What is Trauma Series: Types of Trauma Including Big T Acute Trauma, Little T Trauma, Complex Trauma, PTSD & Complex PTSD
What is Trauma Series: Trauma and EMDR Therapist in Chicago Discusses Types of Trauma
The second installation of the What is Trauma Series aims to clarify some of the different types of traumatic experiences and labels for trauma. For more information about the role of the nervous system in trauma and why a significant experience may occur as traumatic for one person but not for another, check out Part One of the series.
What Is Trauma?
As discussed in Part One of the What is Trauma Series, trauma is any experience that exceeds the nervous system’s capacity to process it in an adaptive way at the time, and results in the experience lingering in the nervous system, ready to be activated and influence the present. Accordingly, trauma can be a single incident that was large, or seemingly small. It can also be the result of a prolonged traumatic environment or the cumulative impact of many traumatic events.
Although there is general agreement about this overarching idea of trauma, there are numerous ways in which trauma can manifest and impact an individual. The severity and frequency of traumatic events, as well as when the trauma occurred during the individual’s development are all factors that may influence how someone is impacted by trauma.
Types of Trauma
Big T Acute Trauma
Large or otherwise catastrophic events in which there is the threat of significant harm to self or others, or witnessing of significant harm or death are often called “Big T” traumas. These events are generally acute, single incidents. Examples of Big T traumas include car accidents, natural disasters, acts of terrorism, sexual assault, physical assault, medical trauma, and traumatic loss.
Big T traumas are likely to be recognized and labeled as traumatic experiences. Accordingly, individuals who had a Big T trauma may be more apt to label their physical, emotional, and behavior changes as trauma reactions and may be encouraged to seek therapeutic support if they struggle with symptoms of trauma such as hypervigilance, sleep difficulties, restlessness, gastrointestinal upset, flashbacks or nightmares, avoidance of reminders of their experience, and sensitivity to stimuli in their environment such as certain sounds.
Little T Trauma or Small T Trauma
Little T traumas, sometimes called Small T traumas, often involve an experience that was difficult and impactful, but may not have posed an actual physical danger to the individual or to others. The nervous system may have perceived the event as overwhelming in the moment and threatening to the physical or emotional safety of the individual, but there was rarely any true imminent danger. Little T traumas can include losses such as divorce, moves, or job loss; embarrassing, humiliating, or shameful experiences; betrayal of trust; frightening experiences; and other events whose impact lingers.
Little T traumas are similar to Big T traumas in that they can result in changes in nervous system sensitivity and avoidance behaviors. Little T traumas differ however because they may not be recognized and labeled by the individual or others as traumatic experiences. Accordingly, the related symptoms of trauma including anxiety, avoidance behaviors, emotional reactivity, heightened sensitivity, sleep disturbance, hypervigilance, and other trauma symptoms may go unrecognized and untreated, or may be misunderstood as symptoms of anxiety, depression, or behavior problems.
Complex Trauma or Developmental Trauma
Complex trauma, or developmental trauma, are terms often used to describe traumatic experiences that existed over time, and during childhood. These experiences may, or may not have been directly violent or life-threatening to the individual, but they created an environment in which there was a persistent lack of a sense of safety, and in which the individual may have felt stuck or trapped. These experiences may include the presence of a caregiver or individual who was physically, emotionally, or behaviorally unavailable or unstable; emotional abuse or neglect; experiencing or witnessing physical or sexual abuse or domestic violence; persistent physical or emotional bullying; or loss of caregivers.
The impact of complex or developmental trauma can be far-reaching due, in part, to the occurrence of trauma during a stage of significant brain development. These effects can be seen in childhood and adulthood in the areas of attachment relationships; sensorimotor development including balance, body awareness, and sensitivity to physical contact; emotional and behavioral regulation and control; executive function, attention regulation, and learning difficulties; difficulty regulating states of consciousness to connect with the present which can impact memory and result in feelings of dissociation and depersonalization; and in poor self-concept including low self-esteem and low sense of self-efficacy, and feelings of guilt and shame (1).
Post Traumatic Stress Disorder (PTSD)
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5-TR), Post Traumatic Stress Disorder (PTSD) is a mental health diagnosis that refers to individuals who are evidencing persistent and significant emotional, behavioral, and physiological symptoms of trauma following exposure to actual or threatened death, serious injury, or sexual violence. This exposure may have been witnessed or experienced directly by the individual; the individual may have learned about a traumatic event experienced by someone close to them; or they may have experienced repeated or extreme exposure to details of a traumatic event. Following the event, the individual exhibits symptoms across three clusters including 1: re-experiencing the event in the here-and-now such as through dreams or flashbacks; 2: avoidance of traumatic reminders; and 3: a heightened sense of threat (2).
PTSD is typically associated with exposure to a single traumatic event, such as an accident or an assault. In situations where an individual has been exposed to prolonged or multiple traumatic events, the individual may experience Complex PTSD.
Complex PTSD
Although not currently recognized as a distinct diagnosis in the DSM, Complex PTSD was recently added as a diagnosis in the World Health Organization’s International Classification of Diseases (ICD-11). The concept of Complex PTSD acknowledges that the impact of multiple or prolonged “Big T” traumatic experiences can have unique effects on an individual that may be more complex than a single incident Big T trauma.
Like a PTSD diagnosis, Complex PTSD involves exposure to a traumatic event and subsequent symptoms across three clusters including re-experiencing the event in the here-and now; a heightened sense of threat; and avoidance of traumatic reminders. However, individuals with Complex PTSD also evidence difficulties across three additional symptom clusters including challenges regulating emotions; difficulties in their relationships with others; and a persistent negative self-concept (3).
Examples of traumas that contribute to Complex PTSD may include domestic violence or other long-term relational abuse or extreme neglect; experiences of war; sex trafficking; persistent community violence; chronic illness, and ethnic cleansing. Additionally, Complex PTSD may be experienced by first responders, medical professionals, and others faced with exposure to multiple traumatic events in the course of their life or work.
Treating Trauma with EMDR Therapy Chicago and Online Trauma Therapy
There are many different types of trauma and complexities impacting symptoms of trauma. Trauma symptoms may include restlessness, irritability, difficulty focusing, relationship struggles, sleep disturbances, poor self-concept, and feeling on high alert. Once you are able to recognize and correctly label symptoms as possibly being related to trauma, it can help you find trauma therapy near you or trauma therapy online.
Trauma is treatable. Therapy aimed at processing trauma, creating a sense of safety, learning skills to regulate emotional and physiological responses, and enhancing positive identity development and feelings of self-worth can all support the healing of trauma. Therapies that target the body and brain such as Eye Movement Desensitization and Reprocessing (EMDR) have been shown to support neurological changes that can help to heal brains and bodies that have been altered by trauma.
Find Trauma Therapy and EMDR in Chicago or PTSD, Trauma, and EMDR Therapy Online
If you are looking for help in getting past traumatic experiences so that they do not limit you in the present, I may be able to help. I treat trauma and PTSD in Chicago, along the North Shore, and across Illinois using evidence-based treatments such as EMDR therapy. I am also a PSYPACT psychologist, who is licensed to provide virtual trauma treatment and online EMDR therapy to people in most states across the United States, including affirming trauma therapy for experiences of marginalization within the LGBT community and for neurodivergent folx; and to treat burnout for struggling parents and parents of children with special needs and high needs. You can read more about how I can help here.
Contact me for a free 15-minute phone consultation to learn about how EMDR and other trauma therapy approaches can help you live a calmer, more connected, and more satisfying life.
(1) Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., DeRosa, R., Hubbard, R., Kagan, R., Liautaud, J., Mallah, K., Olafson, E., & van der Kolk, B. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35(5), 390–398. https://doi.org/10.3928/00485713-20050501-05
(2) American Psychiatric Association Publishing. (2022). Diagnostic and statistical manual of mental disorders, fifth edition text revision: Dsm-5-Tr.
(3) Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y. R., Khoury, B., Hitchcock, C., & Bohus, M. (2022). Complex post-traumatic stress disorder. The Lancet, 400(10345), 60–72. https://doi.org/10.1016/s0140-6736(22)00821-2
