Far from being psychobabble or just another bandwagon, trauma-informed practice is rooted in evidence — and can help GPs manage many of the chronic, complex and difficult cases they encounter, says GP Dr Johanna Lynch, Senior Lecturer at the University of Queensland, Immediate Past President of the Australian Society for Psychological Medicine, and Clinical Advisor to the domestic and family violence team at Brisbane South Primary Health Network. 

Dr Lynch explains how trauma-informed practice is underpinned by biology — and offers practical tips for implementing this approach. 

Trauma often mistaken for a psychiatric condition

“It is well documented that trauma is often misdiagnosed as a psychiatric disorder when instead it is a reasonable response to harm,” Dr Lynch says. “I have lost count of the number of my patients with trauma who have been misdiagnosed as schizoaffective, borderline, social phobia, depressed etc.” 

It is often shrouded in shame, which “keeps things hidden from even the most skilled practitioner,” she says, noting definitions by child development experts and psychophysiologists are helpful for understanding what trauma actually is. 

There are three types of trauma, Dr Lynch says: 

1. Single incident (or single event) trauma – such as a car accident or response to a fire, which can lead to symptoms like flashbacks, hypervigilance and avoidance of certain situations.  
2. Complex trauma – anything that traumatises a person while they’re growing up, which can affect brain development and lead to the above symptoms. It can also cause “wider dysregulation in stress response systems, emotion regulation, capacity to trust others, and altered perception of self, others, and even their own life narrative,” Dr Lynch says.  
3. Compound trauma – when a community experiences a stressor (such as injustice, marginalisation, or racism) over generations—affecting hope, connectedness and meaning. 

Trauma prevalence

Research shows trauma is incredibly common. The 2023 Australian Child Maltreatment Study, for example, found almost 40% of over 8000 respondents said they had been exposed to domestic violence. Approximately 30% had experienced physical, sexual and/or emotional abuse, while 8.9% reported experiencing neglect. 

“This is just recording forms of trauma that are easy to measure, and it is still an enormous number of the everyday GP caseload,” Dr Lynch says. 

Moreover, trauma measured retrospectively tends to be under- rather than over-represented, and many emotional wounds aren’t quantified, she adds.

Emotional neglect is under-researched, but linked to increased health risks

“For example, those who experience emotional neglect in childhood often minimise their own needs, take on responsibilities of adults, and see this as their normal. This group of people is really difficult to capture in surveys that focus on events that did happen, not processes that didn’t.” 

“So this cohort of patients is left out of most trauma research, but their individual risk of sickness and immune system dysfunction is high. As GPs, we see this group of patients every day with complex undifferentiated presentations.”

Psychiatric labels can miss the point

Dr Lynch’s interest in the field stemmed from seeing her own patients “cycling in and out of psych hospitals, not getting better, getting more tablets, more psychiatric labels—and nonsensical labels, like their addiction is now a label, when the addiction is trying to cope with the first diagnosis,” she says.  

“So there’s this bag of labels somebody carries around without actually a deep understanding of the story.” 

Such labelling has resulted from psychiatry’s endeavours to categorise psychological symptoms and abolish the “weird treatments” of yesteryear. In the process, however, current psychiatric diagnostic frameworks have lost the heart of a discerning clinician, Dr Lynch says. 

“The objectivising of anything, including medical things, means we ignore all the subjective information that could help us work out what’s going on. And that leaves the clinician working in a kind of blinkered state,” she says. 

“So incredibly complex things that human beings suffer are being simplified to these psychiatric names based on symptoms with almost no reference to what’s actually going on in someone’s life,” Dr Lynch says.

For example, people with diverse experiences like grief, sorrow, existential distress, disappointment, or despair are lumped together under the label of ‘depression.’ 

Trauma-informed care offers an antidote to such frameworks, she says.

How adverse experiences impact health and wellbeing

Early childhood adversity research spawned a paradigm shift in our understanding of trauma and health, Dr Lynch notes. In 1998, a landmark prospective study of 17,000 middle-class Californians examined the impact of 10 types of childhood adversity, including physical, sexual and emotional abuse, neglect, and family dysfunction involving a missing or unavailable parent (including cases where one parent harmed the other).  

They found each type of adverse childhood experience (ACE) had a similar dose effect. 

“So a missing parent or somebody sexually abusing you had similar dose effects. And if you had four or more of them, you had a 20-year reduction in your life expectancy,” Dr Lynch explains.

Later studies investigated the intensity and frequency of exposure and the impact of peer bullying, witnessing siblings being hurt, and non–verbal emotional abuse. Mounting evidence has confirmed the trauma-health connection, including research exploring relationships and health. 

Loneliness is a type of trauma

“Humans are herd mammals. My research has confirmed that humans are threatened by relational disconnection, violation of safe connection, or confusion about where you belong. This impacts health,” Dr Lynch says. 

“For example, we know people who are lonely die earlier and have more sickness. So when you’re lonely, you actually suffer in a way that changes your biology,” she says, highlighting how being excluded from community is a kind of trauma that impacts health.   

“Similarly, there’s some studies around how marriage quality affects people’s wound healing rates. We also have evidence that ACEs, bullying and witnessing your siblings being hurt changes your brain architecture.  Overall, trauma has long-term impacts on learning, language acquisition, educational achievement, physical growth and so much more,” Dr Lynch explains. 

This knowledge should change how we practice medicine, she adds. 

“The original ACE study confirmed an increase in health-risk behaviours like smoking and promiscuity, drug and alcohol addiction to cope with the distress, as well as independent increased risk in cancer rates, cardiac death, autoimmune disease and other long-term outcomes,” Dr Lynch says.

Researchers have hypothesised that ‘toxic stress’ can lead to disease as the body tries to respond, but isn’t able to overcome it. In other words, if the cumulative burden of chronic stress is too high, disease may develop.

Dr Lynch notes the body does not differentiate between the type of stress, reacting the same way to emotional stress (such as a relationship loss) as it does to biological stress (such as cancer, an infection, or other illnesses).

“And that reaction changes how our cells age and how responsive we are to insulin and to cortisol. And it changes our neurobiological settings in our endocrine system and our autonomic nervous system.”

However, work by Dr. Jack Shonkoff, founding director of the Center on the Developing Child, showed that children can tolerate significant stressors if they have someone “to calm them down, make sense of it, see the big picture and comfort them—essentially soothe their bodies,” Dr Lynch says.

What are the potential mechanisms at play?

“The original ACE study confirmed an increase in health-risk behaviours like smoking and promiscuity, drug and alcohol addiction to cope with the distress, as well as independent increased risk in cancer rates, cardiac death, autoimmune disease and other long-term outcomes,” Dr Lynch says.

Researchers have hypothesised that ‘toxic stress’ can lead to disease as the body tries to respond, but isn’t able to overcome it. In other words, if the cumulative burden of chronic stress is too high, disease may develop.

Dr Lynch notes the body does not differentiate between the type of stress, reacting the same way to emotional stress (such as a relationship loss) as it does to biological stress (such as cancer, an infection, or other illnesses).

“And that reaction changes how our cells age and how responsive we are to insulin and to cortisol. And it changes our neurobiological settings in our endocrine system and our autonomic nervous system.”

However, work by Dr. Jack Shonkoff, founding director of the Center on the Developing Child, showed that children can tolerate significant stressors if they have someone “to calm them down, make sense of it, see the big picture and comfort them—essentially soothe their bodies,” Dr Lynch says.

Tips for trauma-informed practice

Understanding trauma can help clinicians unravel complex cases more easily as they see the whole person in context – and can start to notice patterns that underly their behaviours, Dr Lynch says.

She shares four strategies to better support patients who have been impacted by adverse experiences.

1. Make it strengths-based

Focusing on someone’s trauma will tend to make them worse. Instead, “Focusing on strengths and existing resources can put the patient at the centre of their care,” she says. “Building safety can occur across the whole person and is healing oriented.”

This might involve encouraging them to develop safe friendships, for example, or remove themselves from unsafe situations.

2. Ensure consultations feel safe

“Each of our therapeutic interactions can communicate respect and protect the patient’s dignity and autonomy. This includes simple things like listening well, managing time so they don’t feel ignored or rushed, our tone of voice, and the way we offer choice at every stage,” Dr Lynch says.

“We also may need to be aware of our own body language and actions so we don’t accidentally reenact traumatising processes that confuse, dominate, or disconnect.”

In themselves, the predictable rituals of medical practice, like asking people to sit or touching them to take their blood pressure, can help people calm down and feel safe, she adds.

3. Be alert to their ‘window of tolerance’

People functioning within their window of tolerance can effectively regulate their emotions. This window can get smaller in people who’ve experienced trauma, causing them to become anxious and agitated, or to ‘zone out’, during consultations. Either way, it’s important to bring them back into a “middle space” where they can think and reason, Dr Lynch says.

Well-known clinical psychologist and trauma therapist Janina Fisher recommends using “empathic interruption” to shift patients from being:

too zoned out – by asking about how things felt in their body when ‘x’ happened, or

too agitated/ ‘hyped up’– by asking for more detail about what actually happened.

4. Consider the person’s context and story in everyday practice

This can be especially helpful if you have upsetting news. If you need to tell a patient they have diabetes, for example, and you know their mother died from diabetic complications, you could start by telling them we have better treatments nowadays. You can always schedule another appointment to explain the condition and prognosis in more detail.

“A trauma-informed approach helps GPs to integrate our understanding of the biology and biography of our patients,” Dr Lynch sums up. “This whole person understanding could transform how we understand disease and distress in our community.”

More information

Sense of Safety for Practitioners Foundation Course | A 10-hour course Dr Lynch developed about integrating trauma-informed care into practice 

Sense of Safety website | Links to research about various aspects of trauma-informed care 

NumberStory.org | Designed by paediatrician and former Surgeon General of California Nadine Burke Harris, this site has information and resources to help patients learn about how to heal.  She also has a TED talk. 

Blue Knot Foundation | Resources for GPs