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Mental Health HomepageConditions LibraryConditions CategoryConditions CategoryPTSD and the Difference Between Big ‘T’ and Little ‘t’ Traumas
Table of Contents:OverviewLooking at Big ‘T’ TraumaWitnessing TraumaBig ‘T’ Versus Little ‘t’ TraumaExpanding How We Approach PTSDSeeking Help for PTSD
PTSDRead Time: 6 Minutes
Published On: June 27, 2018
Reviewed On: June 27, 2018
Updated On: October 31, 2023
OverviewWe’ve come a long way in our understanding of post-traumatic stress disorder. From the early designation of “shell shock” for military veterans to transforming the label of “hysteric” to PTSD for survivors of rape, we know that trauma can have lasting physical and emotional effects on those who experience it.However, often we default to discussing only soldiers and victims of sexual violence when we talk about PTSD. These experiences are certainly among the leading causes of the mental illness, yet they aren’t the only type of trauma that result in PTSD. Let’s expand on how trauma of any kind changes us and how that impacts the way we think about PTSD.
Overview
We’ve come a long way in our understanding of post-traumatic stress disorder. From the early designation of “shell shock” for military veterans to transforming the label of “hysteric” to PTSD for survivors of rape, we know that trauma can have lasting physical and emotional effects on those who experience it.
However, often we default to discussing only soldiers and victims of sexual violence when we talk about PTSD. These experiences are certainly among the leading causes of the mental illness, yet they aren’t the only type of trauma that result in PTSD. Let’s expand on how trauma of any kind changes us and how that impacts the way we think about PTSD.
Looking at Big ‘T’ Trauma
Add to the list school shootings, terrorist attacks, residing in war zones; relational violence like domestic abuse, physical abuse, and emotional abuse; to the violence of incarceration and crime — PTSD-causing big ‘T’ trauma casts a wide net.
Witnessing Trauma
Post-9/11 PTSD: A Case Study
The most recognizable case of this phenomenon followed the terrorist attacks on Sept. 11, 2001. As of 2011,The New York Timesreported that three 9/11-specific health organizations found “at least 10,000 firefighters, police officers, and civilians exposed to the terrorist attack on the World Trade Center have been found to have post-traumatic stress disorder.”
First responders who were — and are everyday — on the frontlines of such tragedy have a high risk of developing PTSD from what they witness. A 2017surveyfound that around 30 percent of first responders lived with PTSD, including firefighters, police officers, paramedics, and other emergency workers.
It’s not just first responders. Those who were in the city at the time of 9/11, even if they weren’t in the World Trade Center at the time of the attacks, have also been diagnosed with PTSD. Like with any witnessed trauma, it shakes one’s sense of safety because it happened so close to home. It leaves lasting emotional ties that come with many daily reminders.
“It’s the places you see every day,” Charles Figley, a Tulane University School of Social Work professor, explained toThe New York Times. “Where you proposed to your wife, where you remember getting the news that you got promoted, where your young children played.”
Big ‘T’ Versus Little ‘t’ TraumaThe causes above cover what theDiagnostic and Statistical Manual of Mental Health Disordersspecifies in diagnosing PTSD: “Exposure to actual or threatened death serious injury, or sexual violence” and witnessing “the event(s) as it occurred to others.” As researchers delve deeper into PTSD, they are finding that these qualifications may be limiting.We talked about big ‘T’ trauma, but there’s also that little ‘t’ trauma. Little ‘t’ traumas are classified as stressful events that happen to all of us at one point or another. Think more “personal” stressors, like job changes, messy breakups, unplanned major expenses, and the loss of a loved one.These instances, which seriously challenge our ability to cope, have traditionally been left out of the conversation about PTSD. It’s believed they’re just not “enough” to cause mental illness. However, this may not turn out to be true, as our understanding of trauma advances.“One of the most overlooked aspects of small ‘t’ traumas is their accumulated effect,” writes psychologist Elyssa Barbash inPsychology Today. “While one small ‘t’ trauma is unlikely to lead to significant distress, multiple compounded small ‘t’ traumas, particularly in a short span of time, are more likely to lead to an increase in distress and trouble with emotional functioning.”
Big ‘T’ Versus Little ‘t’ Trauma
The causes above cover what theDiagnostic and Statistical Manual of Mental Health Disordersspecifies in diagnosing PTSD: “Exposure to actual or threatened death serious injury, or sexual violence” and witnessing “the event(s) as it occurred to others.” As researchers delve deeper into PTSD, they are finding that these qualifications may be limiting.
We talked about big ‘T’ trauma, but there’s also that little ‘t’ trauma. Little ‘t’ traumas are classified as stressful events that happen to all of us at one point or another. Think more “personal” stressors, like job changes, messy breakups, unplanned major expenses, and the loss of a loved one.
These instances, which seriously challenge our ability to cope, have traditionally been left out of the conversation about PTSD. It’s believed they’re just not “enough” to cause mental illness. However, this may not turn out to be true, as our understanding of trauma advances.
“One of the most overlooked aspects of small ‘t’ traumas is their accumulated effect,” writes psychologist Elyssa Barbash inPsychology Today. “While one small ‘t’ trauma is unlikely to lead to significant distress, multiple compounded small ‘t’ traumas, particularly in a short span of time, are more likely to lead to an increase in distress and trouble with emotional functioning.”
Expanding How We Approach PTSD
Barbash stops short of saying that a collection of small ‘t’ traumas can cause PTSD, but admits “it is possible that a person can develop some trauma response symptoms.” Psychotherapist Sara Staggs offers a similar perspective in her blog forPsych Central, pointing out that PTSD and stress reactions following trauma are tied not so much to the event itself but to the way our brain processes the information.
“Then there is any other type of event which exceeds our capacity to cope, and can be stored as trauma,” Staggs said. “To some degree, it doesn’t matter what propels us into fight-flight-freeze mode, but only that the event was experienced and then stored that way.”
How the Brain Stores Traumatic Memories
We know that the brain stores traumatic memories differently than regular ones. These memories are so overwhelming our brain doesn’t process them completely the first time around. Staggs describes it as the difference between putting your canned goods neatly away on the shelf versus shoving everything in a cabinet and slamming the door shut in a hurry.
The latter is how the brain might handle traumatic information, which can lead to the tell-tale symptoms of PTSD:flashbacksand nightmares, isolation, dissociation, emotional detachment, heightened anxiety, and avoidance of trauma reminders, among other symptoms.
What We Know About PTSD’s Development
Additional research suggests there are many factors at play that determine who develops PTSD, since only an estimated3.6 percent of the global populationlives with the illness in any given year. Not all of us who experience trauma will develop PTSD, even if we’ve lived through or witnessed the same exact experience.
Seeking Help for PTSDBy expanding how we look at PTSD beyond justveteransand rape survivors, we can raise awareness that there are many traumatic experiences that can lead to PTSD. And when we do that, we reduce the stigma of reaching out for help when we need it.“With sufficient support most people are resilient, most people can work through the effects of post-traumatic stress,” psychologist Arielle Schwartz toldEveryday Health. “Seeking support is not something to be shameful for. It’s something that all humans need.”
Seeking Help for PTSD
By expanding how we look at PTSD beyond justveteransand rape survivors, we can raise awareness that there are many traumatic experiences that can lead to PTSD. And when we do that, we reduce the stigma of reaching out for help when we need it.
“With sufficient support most people are resilient, most people can work through the effects of post-traumatic stress,” psychologist Arielle Schwartz toldEveryday Health. “Seeking support is not something to be shameful for. It’s something that all humans need.”
Renee FabianRenée Fabian is a Los Angeles-based journalist and editor. She has written for Talkspace, The Washington Post, and Healthline, among others, and is currently an editor at The Mighty. Renée holds a master’s degree in journalism and will complete a master’s degree in psychology in fall 2019.
Renée Fabian is a Los Angeles-based journalist and editor. She has written for Talkspace, The Washington Post, and Healthline, among others, and is currently an editor at The Mighty. Renée holds a master’s degree in journalism and will complete a master’s degree in psychology in fall 2019.
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