, possible PCOS, nutrition, and the need for mental-health support.
Our plan involved appropriate medical follow-up, laboratory evaluation, nutrition support, mental-health referral, safety assessment, and continued monitoring.
THIS is one of the reasons I love medicine.
You do not have to be a psychiatrist to ask about trauma.
You do not have to be a psychiatrist to recognize mental-health concerns.
Mental and physical health constantly interact.
Patient Example #2: An Older Adult Afraid of Assisted Living
Another patient was an older man with aphasia who asked me:
"When will I need to move to assisted living?"
I sat down with him and explained in short, simple sentences what assisted living might look like and what would be different—or remain the same—compared with his current independent living situation.
He became frightened and started crying.
He told me that he had never asked anyone that question before.
Previously, whenever someone brought up assisted living, he simply avoided the conversation.
Validate the Fear Behind the Question
Instead of immediately reassuring him:
"Don't worry about that."
I acknowledged that moving into a different level of care IS frightening.
I told him that it demonstrated insight that he was willing to think about the possibility before a crisis forced the decision.
Sometimes validation does not mean saying:
"Everything will be okay."
Sometimes it means:
"Yes. This is scary. And we can talk about it together."
Patient Example #3: Anxiety That Was Affecting an Entire Life
Another older patient presented for routine primary care while struggling significantly with mood and anxiety.
As we talked, she described racing thoughts at night, difficulty falling asleep, exhaustion during the day, decreased appetite, fear of crossing streets, fear of neighborhood violence, discomfort in crowded places, claustrophobia, difficulty leaving home, and difficulty concentrating on activities she once enjoyed.
She also disclosed a remote suicide attempt during adolescence.
At the time of our visit, she denied current suicidal ideation or a current plan.
Ask What the Anxiety Actually Looks Like
Instead of simply documenting:
"Patient has anxiety."
I asked:
"What do you worry about?"
"What happens when you have one of these worry attacks?"
"What activities have you stopped doing?"
"What do you still enjoy?"
"What is your appetite like?"
"How are you sleeping?"
"Have you ever thought about hurting yourself or not waking up?"
Those questions helped demonstrate how deeply anxiety and depression were affecting her daily functioning.
The clinical picture included generalized anxiety, depression, insomnia, avoidance of leaving the home, and episodes consistent with severe anxiety.
The plan included continued mental-health support and consideration of appropriate psychiatric treatment.
Communication Style Can Change an Encounter
Something else I learned while working with older adults was how much communication style matters.
Slowing your speech, speaking clearly, changing your volume or pitch when someone has hearing impairment, sitting down, and allowing additional processing time can dramatically change an interaction.
I once worked with an older patient whom many caregivers described as "grumpy."
After spending time talking with her, I learned that she had previously been a vocal performer and now had significant difficulty hearing higher-pitched voices.
She became frustrated when she could not understand people.
To others, she appeared angry.
From her perspective, she was struggling to communicate.
That context changed the entire way I understood her behavior.
Patient Example #4: A Child With Recurrent Vomiting
Another patient was a girl under ten who presented to the emergency department with several months of intermittent vomiting.
During the interview, she repeatedly made comments about:
Her weight.
Food.
What her family should and shouldn't eat.
That stood out.
After speaking with her parent, we learned that her mother had recently experienced a miscarriage that significantly affected the family.
Interestingly, her parents said the child had never outwardly expressed the same sadness they had.
That raised additional questions.
Could her abdominal symptoms be related in part to stress or grief?
Were her comments about food and weight becoming concerning?
Was she expressing emotional distress physically rather than verbally?
The point was NOT to immediately label her vomiting as psychological.
Medical causes still needed appropriate evaluation.
But trauma-informed care reminded us to consider the emotional and social context alongside the physical symptoms.
Physical Symptoms and Emotional Experiences Can Coexist
One of the biggest lessons I have learned is that we do not need to choose between:
"This is physical."
and
"This is emotional."
Both can be true.
A patient can have a medical illness AND anxiety.
A patient can have endometriosis AND trauma.
A child can have gastrointestinal symptoms AND grief.
A patient can have chronic pain AND depression.
Trauma-informed medicine encourages us to understand how these pieces interact rather than forcing the patient into only one category.
What Trauma-Informed Care Is NOT
Trauma-informed care is NOT about interrogating patients about abuse.
It is NOT diagnosing PTSD in everyone who has experienced something difficult.
It is NOT assuming every symptom is caused by trauma.
It is NOT forcing people to disclose experiences they do not want to discuss.
And it is NOT something only psychiatrists and therapists should practice.
Trauma-informed care is an approach to HOW we interact with people.
Trauma-Informed Care Can Be Practiced in Every Specialty
You can practice trauma-informed care in Psychiatry, Family Medicine, Internal Medicine, Pediatrics, OB/GYN, Surgery, Emergency Medicine, Neurology, or any other specialty.
You can practice it during a five-minute interaction.
You can practice it during a procedure.
You can practice it when delivering difficult news.
You can practice it by explaining before touching someone.
You can practice it by asking:
"Would you like me to explain what I'm going to do before we begin?"
You can practice it by offering choices whenever choices exist.
Five Principles to Remember
If you remember nothing else from this post, remember:
Build trust, avoid judgment, tolerate emotions, understand that trauma can influence health, and collaborate with others when a patient's needs extend beyond what you can provide alone.
You do NOT need to know someone's entire trauma history to treat them in a trauma-informed way.
Final Thoughts
One of the most important lessons trauma-informed care has taught me is:
Every patient has a story.
Sometimes we know only one chapter.
Sometimes the behavior that initially frustrates us makes complete sense once we understand what came before it.
Our goal is not to become detectives searching for hidden trauma.
Our goal is to create enough safety, trust, curiosity, and respect that patients can share the parts of their story that are relevant to their care—if and when they choose to.
Sometimes the most meaningful thing we can do as healthcare professionals is simply sit down and listen.
Trauma-Informed Care Resources
The Body Keeps the Score by Bessel van der Kolk
ACE Provider Training
CDC Adverse Childhood Experiences Resources
My Trauma-Informed Care Collection
Additional writings and presentations available under the My Work section of my website
References
Van der Kolk BA. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking; 2014.
Marek R, Strobel C, Bredy TW, Sah P. The amygdala and medial prefrontal cortex: partners in the fear circuit. J Physiol. 2013;591(10):2381-2391.
Liu WZ, Zhang WH, Zheng ZH, et al. Identification of a prefrontal cortex-to-amygdala pathway for chronic stress-induced anxiety. Nat Commun. 2020;11:2221.
Dube SR, Fairweather D, Pearson WS, Felitti VJ, Anda RF, Croft JB. Cumulative childhood stress and autoimmune diseases in adults. Psychosom Med. 2009;71(2):243-250.
Liu YZ, Wang YX, Jiang CL. Inflammation: The Common Pathway of Stress-Related Diseases. Front Hum Neurosci. 2017;11:316.
Harris HR, Wieser F, Vitonis AF, Rich-Edwards J, Boynton-Jarrett R, Bertone-Johnson ER, Missmer SA. Early life abuse and risk of endometriosis. Hum Reprod. 2018;33(9):1657-1668.
Medical Disclaimer
***This blog post is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. This does not establish a doctor-patient relationship. All opinions are those of the writer and are not reflective of any institution or employer. Please follow up with your healthcare provider or therapist for individualized questions or support.***
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