Trauma Support

This article describes new Path of Exile content released in version 3.22.0. Information may be missing or incorrect.

Please expand this article so that it provides complete and accurate information.

Trauma SupportPhysical, Support, Melee, Attack, Strike, Duration
Icon: #
Level: (1-20)
Cost & Reservation Multiplier: 140%Requires Level 38Supports melee strike skills that do not inherently apply Trauma. Cannot support triggered skills, Vaal skills, or skills used by things other than you. Cannot modify the skills of minions.Supported Skills have (3-11) to (4-24) Added Attack Physical Damage per Trauma
Supported Skills have 5% increased Stun Duration per Trauma
Gain 1 Trauma the first time a Supported Attack Hits an Enemy
Take (13-146) Physical Damage per Trauma when you gain Trauma from Supported Skills
Trauma lasts (5-6.9) seconds
Supported Skills can only be used with Axes, Maces, Sceptres or Staves

Additional Effects From 1-20% Quality:
Supported Skills have 0.5% reduced Enemy Stun Threshold0.5% chance to not take Damage when you gain Trauma from Supported SkillsSupported Skills have 0.05% increased Attack Speed per Trauma
Take 1 Physical Damage per Trauma when you gain Trauma from Supported SkillsThis is a Support Gem. It does not grant a bonus to your character, but to skills in sockets connected to it. Place into an item socket connected to a socket containing the Skill Gem you wish to augment. Right click to remove from a socket.

Acquisition
Drop level: 38Vendor Offer
1x Scroll FragmentMetadata
Item class: Support Gem
Metadata ID: Metadata/Items/Gems/SupportGemTrauma

Trauma Support is a support gem which causes strike attack skills to grant stacks of Trauma on hit which causes attacks to deal added Physical Damage, but also inflicts escalating amounts of physical damage.

Trauma Support can only be used with Axes, Maces, Sceptres or Staves. Trauma Support cannot support totems or minions.

Skill functions and interactions

Main page: Trauma

BoneshatterBoneshatterAttack, Melee, Strike, AoE, Duration, Physical
Level: (1-20)
Cost: 5 Mana
Attack Speed: 85% of base
Attack Damage: (200-250)% of base
Effectiveness of Added Damage: (200-250)%Requires Level 28Attack enemies with a forceful melee strike that also hurts you. Successive uses will raise the damage dealt both to enemies and you. Stunning an enemy with the strike releases a damaging pulse. Requires a Mace, Sceptre, Axe or Staff.(11-158) to (17-238) Added Attack Physical Damage
+0.2 metres to Melee Strike Range
Gain 1 Trauma the first time this Attack Hits an Enemy
Take (6-194) Physical Damage per Trauma when you gain Trauma
Trauma lasts 6.0 seconds
(2-4)% more Damage per Trauma
Pulse has 15% increased Area of Effect per 0.1s of Stun Duration, up to 400%

Additional Effects From 1-20% Quality:
+(0.05-1)% more Damage per TraumaPlace into an item socket of the right colour to gain this skill. Right click to remove from a socket. cannot be supported by Trauma SupportTrauma SupportPhysical, Support, Melee, Attack, Strike, Duration
Icon: #
Level: (1-20)
Cost & Reservation Multiplier: 140%Requires Level 38Supports melee strike skills that do not inherently apply Trauma. Cannot support triggered skills, Vaal skills, or skills used by things other than you. Cannot modify the skills of minions.Supported Skills have (3-11) to (4-24) Added Attack Physical Damage per Trauma
Supported Skills have 5% increased Stun Duration per Trauma
Gain 1 Trauma the first time a Supported Attack Hits an Enemy
Take (13-146) Physical Damage per Trauma when you gain Trauma from Supported Skills
Trauma lasts (5.0-6.9) seconds
Supported Skills can only be used with Axes, Maces, Sceptres or Staves

Additional Effects From 1-20% Quality:
Supported Skills have (0.5-10)% reduced Enemy Stun ThresholdThis is a Support Gem. It does not grant a bonus to your character, but to skills in sockets connected to it. Place into an item socket connected to a socket containing the Skill Gem you wish to augment. Right click to remove from a socket.. Skills that gain bonuses based on your Trauma stacks do not care about the source of that trauma; for example, if you use BoneshatterBoneshatterAttack, Melee, Strike, AoE, Duration, Physical
Level: (1-20)
Cost: 5 Mana
Attack Speed: 85% of base
Attack Damage: (200-250)% of base
Effectiveness of Added Damage: (200-250)%Requires Level 28Attack enemies with a forceful melee strike that also hurts you. Successive uses will raise the damage dealt both to enemies and you. Stunning an enemy with the strike releases a damaging pulse. Requires a Mace, Sceptre, Axe or Staff.(11-158) to (17-238) Added Attack Physical Damage
+0.2 metres to Melee Strike Range
Gain 1 Trauma the first time this Attack Hits an Enemy
Take (6-194) Physical Damage per Trauma when you gain Trauma
Trauma lasts 6.0 seconds
(2-4)% more Damage per Trauma
Pulse has 15% increased Area of Effect per 0.1s of Stun Duration, up to 400%

Additional Effects From 1-20% Quality:
+(0.05-1)% more Damage per TraumaPlace into an item socket of the right colour to gain this skill. Right click to remove from a socket. to generate trauma, skills supported by Trauma SupportTrauma SupportPhysical, Support, Melee, Attack, Strike, Duration
Icon: #
Level: (1-20)
Cost & Reservation Multiplier: 140%Requires Level 38Supports melee strike skills that do not inherently apply Trauma. Cannot support triggered skills, Vaal skills, or skills used by things other than you. Cannot modify the skills of minions.Supported Skills have (3-11) to (4-24) Added Attack Physical Damage per Trauma
Supported Skills have 5% increased Stun Duration per Trauma
Gain 1 Trauma the first time a Supported Attack Hits an Enemy
Take (13-146) Physical Damage per Trauma when you gain Trauma from Supported Skills
Trauma lasts (5.0-6.9) seconds
Supported Skills can only be used with Axes, Maces, Sceptres or Staves

Additional Effects From 1-20% Quality:
Supported Skills have (0.5-10)% reduced Enemy Stun ThresholdThis is a Support Gem. It does not grant a bonus to your character, but to skills in sockets connected to it. Place into an item socket connected to a socket containing the Skill Gem you wish to augment. Right click to remove from a socket. will still be granted added Physical Damage even if they themselves did not generate the trauma.

Gaining Trauma

Hitting an enemy with BoneshatterBoneshatterAttack, Melee, Strike, AoE, Duration, Physical
Level: (1-20)
Cost: 5 Mana
Attack Speed: 85% of base
Attack Damage: (200-250)% of base
Effectiveness of Added Damage: (200-250)%Requires Level 28Attack enemies with a forceful melee strike that also hurts you. Successive uses will raise the damage dealt both to enemies and you. Stunning an enemy with the strike releases a damaging pulse. Requires a Mace, Sceptre, Axe or Staff.(11-158) to (17-238) Added Attack Physical Damage
+0.2 metres to Melee Strike Range
Gain 1 Trauma the first time this Attack Hits an Enemy
Take (6-194) Physical Damage per Trauma when you gain Trauma
Trauma lasts 6.0 seconds
(2-4)% more Damage per Trauma
Pulse has 15% increased Area of Effect per 0.1s of Stun Duration, up to 400%

Additional Effects From 1-20% Quality:
+(0.05-1)% more Damage per TraumaPlace into an item socket of the right colour to gain this skill. Right click to remove from a socket. or strike skill (other than Boneshatter) supported by Trauma SupportTrauma SupportPhysical, Support, Melee, Attack, Strike, Duration
Icon: #
Level: (1-20)
Cost & Reservation Multiplier: 140%Requires Level 38Supports melee strike skills that do not inherently apply Trauma. Cannot support triggered skills, Vaal skills, or skills used by things other than you. Cannot modify the skills of minions.Supported Skills have (3-11) to (4-24) Added Attack Physical Damage per Trauma
Supported Skills have 5% increased Stun Duration per Trauma
Gain 1 Trauma the first time a Supported Attack Hits an Enemy
Take (13-146) Physical Damage per Trauma when you gain Trauma from Supported Skills
Trauma lasts (5.0-6.9) seconds
Supported Skills can only be used with Axes, Maces, Sceptres or Staves

Additional Effects From 1-20% Quality:
Supported Skills have (0.5-10)% reduced Enemy Stun ThresholdThis is a Support Gem. It does not grant a bonus to your character, but to skills in sockets connected to it. Place into an item socket connected to a socket containing the Skill Gem you wish to augment. Right click to remove from a socket. will grant you a Trauma stack, giving more Damage or added Physical Damage respectively. However, you will also take Physical Damage per Trauma stack upon gaining a new one. Only one stack can be obtained per attack, regardless of the number of enemies hit. Repeated attacks from Multistrike SupportMultistrike SupportAttack, Melee, Support
Icon: 3
Level: (1-20)
Cost & Reservation Multiplier: 150%Requires Level 38Supports melee attack skills, making them repeat twice when used, targeting a random enemy each time. Cannot support Vaal skills, channelling skills or triggered skills.Supported Skills Repeat 2 additional times
Supported Skills have (35-44)% more Melee Attack Speed
Supported Skills deal (30-20)% less Attack Damage
First Repeat of Supported Skills deals 22% more Damage
Second Repeat of Supported Skills deals 44% more Damage

Additional Effects From 1-20% Quality:
Supported Skills deal (0.5-10)% increased Melee DamageThis is a Support Gem. It does not grant a bonus to your character, but to skills in sockets connected to it. Place into an item socket connected to a socket containing the Skill Gem you wish to augment. Right click to remove from a socket. will also not grant additional Trauma stacks and only inflicts self-damage every 3rd hit. This can be used to reduce the gain and impact of Trauma for builds incapable of tanking high stacks of Trauma.

Each Trauma stack counts as an individual buff, with each Trauma stack having its own duration. The (now drop-disabled) Mantra of FlamesMantra of Flames
Crimson JewelLimited to: 1Adds (3-5) to (8-12) Fire Attack Damage per Buff on you
Adds (2-3) to (5-8) Fire Spell Damage per Buff on youThe strong grow stronger still.Place into an allocated Jewel Socket on the Passive Skill Tree. Right click to remove from the Socket. Jewel therefore grants a damage bonus for each stack of Trauma. Linking Boneshatter or a Trauma skill with Increased Duration SupportIncreased Duration SupportSupport, Duration
Icon: D
Level: (1-20)
Cost & Reservation Multiplier: 130%Requires Level 31Supports any skill with a duration.Supported Skills have (45-64)% increased Skill Effect Duration

Additional Effects From 1-20% Quality:
Supported Skills have (0.5-10)% increased Skill Effect DurationThis is a Support Gem. It does not grant a bonus to your character, but to skills in sockets connected to it. Place into an item socket connected to a socket containing the Skill Gem you wish to augment. Right click to remove from a socket./Efficacy SupportEfficacy SupportSupport, Duration
Icon: a
Level: (1-20)
Cost & Reservation Multiplier: 130%Requires Level 8Supports any skill that deals damage or has a duration.Supported Skills deal (15-24)% more Damage over Time
Supported Skills have (15-24)% increased Skill Effect Duration

Additional Effects From 1-20% Quality:
Supported Skills deal (0.5-10)% increased Damage over TimeThis is a Support Gem. It does not grant a bonus to your character, but to skills in sockets connected to it. Place into an item socket connected to a socket containing the Skill Gem you wish to augment. Right click to remove from a socket., cursing yourself/being cursed with Temporal ChainsTemporal ChainsSpell, AoE, Duration, Curse, Hex
Level: (1-20)
Cost: (16-33) Mana
Cast Time: 0.50 secRequires Level 24Curses all enemies in an area, lowering their action speed and making other effects on them expire more slowly.Base duration is (5.00-8.80) seconds
+(0-1) metre to radius
50% less Effect of Curse against Players
Cursed Normal and Magic Enemies have (15-29)% less Action Speed
Other effects on Cursed enemies expire 25% slower
Cursed Rare and Unique Enemies have (9-18)% less Action Speed

Additional Effects From 1-20% Quality:
(1-20)% increased Curse DurationPlace into an item socket of the right colour to gain this skill. Right click to remove from a socket., or gaining skill effect duration elsewhere will increase the duration of each Trauma buff stack, reducing the need for high attack speed to maintain high Trauma.

Damage taken from Trauma

With a level 20 gem and N current Trauma stacks, you will take (194<sub>(BoneshatterBoneshatterAttack, Melee, Strike, AoE, Duration, Physical
Level: (1-20)
Cost: 5 Mana
Attack Speed: 85% of base
Attack Damage: (200-250)% of base
Effectiveness of Added Damage: (200-250)%Requires Level 28Attack enemies with a forceful melee strike that also hurts you. Successive uses will raise the damage dealt both to enemies and you. Stunning an enemy with the strike releases a damaging pulse. Requires a Mace, Sceptre, Axe or Staff.(11-158) to (17-238) Added Attack Physical Damage
+0.2 metres to Melee Strike Range
Gain 1 Trauma the first time this Attack Hits an Enemy
Take (6-194) Physical Damage per Trauma when you gain Trauma
Trauma lasts 6.0 seconds
(2-4)% more Damage per Trauma
Pulse has 15% increased Area of Effect per 0.1s of Stun Duration, up to 400%

Additional Effects From 1-20% Quality:
+(0.05-1)% more Damage per TraumaPlace into an item socket of the right colour to gain this skill. Right click to remove from a socket.)</sub>/497<sub>(Boneshatter of Complex TraumaBoneshatter of Complex TraumaAttack, Melee, Strike, AoE, Duration, Physical
Level: (1-20)
Cost: 5 Mana
Attack Speed: 85% of base
Attack Damage: (200-250)% of base
Effectiveness of Added Damage: (200-250)%Requires Level 28Attack enemies with a forceful melee strike that also hurts you. Successive uses will raise the damage dealt both to enemies and you. Stunning an enemy with the strike releases a damaging pulse. Requires a Mace, Sceptre, Axe or Staff.(11-158) to (17-238) Added Attack Physical Damage
+0.2 metres to Melee Strike Range
Lose all Trauma on reaching 10 Trauma
Gain 1 Trauma the first time this Attack Hits an Enemy
Take (18-582) Physical Damage per Trauma when you gain Trauma
Trauma lasts 6.0 seconds
(8-15)% more Damage per Trauma
Pulse has 15% increased Area of Effect per 0.1s of Stun Duration, up to 400%

Additional Effects From 1-20% Quality:
+(0.25-5)% more Damage per TraumaPlace into an item socket of the right colour to gain this skill. Right click to remove from a socket.)</sub>146<sub>(Trauma SupportTrauma SupportPhysical, Support, Melee, Attack, Strike, Duration
Icon: #
Level: (1-20)
Cost & Reservation Multiplier: 140%Requires Level 38Supports melee strike skills that do not inherently apply Trauma. Cannot support triggered skills, Vaal skills, or skills used by things other than you. Cannot modify the skills of minions.Supported Skills have (3-11) to (4-24) Added Attack Physical Damage per Trauma
Supported Skills have 5% increased Stun Duration per Trauma
Gain 1 Trauma the first time a Supported Attack Hits an Enemy
Take (13-146) Physical Damage per Trauma when you gain Trauma from Supported Skills
Trauma lasts (5.0-6.9) seconds
Supported Skills can only be used with Axes, Maces, Sceptres or Staves

Additional Effects From 1-20% Quality:
Supported Skills have (0.5-10)% reduced Enemy Stun ThresholdThis is a Support Gem. It does not grant a bonus to your character, but to skills in sockets connected to it. Place into an item socket connected to a socket containing the Skill Gem you wish to augment. Right click to remove from a socket.)</sub>) *(N+1) physical damage (before damage mitigation) upon your next attack.

The damage taken per Trauma stack counts as a hit, which means that skills like VengeanceVengeanceTrigger, Attack, AoE, Physical, Melee
Level: (1-20)
Cooldown Time: 1.20 sec
Can Store 1 Use(s)
Attack Damage: (170-255)% of base
Effectiveness of Added Damage: (170-255)%Requires Level 24Chance to perform a swift counter-attack against all enemies around you when you are hit. Weapon range increases the area of this attack. Requires a Melee Weapon.(8-56) to (12-85) Added Attack Physical Damage
30% chance to Trigger this Skill when Hit

Additional Effects From 1-20% Quality:
(1-20)% chance to Trigger this Skill when HitPlace into an item socket of the right colour to gain this skill. Right click to remove from a socket. will trigger, Cast when Damage Taken SupportCast when Damage Taken SupportSupport, Spell, Trigger
Icon: !
Level: (1-20)
Cost & Reservation Multiplier: 250%
Cooldown Time: 0.25 sec
Can Store 1 Use(s)Requires Level 38Each supported spell skill will track damage you take, and be triggered when the total damage taken reaches a threshold. Cannot support skills used by totems, traps, or mines. Vaal skills, channelling skills, and skills with a reservation cannot be triggered.This Gem can only Support Skill Gems requiring Level (38-70) or lower
Supported Skills deal (65-27)% less Damage
Trigger Supported Spells when you take (528-3272) total Damage from Hits

Additional Effects From 1-20% Quality:
Supported Skills require (0.5-10)% reduced amount of Damage taken to TriggerThis is a Support Gem. It does not grant a bonus to your character, but to skills in sockets connected to it. Place into an item socket connected to a socket containing the Skill Gem you wish to augment. Right click to remove from a socket. will trigger, etc. It also allows your armour and/or physical damage reduction to prevent some of the physical damage taken. However, the damage cannot be blocked or evaded via evasion rating/dodge. "Avoid damage from hits" effects (e.g. Elusive) do work, however.

Damage conversion modifiers do not affect the damage from Trauma. However, damage taken as modifiers such as #% of Physical Damage from Hits taken as Cold Damage will shift the damage you take, allowing mitigation via elemental resistances. Additionally, it is possible to chill, freeze, or shock yourself this way; it is not possible to self-inflict damaging ailments unless you have a source of All Damage from Hits can Ignite/Poison you such as Mokou's EmbraceMokou's Embrace
Ruby RingRequires Level 16+(20-30)% to Fire Resistance+(25-40)% to Cold Resistance
(25-40)% increased Attack Speed while Ignited
(25-40)% increased Cast Speed while Ignited
+25% chance to be Ignited
All Damage Taken from Hits can Ignite youFire makes the perfect blossom in the endless night..

Recoup is a valuable stat to have due to the escalating damage quickly exceeding and overpowering other forms of recovery, whereas Recoup will always recover the same percentage of damage received.

Gem level progression

Level			Exp.	Total Exp.
1	38	63	0	0
2	40	66	388734	388734
3	42	69	477437	866171
4	44	72	583786	1449957
5	46	75	710359	2160316
6	48	78	1355511	3515827
7	50	81	1138877	4654704
8	52	84	1368233	6022937
9	54	87	1638338	7661275
10	56	90	1956648	9617923
11	58	93	3655184	13273107
12	60	96	3017327	16290434
13	62	99	3576232	19866666
14	64	102	4231667	24098333
15	65	103	2395078	26493411
16	66	105	8421063	34914474
17	67	106	16159983	51074457
18	68	108	41170367	92244824
19	69	109	86794448	179039272
20	70	111	157405063	336444335
21	72	114	N/A	N/A
22	74	N/A	N/A	N/A
23	76	N/A	N/A	N/A
24	78	N/A	N/A	N/A
25	80	N/A	N/A	N/A
26	82	N/A	N/A	N/A
27	84	N/A	N/A	N/A
28	86	N/A	N/A	N/A
29	88	N/A	N/A	N/A
30	90	N/A	N/A	N/A
31	91	N/A	N/A	N/A
32	92	N/A	N/A	N/A
33	93	N/A	N/A	N/A
34	94	N/A	N/A	N/A
35	95	N/A	N/A	N/A
36	96	N/A	N/A	N/A
37	97	N/A	N/A	N/A
38	98	N/A	N/A	N/A
39	99	N/A	N/A	N/A
40	100	N/A	N/A	N/A

Gem quality

Type	Additional Effects per 1-20% Quality	Weight
Superior	Supported Skills have (0.5-10)% reduced Enemy Stun Threshold	1

Item acquisition

Trauma Support can drop anywhere.

Recipes

Trauma Support can be created from the following recipes:

Amount	Part	Description	Meta
1	BitterdreamBitterdream Shadow SceptreSceptre Physical Damage: 29-44 Critical Strike Chance: 6.20% Attacks per Second: 1.25 Weapon Range: 1.1 metresRequires Level 32, 52 Str, 62 Int22% increased Elemental DamageSocketed Gems are Supported by Level 15 Bonechill Socketed Gems are Supported by Level 15 Hypothermia Socketed Gems are Supported by Level 15 Ice Bite Socketed Gems are Supported by Level 15 Cold Penetration Socketed Gems are Supported by Level 15 Added Cold Damage Socketed Gems are Supported by Level 15 InspirationFight not the cold Forsake hope Be still.	level 1 Bonechill Support and 5 other gems	M
9	Gift of the Gemling QueenGift of the Gemling Queen9Level 20 Support GemOur Lady Dialla, as a symbol of our progress, shines greater than all the gems.	Random level 20 support gem	A
7	Dialla's SubjugationDialla's Subjugation7Support Gem Quality: +23% CorruptedA symbol of beauty and innocence The gems corrupted her mind Malachai corrupted her gems All but a glimmer of greatness lost in madness	Random corrupted support gem with 23% quality	A
6	The FoxThe Fox6Level 20 Gem"Masters of wit, strength and cunning. To survive the harsh winters, you must be like the fox." - Ezomyte Proverb	Random level 20 gem	A
3	Gemcutter's PromiseGemcutter's Promise3Gem Quality: +20%"I swore to use my position to help the people. What good is power when it just accumulates on the already-powerful?" - Erasmus, Imperial Gemcutter	Random gem with 20% quality	A
1	Gemcutter's IncubatorGemcutter's IncubatorStack Size: 10Adds an incubated Quality Gem item to an equippable item Item drops after killing {0} monstersRight click this item then left click an item to apply it. The Incubated item drops after killing a specific number of monsters.	Random gem with 1–20% quality	A
1	The VoidThe Void1Reach into the Void and claim your prize.	Random divination card set exchange	A

Quest reward

This item is given as a quest reward for the following quests:

Class →	Witch	Shadow	Ranger	Duelist	Marauder	Templar	Scion
Quest ↓
The Eternal Nightmare Act 4	✗	✗	✗	✓	✓	✗	✗

Vendor reward

This item can be bought at the listed NPC vendors, after completing the following quests:

Class →	Witch	Shadow	Ranger	Duelist	Marauder	Templar	Scion
Quest ↓
The Eternal Nightmare Act 4 Petarus and Vanja	✗	✗	✗	✓	✓	✓	✓
Fallen from Grace Act 6 Lilly Roth	✓

Version history

Version	Changes
3.22.0	Added to the game.