Understanding Trauma-Informed Psychiatric Care and How Medication Supports Healing
Trauma is the emotional response to a distressing or disturbing event that overwhelms an individual’s ability to cope. It can be acute (a single event like a car accident), chronic (repeated exposure such as childhood abuse), or complex (exposure to multiple traumas, often in a relational context).
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma can have lasting adverse effects on an individual’s physical, emotional, and psychological well-being.
Now… How Is Trauma Diagnosed?
In clinical settings, trauma-related conditions are most often diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). The most well-known trauma-related diagnosis is Post-Traumatic Stress Disorder (PTSD).
Core Diagnostic Features of PTSD:
- Re-experiencing symptoms (flashbacks, nightmares)
- Avoidance behaviors (avoiding people or places that are reminders of the trauma)
- Negative changes in mood and cognition (guilt, detachment, low self-worth)
- Hyperarousal (exaggerated startle response, difficulty sleeping, irritability)
Other trauma-related diagnoses may include:
- Acute Stress Disorder (ASD)
- Adjustment Disorders
- Complex PTSD (recognized by WHO’s ICD-11)
Recognizing the Characteristics of a Person Living with Trauma
Not everyone processes trauma in the same way. Some common signs and characteristics include:
- Emotional numbing or emotional volatility
- Difficulty trusting others
- Sleep disturbances and fatigue
- Somatic symptoms like headaches or chronic pain
- Intrusive thoughts or flashbacks
- Dissociation or feeling disconnected from oneself or surroundings
- Self-harming behaviors or substance use as coping mechanisms
These symptoms often coexist with anxiety, depression, or mood instability, complicating diagnosis and treatment.
What Is Trauma-Informed Psychiatric Care?
Trauma-informed care is an approach that acknowledges the prevalence and impact of trauma and ensures that care delivery avoids re-traumatization, promotes empowerment, and respects the patient’s autonomy.
In psychiatry, this means shifting from “What’s wrong with you?” to “What happened to you?”
The five key principles of trauma-informed care are:
- Safety
- Trustworthiness and Transparency
- Peer Support
- Collaboration and Mutuality
- Empowerment, Voice, and Choice
The Psychiatrist’s Role in Trauma-Informed Care
Psychiatrists provide a unique and essential role in trauma recovery through a bio-psycho-social lens. Their contributions include:
Thorough Assessment
- Psychiatrists evaluate psychiatric symptoms, trauma history, family background, and co-occurring conditions.
- Assessment tools may include the Clinician-Administered PTSD Scale (CAPS-5) or PTSD Checklist (PCL-5).
Medical Stabilization
In severe cases, psychiatrists may address safety concerns such as suicidality, self-harm, or substance withdrawal.
Medication Management
Medication can be a crucial part of symptom relief, helping patients become emotionally regulated enough to participate in therapy.
Collaboration with Therapists
Psychiatrists coordinate care with trauma-informed therapists who use EMDR, cognitive processing therapy, or somatic approaches. Psychiatric check-ins can help pace therapy by addressing destabilization or emotional flooding.
Psychoeducation
Teaching patients how trauma affects the brain and body (e.g., amygdala overactivation, hippocampus shrinking) can normalize symptoms and reduce shame.
Common Medications Used in Trauma Recovery
There is no single “trauma medication,” but several classes of medications can support recovery depending on symptoms:
| Medication Class | Common Examples | Purpose in Trauma Care |
|---|---|---|
| SSRIs (Selective Serotonin Reuptake Inhibitors) | Sertraline, Paroxetine | First-line treatment for PTSD; reduce anxiety, depression, intrusive thoughts |
| SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) | Venlafaxine, Duloxetine | May be helpful if there’s a prominent pain or fatigue component |
| Prazosin | — | Specifically targets nightmares and sleep disturbances in PTSD |
| Mood Stabilizers | Lamotrigine, Valproate | Help with emotional dysregulation, especially in complex PTSD |
| Atypical Antipsychotics | Quetiapine, Aripiprazole | May be used short-term for severe anxiety or mood instability |
It’s important to emphasize that medication does not erase trauma, but it can reduce distress and allow the brain to engage in the healing process more effectively.
Integrating Medication and Mindfulness in Trauma Care
Psychiatrists working in a trauma-informed framework may also introduce or recommend mindfulness practices to:
- Reduce hyperarousal
- Reconnect the patient with their body
- Cultivate nonjudgmental awareness of intrusive thoughts or triggers
Examples include:
- Grounding exercises (5-4-3-2-1 technique)
- Safe place visualizations
- Breathing practices focused on activating the parasympathetic nervous system
Key Point: Psychiatry as a Partner in Recovery
Trauma recovery is not linear, and it cannot be reduced to one treatment approach. Psychiatrists play a critical, supportive role, providing medication, safety, and education while partnering with therapists to promote long-term healing.
By applying a trauma-informed lens, psychiatrists can avoid re-traumatization, empower their patients, and help them reclaim agency and trust in the healing journey.
References
- SAMHSA. Trauma and Violence. https://www.samhsa.gov/trauma-violence
- Fallot, R. D., & Harris, M. (2009). Creating Cultures of Trauma-Informed Care (CCTIC).
- American Psychiatric Association. Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder.
- VA/DoD Clinical Practice Guidelines for the Management of PTSD (2023).
- Yehuda, R. (2002). Post-traumatic stress disorder. New England Journal of Medicine, 346(2), 108-114.