I have lost track of the number of times a client has been surprised to hear the experience they shared with me qualifies as traumatic. Commonly a client will explain to me that they think something they went through is not a trauma because, “It’s not THAT bad.”
But, you, like them, may be surprised by the criteria that comprise a trauma. There are at least five different types of traumas: sexual, physical, emotional, neglect, and witnessing a traumatic event.In my experience, the latter three (emotional, neglect, and witnessing a trauma) are often the easiest for clients to overlook as traumatic. After all, sexual and physical traumas are external, concrete experiences that leave evidence. All traumas, though, are deserving of therapeutic interventions, discussion, and attention. To understand them better, let’s take a look at the difference between these types of traumas.
Two Ways to Define Trauma
‘Capital T’ Traumas
‘Capital T’ traumas are overt, extreme, and fit the common conception of a trauma. Natural disasters, diseases, physical, sexual harm, witnessing death, witnessing abuse, experiencing neglect – these experiences all fall into this category.
All of these ‘capital T’ trauma experiences are valid traumas. Those who have gone through such tragedies often suffer the effects in very visceral ways.
Bessel Van Der Kolk writes, “Dissociation is the essence of trauma. The overwhelming experience is split off and fragmented, so that the emotions, sounds, images, thoughts, and physical sensations related to the trauma take on a life of their own.”
When we experience a trauma, especially one of this caliber, our ability to organize confusing or terrifying experiences in our brain in a way that makes sense to us becomes compromised. Those terrifying experiences, ‘take on a life of their own’ and show up in the form of nightmares, flashbacks, and trigger responses.
Lowercase ‘t’ traumas (a.k.a., micro-traumas)
Let me begin this section by saying that a lowercase ‘t’ trauma is in no way less significant or harmful than a ‘capital T’ trauma. The use of capital and lowercase is simply to distinguish the obviousness that these types of traumas have.In many cases, lowercase ‘t’ traumas can actually be more harmful in the long term than ‘capital T’ traumas because they are internalized. Ask any domestic violence survivor what they find more upsetting from being abused by their spouse, and many of them will tell you the emotional harm they suffered had longer lasting impacts on their sense of worth and on their ability to recover than the physical harm done.
Anyone who is made to feel less than, who is ridiculed, manipulated, lied to, or shamed has experienced a lowercase ‘t’ trauma. These traumas are primarily identifiable by the psychological impact they have on us. Take a moment and think about the damage done to someone who has been told by their parents they’re ugly, or by a wife whose husband ignores or labels her loneliness as unworthy of attention. Being deprived of emotional nutrition is how I like to think of these traumas.
Let’s now talk about how the field of psychology defines trauma.
How Psychology Defines Trauma
If we look at the DSM-5’s diagnosis of Post-Traumatic Stress Disorder, we will find the extensive clinical definition of trauma.
A person has to meet specific criteria to qualify as someone suffering from PTSD, such as:
- A person must have directly been exposed to a trauma, witnessed it, learned that someone close to them was exposed to trauma, or have been indirectly exposed to details of a trauma.
- Persistent re-experiencing of the trauma that occurs in the form of nightmares, flashbacks, intrusive thoughts, etc.
- Avoidance of reminders.
- Negative thoughts or feelings began or worsened after the trauma occurred, such as feelings of isolation, difficulty experiencing positive affect, negative cognitions, inability to recall details of the trauma, and more.
- Trauma-related arousal and reactivity that began or worsened after the trauma occurred such as they are irritable or aggressive, hypervigilant, have difficulty concentrating, etc.
- These symptoms must have lasted for more than one month, create distress, and are not due to medication, substance use, or other illness.
While the DSM offers a quick glimpse at cues that someone might be re-living a trauma experience, I also like to turn to neuroscience in order to understand what exactly the brain is doing that makes an experience considered traumatic.
One of my favorite authors, Bessel van der kolk, writes in his book The Body Keeps the Score about how we should understand the complexity of trauma. Let’s take a look at his understanding of trauma.
How Our Brains Define Trauma
In the brain there are several specific areas that trauma affects. When we become exposed to something endangering or something that makes us fearful, or, something that makes us feel uncertainty even, part of our brain is activated to alert us to respond. Our survival is dependent upon these parts of the brain operating at a high function.
The amygdala is the brain’s emotional memory center. It sounds the alarm when danger is near. Bessel refers to it as “the brain’s smoke detector” because tells the hypothalamus and brain stem to respond to the smoke. These parts of the brain act like a fire alarm going off and “recruit the stress hormone system and the autonomic nervous system (ANS) to orchestrate a whole-body response.”
A typical example of this is when we place our hand over the flame of a fire and react immediately. Our automatic nervous system (ANS), because it causes us to ‘automatically’ respond (as the name indicates), prevents our hand from being burned. Before our brain can even process the thought ‘I need to pull my hand away,’ we are reacting to the intense heat sensation which our brain perceives is a threat.
Bessel validates this, saying that the amygdala “decides whether incoming information is a threat to our survival even before we are consciously aware of the danger.” If our brain had waited for us to understand what was happening before our hand drew back from the flame, we would have gotten burned.
Another example of this is when you are walking down a dark alley at night and can sense something feels off. You might feel like someone is following you. As a result, our body begins to emit stress hormones that will cause us to either fight, flight or freeze in order to survive.
In normal circumstances, our brain knows to secrete this hormone when it senses fear, and then as soon as the threat has gone away, the secretion will stop. Per Bessel, “your frontal lobes can restore your balance by helping you realize that you are responding to a false alarm and abort the stress response.”
But, in cases of trauma, the ‘smoke detector’ also known as the amygdala, continues to go off, telling the brain there is danger and to rally the troops to respond with a surge of cortisol — but this time, there really is no threat. Post-traumatic stress then, can be described as a false sensation that we should be afraid. This is why when someone says ‘I get triggered,’ what they mean is, their body literally is responding to a perceived threat.
How Bessel Defines Trauma
To summarize Bessel’s neuroscience findings, trauma can be defined or understood as one’s inability to regulate – when our brain is not experiencing a trauma, it can regulate itself. It can organize thoughts, feelings, and experiences into memories that can be accessed readily and un-alarmingly.
Regulation occurs in our brain and “involves strengthening the capacity of the watchtower [Bessel’s name for the prefrontal cortex], to monitor your body’s sensations.” When we are unable to see the big picture of something, (such as to have the time to emotionally process being robbed, or suddenly losing a loved one), these unforeseen circumstances lead to a reactive response that no longer have the ability to control or regulate. As Bessel writes, “the thalamus stirs all the input from our perceptions into a fully blended autobiographical soup, an integrated, coherent experience of ‘this is what is happening to me.’”
Above, Bessel looked primarily at the brain’s response to ‘capital T’ traumas (traumas that are sudden, life-altering, and extreme), but it is also important to note that lowercase ‘t’ traumas also affect our ability to self-regulate.
Examples of this include a young girl whose father tells her to stop crying when she is in distress, calls her names, body shames, and who rejects her feelings overtly on a daily basis. Her amygdala is probably not going to be reacting to these stressors in the same intense ways as someone’s would who had just witnessed a friend get shot, but her ability to self-regulate her emotions is still going to be compromised progressively.
Her frontal lobes, which are “the seat of empathy” as Bessel describes, will be under-developed due to not having been provided with an empathetic caregiver. This is huge because, Bessel writes, “if you have no internal sense of security, it is difficult to distinguish between safety and danger.” This means the less noticeable but still damaging effects that lowercase ‘t’ traumas have on the brain include developing inflexible frontal lobes, non-harmonious relationships, and lowered impulse control.
How to ‘Un-Define’ Trauma
Now that we’ve talked about all the ways trauma defines our lives (by disorganizing, de-regulating, and hijacking our cognitive abilities to respond calmly and rationally), the good news is that there are things that we can do to help us recover from traumas.
Bessel writes, “Trauma almost invariably involves not being seen, not being mirrored, and not being taken into account. Treatment needs to reactivate the capacity to safely mirror and be mirrored by others, but also to resist being hijacked by others’ negative emotions.”
Three Ways to Reduce Symptoms of Trauma
Three ways you can practice tackling your trauma symptoms both on your own and in therapy include practicing:
1. Mindfulness: “Being able to hover calmly and objectively over our thoughts, feelings ane emotions.”
All of these practices involve a reintegration of the emotional parts of the brain with the rationale and thinking parts of the brain. They involve slowing down our ability to process information enough to organize the feelings we have with the words we need to describe them.
The more we practice doing this, the less of a ‘life of their own’ our traumas take on. We begin to find words to talk about them, reclaiming them as a part of our life that was (we see now clearly) just very disruptive.
If you think someone has gone through a trauma . . .
Just because to you it might seem traumatic, never assume it was experienced as traumatic to the person who went through it. An example of this would be if your 4-year-old child was touched inappropriately by another child at daycare. Many parents, from an adult perspective, view this as sexual assault and can wonder if their child might now develop PTS symptoms.
Although this type of experience can objectively be labeled a trauma, developmentally it may not have been experienced as such to the child. It is important not to assume the impact that such an experience had on the child before taking the time to listen and understand what the child thinks about it.
If they are young, kids often might find that experience distressing, but also respond with resilience. Note: Please do not hear that as an invitation to minimize harm, simply an example of the complexity in defining traumas on behalf of others.
“Snow,” courtesy of Andre Chivinski, Flickr Creative Commons, Public Domain, “Pine tree,” courtesy of Jdmoar, Flickr Creative Commons, Public Domain; “Wet spiderweb,” courtesy of Дмитрий Проценко, Flickr Creative Commons, Public Domain;