Intro to Traumatic Stress: Trauma, Stress, and Trauma-Informed Practice for Community Health and Well-Being

2023 marks the 25-year anniversary of the landmark Adverse Childhood Experiences (ACEs) study, which demonstrated how toxic stress—especially during childhood—can lead to poor health and premature death. Repeatedly called out as one of the most significant public health crises in the United States today, exposure to trauma impacts up to 90% of the population and influences every aspect of our well-being. Exposure to trauma dramatically increases the risk of 7 out of 10 of the leading causes of death in the U.S., and results in a 20-year difference in life expectancy for those most impacted

A quarter of a century after the ACEs study solidified the connections between traumatic stress, behavioral health, and physical health, however, holistic care and trauma-informed practices remain disturbingly underadopted. Despite widespread promotion of Preventing ACEs and related frameworks, many providers and community health workers struggle to implement ACEs screening and prevention in their practice. In Muskegon County, Michigan, for example, as few as 3% of physicians actually use ACEs prevention in practice.

Widespread adoption of trauma-informed practices like Preventing ACEs can improve services and care for people who have experienced trauma, while also increasing population health, life expectancy, and well-being for our communities’ most vulnerable members. Additionally, studies show that protective factors and increased resilience among youth with ACEs exposure decreases symptoms of traumatic stress, pointing to potential strategies to combat the effects of ACEs for older children and even adults. Explore this collection and the embedded resources to learn more about how traumatic stress impacts our lives and what we can do to prevent and combat it.

Trauma, Toxic Stress, or Traumatic Stress?

Stress is a normal human feeling that activates the body and brain’s stress response system, or fight or flight response, which helps us navigate new situations and cope with potential dangers. It is characterized by an increased heart rate and mild elevation of stress hormones. Stress is considered tolerable when serious but temporary stress responses are buffered by supportive relationships and coping mechanisms.

When a person experiences chronic, long-term stress, or lacks adequate coping mechanisms or supportive relationships, the repeated activation of this response begins to wear on the brain and body. Chronic stress can lead to mental, behavioral, and physical symptoms, like chronic pain, fatigue, difficulty sleeping, headaches, dizziness, shaking, high blood pressure, digestive issues, muscle tension, compromised immunity, anxiety, depression, and behavioral health issues.

Traumatic stress—also known as toxic stress—occurs when the stress response system is activated so intensely or so frequently that it shifts from adaptive (life-saving) to maladaptive (life damaging). Stress-associated symptoms like heightened heart rate, elevated blood pressure, and increased cortisol remain after the traumatic event. This ongoing stress response activation and associated physiological symptoms can lead to health complications, including increased risks of injury, STIs, birthing and child health complications, cancer, diabetes, cardiovascular disease, respiratory diseases including COPD, hepatitis, depression, substance use disorders, and suicide. In early childhood, traumatic stress impacts childrens’ brain structure and function, and the development of the immune and hormonal systems. As a result, childrens’ relationships, attention, decision-making, learning, growth, and educational and economic opportunities can all be affected later in life.

What makes an event or situation traumatic is deeply-personal and unique to one’s experiences. Trauma is a response that remains after a deeply distressing or overwhelming event, series of events, or set of circumstances. Individuals who have experienced trauma often feel helpless, have diminished or disconnected senses of self, and struggle with the abilities to feel full ranges of emotions and experiences. Many people—especially people who are Black, Indigenous, of color, LGBTQ+, disabled, immigrants, and/or living in poverty—face exposure to traumatic stress through historical and ongoing traumatic events, such as racism, poverty, genocide, sterilization, and displacement. Because traumatic stress impacts relationships, it can be passed down through generations, creating intergenerational trauma.

Types of traumatic stress include:

Post-traumatic stress
Acute trauma
Chronic trauma
Complex and developmental trauma
Race-Based Stress
Identity-Based Stress
Medical trauma
Religious trauma
Intergenerational trauma

Causes and Health Outcomes of Traumatic Stress

Traumatic stress occurs in all communities, increases the risk of health complications, and is caused by a wide range of factors and lived experiences. Layers of traumatic stress include:

Individual: traumatic stress experienced by or impacting one person
Family: or Interpersonal: traumatic stress experienced by or impacting a couple, a family, or another small group of people
Community: traumatic stress experienced by a geographic community, identity group, or other sub-group of the population
Cultural or Intergenerational: traumatic stress experienced by an entire culture over time and/or throughout multiple generations

Causes of Stress and Trauma

Resulting Stress and Trauma

Impacts of Stress and Trauma

Assault and violence
Abuse—sexual, physical, verbal, mental, emotional, religious, financial, legal, cultural/identity, digital
Neglect, isolation, and abandonment, especially of children, elders, and people with disabilities
Kidnapping and forced separation from parents or family members
Grief and traumatic loss
Bullying and harassment (including school, workplace, public, sexual)
Cyber-bullying, digital exploitation, stalking, doxxing, leaking, revenge pornography, and identity theft
Oppression, exclusion, hate, and discrimination (including racism, sexism, ableism, inaccessibility, homophobia, transphobia, anti-Semitism, Islamophobia, etc.)
Intergenerational oppression, genocide, war, abuse, and exclusion
Military service and combat
Natural disasters, involuntary displacement, and climate anxiety
Poverty and socioeconomic factors, such as food, housing, and financial insecurity
Compulsive heteronormativity and cisnormativity
Medical and mental health care experiences, which are traumatic, invasive, nonconsensual, insufficient, and/or occur during childhood
Diagnosis, treatment, and experiencing symptoms of serious health and mental health conditions
Proximity to trauma, traumatic stress, violence, and abuse, including at home, at work, or in communities
Other exposures to adversity, including family members struggling with mental health conditions, substance use, or incarceration

Resulting types of stress:

Positive Stress
Tolerable Stress
Chronic stress
Adverse Childhood Experiences (ACEs)
Pre-Traumatic Stress and chronic fear for the future

Resulting types of trauma and traumatic stress:

Toxic or traumatic stress
Post-traumatic stress
Acute traumatic stress
Complex and developmental trauma
Race-Based Stress
Identity-Based Stress
Medical trauma
Religious trauma
Family trauma
Community or population trauma
Intergenerational or cultural trauma
Secondary traumatic stress

Common negative health outcomes:

Negatively impacted brain development, including stress response systems
Negatively impacted immune system and hormonal systems
Increased risk for developing COPD, heart disease, cancer, asthma, and hepatitis
Increased likelihood of suicidality and poor mental health

People with 4 or more ACEs (12.6% of the population) are:

2.5x more likely to develop COPD or hepatitis
4.5x more likely to develop depression
12x more likely to experience suicidality

People with 7 or more ACEs have:

3.5x the risk of ischemic heart disease
3x the lifetime risk of lung cancer

Common mental health diagnoses include:

Adjustment Disorders or Stress Response Syndrome
Post-Traumatic Stress Disorder (PTSD)
Complex PTSD (C-PTSD)
Acute Stress Disorder
Dissociative Disorders (DID, OSDD)
Substance Use Disorders
Eating Disorders
Personality Disorders (such as BPD, HPD, ASPD, and NPD)
Anxiety Disorders
Depressive Disorders
Conversion Disorder
Obsessive Compulsive Disorder (OCD)
Specific Phobias

Preventing traumatic stress means implementing systems-wide changes to reduce violence, abuse, discrimination, oppression, marginalization, poverty, and all other root causes perpetuating the cycle of trauma. In the ACEs model, traumatic stress is conceptualized by individual and family-level adversity, which causes overwhelm, stress, and trauma for children. The Pair of ACEs (Adverse Childhood Experiences and Adverse Community Environments) and ACE|R (Adverse Community Experiences and Resilience) models emphasize community and environmental factors contributing to traumatic stress, as well as the powerful potential of individual and community resilience. All three of these strategies—addressing systemic factors, supporting families and children, and building community resilience—are essential to prevent traumatic stress and advance equitable well-being.

Compounding Traumatic Stress and Emerging Impact Areas

Black, Indigenous, and communities of color, children and youth with ACEs, disabled people, LGBTQ+ people, veterans, and survivors of domestic violence, trafficking, and sexual assault are all key impact groups who are already highly active in this space. Because traumatic stress can build over time and is frequently caused by demographic and identity factors, individuals and communities who are multiply marginalized are often disproportionately impacted, and should be centered throughout all efforts to all mitigation and prevention work.

In addition to compounding—or growing over time—from multiple marginalizations, traumatic stress also perpetuates itself. Traumatic stress can cause health and mental health conditions, which are often traumatic in and of themselves, and cause people to feel caught in a cyclical effect of compounding trauma. For example, women of color struggle with the intersection of colonization, racism, and gendered violence. When they interact with (often white) healthcare providers and have negative experiences, it reinforces previous intergenerational, medical, race-based, identity-based, and other trauma they may already carry.

Browse the mini collections below to learn more about emerging impact areas in traumatic stress, and explore additional context, resources, and stories: