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:

    Close-up photo of two people holding hands, and rainbow light reflected on their hands.
    LGBTQ+ People and Identity-Based Stress
    Story - Original
    Brought to you by Community Commons
    Photo of young Black child with short hair sitting on the ground with their head in their hands.
    Race-Based Stress and Intergenerational Trauma
    Story - Original
    Brought to you by Community Commons
    Published on 09/16/2022
    Photo of an unhappy young boy looking at a laptop. On the right, emojis and random text are floating in the air.
    Youth, Young Adults, and Digital Abuse
    Story - Original
    Brought to you by Community Commons
    Photo of person in a powerchair looking at a set of stairs with no ramp
    Disability-Related Stress and Inaccessibility as Trauma
    Story - Original
    Brought to you by Community Commons

    Measuring, Preventing, and Combating Traumatic Stress

    Improving community health by mitigating and preventing traumatic stress will require uprooting systems designed to cause trauma—such as colonialism, racism, sexism, and ableism. This includes eliminating systems of data gathering, reporting, funding, and policing, which uphold traumatic and dangerous norms, and improving data collection, monitoring, and scientific studies around traumatic stress.

    Since the original ACEs study was published in 1998, thousands of studies have been published on ACEs and related topics, and yet many providers and health workers are still unfamiliar with traumatic stress. Similarly, dozens of state and local jurisdictions have implemented ACEs prevention strategies, but progress is deeply inconsistent across the U.S., with more gaps than positive implementation examples.

    Investment in data, mapping, and research in intersectional areas is one way to build toward preventing traumatic stress. Investment strategies shown to mitigate the effects of trauma include: 

    • Care coordination and integrated, holistic services

    • Mental and behavioral health care

    • Access to medications and physical health care

    • Family support and education without harmful policing of BIPOC families

    • Nutrition and food security

    • Accessibility and cultural competence in care, services, education, and employment

    • Antiracism, equity, and justice

    • Poverty reduction

    • Improving community security, cohesion, and resilience by reducing Adverse Community Environments

    It is important to note that hope is not lost for those who have experienced ACEs or traumatic stress—the use of protective factors may be an effective prevention strategy for ACEs and its associated outcomes, and may even serve as a mechanism to “break the cycle” of childhood trauma. There are many established protective factors that reduce symptoms of traumatic stress among those exposed and build resilience, including:

    • Nurturing and attachment

    • Knowledge of parenting and of child and youth development

    • Parental resilience

    • Concrete supports for parents

    • Social connections and sense of belonging

    • Social and emotional competence of children

    Screen capture of BRFSS image: Behavioral Risk Factor Surveillance System ACE Data
    Behavioral Risk Factor Surveillance System ACE Data
    Resource - Data Bank/repository
    Cover page of Tribal BRFSS Toolkit
    Tribal BRFSS Toolkit
    Tool - Toolkit/toolbox
    Brought to you by National Native Network
    PDF Cover: Embracing Data Preservation, Sharing, and Re-Use in Traumatic Stress Research
    Embracing Data Preservation, Sharing, and Re-Use in Traumatic Stress Research
    Resource - Journal Article
    Brought to you by Taylor & Francis
    Screen capture of interactive map: An Interactive Map of Adverse Childhood Experiences (ACEs)
    An Interactive Map of Adverse Childhood Experiences (ACEs)
    Tool - Data/mapping Tool
    Brought to you by Council for a Strong America

    Leveraging Trauma-Informed Practice to Improve Community Health

    In addition to advocating for better data and more funding surrounding traumatic stress, changemakers can support people living with traumatic stress by advocating for and implementing trauma understanding, awareness, and competence. Trauma-informed practices (TIPs) are based on the knowledge and understanding of trauma and its systemic causes and impacts. Because trauma’s impacts are so far-reaching, TIPs can be effectively implemented throughout all sectors and all roles. Trauma-informed practices take into account the pervasive nature of trauma and promote environments of accessibility and recovery without potential re-traumatization. When done properly and equitably, they also acknowledge multiple marginalizations and compounding traumatic stress.

    Trauma-informed practices should be nested within a three-pronged approach, including:

    1. Self-empowerment and self-advocacy by survivors

    2. The adoption of trauma-informed practices by providers, organizations, and systems

    3. Systemically addressing Adverse Community Environments and building community resilience

    To learn more about trauma-informed practices and advancing community well-being, explore the resources and related topics below. 

    Sarah Bond-Yancey (they/she) is a disabled, queer, multiply-neurodivergent communications and accessibility professional. They are the Senior Communications and Design Consultant at IP3, and a Staff Editor for Community Commons.

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