The Trauma Glossary: Do I Have That?
Have you been traumatized? Are you a victim of trauma? But that happened to me a long time ago, you might be thinking. Or, I only witnessed that, it wasn’t so terrible, or I survived, it wasn’t major. The truth is that trauma happens to many many people and comes in all shapes and sizes, not just the catastrophic events that make the news. I recently attended training in Eye Movement Desensitization and Reprocessing (EMDR) parts 1 and 2, and noted EMDR trainer Laurel Parnell talked about the big Ts and the little ts, and the therapists in the room practiced this form of trauma processing on both upper and lowercase ts. What does this all mean though? What does it mean to have a big T vs a little t? What if I was abused long ago and think I should be over it but it bleeds through into my life? What if I have experienced a lot of trauma in my life? Do I have PTSD? What does PTSD even mean? There is certainly a lot of talk in the world of trauma treatment about all of this, so I want to break it down:
Trauma: The American Psychological Association describes psychological trauma this way: “Trauma is an emotional response to a terrible event like an accident, rape or natural disaster. Immediately after the event, shock and denial are typical. Longer -term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea.” (American Psychological Association, 2016).
Big T trauma: Francine Shapiro, the creator of EMDR, describes big T traumas as those that impact one drastically, such as war, assault, rape, childhood physical and sexual abuse, disasters, accidents, and losses. Big T traumas can shatter your worldview and are more likely to cause symptoms of Posttraumatic Stress Disorder (PTSD) such as flashbacks and nightmares (Parnell, 2006, page 4).
Little t trauma: These are experiences that negatively impact self- confidence and sense of self –efficacy, causing narrowing of worldviews and can impact one’s ability to live life to the fullest. Examples include job loss, a sudden move, a divorce, the death of a pet. The” little” should not imply that they are not significant, but they tend to impact one differently than the big T traumas (Parnell, 2006, page 4).
Single Incident Trauma: As it sounds, this is trauma stemming from one event, such as a car accident, a natural disaster, a sudden death. Single incident traumas can cause PTSD and can be debilitating despite the fact that the trauma is the result of a singular event. 9/11 was a single-incident trauma.
Complex Trauma: The National Child Traumatic Stress Network defines complex trauma as resulting from exposure to multiple traumatic events, often of an invasive, interpersonal nature. These events are severe and pervasive, such as abuse or profound neglect. They usually begin early in life and can disrupt many aspects of a child’s development and formation of self. Since they often occur in the context of the child’s relationship with a caregiver, they interfere with the child’s ability to form secure attachment (National Child Traumatic Stress Network). Early traumatic experiences predispose one to developing PTSD (Parnell, 2006, p. 16).
Posttraumatic Stress Disorder: PTSD is a specific diagnosis that is defined by theDiagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) as resulting from exposure to actual or threatened death, serious injury, or sexual violence by: directly experiencing the event; witnessing the event occur to others; learning that the event happened to a close family member or friend; or experiencing repeated or extreme exposure to details of the traumatic event. PTSD symptoms include recurrent intrusive thoughts, nightmares, flashbacks, distress at reminders of the trauma, hypervigilance, difficulty concentrating, and difficulty falling and staying asleep. A person with PTSD will also go to great lengths to avoid memories and reminders of the event. PTSD is diagnosed once the symptoms have persisted for at least 30 days (American Psychiatric Association, 2013).
I have heard many people with PTSD admonish themselves for not seeking help sooner. I always remind them that avoidance is one of the primary symptoms of PTSD.
If I experienced trauma does that mean I have PTSD? No, not necessarily. According to the National Center for PTSD, 60% of men and 50% of women experience at least one trauma in their lives. Only 8% of the population will experience PTSD. What causes some people to experience PTSD and others not to is still being studied, but we know that if you have multiple traumas, particularly traumas early in life, you are more likely to develop PTSD, and that strong support networks protect people from developing PTSD (US Department of Veterans Affairs: National Center for PTSD).
Dissociation: Dissociation is a mental process that allows someone who has experienced trauma to compartmentalize those memories. Mild dissociation is common and can be likened to daydreaming or tuning out to the point that you momentarily forget where you are, like driving and not paying attention to the exits. More severe dissociation can make it difficult to recall memories or experience emotion in connection to reminders of the event. It can make you feel numb and disconnected from yourself, like floating above yourself and looking down. At its most severe, dissociation can cause Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, where split off parts of yourself take on new identities (Encyclopedia of Mental Disorders, 2016). DiD is rare and affects an estimated .01 to 1% of the population. It is most commonly seen in people who have experienced severe sexual abuse in childhood (International Society for the Study of Trauma and Dissociation).
Acute Stress Disorder is characterized by the development of severe anxiety, dissociation, and other symptoms that occur within one month of exposure to an extreme trauma (e.g., witnessing a death or serious accident). It differs from PTSD in that its symptoms are short term, lasting anywhere from 2 days to 4 weeks. It is acute, whereas PTSD is more chronic. As a response to the traumatic event, the individual develops dissociative symptoms, experiences less emotional responsiveness, and can find it challenging to experience pleasure in activities that were once enjoyable. Theycan also feel guilty about pursuing usual life tasks (American Psychiatric Association, 2013).
Adjustment disorder: If you don’t meet the criteria for PTSD but you still feel disturbed by your experience you might be told you have an adjustment disorder. An adjustment disorder is by definition a short-term response to a stressful situation, such as a loss, life change, or other event. What makes it different than a typical response is that it causes reactions that are more severe than normal and can be accompanied by symptoms of depression, anxiety, and increased agitation. Acute adjustment disorder lasts less than 6 months, and chronic adjustment disorder lasts more than 6 months(American Psychiatric Association, 2013).
Developmental Trauma Disorder: Bessel van der Kolk , a pioneer in the field of trauma research and treatment, created the DTD diagnosis after researching abused and neglected children, discovering that they had consistent problems with attention and concentration, they could not regulate their emotions, and they had difficulty getting along with others. Despite a strong push, DTS was not added to the DSM-5, but proposed criteria for the diagnosis include the following: the child or adolescent has experienced or witnessed multiple or prolonged adverse events for at least one year, including direct experience or witnessing of repeated and severe episodes or interpersonal violence; the child has experienced significant disruptions in caregiving as the result of repeated changes in primary caregiver; the child was exposed to severe and persistent emotional abuse.
Symptoms of DTS include difficulty regulating extreme emotional states, resulting in anger, tantrums, and difficulty sleeping, eating, toileting, and transitioning from one activity to another. These children also exhibit risk taking and thrill seeking behavior, have difficulty maintaining goal-directed behavior, underperform in school, engage in family conflict, and experience social isolation, legal problems, and physical illness that cannot be attributed to injury (van der Kolk, 2014).
This information is surely a lot to process, but bear in mind that this list is meant merely as an overview and source of information. it is not meant to be a tool for self diagnosis. It might, however, give you enough information to decide to seek out therapy and get clarity about what you are experiencing. Find a licensed mental health professional that specializes in treating trauma.
There are many approaches to treating trauma that I will go into in a future blog post.
If you would like a consultation, please call me at 917-749-4195 or firstname.lastname@example.org.
American Psychological Association: Trauma (2016). Retrieved from http://www.apa.org/topics/trauma/
L.P. (2006). A Therapist's Guide to EMDR: Tools and Techniques for Successful Treatment (1st ed.). W. W. Norton & Company.
The National Child Traumatic Stress Network: Complex Trauma. Retrieved from http://www.nctsn.org/trauma-types/complex-trauma.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
US Department of veterans Affairs: National Center for PTSD. Retrieved at http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp.
Encyclopedia of Mental Disorders: Dissociation and dissociative disorders (2016). Retrieved from http://www.minddisorders.com/Del-Fi/Dissociation-and-dissociative-disorders.html.
International Society for the Study of Trauma and Dissociation. Retrieved at http://www.isst-d.org/?contentID=76.
van der Kolk, B., MD. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.