people experience trauma in early life, they may have the same struggles associated with posttraumatic stress disorder (re-experiencing, hyperarousal, and avoidance), along with a myriad of other issues caused by disrupted neurodevelopment because of dysregulation. On the other hand, with the many injustices embedded into systems and repeated throughout American history, a person’s survival can be rooted in behavior that protects them. They may be more passive, or they may be more expressive with their words and actions. They may engage in self-harming behavior or turn to substance use to mitigate the physiological response in their body. Some providers are still not fully knowledgeable about complex trauma because it is not a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders . Therefore, people with trauma may be misdiagnosed. National trauma expert Sandra Bloom says, “Our labels don’t describe the complex interrelated, physical, psychological, social, and moral impacts of trauma…and they rarely help us know what to do to help.” Categories of trauma There are many categories of trauma. Here is an overview of some of the categories. • Psychological trauma is trauma that includes observing or experiencing a life- threatening event or being violated by people on whom you depend on for your well-being. Examples of psychological trauma include abrupt changes in health or employment, abuse of any kind, bullying, experiencing food insecurity, exploitation, disasters (natural or human-caused), violence, and war. • Sanctuary trauma is trauma that occurs in settings that are socially sanctioned as safe. Sanctuary trauma involves actions of providers or systems that bring up feelings of vulnerability, helplessness, fear, shame, etc. This can occur within the medical system, the substance use and mental health services system, justice system, foster care, child protective services, school, and faith communities. Provider bias is a part of sanctuary trauma. It refers to attitudes and behaviors by service providers that unnecessarily restrict client access and choice. These biases are often a result of a provider’s culture, religious beliefs, or lack of knowledge. Provider bias can be explicit (conscious and intentional) or implicit (unconscious and unintentional). • Historical trauma or generational trauma or intergenerational trauma is trauma that refers to the cumulative or collective emotional harm experienced by an individual or a group across generations that are still suffering the effects. Examples include racial and ethnic discrimination and violence. This type of trauma can result in people being hesitant to enter systems of care that have historically oppressed
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