A Trauma Survivor Explains the Harms of Screening

After choosing to disclose past trauma or sexual abuse on screening forms, patients are often left wondering if it was a mistake to disclose.

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Anna Austin identifies as a trauma survivor. In a new article in JAMA Internal Medicine, she describes how trauma screening in the doctor’s office—while ostensibly coming from the best motives—can actually be harmful and invalidating.

“For more than a decade, I have consistently indicated on screeners that I was sexually abused as a child. Not once have I received any form of follow-up,” she writes.

Austin writes of the deep shame that accompanies experiences of trauma, particularly sexual abuse, and how any disclosure can be a frightening and anxiety-provoking event. But, she says, in the hopes of getting some help, she began answering “yes” on the trauma screening questionnaires she was given when seeking medical care.

Unfortunately, the lack of any acknowledgment of this positive screening by medical professionals left her with more questions.

“Disclosing this information was a significant moment in my life, and the lack of follow-up reinforced my fears. Was my physician not asking me about my abuse because she did not believe me? Was my sexual abuse, in fact, something I should feel ashamed of? Should I continue to be silent about my trauma?” she writes.

Austin writes that she eventually independently sought out help working through her trauma and is doing well now. But she suggests that others may not take this step, especially if their first attempts to disclose trauma are repeatedly ignored.

“There was a time when I desperately needed some form of support or intervention, and checking ‘yes’ on those screeners was the only way I felt comfortable asking for help,” she writes.

Austin then segues into a discussion around the evidence base for screening. She notes that research has not found any health or safety benefits for screening for intimate partner violence, for example, and that a review found no studies that examined whether screening for childhood trauma actually improved outcomes.

In fact, guidelines from Canada and the UK do not promote screening at all for psychosocial experiences, including intimate partner violence and trauma, as they acknowledge that there is no evidence that screening leads to better outcomes.

“Questions about traumatic experiences are deeply personal. And while perhaps well-intentioned, asking patients to disclose potentially painful and distressing experiences with no follow-up can cause more harm,” she writes. “A key tenet of public health and medical ethics is that screening without readily available and accessible evidence-based interventions, let alone a compassionate conversation, is unethical.”

In conclusion, Austin writes:

“Screening can provide a window of opportunity to offer help and improve outcomes. But without appropriate follow-up, it can retraumatize survivors and create hesitancy to seek help in the future.”

 

 

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Austin, A. E. (2021). Screening for traumatic experiences in healthcare settings: A personal perspective from a trauma survivor. JAMA Internal Med. Published Online: May 3, 2021. doi:10.1001/jamainternmed.2021.1452 (Link)

5 COMMENTS

  1. “’Questions about traumatic experiences are deeply personal. And while perhaps well-intentioned, asking patients to disclose potentially painful and distressing experiences with no follow-up can cause more harm,’ she writes. ‘A key tenet of public health and medical ethics is that screening without readily available and accessible evidence-based interventions, let alone a compassionate conversation, is unethical.’”

    I couldn’t agree more. But this problem is a systemic problem, based on a flaw in the DSM itself.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    Since no DSM biller/doctor/”mental health professional” may ever bill any insurance company for ever helping any child abuse or rape survivor, unless they first misdiagnose them with one of the “invalid” DSM disorders.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis

    And this particular flaw in the DSM has resulted in the “mental health” industries, systemically, turning themselves into primarily child abuse covering up – pedophile aiding, abetting, and empowering – industries. And this problem with the psychological and psychiatric industries, et al has been a problem for a long time.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/

    And this “dirty little secret of the two original educated professions,” “partnership” – between the medical/”mental health”/social worker industries and the religions – has turned the bishops and pastors of my childhood religion into systemic child abuse cover uppers, too.

    https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

    And, most definitely, this problem is not just destroying individuals, it’s destroying our entire country, and the world.

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT
    https://community.healthimpactnews.com/topic/4576/america-1-in-child-sex-trafficking-and-pedophilia-cps-and-foster-care-are-the-pipelines

    I do understand this multibillion dollar, systemic child abuse and rape covering up, medical/religious “partnership” is a hard business for the doctors, “mental health” workers, pastors, and bishops – many of whom are systemically profiteering off of covering up child abuse and rape on a massive societal scale – to end. But, truly, we do need an end to “the dirty little secret of the two original educated professions.”

  2. Agreed…the question being asked, without any offer of help if the answer is yes, leads to more harm.

    The last time I was in a hospital CIU, and I hope the last time ever I am in any hospital CIU, I’d been brought there by the police after making some statements regarding suicide and euthanasia in an email to a clinician who ran a trauma/DBT program I’d been trying to get into for 2 years. The last thing I had heard from anyone in the program was, in a call they made to me, they said that they were preparing a letter to send to me that would outline the steps I would need to take to gain entry to the program. Several weeks went by. I never received a letter and my calls and emails were ignored. But the email I eventually sent in which I asked for euthanasia was not ignored

    That night two police arrived at my door and put me in an ambulance to the CIU. I was kept there for approximately one day during which time I didn’t eat, listened to a lot of screaming and did some screaming myself, was called an animal by a psych tech, and was told by a nurse that the things I had said in in the email to the clinician were “very provocative” and that I must be “possessed” to say those things.

    When I started screaming after being there overnight, they sent four male security guards into the room. The guards all watched while a nurse made me lie on the bed and shot me in the ass with a needle full of something.

    At some point during that horrific stay, a student nurse came in and asked me if I’d been sexually abused as a child. I just stared at her.

    They discharged me without so much as a taxi ride home. I walked home alone in the dark.

  3. The terrible thing about trauma is how frigging normal it becomes to you. You become desensitized to hearing the most gods-awful stories, even – and perhaps especially – as a trauma survivor yourself. “Yeah. That’s just how things are. No one gives a shit. Suck it up, buttercup.” That’s my inner dialog. Because over and over again, it is proven to you that no one cares. Doctors offering zero follow up after asking you to relate personal trauma history to them is but one example and a fairly mild one. (See? I told you. My reaction is “Suck it up, buttercup.”)

    The reason I say that doctors not referring you to services related to coping with or – wouldn’t this be fricking amazing – systemically addressing your trauma in an affirming way is a mild microaggression is that we all know medical doctors can be, and often are, a lot more actively abusive.

    Once you are psych-labeled, medical doctors have a tendency to think that is the origin of ALL of your medical issues. I have a documented history of depression, anxiety and alcoholism. Last detox 2016. Tapered off psych meds and haven’t needed treatment (am better without it, in fact) since 2017.

    It took me two years to finally get two large parathyroid adenomas removed in March of 2021, because most of the symptoms are attributed to depression, primarily fatigue and bone & joint pain. I had scans showing bone loss (osteopenia) at age 49. I had many, many, many high calcium & parathyroid hormone labs. (“But not high enough! You need to hit 11 on the calcium before you’d have any symptoms.” Which is total bullshit as anyone who had cracked a medical journal in the past decade would know.) I stopped going to the ER in 2018 with chest pain radiating into my right arm or heart palpitations and headaches making me nauseous, because I kept getting “How much stress are you under?” rather than medical evaluation for my worsening ECGs. I finally gave in and went again in December of 2020. THAT ECG said it looked like I had a heart attack sometime since 2018. They recommended a stress test. My primary (at the time, since fired) was going to deny it! She said, and this is almost a direct quote, “You are getting off acid reducers and everything is going to feel like a heart attack. Don’t go running to the ER everytime.” 1. I went to Express Care. They sent me to the ER after their ECG. 2. She had my ER records. Did she read them? 3. I hadn’t been to the ER since 2018, because I was always gaslit and I was tired of it. I fought her. I got the nuclear stress test. I have a 4.8 cm ascending aortic aneurysm, the kind of thing that can blow up and kill you quickly. You likely won’t make it to an ER.

    This… This is what doctors can do to patients who allow their psych records to mingle with the medical health records. You are FOREVER just a psych patient. This is how we die, on average, 15 to 25 years earlier of cancer and cardiovascular diseases than people without psych diagnoses.

    My best advice? If you can, avoid the fricking mental health system entirely. Most of the meds are useless anyway and have horrific side effects and withdrawal. If you absolutely NEED help, do not sign releases. Do NOT let those records be shared anywhere. Do not go to the same health network within which you seek medical treatment. If your records are already entwined, it is worth actively demanding amendments to those records IN WRITING. If the doctor disagrees with your assessment that your mental health diagnoses are doing more harm than good in your medical chart, you still have the right to insist that your words be added to those records to dispute them.

    It can be WAY worse than having your mental health needs ignored. They can ignore you AND use your answers on the Pfizer-gifted GAD 7 and PHQ 9 to block your access to life-saving medical care.

    • [email protected], everything you said is spot on. Maybe a person has to directly experience this level of abuse to believe that 1) it’s really that bad and 2) it’s not uncommon for patients with psych diagnoses to be victims of this type of treatment from the “health care system”. I’ve been accused of playing the victim in numerous similar scenarios and told to “get over it” in one way or another by many people (“but you’re off the meds now so you’re fine”). To me it’s just another element of the gaslighting.

      I’ve moved twice to escape my medical “rap sheet” that included all the classic words like borderline, drug addiction, non-compliance, lack of insight, etc. And I do, also, avoid the medical system like a plague because I don’t want anything on my records here in the event that I break a bone or have some type of accident that that requires immediate medical attention. If I show up in the ER at any point, I don’t want them to know who I am. I don’t want them to know anything about me. That’s the best chance I’ll have to get whatever medical treatment I require.
      That statement, “don’t go running to the ER every time…” is so classic. There’s so much wrong with that statement…I’m glad you fired her. So many doctors are very practiced and very skilled at blaming everything on the patient, to the point that any move the patient makes is “wrong”.

      • I understand completely. It really only takes picking the wrong primary doc out of a hat from your list of in-network providers to poison all local doctors against you.

        Maine docs require referrals, even if your insurance does not. If you have the wrong primary, you will never get appropriate care. Most people will never figure out why, as their docs will lie to their face and pretend to be on their side.

        I have gotten good about maintaining my own set of lab and imaging records, because I know what my office notes look like. Those aren’t being shared anywhere, if I can help it.

        What I realized only recently is that you need to ask for a copy of any referrals that went out on your behalf. If you ever have a mystifyingly bad appt with a specialist who seems to just ignore the mountain of lab and imaging evidence you sent in advance, that referral is probably why. Your PCP sent notes that basically say “Ignore the cray-cray person.”

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