Different Types of Trauma: Small “t” vs. Large “T” Trauma

There are Different Kinds of Trauma to be Aware of

Most people know that trauma arises from disturbing and sometimes unanticipated life events.  The most disturbing forms of trauma, also known as large “T,” involve life- or bodily-threatening events like war, natural disasters, or sexual abuse, and fall into the rubric of PTSD (post-traumatic stress disorder) trauma as defined by the DSM-5.

By contrast, small “t” trauma includes stressful events that are not quite as pronounced.  Small t trauma often includes incidents of conflict that arise with family members.

What may be surprising is that even events that are thought of in happy terms, like giving birth, can be traumatic.  Birth is an emotional event and can be perceived as having gone “wrong,” despite the fact that it may have been a perfectly normal birth.  It is vital for people to realize that experiencing trauma of any type is not a form of weakness. A person’s beliefs, values, and levels of stress tolerance affect how they deal with trauma.

Small “t” trauma

Small “t” events can be described as dramatic, but less pronounced than cataclysmic large t events. Small t events include:

  • Divorce
  • Infidelity
  • Legal trouble
  • Conflicts with a spouse or one’s children
  • Financial worries

While not necessarily life-threatening, small “t” events often induce distress and a feeling of helplessness.  While they do not typically trigger symptoms associated with PTSD, it is still possible for someone to have an accumulation of small t stressors that eventually bring about trauma response symptoms.  Since small “t” events are fairly common, people often avoid dealing with them directly, and on occasion even mental health practitioners can overlook these lesser incidences of trauma.

Large “T” trauma

A single large “T” event is often enough to cause severe distress and interfere with a person’s daily functioning.  After experiencing a large “T” event, a person often engages in avoidance behaviors, including avoiding crowds, burying or hiding items that can trigger a recapitulation of the trauma-inducing event, and avoiding phone calls.  The scope and severity of avoidance behaviors are one key element that distinguishes small “t” and large “T” trauma.

Ignoring Symptoms of Either Small “t” or Large “T” Trauma is Dangerous

It is however important to note that avoidant behavior is never a solution for trauma of any type, and that the manifestation of trauma should be addressed by an individual approach to restoring wellness.

Amanda Itzkoff, MD offers treatments which may be effective for alleviating symptoms of large “T” and small “t” trauma PTSD including psychotherapy, pharmacology as well as innovative treatments like ketamine therapy. Amanda Itzoff, MD also specializes in reproductive psychiatry.

For general information, please feel free to email our office at Amanda.Itzkoff@gmail.com. To schedule an appointment, call our offices at 917-609-4990.

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