Definition of Trauma

The DSM-5 defines PTSD trauma as any situation where our life, physical or psychological integrity is threatened. These can be thought of as large ‘T’ traumas, which can lead to developing PTSD and can include symptoms described below as well as flashbacks, anxiety, depression, anger changes in personality and often substance misuse. There are also small ‘t’ traumas which may be signs which may be signs of problematic trauma or stress rather than symptoms fitting a PTSD diagnosis, these include being triggered by situations, not being able to stop thinking about issues, being unable to recall experiences, being upset all the time, low mood, anxiety and poor energy levels, and difficulty engaging fully with life and others.

While we can often deal with small T traumas with assistance or on our own, some people experience lots of small T trauma in their lives. Multiple small T traumas can have a compounding effect and put us at risk for PTSD.

Both big T and small T trauma affect quality of life and intimate relationships. It is important to seek assistance to resolve both types of trauma as there is growing evidence that many people who resolve traumas experience a phenomenon called post-traumatic growth. This means that not only do they recover, they make positive changes in their lives and actually, cope better than before the trauma. This is because successfully working through trauma causes us to change our worldview and leads us to develop new perspectives and life skills.

Different Types of Trauma:

Small ‘t’ versus Large ‘T’ – Smaller, everyday events can still be traumatic.

Most people recognise a large ‘T’ trauma and tend to think that trauma only affects those who have been exposed to these types of events.

Examples of Large ‘T’ Trauma

• War
• Combat
• Natural disasters
• Abuse: physical or sexual
• Terrorism
• Catastrophic accidents

Examples of Small ‘t’ Trauma

• Conflict with significant others or children
• Infidelity
• Divorce
• Conflict with supervisor/boss or colleagues
• Abrupt or extended relocation/move
• Planning a wedding
• Starting a new job
• Having or adopting a child
• Legal trouble
• Financial worries or difficulty
• Expensive and unplanned home repairs (e.g., after storm damage)

Small ‘t’ traumas can sometimes tend to be rationalised as common, and therefore we feel ashamed or think that we are overreacting or not coping.  There are also people who may not recognise just how disturbing the event or situation was to them until later.

Not everyone will become traumatised by the same traumatic experience, as we are all different. However, everyone can become traumatised if they experience a sufficiently stressful event.  Personal reaction to trauma is dependent on predisposing factors, such as our past experiences, personality type, beliefs, perceptions, expectations, level of stress tolerance, values, and morals. One issue to be aware of is both big T and small T trauma is marked by avoidance. When people attempt to avoid their trauma or aspects of their trauma, it makes the trauma response worse and increases anxiety and mood problems.

Developing post-trauma symptoms is by no means an indication of psychological weakness or deficiency. By most standards, these individuals would likely be referred to as “strong-minded” or “tough”; their ability to experience such hardships and seek assistance is considered a sign of strong character and self-responsibility. There is some positive news here as there is a significant body of evidence in scientific studies that psychological treatment is very effective for treating both big T and small T trauma. People often find they improve in a surprisingly short period of time compared to the amount of time they have had the trauma. Examples of approaches to trauma that are evidence-based include EMDR, CBT, Exposure Therapy, and Psychodynamic therapy.