RECOGNITION

Recognition is the first and most crucial step in trauma-informed care. It is not as simple as identifying obvious distress; rather, it is about actively noticing the subtle ways that trauma can manifest in a patient interaction. With appropriate training and effort, healthcare workers can cue into emotional, behavioural, and/or physical responses that indicate a prior trauma. 

Recognition directly aligns with four of SAMHSA’s six principles: safety, trust and transparency, peer support, and cultural awareness.

Recognition of perceived safety is paramount to a helpful encounter. Recognizing when a patient feels fear or overwhelmed allows us to adjust our tone, posture, and approach to make them feel more secure. Making patients feel safe is the first step to treating them in the short term and ensures that we do not create a re-traumatizing environment that harms them in the long term. 

Trauma is deeply influenced by an individual's background, culture, and lived experience. Patient hesitancy towards physical contact, authority, or fear of hospitals might not just be personal but rooted in cultural, gender-based or historical experiences. Recognizing these nuances through cultural awareness helps healthcare providers avoid misinterpretation. 

Recognition is what makes the rest of trauma-informed care possible. If we fail to see trauma, we fail to respond appropriately. But when we recognize it, we set the stage for building trust, offering support, and ensuring that our care does more good than harm. Here is a list of indicators all healthcare providers should be aware of. Recognizing these can be the difference between treating a patient appropriately or allowing them to fall through the cracks. 

Emotional Indicators 

• Anxiety – Persistent worry, fear, or feelings of dread.

• Depression – Low mood, hopelessness, or withdrawal from pleasurable activities.

• Emotional numbness – Difficulty feeling or expressing emotions, often as a defence mechanism.

• Irritability or anger – Heightened emotional reactivity, often disproportionate to the situation.

• Mood swings – Rapid changes in emotional state without a clear trigger.

• Shame – Feelings of self-blame or worthlessness tied to the traumatic event.

Behavioural Indicators

• Avoidance – Deliberate efforts to stay away from places, people, or situations that remind them of the trauma.

• Hyper-vigilance – Constantly feeling on edge or being easily startled.

• Substance misuse – Using alcohol or drugs as a coping mechanism.

• Compulsive behaviour – Repetitive actions to regain a sense of control.

• Difficulty concentrating – Struggling to focus on tasks or experiencing memory lapses.

Physical Indicators

• Sweating or shaking – Physical signs of anxiety, especially in triggering situations.

• Unexplained headaches or migraines – Persistent head pain with no clear medical cause, often tied to stress or tension.

• Appetite changes – Overeating or loss of appetite.

• Increased heart rate or palpitations – A physical response to perceived threats or triggers.