PTSD and the Difference Between Big ‘T’ and Little ‘t’ Traumas

Looking at Big ‘T’ Trauma

Trauma is generally categorized by what experts call big ‘T’ trauma or little ‘t’ trauma. Officially, PTSD diagnoses result after big ‘T’ trauma, events that anyone would consider extremely distressing. Combat and sexual violence certainly qualify, but so do major car accidents, plane crashes, and living through natural disasters.

Following Hurricane Sandy in 2012, for example, a study that screened residents along the New Jersey coast found that 14.5 percent of adults were likely suffering from PTSD six months after the hurricane hit.

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.

“I have PTSD from being in prison and the gang life,” Alan B. revealed to The Mighty. “When I was released from prison I was nearly murdered by the gang I was involved in. I have nightmares of that night still and it makes me paranoid. Although that lifestyle is not a part of my life anymore, it still haunts me.”

Witnessing Trauma

PTSD can also be caused by witnessing trauma happening to others, or learning a loved one has experienced a traumatic event. According to a World Health Organization survey of citizens in 21 countries, 10 percent of respondents reported witnessing violence (21.8 percent; the largest response in the survey) and trauma to a loved one (12.5 percent).

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 Times reported 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 2017 survey found 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 to The New York Times. “Where you proposed to your wife, where you remember getting the news that you got promoted, where your young children played.”

Even those who witnessed the graphic news coverage on television following the attacks were at risk for developing PTSD. The National Center for PTSD points to a study that found in the three to five days following 9/11, survey participants who reported watching the most TV showed “more substantial stress reactions than those who watched less.”

Big ‘T’ Versus Little ‘t’ Trauma

The causes above cover what the Diagnostic and Statistical Manual of Mental Health Disorders specifies 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 in Psychology 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 for Psych 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: flashbacks and 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 estimated 3.6 percent of the global population lives 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.

For example, we’re more susceptible when we’ve had a major trauma in the past. There may be a genetic predisposition to PTSD. Having limited social support following a stressful event also increases our risk for PTSD, as does experiencing multiple traumas at the same time. In time, how trauma is defined when diagnosing PTSD may change to incorporate a growing understanding of how we’re impacted by traumas large and small.

Seeking Help for PTSD

By expanding how we look at PTSD beyond just veterans and 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 told Everyday Health. “Seeking support is not something to be shameful for. It’s something that all humans need.”