Introduction to Trauma - Trans Survivor Toolkit

Overview

Trauma is defined by the American Psychological Association as “an emotional response to a terrible event like an accident, crime, natural disaster, physical or emotional abuse, neglect, experiencing or witnessing violence, death of a loved one, war, and more. Immediately after the event, shock and denial are typical.” Trauma can have long-term impacts, like “unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea.”[i]

Trauma may impact all aspects of a person’s life. This includes their physical and emotional health, their executive functioning, coping skills, and interactions with others. Not all traumatic events lead to long-term trauma symptoms.

Healing is possible. The support that someone receives in the immediate aftermath of traumatic events as well as over the long-term can make a major difference in the person’s healing and how trauma impacts them. While some people may experience the impacts of trauma throughout their lifespan, they are still able to lead fulfilling lives and find different strategies to cope and heal.

Trauma-informed care refers to services that are provided with an understanding of the pervasive and multi-dimensional impact of trauma and the steps taken to meet the needs of people who have experienced trauma without causing further harm. SAMHSA (Substance Abuse and Mental Health Services Administration) describes 4 Rs of trauma-informed care – Realize the widespread impact of trauma; Recognize trauma symptoms; avoid Re-traumatizing people; and have a systemic Response to trauma. [ii]

Practical steps

Learn about the impacts of trauma.
Recognize that anyone can be affected by trauma.
Plan ahead to create a supportive environment to work with survivors.
Build time into your practice to introduce yourself more thoroughly.
Check in throughout a meeting to see if the person has any questions.
Share information about what to expect ahead of time and be clear about when things might be different than what was planned.
Assume everyone could have traumatic experiences.

What is trauma?

The word trauma is often used to describe painful experiences that have a deep and lasting impact on our lives, our relationships, and our understanding of the world. Trauma includes experiences that threaten our sense of safety or our ability to control our own lives. It can also refer to the experiences of people who have never had a strong sense of safety or control—or who have had very little of either throughout their lives.

Trauma is not simply what happens to us—it also involves how our minds and bodies respond to overwhelming experiences.

Trauma is not limited to a single event. It can result from a series of events, an ongoing situation, or the world we are born into – one in which safety is rarely, if ever, possible. This may include people growing up in occupied territories or war zones, or those experiencing racism, discrimination, and oppression while witnessing the intergenerational effects on their families and communities. This does not mean that people living in these circumstances lack agency or resilience. Rather, sense of safety and control may be very different from someone raised in a more secure or safe environment.

Trauma can also refer to our responses to events or circumstances. These responses are shaped by our previous life experiences, identities, relationships, and the resources available to us.

For example, two transgender people hear the same news about the ongoing legislative attacks targeting transgender communities. One person has a strong support network, access to safety resources, and knows many people actively working to oppose these policies. Although they may feel distressed or discouraged by the news, they do not develop significant trauma responses.

The other person has far less social support. They may have been told not to discuss transgender issues at work and may feel isolated or unsure how to process or respond to the news. As a result, they develop trauma responses such as hypervigilance, anxiety, difficulty sleeping, and despair.

Many definitions of trauma and trauma responses come from mainstream psychology. Although these definitions have evolved over time, they still do not capture the full range of human experiences. A mental health professional may diagnose someone with Post-Traumatic Stress Disorder (PTSD), but that diagnosis is not required for a survivor to deserve, receive, or benefit from support. Likewise, if a person does not meet the diagnostic criteria for PTSD, it does not mean they are not experiencing trauma responses.

Types of Trauma

Few traumatic experiences fit neatly into a single box. However, understanding the different ways trauma can be categorized can help us better recognize how trauma affects people. Some common types of trauma are:

Acute Trauma.

Acute trauma results from a single, identifiable event or incident, such as a car crash, wildfire, natural disaster, physical assault, or other overwhelming experience.

Complex Trauma.

Complex trauma refers to repeated, prolonged, or multiple traumatic experiences, as well as the challenges that arise from adapting to or surviving those experiences. One definition describes complex trauma as “the exposure to multiple, often interrelated forms of traumatic experiences AND the difficulties that arise as a result of adapting to or surviving these experiences.”[iii]

Complex trauma often begins in childhood, although it can also develop during adulthood. Common examples include ongoing child abuse or neglect, repeated harassment, chronic intimate partner violence, or long-term exposure to unsafe environments. Service providers benefit from recognizing that trauma is often cumulative rather than limited to a single event. The compounding effects of complex can profoundly shape a person’s physical health, emotional wellbeing, relationships, and ability to cope with future stressors.

Historical Trauma.

Historical trauma refers to the cumulative emotional, psychological, social, and spiritual harm experienced across generations by members of a cultural, racial, ethnic, or other marginalized group. It is associated with large-scale events such as slavery, the Holocaust, forced migration, genocide, and the colonization of Indigenous peoples.[iv]

Another definition describes historical trauma as “intergenerational trauma experienced by a specific cultural group that has a history of being systematically oppressed.”[v]

Trans and nonbinary people may experience historical trauma related to racial or ethnic identities, gender identities, or other marginalized identities they hold. Understanding historical trauma helps service providers recognize that past collective experiences of oppression continue to shape peoples’ lives, health, relationships, and sense of safety today.

Generational Trauma.

Generational trauma (also called intergenerational trauma) refers to the transmission of trauma from one generation to the next. This transmission can occur through family relationships, parenting practices, beliefs, behaviors, and coping strategies that develop in response to trauma. Some research suggests that trauma may contribute to biological or epigenetic changes that influence how stress responses are regulated in future generations (and can be passed from one generation to the next). However, researchers are still working to understand these mechanisms, and trauma is also transmitted through family relationships, caregiving, culture, and social environments.[vi]

Learn more about Intergenerational Trauma:

Collective Trauma.

Collective trauma refers to traumatic events experienced by entire communities or societies (e.g. the COVID-19 pandemic, mass shootings, natural disasters). The extreme targeting of trans people during these current times may result in collective trauma.

Minority Stress

“The minority stress model is a framework that foregrounds the central role of stressors uniquely experienced among members of a minority group, including expressions of violence, stigma, and discrimination targeting the group in question, as potentially salient contributors to poor physical and mental health (Kelleher, 2009; Lick et al., 2013; Meyer, 1995).”[vii]

Transgender/nonbinary communities often experience discrimination, harassment, stigma, and other forms of prejudice. The Minority Stress Model helps explain how these experiences – and events affecting others who share their identities – can influence an individual’s health and wellbeing. Minority Stress is associated with poorer physical and mental health outcomes. Many of its effects resemble trauma responses, even when there is no single event that can be identified as the cause.

Minority stress is not just a model that applies to a person’s transgender identity/experiences; it also applies to people who experience marginalization based on race, ethnicity, religion, disability, language, socieoeconomic status, sexual orientation, and other aspects of identity that is marginalized. Individuals with multiple marginalized identities may experience compounded or intersecting minority stress, as multiple forms of discrimination and oppression interact to affect their health, safety, and wellbeing.

Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences (ACEs) are a set of childhood experiences that research has linked to increased risks for physical, mental, and behavioral health challenges in later life. The original ACEs framework does not capture every type of childhood adversity. Academics have proposed expanded measures to better reflect the experiences of marginalized communities, including Sexual Gender Minority ACEs (SGM ACEs), which recognize additional forms of adversity experienced by LGBTQIA+ people.

Research consistently finds that trans/nonbinary people report higher rates of both traditional ACEs and SGM ACEs than their cisgender peers.

Although ACEs research has significantly advanced our understanding of childhood adversity, the original study and the ways its findings have sometimes been applied have also been criticized.[viii] The initial study primarily included white, middle class, heterosexual adults, limiting its ability to reflect the harmful experiences of all children. In addition, the original list of ACEs does not include important forms of adversity such as discrimination, community violence, poverty, housing instability, or identity-based victimization. For example, parental divorce is included as one of the original ACEs. However, divorce itself is not inherently harmful. Children are often remarkably adaptable, and with stability, honest communication, and supportive relationships, many thrive through changing family structures. More broadly, the long-term impacts of adverse experiences is influenced not only by what happens to children, but also by the support, protection, and resources they receive before, during, and after those experiences.

What is important to know is that what happens to people in childhood makes a difference in their adult lives. How we treat children matters. The environments we create, the relationships we build, and the ways we respond to children during difficult times can have lasting effects throughout adulthood.

The Impacts of trauma

Trauma can affect nearly every aspect of a person’s life, both immediately following a traumatic event and over time.[ix] While every person’s experience is unique, common impacts include:

Physical Health

Chronic or recurring pain
Changes in appetite or eating habits
Sleep disturbances
Digestive or stomach problems
Weakened immune function

Emotional Health

Anxiety or heightened fear
Difficulty regulating emotions
Feelings of nervousness, distrust, shame, or hopelessness

Cognitive and Behavioral and Effects

Distrust of others
Social withdrawal or Isolation
Difficulty concentrating, planning, or remembering information

These are only a few of the many ways trauma can affect people. Trauma can influence physical health, emotions, thoughts, relationships, work, school, and daily functioning. Because trauma responses resemble symptoms of other mental health conditions, they are sometimes misunderstood or misdiagnosed if a person’s trauma history is not considered.

These videos help illustrate some of the effects of trauma on the brain:

If this topic interests you, you can also check out these articles:

Physical effects

Trauma can produce physical changes to the brain and body. People who experience trauma have an increased risk of a variety of physical health concerns.

Common physical effects of trauma include chronic pain, headaches, digestive problems, changes in appetite, sleep disturbances, fatigue, and lowered immune functioning. These symptoms may appear immediately after a traumatic event or emerge months or years later.

Changes in thoughts and feelings

Trauma can change how the brain responds to stress. Some people become “stuck” in survival mode (fight, flight, or freeze), with the brain remaining on high alert even when there is no immediate danger. This can contribute to anxiety, rapid mood changes, hypervigilance, irritability, emotional numbness, or feeling easily overwhelmed.

Trauma often changes how people think about themselves, others, and the world around them. Survivors may struggle with self-blame, feelings of worthlessness, difficulty trusting others, or believing that the world is fundamentally unsafe. (In some cases, with ongoing trauma, the world the survivor lives in is unsafe.)

Trauma can also affect memory, attention, and executive function. Some people experience intrusive memories, while others have gaps in memory or difficulty recalling details. Many find it harder to concentrate, organize tasks, make decisions, or plan ahead.

Trauma can affect how people seek and receive services

Service providers will interact with survivors in many different settings and circumstances, and at different points in their healing journey. Trauma may influence how people seek help, interact with providers, and respond to services. For example, trauma may affect:

What feels helpful or safe
Who is perceived as trustworthy
Memory and planning
Feelings of overwhelm
What people feel comfortable sharing
How people remember and tell their stories

Immediately Ater Trauma

Immediately after a traumatic event, a person may:

Experience a wide range of emotions – including panic, laughter, fear, anger, or numbness
Have difficulty remembering details
Tell events out of chronological order
Focus intensely on details that may not seem relevant to a service provider
Struggle to follow directions or retain information
Feel the need to explain or justify what happened
Believe they are responsible or that it was their fault

Trust and Relationships

People who have experienced trauma are often more cautious about trusting other people. Here are some ways that a survivor’s perception of other people can be changed by trauma:

Seeing others as a threat. Some survivors become fearful of being around other people or believe others are likely going to hurt or threaten them.
Questioning their own judgment of who is and isn’t safe. Survivors may lose confidence in their ability to recognize who is safe, particularly if they were harmed by someone they once trusted.
Feeling afraid to be alone. Some people avoid being alone, while others avoid being around people altogether in order to feel safer or calmer.
Interpreting boundaries as rejection. This is especially common among people who have experienced neglect or long-term child abuse.
Heightened awareness and sensitivity of others. Survivors often become highly attuned to other people’s moods, body language, and behavior as a form of self-protection. Sometimes they accurately recognize subtle changes; at other times they may perceive threats that are not present.
Increased sensitivity to conflict. Some people will find being around conflict, including healthy conflict, to feel overwhelming or dangerous.

Trauma responses often change over time. People may not immediately recognize the connection between earlier experiences and their current reactions. With support, healing, and opportunities to experience safety and connection, many trauma responses become less intense and more manageable over time.

Learn more

Trauma-informed care

Being trauma-informed means understanding how trauma affects people’s lives and intentionally designing services, policies, and interactions to respond to those effects. Trauma-informed individuals and organizations recognize the prevalence of trauma, are prepared to support people who have experienced it, and actively work to avoid re-traumatization.

A common way of describing trauma-informed care is the shift from asking “What is wrong with you?” to asking “What happened to you?” The value of this phrase is not that providers should literally ask this question, but that it encourages a different way of understanding people’s experiences. Rather than viewing behaviors as problems to be fixed, trauma-informed care invites us to consider how those behaviors may have developed as ways of surviving difficult experiences.

For example, imagine a provider working with a person who does not trust anyone. Rather than assuming the person is rude, resistant, or unwilling to accept help, the provider approaches them with compassion, curiosity, and an understanding that distrust may once have been an important survival strategy.

Instead of immediately focusing on diagnostic criteria, the provider first takes time to explore and understand the person’s experiences, builds trust through consistency and honesty, and respects the person’s right to decide whether and when to trust them.

Elements of Trauma-Informed Care

Trauma-infomed care is more than understanding trauma – it also involves designing services that respond to the needs of people who have experienced it. Because trauma can affect emotions, memory, concentration, trust and a person’s sense of safety, providers can anticipate these challenges and structure services in ways that reduce barriers and promote healing. Working with people who have trauma responses means that people may be more likely to feel high amounts of anxiety, have fast changes in mood, and/or feel on guard a lot of the time. People may be hesitant to trust and build connections; they may struggle with memory and keeping track of things. Knowing these basics, a provider can plan ahead.

Supporting People After Trauma

Trauma-informed care is rooted in principles that support people while reducing the risk of re-traumatization. The Substance Abuse and Mental Health Services Administration (SAMHSA) identifies six key principles: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment and agency, and culture. While organizations may emphasize these principles differently, they should guide both organizational policies and individual interactions with survivors.

Safety

Ask and listen to survivors about what helps them feel safe.
Provide places to meet with survivors that feel safer to them.
Develop safety plans collaboratively with the survivor.
Avoid making assumptions about what safety looks like for the survivor.
Respect each person’s name, pronouns, and gender.

Transparency

Explain what you are doing and why.
Be honest about limitations of your services.
Clearly describe what to expect when receiving services or about the system.

Trust

Build trust through consistency, honesty, reliability, and follow-through.
Explain confidentiality, privilege, and mandatory reporting requirements that may apply.
Check in on whether information related to their gender is private or not.

Collaboration

Partner with survivors when identifying concerns, setting goals, and making decisions.
Avoid making decisions for the person whenever possible.

Agency: Empowerment, Voice, and Choice.

Affirm survivor’s choices, strengths, and decision-making.
Provide information and resources so that the survivor can make their own informed choices.
Look for ways your services may unintentionally reduce a person’s autonomy or control.

Culture

Learn about the cultures and communities of people you serve.
Invite conversations about culture, identity, and lived experience.
Recognize that people bring different values, beliefs, traditions, and experiences.
Create space for culture to come up during work with a survivor.
Consider how culture, history, gender, and experiences of oppression may influence a survivor’s needs and perceptions.

Trauma-informed care is not a specific intervention or treatment. Rather, it is an approach that shapes every interaction, policy, and decision by asking, “How can we create an environment that promotes safety, trust, collaboration, and healing?”

Trust Building

Trust is earned over time. Rather than expecting survivors to trust you immediately, focus on demonstrating through your words and actions that you are trustworthy. Change your behavior rather than try to change the survivor to get them to trust you.

Everyone is unique, but the following practices can help build trust:

Introduce yourself and explain your role.
Explain why you are asking questions and how the information will be used.
Follow through with things you say you will do.
Validate and affirm the survivor’s experiences without making assumptions.
Consistently use the person’s correct name and pronouns.
Demonstrate active listening and let the survivor know they have been heard.

Messing up/making mistakes

Everyone makes mistakes. When you do, acknowledge the mistake, offer a brief and sincere apology, correct it, and move forward. Focus on changing your behavior rather than asking the survivor to reassure you or minimize the impact of the mistake. Repeated effort and consistency are often more meaningful than perfect interactions.

For guidance on mistakes involving names and pronouns, see the Pronoun section.

Trauma Reminders

Another important aspect of trauma-informed care is understanding trauma reminders (sometimes referred to as triggers). Trauma reminders vary from person to person, making it impossible to predict what may bring back memories or activate a trauma response. For some people, reminders may include a particular smell, sound, piece of clothing, or location. For others, they may be more situational, such as a certain tone of voice, a closed door, being touched in a specific way or unexpectedly, or prolonged silence.

It is not realistic – or even possible – to eliminate every trauma reminder. Survivors will sometimes encounter situations that activate trauma responses, and service providers will inevitably work with people who become distressed during services. Trauma-informed care therefore has two goals: to reduce unnecessary trauma remidners whenever possible and to respond skillfully and compassionately when they occur.

Service providers can identify common trauma reminders within their settings and make adjustments to reduce them. Examples include loud or unexpected noises, closing doors without asking/permission, touching someone without first asking, or involving law enforcement without overt agreement and consent from the survivor.

Small changes can make a meaningful difference. For example, an office-based provider I might ask before closing the door. A group facilitator might warn people before a loud noise. In medical settings, practitioners can ask permission before touching someone and explain each step of a procedure before it begins. For example, “First I will wrap this band around your arm. Then it will tighten a lot, before slowly loosening. Is that okay with you?” Offering information and choice whenever possible helps people feel more prepared and in control.

Organizations can also consider how their physical environment and security practices affect survivors. For some people, highly visible police presence, armed security, metal detectors, or body searches may increase anxiety or activate trauma responses. These practices may also create additional barriers for transgender and nonbinary people, who are disproportionately subjected to scrutiny and policing of their bodies. When appropriate, organizations can explore less intrusive approaches to safety, such as staff training in de-escalation, visible staff presence, environmental design, and other strategies that promote safety while minimizing unnecessary distress (and even potential re-victimization by systems).

Because trauma reminders cannot always be prevented, providers should have basic skills to recognize trauma responses and help people regain a greater sense of safety and grounding. Equally important is responding to survivors who have trauma responses without judgment, punishment, or shaming. Mental health professionals and anti-violence advocates may share coping and grounding strategies throughout their work with survivors. These might include sharing breathing techniques, sensory grounding practices, or helping survivors develop ways to recognize flashbacks/re-experiencing, and reconnect with the present moment.

[i] American Psychological Association. (n.d.). Trauma. American Psychological Association. Retrieved August 13, 2026, from https://www.apa.org/topics/trauma

[ii] University of Portland. (2014). Library Guides: Trauma Informed Educational Practice: “The Four R’s” (Realize / Recognize / Respond / Resist). In Up.edu. https://libguides.up.edu/tiep/four-rs

[iii] Complex Trauma Resources. (2018). Complex Trauma: What is it and how does it affect people? In Complex Trauma Resources. https://www.complextrauma.org/complex-trauma/complex-trauma-what-is-it-and-how-does-it-affect-people/

[iv] Administration For Children and Families. (2014). Trauma. In Hhs.gov. https://www.acf.hhs.gov/trauma-toolkit/historical-trauma-concept

[v] Administration for Children and Families. (2025). Trauma. In Acf.gov. https://acf.gov/trauma-toolkit/historical-trauma-concept

[vi] Sharma, S., et al. (2025). Epigenetic changes associated with multi-generational trauma: Characterization, mechanisms, and therapeutics. Frontiers in Cell and Developmental Biology.

[vii] Kia, H., & Bonato, S. (2021). Minority Stress Model – an overview | ScienceDirect Topics. In www.sciencedirect.com. https://www.sciencedirect.com/topics/psychology/minority-stress-model

[viii] Beyond the ACE Score: Perspectives from the NCTSN on Child Trauma and Adversity Screening and Impact. (n.d.). Retrieved August 13, 2026, from https://www.nctsn.org/sites/default/files/resources/special-resource/beyond-the-ace-score-perspectives-from-the-nctsn-on-child-tauma-and-adversity-screening-and-impact.pdf

[ix] National Institute of Mental Health. (2024). Coping with Traumatic Events. In www.nimh.nih.gov. https://www.nimh.nih.gov/health/topics/coping-with-traumatic-events