If a patient becomes significantly dysregulated or re-experiences the trauma during the discussion, reorient the patient to their surroundings and remind them that the traumatic event is not happening in that moment. For example, if shame is prominent, say, “Many people who have experienced this kind of event feel shame or blame themselves, even though it was not their fault.” How do you think it has affected you? Do you think it is still affecting you now?” Maintain a non-judgmental stance and normalize the wide range of emotions, including shame and numbness. Do not probe for excessive detail or extensive recounting of memories because it can trigger decompensation.īe attentive to the emotions that may emerge during disclosure, and use validating statements for example, “That sounds like a very difficult experience. Respond sensitively to disclosureĭisclosing a history of trauma can be emotionally evocative, so be careful not to destabilize the patient. The ACE questionnaire is available for free online here. High scores have been associated with adverse health behaviours and outcomes, including cigarette smoking, coronary artery disease and cancer (Felitti et al., 1998). It can be used to quantify childhood exposure to trauma (although it does not encompass all types of events that would be considered traumatic). The Adverse Childhood Experiences questionnaire (ACE) assesses for seven types of early-life adversity. Given the wide range of experiences that can be considered traumatic, it can be worthwhile to ask a more general question, such as “Have you ever experienced any other difficult event that overwhelmed your ability to cope?” With patients at high risk for occupational exposures to trauma, such as first responders, explore the impact of vicarious exposures. “Have you ever experienced any unwanted sexual contact in childhood or adulthood?”īecause some patients may not identify their experiences as abusive, if you suspect trauma, it can be useful to ask more generally about how “discipline” was handled in the home, or about “early sexual experiences” (Lanius et al., 2016).“Have you ever been exposed to violence as an adult?”.“Was there violence in your home during childhood?”. Ask about personal experiences of abuse, assault or catastrophic events in childhood and adulthood (Lange et al., 2000).
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