How GPs can support patients living with complex trauma

Complex trauma is common, pervasive, and frequently invisible in primary care settings. Many patients present repeatedly with chronic, unexplained symptoms, dysregulated nervous systems, or fragmented help-seeking patterns without ever naming their trauma experiences. Recognising the patterns and responding sensitively can position medical practitioners as pivotal figures in a patient’s recovery journey.

Complex trauma refers to trauma that is prolonged, repeated, often interpersonal and which affects every system of the body. It can manifest in multiple ways, including:

• chronic pain, fatigue, fibromyalgia, or medically unexplained symptoms;
• sleep disturbance, hypervigilance, dysregulated arousal;
• anxiety, depression, dissociation, emotional dysregulation;
• early onset of chronic disease (cardiovascular, metabolic, autoimmune);
• gastrointestinal disturbances such as IBS; and
• recurrent presentations with no clear biomedical cause, or limited response to standard treatment

Patients may attend frequently, miss appointments, or describe different symptoms over time. These patterns can represent coping strategies which people adopt to survive rather than non-compliance or resistance to treatment.

Core Principles of Trauma-Informed Medical Care

Trauma-informed care is not a particular intervention but rather a universal approach to care and support. The following principles should underpin all interactions including in the consulting room:

Consultation strategies: small actions, big impact

1. Use trauma-sensitive language and tone.
2. Engage with curiosity, rather than overly intrusive questioning, eg “What helps you feel comfortable in appointments?”
3. Slow the pace. Many trauma survivors have a nervous system which is on high alert much of the time.
4. Prepare the patient before touching them or undertaking any invasive procedures — describe what you are going to do clearly, gain their consent, allow times to pause.
5. Monitor your patient for signs of possible distress: agitation, freeze, shutdown, dissociation, sudden fatigue.
6. Gently offer grounding strategies (focus on their breathing, orienting to the space, naming what will happen next).
7. Do not actively seek disclosures. Focus on the person’s safety and emotional regulation rather than trying to draw out their trauma stories.
8. Document your notes succinctly and respectfully. Record what supports the person’s care and avoid unnecessary detail.

Indicators That May Suggest a Complex Trauma History

These are not diagnostic markers but patterns that should prompt you to apply a trauma-informed lens and consider a complex trauma history:

• childhood adversity or lifelong interpersonal trauma;
• chronic pain / somatic symptoms not responding to usual pathways;
• flashbacks, dissociation, memory gaps;
• substance use, eating disorders, suicidality, self-harm;
• relational instability, avoidance of care, mistrust of services;
• early chronic disease, immune dysregulation, fatigue syndromes;
• frequent urgent care presentations with inconsistent follow-through; and
• over-compliance or excessive apologising / shame responses.

Referral and Support Pathways

Effective trauma-informed care extends beyond the consultation room. While medical intervention plays a vital role, recovery is enabled when patients are supported to build safety, regulation, and connection across multiple domains of their lives. GPs are often the central coordinating point in that journey and can gently guide patients towards resources and relationships that forge and sustain long-term healing.

• Encourage self-regulation and healthy routines such as regular gentle exercise, sufficient rest, and activities to support nervous system regulation.
• Try and engage in ongoing care and support as a stable medical relationship provides both continuity of care and corrective safety.
• Develop a Mental Health Treatment Plan where it is indicated to enable ongoing mental health support.
• Refer your patient to counsellors, psychologists, social workers, psychiatrists who are trauma-informed and who have expertise and experience in working with complex trauma patients.
• Provide psychoeducation as having a basic understanding of the physiology and dynamics of trauma physiology can help reduce shame and self-blame.
• Encourage your patient to identify people they can trust or with whom they feel safe to build peer and social support networks.
• Provide contact details for Blue Knot Helpline: 1300 657 380 – specialist support for adult survivors of complex trauma and other relevant services.
• Engage Aboriginal Community Controlled Health Services and CALD agencies for culturally safe care.

Treatment Approaches – Phase-Oriented and Integrated

Complex trauma recovery is not linear and requires careful pacing so as not to destabilise the person further. This is why a phase-oriented framework remains widely recognised as best practice, guiding clinicians and allied professionals to match interventions to the patient’s current capacity rather than the content of their trauma history.

Phase 1 – Safety and Stabilisation:

Focus on nervous system regulation, emotional containment, body awareness, grounding strategies, and building internal and external resources. The goal is not symptom removal but establishing enough stability to reduce crisis-driven care and improve daily functioning.

Phase 2 – Trauma Processing and Integration:

Once sufficient safety is established, some patients may engage in processing trauma memories or the emotional impact of past experiences. This stage must only occur when the patient demonstrates readiness and sufficient skill in self-regulation.

Phase 3 – Rehabilitation and Reconnection:

This phase supports identity rebuilding, meaning-making, community reconnection, and re-establishing life roles, purpose, and relationships on new foundations of safety and agency.

For patients with complex trauma, safety and stabilisation must come before exploring their story (which may never be part of the process). Engaging in trauma processing too early, ie, before emotional regulation, grounding and safety are established can increase distress, trigger dissociation, escalate self-harm or suicidality, and overwhelm the nervous system.

GPs play a crucial role in reinforcing that there is no urgency to “go into the trauma”. Supporting patients to build regulation, predictability, routine, body awareness and safe relational connection is the optimal treatment. Premature exposure or pressure to disclose can inadvertently cause harm, even when well intentioned.

While most GPs will not deliver trauma-specific therapies directly, awareness of the therapeutic landscape supports safe referral, realistic expectation-setting, and continuity of care. It is also important to note that no single modality is sufficient for complex trauma. Recovery typically involves an integration of body-based regulation, relational repair, and meaning-making processes over time.

Evidence-informed modalities to consider for referral include:

• somatic and body-based therapies (sensorimotor psychotherapy, somatic experiencing);
• EMDR;
• Internal Family Systems (IFS) and narrative therapy approaches;
• relational / attachment-based psychotherapy and trauma-focused psychodynamic approaches;
• Dialectical Behaviour Therapy (DBT) and skills-based emotion regulation models;
• creative and expressive therapies (art, movement, drumming, music);
• trauma-informed mindfulness and trauma-sensitive yoga; and
• Psychoeducation as a therapeutic tool to reduce shame, increase self-understanding, and normalise trauma responses.

Research shows that effective trauma treatment needs to involve all dimensions of the person; body as well as mind and emotions. Bottom-up (nervous system and sensory regulation) and top-down (cognitive and narrative integration) processes need to work in concert. Across all modalities, the therapeutic relationship paced by the patient’s capacity remains the core agent of healing.

The role of the GP: holding the thread

Healing from complex trauma is possible but not linear. Medical practitioners are uniquely placed to offer:

• a reliable, non-judgmental presence;
• advocacy and system navigation;
• gentle checkpointing of safety, health maintenance, and self-agency; and
• protection against re-traumatisation through respectful care.

However, exposure to trauma material can impact practitioners too. Protecting your wellbeing is part of trauma-informed practice.

• Access peer support, reflective supervision, debriefing.
• Maintain professional boundaries and self-care routines.
• Be mindful of signs of vicarious trauma or compassion fatigue.

Trauma-informed care is not an add-on for counsellors and psychologists, it is a core skill for modern medicine. When we shift from “What is wrong with you?” to “What has happened to you” and “What keeps you safe now?”, we not only improve medical outcomes but contribute meaningfully to patients’ long-term healing.

Dr Cathy Kezelman AM is a medical practitioner, President of Blue Knot Foundation, Chair of National Centre for Action on Child Sexual Abuse and has a lived and living experience of complex trauma.

For further information, read Talking about Trauma: Guide for Primary Health Care Providers from The Blue Knot Foundation.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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