Interpersonal trauma, such as abuse or neglect, has been consistently linked to greater psychiatric severity than non-interpersonal trauma (e.g., accidents). Research shows that survivors of interpersonal trauma experience more severe and longer-lasting PTSD symptoms, and childhood interpersonal trauma is associated with higher rates of adult psychiatric disorders and poorer functional outcomes even after accounting for other childhood risk factors. [1][2] These findings suggest that interpersonal trauma is linked to a more complex and severe clinical presentation in psychiatric populations.
Given these findings, we wanted to answer two practical questions within our own inpatient treatment population:
- Do patients with interpersonal trauma histories enter treatment with higher symptom severity?
- Do they improve at the same rate as patients without trauma histories?
Trauma Is Common Among Patients Seeking Care
Among adults, nearly 22% reported a history of interpersonal trauma. Among children and adolescents, trauma exposure was even more prevalent, affecting more than 41% of patients. These numbers explain why trauma-informed care has become such an important focus across psychiatric treatment settings. However, the higher rates observed in youth may partly reflect more complete documentation, as clinicians often have additional information sources available when assessing children and adolescents.
Table 1. PTSD and Trauma Exposure by Age Group
| Age Group | N | Mean Age | Primary PTSD (n, %) | Secondary PTSD (n, %) | Any PTSD (n, %) | Child Trauma (n, %) | Adult Trauma (n, %) | Any Trauma (n, %) |
| Adult | 338968 | 40.14 | 1,854 (0.55%) | 41,515 (12.25%) | 43,352 (12.79%) | 63,098 (18.61%) | 22,344 (6.59%) | 74,420 (21.95%) |
| Child | 133687 | 13.86 | 1,605 (1.20%) | 20,278 (15.17%) | 21,878 (16.37%) | 55,935 (41.84%) | NA | 56,047 (41.92%) |
Do Patients with Trauma Histories Present with Greater Clinical Severity?
The short answer is yes.
Across all clinical outcomes assessments, inpatients with interpersonal trauma histories entered treatment with higher symptom severity than inpatients without trauma histories.
Among adults, trauma-exposed patients reported:
-
- Worse overall psychiatric functioning on the BASIS-32[3] (1.77 vs. 1.63)
- Greater depression severity on the PHQ-9[4] (14.51 vs. 12.58)
- Higher PTSD symptom severity on the PCL-5[5] (41.00 vs. 31.12)
- Among children and adolescents, patients with trauma histories also reported greater impairment at admission on the CABA-Y[6] (1.09 vs. 0.99).
Figure 1. Clinical Outcome Scores at Admission, Discharge, and Change by Interpersonal Trauma Status (interactive graph)
The largest difference was observed for PTSD symptoms, while differences in functioning and depression were smaller but still consistent.
A key limitation is that PCL-5 results do not necessarily reflect PTSD symptoms related to interpersonal trauma. Interpersonal trauma was identified through trauma-related Z-codes in the medical record, while the PCL-5 was completed mainly by patients with a PTSD diagnosis, without information on whether their symptoms were linked to interpersonal trauma, non-interpersonal trauma, or multiple traumas. Therefore, PCL-5 findings should be interpreted as reflecting overall PTSD symptom burden rather than symptoms associated with a specific trauma type.
Taken together, these findings closely mirror what has been reported in the broader research literature: patients with interpersonal trauma histories tend to present to inpatient treatment with a greater overall symptom burden, particularly when it comes to trauma-related symptoms.
Do Trauma-Exposed Patients Improve at the Same Rate?
This is where findings become particularly encouraging.
All patient groups demonstrated meaningful improvement during treatment, regardless of trauma history. In fact, trauma-exposed patients often showed slightly larger symptom reductions than those without trauma histories. However, the differences between groups were extremely small from a practical standpoint.
In other words, patients with trauma histories improved at essentially the same rate as patients without trauma histories.
What This Means for Facilities
Patients with interpersonal trauma histories present to inpatient treatment with greater psychiatric severity, yet despite these higher starting levels of distress, their discharge severity is similar to other patients.
These findings support continued investment in trauma-informed assessment and care models while reinforcing an encouraging reality: patients with trauma histories can achieve meaningful recovery when provided effective treatment
References
[1] Forbes, D., Fletcher, S., Parslow, R., et al. (2012). Trauma at the hands of another: Longitudinal differences in PTSD symptoms following interpersonal versus non-interpersonal trauma. Journal of Clinical Psychiatry, 73(3), 372–376
[2] Copeland, W. E., Shanahan, L., Hinesley, J., et al. (2018). Association of childhood trauma exposure with adult psychiatric disorders and functional outcomes. JAMA Network Open, 1(7), e184493. [jamanetwork.com], [scholars.duke.edu]
[3] BASIS-32TM: The Behavior and Symptom Identification Scale is a self-report measure of a patient’s functioning, rated on a scale of 0 “no difficulties” to 4 “extreme difficulties”. BASIS-32 © Mclean Hospital, used by licensee with permission from Mclean Hospital.
[4]PHQ-9: The Patient Health Questionnaire is a self-report measure of a patient’s depression, rated on a Scale of 0 “Not at all” to 3 “Nearly every day”. Developed by Drs. Robert L. Spitzer, Janet B. W. Wiliams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc.
[5] PCL-5: The PTSD Checklist for DSM-5 is a 20-item self-report measure used to assess the presence and severity of posttraumatic stress disorder (PTSD) symptoms experienced during the past month. Items are rated on a scale of 0 “Not at all” to 4 “Extremely.” The PCL-5 was developed by the National Center for PTSD and corresponds to the DSM-5 diagnostic criteria for PTSD.
[6] CABA-Y: The Child and Adolescent Behavior Assessment-Youth is a self-report structured questionnaire developed to assess problem behaviors during the past week, rated on a scale of 0 “No problem” to 3 “A big problem”.
