Trauma Patient: Prevalence, Pathophysiology, and Trauma-Informed Care

This essay report discusses the prevalence of trauma in mental health, pathophysiology of trauma, and trauma-informed care. It also includes the implementation of trauma-informed care for a patient who experienced traumatic events.

Running Head: TRAUMA PATIENT
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Trauma Patient
Student name

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Trauma
Trauma can be defined as the emotional and psychological event, which is extremely
distressing and disturbing. When an individual face highly stressful event that makes him or
her feeling out of control emotionally and hopelessness, this may lead to trauma. The
traumatic condition normally includes a life-threatening risk to like or safety of the person.
Trauma can be classified into three different types: post-traumatic stress disorder (PTSD),
complex trauma and developmental trauma. Symptoms of psychological trauma include
depression, shame, emotional shock, overwhelmed fear, emotional numbing, social isolation
and withdrawal, mood swings, disorientation, confusion, visual images of the event, lack of
concentration, avoidance of activities, lack of activities that are previously enjoyable. Trauma
can be caused by various factors like the death of loved ones, accident, surgeries, and one-
time events. As mentioned in the case scenario Mr. Daud experienced various traumatic
events like the death of his family member, discrimination, years in retentions, guilt for
leaving his family behind, lack of sleeping, anxiety, and lack of concentration. In this essay
report some of the topics like the prevalence of trauma in a mental health presentation, the
pathophysiology of trauma, and trauma-informed care. In this essay implementation of
trauma, informed care will also be discussed.
This health condition is a worldwide problem that affecting people psychologically,
emotionally and physically. This mental health issue is not a new concept, it has been
affecting people for many years. The psychological evidence of this mental health problem
was seen in the inception of different wars such as the epic of Gilgamesh, and homer Iliad.
The evidence of psychological and emotional trauma was mentioned in Shakespeare’s work.
War tiredness, exhaustion and depression or anxiety has been observed during the First
World War. Another war fought between 1995- 1975" evidenced the symptoms of trauma

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such as anxiety, nightmares, drug dependence, alcohol use, and lack of responsiveness. The
females in armed forces or military specifically nurses experienced severe trauma issues like
post-traumatic stress disorder. Particularly in the US the lifelong prevalence was nearly 7 to
13 % and 1-year prevalence was nearly 4 to 6 %. Females develop trauma issues more than
males. The rates of post-traumatic stress disorder are similar in both male and females. Each
year in the United States more than 1400 kids nearly 2 children per 100000 die due to abuse
or neglect. Particularly in 2005, estimated 900,000 kids were the victim of child
maltreatment. A study conducted by pence et al (2012) on nearly 926 Tanzanian patients
revealed that those established HIV infections had the maximum exposure to childhood and
lifetime traumatic experience, and the newly diagnosed cases have lower exposure. Another
study conducted by Kilpatrick, Resnick, Milanak, Miller, Keyes, & Friedman, 2013) on
2,953 participants revealed that prevalence of one type of violence victimization (physical
abuse, assault) was 53.1 percent. Lifetime prevalence recorded by using DSM 4 was 10.6 and
past 12 months prevalence was 6.9 percent. Shi et al (2017) also conducted a study on 2706
of health care workers and found that overall prevalence of the physical violence in the last
12 months was 13.60 percent. PTSD prevalence month the healthcare providers who faced
physical violence was 28 percent. Another study conducted by surveying 1000 people from
four different Southern US cities found that nearly 69 % of participants experienced
minimum one type of trauma out of nine major stressors of trauma once in a life, and nearly
21 percent reported top had one event in last one year. A report published by Australian
Bureau of Statistics (2012) revealed that particularly in 2007 in Australia females aged
between “16 to 85” experienced higher rate (22%) of mental health problems than males.
Trauma is the health condition which is highly distressing and disturbing; it is both
physiological and psychological. In the psychological trauma, the damage has been caused to
the person’s psychological health or psyche due to an event that was extremely stressful. The

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neurobiology of trauma includes the stimulation of the HPA axis which is the connection
between the hormones and the nervous system. It connects the 3 structure of the brain:
pituitary gland, hypothalamus, and adrenal gland (Sherin, & Nemeroff, 2011). Hypothalamus
is present inside the brain that in the communication with other structures of the brain such as
pituitary gland. In traumatic events, the Hypothalamus triggers the secretion of hormones
from the pituitary gland in response to traumatic situations. These hormones then stimulate
the secretion of other hormones like catecholamine, opiates, oxytocin, and cortisol from the
adrenal gland. These hormones work like a signal in order to help the body to respond to any
traumatic event (Heim, & Nemeroff, 2009). Another brain part called Amygdala specifically
work in the processing of emotional information. When any stressor attacks the body,
amygdala processes the fast assessment of the condition and whether the stressful event
needs a systematic reaction. If the events required that systematic response then this part of
the brain stimulate the system handle the situation. Further, the sympathetic nervous system
has been activated by the Amygdala to prepare the body for a fight or flight response. This
condition may cause improper heart rate and muscle tone and change on breathing activity.
Amygdala also activates the HPA axis that is the main circuit of the brain cells.
Corticotrophin-releasing hormones also release from the hypothalamus (Lanius et al, 2010).
Corticotrophin-releasing hormones also abbreviated as CRH (Wegner, Helmich, Machado,
Nardi, Arias-Carrión, & Budde, 2014). The secretion of two other hormones beta-endorphins
and ACTH (Adrenocorticotropic hormone) has been improved by these hormones from the
pituitary gland. This ACTH triggers the release of cortisol, this hormone plays a key role in
the human nervous system through affecting the person’s memory, emotions, and learning
ability. Some of the researchers found that chronic stress and the psychological and
emotional trauma lead to impair the regulation of HPA. Beta-endorphins play specific
function to prepare the body to cope with stressors and pain associated with trauma. In

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trauma events and PTSD, these beta-endorphins release does not stop and continuously
secretes in response to the intrusive memories and flashback of the traumatic events occurs in
their lives (Rutten et al., 2013).
As discussed in the case study Mr. Amir Daud experienced deeply stressful events in
his life like his detention time, discrimination for being Hazara, the sudden death of his
family member, and homesickness and guilt for leaving them behind. Traumatic informed
care is the complete strategy that can help Mr. Daud to cope with the issues he is facing due
to the past traumatic events. There are six important components of trauma-informed care:
safety, transparency & trustworthiness, collaboration, empowering the patient, and choice of
the patient (Miller, & Najavits, 2012). The patient experienced traumatic events commonly
not open to discussing those events with others in order to keep private those events.
Therefore safety and privacy should be the priority for health care providers. Mr. Daud faced
various traumatic situations in his life and experiencing the mental health problems due to
those events. It should make sure that his emotional safety will be safe and secure and the
events are not discussed with others. The healthcare providers like nurses should be built a
therapeutic relationship with Mr. Amir Daud to get the information related to his condition
easily. Another important component of trauma-informed care is choice. According to this
component of the model, the person with trauma issues has the choice about the treatment.
The patient should be clearly informed about the responsibility and rights for having the
choice in the treatment. The third component of the model is collaboration which indicates
collaborating with the person in the process of decision making and the power should be
shared with him. According to this component, the patient should have the significant role in
evaluating services and planning (Brewin, Gregory, Lipton, & Burgess, 2010). Another
component is trustworthiness and transparency according to which informing the patient
about the task, making interpersonal boundaries and consistency to the patient is the

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important steps that should be followed during treatment. In this component, the respectful
boundaries that are respectful and professional should be built between the patient and nurses
so that the cultural and ethical aspects issues cannot be raised. Empowerment is the important
component of trauma-informed care model according to which empowerment and skill
building should be the priority of healthcare providers. Mr. Amir Daud experienced traumatic
events like homesickness, guilt, and fear, therefore the nurses and other team member be
polite to him in order to make him feel that somebody care form him. A nurse should actively
listen to the patient carefully to build a therapeutic relationship with him. These components
may provide the complete treatment Mr. Daud to cope with the traumatic symptoms (Dass-
Brailsford, & Myrick, 2010).
Traumatic informed care is the widely accepted model for people with symptoms
associated with traumatic events. In the case of Mr. Daud this model can be implemented to
achieve the health goals set for the patient. There four different ingredients of trauma
implementation process: including the patient in the process of treatment, screening the
patient for trauma, providing trauma-specific training to the staff involved in Mr. Amir
Daud’s care (Muskett, 2014). In the very first ingredients the patient should be involved in
their planning for treatment and active role should be given in the process of decision making
which is the right of every patient. The feedbacks of patients drive the direction of the care
plan. Engaging the patient experienced traumatic events in the process of treatment and
decision making may build a trust between both the parties. Screening is another ingredient
which indicates that screening is the essential step of trauma-informed care that provides a
clear knowledge about the complete history of patient's trauma events. It helps the health care
providers to decide which intervention can be beneficial for the patient, and help to quantify
the associated risk of disease that may take place in coming days or months. Screening may
reduce the risk of ethnic and racial bias. Screening is done by asking some question to the

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patient that is related to his past experience. It allows the diseased person to decide what
information they should share. The aspects associated with screening includes treatment
setting needs to guide practices, the screening of the trauma should be beneficial to the
person, re-screening should not be done (Muskett, 2014). The last ingredients of the
implementation process of trauma-informed care are providing trauma-specific training the
staff working in the care team assigned for Mr. Daud. This step is the most impotent part of
this model because it might be possible that some of the members of the team do not have
knowledge of trauma (Miller, & Najavits, 2012). The patient might have complex behavior
which can be only handled by the trained people, therefore, the involving the referral sources
and partnering organization is a good idea in case of Mr. Daud (Brown, King, & Wissow,
2017).
Trauma is the global issues that affect people from all around the world equally. It can
be defined as the stressful events that may leave the person feeling hopeless, lonely and out
of control emotionally and psychologically. The prevalence studies of this health condition
indicated that in the United States the lifelong prevalence reported 6.8 to 12.9 percent and 12
months prevalence were estimated 4 to 6 percent. Women’s are more likely to develop this
health issue. Australian Bureau of Statistics reported that in Australia 22 % females aged 16
to 85 years faced mental health issues. Neurobiology psychological and emotional trauma
includes stimulation of HPA axis, the involvement of hormones like catecholamine, opiates,
oxytocin, and, corticotrophin, ACTH, CRH, and cortisol that are secrets form secretory
glands like pituitary glands and adrenal glands. Amygdala also associated with the
pathogenesis of trauma. Components of TIC include safety, transparency & trustworthiness,
collaboration, empowerment, and choice. Implementation of TIC includes for different steps
of ingredients that are engaging the patient in the decision-making process, screening,
training of staff and involving referral sources and partnering organization.

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References
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