Re-enacting unhelpful relationships from the past (eg becoming abusive themselves, or partnering with an abusive partner) Psychoeducation regarding the psychological awareness of the link between distress and situation Maladaptive coping strategies (eg addictions, eating disorders) Psychoeducation regarding the psychological awareness of the link between symptoms and situation Validation of the patient’s physical distress and appropriate investigation May be associated with strong emotional states Syndromes such as irritable bowel syndrome, chronic fatigue and fibromyalgiaĬonsequences of maladaptive coping (eg substance abuse, eating disorders) Common symptomatology seen in survivors of childhood trauma linked to interventionĬommon symptomatology seen in survivors of childhood trauma

Figure 1 summarises the features of complex post-traumatic stress disorder (PTSD), one diagnostic formulation for the consequences of childhood abuse. The following are typical symptoms for adult survivors of childhood trauma (Table 1). These consultations require listening to both the overt distress and the ‘underneath story’ of trauma and recovery. 17 Instead, patients may present with conscious or subconscious manifestations of distress: somatic, psychiatric, psychological or social. It can be challenging for survivors of childhood trauma to directly disclose it may take up to decades for some to do so, if they do so at all. 16 The combination of these factors means that it may be difficult to manage such a sensitive and traumatic issue appropriately. 15 Many GPs may still be developing their capacity to ‘sit with uncertainty’ and to support a patient in distress without attempting to ‘fix the problem’. 14 Vicarious trauma is common, 9 and GPs frequently feel unsupported and uncertain about how best to manage the distress that can be associated with trauma. 13 Given the prevalence of childhood trauma, many GPs will have their own trauma histories, which complicates the therapeutic relationship.

11,12 Medicare Benefits Schedule rebates favour short consultations, and this makes mental healthcare in general practice financially difficult. General practice management of adult survivors of childhood traumaĪdult survivors of childhood abuse pose a number of challenges for general practitioners (GPs): the diagnosis of their medical and psychiatric illnesses is complex 9 the therapeutic relationship can be both delicate and critical to recovery 10 and the treatments available are varied, often expensive and frequently inaccessible. 3 Trauma may or may not be deliberate: a young child with leukaemia may experience hospitalisations as deeply traumatic despite no intent to harm on the part of the caregivers. Multiple forms of trauma can occur, and cumulative trauma is more damaging than single-episode trauma. Note that complex PTSD is a new diagnosis in the International Classification of Diseases, 11th Revision, and was endorsed by the member nations of the World Health Organization in May 2019, due to come into effect from 1 January 2022.Ī systematic review of Australian research estimates prevalence rates of childhood sexual abuse are approximately 8.6%, physical abuse 8.9%, emotional abuse 8.7% and childhood neglect 2.4%. The definition of child abuse and neglect can be found on the Centers for Disease Control website ( The definition of and diagnostic requirements for complex post-traumatic stress disorder (PTSD) can be found on the International Classification of Diseases website ( ). The presence of ACEs does not mean that a child will experience poor outcomes. What is childhood trauma, and how common is it?Īdverse childhood experiences (ACEs) is the term used to describe all types of abuse, neglect, and other potentially traumatic experiences that occur to people under the age of 18 years.ĪCEs have been linked to risky health behaviours, chronic health conditions, low life potential and early death.Īs the number of ACEs increases, so does the risk for these outcomes. 2 Cumulative trauma, where there are multiple adverse childhood experiences, leads to poorer health outcomes. 6,7 The impact of childhood abuse is significant, comprising approximately 2% of the total disease burden. 5 Trauma is more common in women 2 and in population groups that have a higher incidence of cumulative or intergenerational trauma, such as refugees or Aboriginal and Torres Strait Islander communities.

2–4 Although the total prevalence of childhood mistreatment is difficult to measure, it may be as high as 28%. Childhood trauma is common 1 and can have profound consequences throughout a person’s life (Box 1).

Complex trauma