Trauma Talk is a Q & A about all things trauma related. Emily Healy answers your questions. You can submit your questions here. The views communicated within the column do not necessarily reflect the views of the Observer staff.
What are common types of trauma?
One way that a lot of people think about trauma is naming both “Big T” and “little t” traumas. While this isn’t a clinical framework, it is a useful way of conceptualizing trauma. The “Big T” traumas include significant events like sexual abuse, getting in a serious accident, being victimized in a crime, or natural disasters. We can also experience “little t” traumas, which can include verbal abuse, betrayal, insufficient protection or support when we needed it most, or being controlled by someone else. While “little t” traumas may not be immediately life-threatening, studies in behavioral science are increasingly showing that the “little t” traumas can be just as impactful as the “Big T” traumas in our lives.
Some researchers, such as Harvard psychiatrist Judith Herman, are taking the trauma conversation one step further. In her book Trauma and Recovery first published in 1992, Herman proposed the groundbreaking expansion of post-traumatic stress disorder (PTSD) to include complex trauma, and contributed significantly to development of the term “complex PTSD” (CPTSD). CPTSD results from prolonged, repeated exposure to traumas over the course of a childhood or lifetime. Herman emphasizes that rather than emerging from a serious single-incident event, CPTSD can take place when your safety or sense of self has been damaged over a period of time. This is the kind of damage that happens in childhoods marked by a lack of parental attunement, in emotionally abusive relationships, or even in societies that deny us access to our humanity and systemically devalue our lives.
In 2018, the World Health Organization (WHO) finally included CPTSD in its most recent update to the International Classification of Diseases, the ICD-11. This was a revolutionary inclusion, because it was the first time in history that any medical diagnostic manual recognized complex trauma in this way. There had been hopes in the trauma community for the inclusion of CPTSD for use by mental health practitioners in the United States. However, when the American manual, the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V-TR) was updated in 2022, CPTSD was not included. This is devastating for the countless people who continue to suffer from trauma without formal recognition of the impact of their suffering. This recognition is important, because rather than problematizing how people react after trauma, it would help to reframe these very reactions as ones that protect survivors from a world that can be hostile to their experiences.
While not all clinicians may use the terms “Big T” or “little t” to describe trauma, these terms can be a helpful entry point to start a conversation about how trauma can encompass a wide range of experiences. In other words, just because an event does not involve a violent act or catastrophic event doesn’t mean it isn’t traumatic. I hope this helps to dispel the myths that someone’s experiences have to be bad enough to qualify as trauma. Trauma comes in a variety of forms, and all trauma is valid.
What are some of the symptoms of trauma?
While not all people exposed to trauma develop symptoms, trauma symptomatology is a complex topic, because trauma responses can surface in so many different ways. Whether or how a person experiences trauma depends on the individual, what happened to them, their previous experiences, and whether or not they received adequate support in the aftermath. Many trauma scholars distinguish between adversity (the harmful events which happen to us), stress (the physiological responses we experience), and trauma (the lasting wounds that persist long after an event is over). Trauma is subjective, and your personal experiences matter significantly.
One way trauma can surface is the recurrence of disturbing or distressing memories. Sometimes these occur in nightmares, and at other times, they may take place in flashbacks. For some people, flashbacks involve seeing images, hearing sounds, or even remembering smells from a past experience. In such cases, these are not signs that a person has lost touch with reality. Rather, they show that trauma symptoms can be so real that they are viscerally felt. Some scholars are increasingly identifying emotional flashbacks, which are states of emotional flooding that seem disproportionate to your present circumstances. These often take place due to older wounds, and can be particularly disorienting because they may not always have a clear narrative memory attached to them.
Many trauma symptoms are experienced in a somatic way, which comes from the Greek word “soma” meaning “body.” Some people actually experience numbing after trauma, meaning that it can be more difficult for them to accurately sense whether they feel tired, hungry, or in pain. In dissociative responses, these symptoms are actually adaptations, and may include a decreased sense of bodily presence, sensations, or even memories. This can actually help a person to survive an ongoing threat because the body cannot sustain an intense trauma response indefinitely. Other symptoms of trauma reactivation may include trembling, shaking, heightened startle responses, or panic-like symptoms such as a rapid heart rate and shallow breathing. When the body encodes trauma over an extended period of time, it can result in additional physiological symptoms that may appear unrelated to the original trauma, and may eventually develop into long-term health problems.
Reading this article, I’m sure many of us are asking ourselves this important question: Have I experienced trauma? While only you can answer that question, hopefully with the support of a trauma-trained professional, know that your own increased awareness is often the key to understanding your experiences. Trauma is about impact, rather than the intensity of the event itself. Many people often don’t recognize their symptoms as trauma-related. This is due in large part to the fact that trauma behaves differently from other medical presentations, can be incorrectly misattributed to a variety of problems, and perhaps most importantly, because we are not yet a trauma-literate culture. I encourage you to ask, and to keep asking, because asking hard questions is one of the most powerful acts of self-love we can ever do.
Emily K. Healy is a tenured instructor of sociology who brings both compassion and her expertise in trauma to the campus community. Healy holds multiple professional certifications, specializing in traumatic grief and advocacy for survivors of domestic violence and sexual assault. As a spiritual care provider and training chaplain, Healy’s philosophy is rooted in empathic witness for each individual’s story. Her approach to trauma-informed care believes that people are not pathologies, centering consent, harm reduction, and honoring that healing is among the hardest work we will ever be called to do.
