What is Trauma?

What do  therapists mean when we talk about trauma?

One definition I like states that “psychological trauma is the unique individual experience of an event or enduring conditions in which: “The individual’s ability to integrate his/her emotional experience is overwhelmed or the individual experiences (subjectively) a threat to life, bodily integrity, or sanity.” (Pearlman & Saakvitne, 1995, p. 60)

The important part of this definition in my practice is the emphasis on “unique individual experience”.  You get to define which experiences are traumatic for you, whether or not it would impact others in the same manner.  It’s not the objective facts that determine whether an event is traumatic,  but your own emotional experience of the event.

Put more plainly, psychological trauma is the result of extraordinarily stressful events that shatter your sense of security and result in you feeling helpless, alone  and vulnerable in a dangerous world.

Sometimes therapists talk about “big T trauma” and “little t trauma”.  This is in no way meant to imply that any traumatic events are insignificant! I understand it as a way of expanding the definition and understanding of trauma to include things that may not be found within the DSM IV (the Diagnostic and Statistical Manual of Mental Disorders) definition. We are all familiar with examples of big T traumas: childhood sexual, physical or emotional abuse,  natural disasters, war experiences,  severe car accidents,  rape.  Little t traumas can be just as damaging, especially because they tend to occur over time, and build upon each other. Examples would be ongoing emotional abuse or neglect,  experiences of shame, humiliation, being left out, bullied or ridiculed and feeling not cared for.  The experience of growing up gay in a homophobic culture would be an example of this sort of trauma.  All traumatic experiences affect how we experience the world around us,  and our relationships with other people.

Psychological effects are likely to be most severe if the trauma is:

  • Human caused
  • Repeated
  • Unpredictable
  • Multifaceted
  • Sadistic
  • Undergone in childhood
  • Perpetrated by a caregiver

Impact can be ameliorated by existence of a support system at the time of the traumatic event.  When you do not have  family or friends to  help you to make sense of the event,  normal development is interrupted and various symptoms occur.

Therapy is crucial for recovering from the impact of traumatic events. Time alone does not heal all wounds, no matter what that old trope claims!

I found a passage from The Kite Runner by Khaled Hosseni to be a striking depiction of what unresolved trauma can feel like, even decades later:

I became what I am today at the age of twelve, on a frigid overcast day in the winter of 1975. I remember the precise moment, crouching behind a crumbling mud wall, peeking into the alley near the frozen creek. That was a long time ago, but it’s wrong what they say about the past, I’ve learned, about how you can bury it. Because the past claws its way out. Looking back now, I realize I have been peeking into that deserted alley for the last twenty-six years.

Kathleen Young, Psy.D.

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35 Responses to What is Trauma?

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  22. I think there is a third type of trauma that is often overlooked — Big-little “T” — where the experience of the trauma is artificially inflated, due to neurological issues like traumatic brain injury. The events themselves may not objectively be considered “big”, but the experience and reaction of the subject (due to intense emotional lability or a hyper-active sympathetic nervous system or any other number of TBI-related issues) qualifies the events as “BIG T” Traumas.

    In addressing these, I think a fine line needs to be walked between the objective valuation of the event and appreciating the subjective impact of it on the concussed/brain-injured individual. The events themselves may not be that big of a deal at first blush, but the biochemical impact and consequent physiological consequences, can be considerable.

    This disconnect, and lack of appreciation for its significance, can contribute to post-TBI issues. Addressing it takes particular care, along with a familiarity with neurological issues (and the ability to avoid psychologizing symptoms which may in fact be physiological/neurological in nature).

    I’m doing some writing about the intersection and interactions of Traumatic Brain Injury and PTSD. You may find it interesting… See http://brokenbrilliant.wordpress.com/2009/03/28/ptsd-from-tbi-exploring-some-possibilities/

    Thanks for your work

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  25. ak says:

    Thanks for a good description of small t trauma. Another example, by the way, of small T trauma is growing up with mentally ill or drug addicted parents that are incapable of attuning to their child.

    I’d like to add the following advice for anyone struggling to recover from small t complex trauma, for example, caused by mentally ill or drug addicted parents. In addition to the important benefits of analytical talk therapy, you should look into the various forms of body based psychotherapy: Somatic Experiencing, Somatic Processing Institute, Hakomi Method, Neuroaffective Relational Model, Neuroaffective touch, meditation, equine-assisted therapy and EMDR. EMDR is great but note it doesn’t develop the self-awareness and skills one can use without a therapist, which the other methods do.

    My own belief is that all analytical therapists should be required to learn a form of body-based psychotherapy if they are treating people with complex trauma (whether it be due to big T or small T) and probably for regular big T trauma recovery as well. Frankly, everybody would benefit from being more attuned to their own body sensations that underlie and can even circumscribe their thoughts and emotions.

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    June is PTSD Awareness Month. As promised yesterday, I am sharing this 2009 post to start with the basics:

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