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Understanding the Damaging Effects of Trauma

February 20, 2020

Elevate Speaker Will Discuss Identifying, Treating Trauma in Patients

Sarah Vinson, MD

Trauma is widespread among mental health patients and in the general population. It doesn’t discriminate by age, gender, race, or socioeconomic level, and its damaging effects can manifest in a slew of ways—such as aggression, avoidance, and anxiety—or work quietly, going unnoticed by friends and family. With its many variables in presentation and course, Sarah Vinson, MD, calls it “the lupus of mental health.”

Founder of the Lorio Psych Group private practice and an associate clinical professor of psychiatry and pediatrics at Morehouse School of Medicine, Atlanta, Georgia, Dr. Vinson will coach attendees on trauma diagnosis and treatment at the upcoming Elevate by Psych Congress conference.

Q: Can you briefly tell me about yourself and what drew you to present on the topic of trauma?

A: As a child, adult, and forensic psychiatrist, I see the manifestations and impact of trauma across generations, age groups, culture, and socioeconomic status. It is a central issue in mental health and in our society more broadly. I think it is the single most important issue in mental wellness, and that our society would be better mentally, physically, and socially if we collectively decided to address this issue. 

Q: Why is trauma an especially tricky condition for mental health providers to identify?

A: The psychological responses to trauma, which can be adaptive for individuals in the moment, can be barriers to disclosure. For example, a patient cannot tell a provider something that the patient is in denial about or has repressed. Even when the person can readily access the memory, doing so may come with psychological fallout, such as intense fear or anxiety, that the person wants to avoid. This can make people reluctant to bring it up. Also, when domestic trauma was caused by people the victim knew, it can undermine trust of others.

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Q: Looking back at patients you’ve treated, how has trauma manifested? Can you describe the different effects it has had on patients?

A: I call trauma the lupus of mental health. It can result in symptoms along a continuum in a myriad of ways. Some become more aggressive, while others become more passive. Some can't sleep while others sleep to avoid the negative feelings associated with it. Some strive to become successful and are obsessive about controlling their environment, while others don't think they have any chance of success and act recklessly.

There is no singular response to trauma, and that's evident in every treatment setting where I've worked — whether it's my high-functioning professional clientele in my private practice, the people on death row I see for forensic cases, or the children I treat in my county clinic. 

Q: How common is trauma? Should mental health providers be on constant lookout for this condition?

A: It is very common in the general population but even more so in people who show up in both mental health and primary care clinics. Mental health providers absolutely should be on the lookout for it, irrespective of their treatment settings. 

Q: How can providers dig deep and diagnose trauma despite its ambiguity in patient presentation?

A: One of the big things is to stay curious and understand there may be reasons the patient doesn't tell you everything all at once during your first meeting. Rapport building is critical in creating a space that allows people to disclose information about the most challenging moments of their lives. 

Q: Does trauma affect patient engagement in treatment and, if so, in what ways?

A: It absolutely can. Avoidance is a common response to trauma because of the negative, difficult feelings that thinking or talking about it can elicit. Patients may want to avoid places where they are expected to talk about it. Additionally, depending on the person who victimized them, patients may have a hard time in situations with a power differential, such as patient-doctor relationships.

Also, depending on how impairing someone's trauma symptoms are, they may have fewer resources available to them to access treatment. For example, someone who loses a job because of poor concentration and hypervigilance may have difficulty affording the train fare necessary to get to therapy consistently. 

Q: How effective is treatment?

A: The impact of trauma is treatable. Just as it can have biological, psychological, and social ramifications, treatment should take all of these categories into consideration as well. 

Q: What other aspects of trauma do you plan to cover in your session?

A: In my session, I'll talk about structural and institutional trauma, which are often left out of these conversations, as well as interpersonal trauma.

Q: What do you hope session attendees will take away with them?

A: I hope that they will emerge with more understanding of their patients' experiences, awareness of their own biases, and actionable ideas about how they can be more trauma-informed in their work. 

— Jolynn Tumolo

The 2020 Elevate by Psych Congress conference is being held virtually July 25-27, 2020.
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