The answers to the quizzes in Section 1 of this guide are listed below. Each answer is followed by a reference to an academic research article which highlights why the question was true or false. Click here to download a pdf version of the answers.

 General Quiz

1.      True - “Exposure to trauma is pervasive in societies worldwide and is associated with substantial costs to the individual and society, making it a significant global public health concern. We present evidence for trauma as a public health issue by highlighting the role of characteristics operating at multiple levels of influence – individual, relationship, community, and society – as explanatory factors in both the occurrence of trauma and its sequelae.” Reference: Magruder et al. (2017). Trauma is a public health issue. European Journal of Psychotraumatology, 8(1). https://doi.org/10.1080/20008198.2017.1375338  

 2.      False – “Traumatic stressors ….are events, experiences, and exposures — that greatly exceed the individual’s capacity to control, cope with, or withstand and that compromise the individual’s psychophysiological equilibrium or stasis…. they pose an imminent threat or actuality of death, or through other means cause fundamental and life altering psychophysiological harm.” Reference: Ford, J. & Courtois, C. (Eds.) (2020). Treating Complex Traumatic Stress Disorders in adults: Scientific foundations and therapeutic models. (2nd ed.). New York, NY: Guilford Press. 

3.      False - While complex PTSD is not yet included in the American Psychiatric Association’s DSM, “the World Health Organization (WHO) ICD-11 now includes a distinction between the diagnoses of PTSD and complex PTSD (CPTSD). … Over 40 studies across at least 15 different countries have consistently demonstrated the distinction between PTSD and CPTSD and replicated the key symptoms associated with each disorder.” Reference: Cloitre, M. (2021). Complex PTSD: Assessment and treatment. European Journal of Psychotraumatology, 12(sup1). https://doi.org/10.1080/20008198.2020.1866423  

4.      True - “The impact of pervasive trauma in our society continues to be largely ignored. We know today that one out of eight kids in the U.S. have been a victim of maltreatment, and that half of all kids in the world are exposed to extreme violence. The Adverse Childhood Experiences studies have demonstrated that early exposure to family violence and emotional abuse is the largest and costliest public health issue in America. As a society, we mobilize against threats like ISIS, but most American kids are not the victims of foreign terrorists; they’re the victims of the social conditions in which they mature.” Reference: van der Kolk, B. (2019). The politics of mental health. Psychotherapy Networker. https://www.psychotherapynetworker.org/magazine/article/2368/the-politics-of-mental-health    

5.      True - “One of the most salient and challenging factors associated with violence prevention is the fact that violence most often occurs within households and is very often shrouded in secrecy, shame, and self-blame. This occurs at the individual level and is mimicked at the social level in the form of collective denial and minimization of abuse.”  Reference: Davies et al. (2015). Creating a trauma-sensitive practice: A health care response to interpersonal violence. Analytic Review, 11(6).  https://pmc.ncbi.nlm.nih.gov/articles/PMC6125000/

6.      True - “Trauma-informed care (TIC) is a comprehensive approach that focuses on the whole individual. It acknowledges the experiences and symptoms of trauma and their impact on health. TIC prioritizes physical and emotional safety through a relationship of trust that supports patient choice and empowerment. It provides a safe and respectful healing environment that considers specific needs while promoting a greater sense of well-being, patient engagement, and partnership in the treatment process.”  Reference: Novilla, M. L. B., et al. (2024). U.S. physicians’ training and experience in providing trauma-informed care in clinical settings. International Journal of Environmental Research and Public Health, 21(2), 232. https://doi.org/10.3390/ijerph21020232

7.      True - “Adults exposed to traumatic events during childhood commonly seek medical services, but health care practitioners hesitate to address and assess early trauma despite its known negative health effects.” Reference: Goldstein, E., Murray-García, J., Sciolla, A. F., & Topitzes, J. (2018). Medical students' perspectives on trauma-informed care training. The Permanente Journal, 22. https://www.thepermanentejournal.org/doi/10.7812/TPP/17-126  

8.      True - “Without trauma-informed treatment, traumatized clients may not respond optimally and they may even be re-traumatized by the mental health system if they are labeled as “treatment resistant” because the treatment does not address the core issue of trauma; some may be misunderstood as fabricating or exaggerating their trauma history or symptoms. Reference: Brand, B. L. (2016). The necessity of clinical training in trauma and dissociation. Journal of Anxiety and Depression, 5(4). https://www.researchgate.net/publication/309297530_The_Necessity_of_Clinical_Training_in_Trauma_and_Dissociation

9.      True - “Despite conscious efforts to provide equitable care to all patients, studies show that at least two-thirds of health providers hold some form of implicit bias against marginalized groups (4). Implicit biases can negatively influence a provider’s willingness to engage in patient-centered care, provide referrals to specialized treatment, or even adhere to evidence-based guidelines when serving diverse populations.”  Reference: Merino, Y., Adams, L., & Hall, W. J. (2018). Implicit bias and mental health professionals: Priorities and directions for research. Psychiatric Services, 69(6). https://psychiatryonline.org/doi/10.1176/appi.ps.201700294  

Quiz for Those in Medicine

1.      False - The Adverse Childhood Events study (ACEs) by Felitti and colleagues in the 1990’s demonstrated that “the number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.” Reference: Felitti et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences study (ACEs). American Journal of Preventive Medicine, 14(4). https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext  

 2.      True - “Commonly perceived barriers to providing TIC were resource/ time/ administrative constraints, provider stress, limited awareness of the right provider to refer patients who experienced trauma, and inadequate TIC emphasis in medical education/training. Expanding physicians’ knowledge base of trauma through training and organizational policy/support is crucial in enhancing their TIC competence, particularly in caring for patients with complex care needs whose social determinants increase their risk of exposure to adverse experiences that carry lasting physical and psychological effects.” Reference: Novilla et al. (2024).  U.S. physicians’ training and experience in providing trauma-informed care in clinical settings. International Journal of Environmental Research and Public Health, 21(2). https://doi.org/10.3390/ijerph21020232  

 3.      True - “Inquiring about trauma history was the lowest rated [trauma informed care] TIC aspect among both patients and physicians. It is possible that this is the case as patients and physicians may believe this type of screening is not relevant in a primary care setting. Relatedly, lack of awareness and training on how to screen for trauma and how to intervene may be a barrier for physicians and result in physicians viewing this aspect as less important.” Reference: Kokokyi S, Klest B, & Anstey H. (2021). A patient-oriented research approach to assessing patients' and primary care physicians' opinions on trauma-informed care. PLoS One, 16(7). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254266

 4.      False - “Research has established that trauma is nearly universal and a root cause of numerous health and social problems, including 6 of the 10 leading causes of death, with devastating consequences across the life course. … These findings substantiate the profound impact of trauma on the brain and body and why trauma training is critical to the education and practice of physicians. However, a critical lag remains in translating essential research insights into clinical teaching and care.”  Reference: Berman, et al. (2023). Roadmap for Trauma-Informed Medical Education: Introducing an Essential Competency Set. Academic Medicine 98(8). https://pubmed.ncbi.nlm.nih.gov/36862618/

5.      True - “I didn’t tell you how in adulthood, books on incest made me nauseous. I didn’t tell you I had joined an incest survivors support group. I didn’t tell you how spacey and jumpy I felt at times, especially when surprised. I didn’t tell you that I could not remember much of my childhood. You didn’t ask me, and I didn’t think to tell you.” Anonymous. (2002). Dear doctor. Permanente Journal, 6(1). https://pmc.ncbi.nlm.nih.gov/articles/PMC6220627/  

Quiz for those in Mental Health

1.      True - “Academic training programs for mental health professionals rarely include comprehensive instruction on trauma, consequently leaving clinicians inadequately prepared to provide trauma treatment.” Reference: Kumar et al. (2022). The need for trauma training: Clinicians’ reactions to training on complex trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 14(8). https://pubmed.ncbi.nlm.nih.gov/31580137/

2.      False - “The current mental health system tends to conceptualize extreme behaviours and distress as symptoms of mental illnesses, rather than as coping adaptations to past or current traumas.” Reference: Sweeney et al. (2018).  A paradigm shift: Relationships in trauma-informed mental health services. British Journal of Psychological Advances, 24(5). https://pmc.ncbi.nlm.nih.gov/articles/PMC6088388/

3.      True - “Traumatic events destroy the sustaining bonds between individual and community. Those who have survived learn that their sense of self, of worth, of humanity, depends upon a feeling of connection with others. The solidarity of a group provides the strongest protection against terror and despair, and the strongest antidote to traumatic experience. Trauma isolates; the group re-creates a sense of belonging. Trauma shames and stigmatizes; the group bears witness and affirms. Trauma degrades the victim; the group exalts her. Trauma dehumanizes the victim; the group restores her humanity.” Reference: Herman, J. (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books. 

4.      True - “First, human experiences leave predictable and understandable marks; trauma in particular, and interpersonal trauma more specifically, impacts survivors’ minds, bodies, and spirits. Second, these scars do not constitute psychological disorder but instead are the natural and expected consequences of abnormal events, including betrayed trust, violated bonds, and broken boundaries. The effects of trauma are indeed just that—effects of an event—and as such are causally related to the trauma and not to the harmed individual. And third, when psychology and mental health professionals draw that causal path incorrectly, when the field fails to place the dysfunction solidly on the shoulders of individual and societal wrongdoing, survivors of trauma are thus reduced to a single experience that was enacted on them. They end up shouldering the burden. This, in essence, is pathologizing—the assumption that because individuals exhibit certain sets of symptoms, they are themselves disordered.” Reference: Rosenthal et al. (2016). Guest editorial: [Complex PTSD] Deconstructing disorder: An ordered reaction to a disordered environment. Journal of Trauma & Dissociation, 17(2). https://doi.org/10.1080/15299732.2016.1103103   

5.      True - “Despite the high prevalence of societal trauma exposure and its link with a wide variety of psychopathology symptoms and human suffering, most mental health clinicians receive little systematic training in assessing or treating trauma in their professional training programs. This situation has created a widespread and unfortunate disparity between clinical need and availability of suitably trained providers.” Reference: Henning, J., Brand, B., & Courtois, C. (2022). Graduate training and certification in trauma treatment for clinical practitioners. Training and Education in Professional Psychology, 16(4). https://doi.org/10.1037/tep0000326    

Quiz for Those in Dentistry

1.      False - “Traumatic experiences can impact individuals’ oral health and how they experience dental treatment in ways patients and their dental providers may or may not initially anticipate. As approximately half of children and two-thirds of adults in the United States have experienced some type of traumatic event, it is critically important for providers to be aware of patients’ trauma histories and to appropriately provide trauma-informed care to their patients when needed.” Reference: Heaton, L. & Cheung, H. (2024). Trauma-informed care in oral health care: the role of dental hygienists. American Dental Hygienists' Association, 98(4). https://jdh.adha.org/content/98/4/50.short

2.      False - “Specific communication and behavioral techniques can help manage patients’ anxiety and increase the provider’s rapport with trauma survivors. Many of these behaviors fall under the guise of universal trauma precautions, which do not require screening of patients or knowledge of a patient’s trauma history (or lack of it. Instead, they involve small changes to practice that can be used with all patients, and these changes may be particularly beneficial for establishing trust with traumatized people.” Reference: Raja, S., Hoersch, M., Rajagopalan, C. & Chang, P. (2014). Treating patients with traumatic life experiences: Providing trauma-informed care. The Journal of the American Dental Association, 14(3). https://healtorture.org/wp-content/uploads/2024/09/Raja_et_al_2014.pdf

3.      True - “Individuals with a trauma history may experience significant anxiety and distress in the dental setting, even for treatment many providers and patients consider to be “simple,” such as a brief intraoral examination, radiographs, or prophylaxis. Such aspects of the dental setting may trigger memories and emotions related to the original trauma and may re-traumatize patients. This short report introduces links between traumatic history, poor oral health, and dental care-related fear and anxiety.” Reference: Heaton, L., & Cheung, H. (2024). Trauma-informed care in oral health care: the role of dental hygienists. American Dental Hygienists' Association, 98(4). https://jdh.adha.org/content/98/4/50.short     

4.      True - “Oral healthcare, traditionally approached through a purely clinical lens, has evolved to embrace interdisciplinary perspectives, highlighting the interplay between biological, psychological, and social determinants. … Trauma, both psychological and physical, can leave lasting impressions on the mind and oral health, influencing routine care, treatment adherence, and client-practitioner dynamics. Recognizing and addressing these effects is not merely a clinical imperative but also a moral one, as it touches upon issues of clients’ dignity, trust, and holistic well-being.” Reference:  Xu, Q., York, J., & Yuan, S. (2024). Trauma’s impact on oral healthcare: A biopsychosocial and trauma-informed approach. Journal of the California Dental Association, 52(1). https://www.tandfonline.com/doi/epdf/10.1080/19424396.2024.2426247?needAccess=true