Fact Sheet: Trauma, PTSD, ACE Scores and Trauma-Informed Care

Fact Sheet published via downloadable pdf produced by Mental Health America (MHA), the nations leading community-based mental health non-profit.

What is Trauma?

The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV) defines a “traumatic event” as one in which a person experiences, witnesses, or is confronted with actual or threatened death or serious injury, or threat to the physical integrity of oneself or others.

Trauma is a public health issue that happens as a result of physical, sexual, or emotional abuse, neglect, violence, war, loss, disaster, and other emotionally harmful experiences. Like individuals, communities at large can be traumatized as well.

While many people who experience a traumatic event are able to move on with their lives without lasting negative effects, others may have more difficulty managing their trauma responses. Trauma can have a devastating impact on physical, emotional, and mental well-being.

How Does Trauma Affect Survivors?

Trauma affects the developing brain and body and alters the body’s stress response mechanisms. Emerging research documents the relationship between traumatic events, impaired brain function, and immune system responses. Trauma induces powerlessness, fear, hopelessness, and a constant state of alert, as well as feelings of shame, guilt, rage, isolation, and disconnection.

Unresolved trauma can manifest in a variety of ways including:

  • anxiety disorders

  • panic attacks

  • intrusive memories (flashbacks)

  • obsessive-compulsive behaviors

  • post-traumatic stress disorder PTSD

  • addictions

  • self-injury

Trauma increases health-risk behaviors such as overeating, smoking, drinking, and risky sex. Trauma survivors can become perpetrators themselves.

Unaddressed trauma can significantly increase the risk of mental and substance use disorders, suicide, chronic physical ailments, as well as premature death.

A New Understanding of Trauma

Until recently, trauma survivors were largely unrecognized by the formal treatment system. The costs of trauma and its aftermath to victims and society have not been well documented. Because of this, treatment systems may have frequently re-traumatized individuals and failed to understand the impact of traumatic experiences on general and mental health.

Today, the causes of trauma—sexual abuse, violence in families and neighborhoods, and the impact of war, for example—are matters of public concern. Trauma survivors have formed self-help groups to heal together. Researchers have learned how trauma changes the brain and alters behavior. A movement for trauma-informed care has emerged to ensure that trauma is recognized and treated and that survivors are not re-victimized when they seek care.

Facts at a Glance

The Adverse Childhood Experiences (ACE) Study, an observational study of the relationship between trauma in early childhood and morbidity, disability, and mortality in the United States, demonstrated that trauma and other adverse experiences in are associated with lifelong problems in behavioral health and general health.

More than 6 in 10 U.S. youth have been exposed to violence within the past year, including witnessing violence, assault with a weapon, sexual victimization, child maltreatment, and dating violence. Nearly 1 in 10 was injured.

Predicted cost to the health care system from interpersonal violence and abuse ranges between $333 billion and $750 billion annually or nearly 17% to 37.5% of total health care expenditures.

A lifetime history of sexual abuse among womxn in childhood and adulthood ranges from 15 to 25 percent.

An estimated 5 percent of males under the age of 18 experienced sexual victimization in the past year.

Racial violence and discrimination can be traumatic and have been linked to PTSD symptoms among communities of color.

LGBTQIQ people experience violence and PTSD at higher rates than the general population.

For those who access the public mental health, substance abuse, and social services, as well as people who are justice-involved or homeless, trauma is an almost universal theme.

Between 75 and 93 percent of youth in the juvenile justice system have experienced some degree of trauma.

Key Messages

The aftermath of trauma is costly to victims and to their community.

Healing from trauma is possible.

Validating the trauma and establishing trust and safety are the first steps.

When dysfunctional behaviors are trauma-induced, whether our own or someone we love, treating symptoms without understanding their functional value does not fully address the problem.

Addressing trauma is key to successfully treating self-harming and risky behaviors.

Coercive and disempowering practices in traditional behavioral health treatment of children and adults can re-victimize trauma survivors.

Trauma-informed care is an approach to engaging people with histories of trauma that acknowledges the role that trauma has played in their lives and treats symptoms as reflecting this experience.

Trauma-informed services incorporate knowledge about trauma in all aspects of service delivery and facilitate recovery and empowerment.

Mental health systems, correctional systems, and other local human service agencies are revamping practices to adopt trauma-informed care.

Ask “what happened to you?” not “what’s wrong with you?”

Data supports the need for broad-based programs and policies that help to reduce child maltreatment as well as enhance positive family functioning.

According to the Substance Abuse and Mental Health Services Administration, addressing individual, family and community trauma requires a comprehensive approach that includes:

· increasing awareness of the harmful effect of trauma in children and adults,

· developing effective preventative, treatment and recovery support services reflecting the needs of diverse populations,

· providing training and tools that help systems identify trauma and intervene early &

· informing public policy that supports these efforts.

Who Should Address Trauma Reduction and Treatment?


1. Recognize the toll that unaddressed trauma takes on citizens and society.

2. Encourage the study & adoption of trauma-informed practices by state & local agencies.

3. Promote policies and programs that reduce child maltreatment and interpersonal violence.

4. Promote cost-effective prevention programs in schools and communities to promote healthy behaviors in order to reduce the incidence of trauma.

Mental Health Administrators and Human Service Providers

1. Understand and recognize the signs and behaviors associated with trauma.

2. Screen for trauma history.

3. Introduce trauma-informed care to change practices and eliminate coercive and disempowering practices.

4. Eliminate re-traumatizing treatments such as seclusion and restraint.

5. Establish trauma healing groups and promote peer-led survivor groups.

6. Establish shelters for battered womxn, LGBT people, and other vulnerable groups.

Communities and Community-based Organizations

1. Identify sub-groups, like This is Jane Project, in your community who have experienced trauma, such as abused and neglected children, victims of violent crime and assault, refugees, veterans, womxn, and minority groups.

2. Educate the community on reporting child abuse, domestic abuse, and hate crimes.

3. Educate young womxn, LGBTQ, and other vulnerable groups on safety and self-defense.

4. Strengthen local policies and programs to protect and shelter trauma victims.

5. Recognize trauma experiences among first responders.

6. Learn about prevention programs in the community and schools to promote positive parenting and healthy behaviors in children and adolescents.

Selected Resources

Substance Abuse and Mental Health Services Administration

Trauma and Justice Initiatives

Models for Developing Trauma-Informed Behavioral Health Systems

Responding to Childhood Trauma, the Promise and Practice of Trauma-informed Care

National Center for PTSD

Parts of this fact sheet from programming developed by Mental Health America and the National Association of State Mental Health Program Directors with support from the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.