An Integrated Approach to Young Adult Mental Health Rehab

Big T vs. Little t Trauma in Young Adults: Is There a Difference?

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Does trauma come in different sizes? In the mental health field, traumatic experiences are sometimes categorized as big T vs. little t trauma. The idea is that some traumatic events are more intense and severe than others. 

Regardless of how they are labeled, however, all types of trauma can have negative effects on young adults. Traumatic stress can catalyze PTSD, depression, anxiety, substance abuse, physical problems, and other mental health and co-occurring disorders. 

At Newport Institute, we don’t distinguish between big T and little t trauma. What matters is the impact the traumatic experience had on the individual and how it continues to affect their life. “It’s not what happened on the outside, it’s what happened on the inside,” says Barbara Nosal, PhD, LMFT, LADC, Newport’s Chief Clinical Officer. 

What Is Big T Trauma vs. Little t Trauma?

The main difference between big T and little t trauma, according to the standard definitions, is the event that catalyzed the traumatic response. Big T Trauma is generally related to a life-threatening event or situation. This could be a natural disaster, a violent crime, a school shooting, or a serious car accident. In addition, acute psychological traumas, such as the death of a parent, are part of the big T trauma definition. Chronic (ongoing) trauma, such as repeated abuse, can also qualify as big T trauma.

Little t trauma refers to events that typically don’t involve violence or disaster, but do create significant distress. For young adults, examples of small trauma might be a breakup, the death of a pet, losing a job, getting bullied, or being rejected by a friend group. While these incidents don’t threaten a young adult’s physical safety, they can produce the same trauma responses in adults and children as big T trauma does. In fact, there is now evidence that repeated exposure to little t trauma can cause more emotional harm than exposure to one big T traumatic event. 

Ultimately, any event or ongoing situation that causes distress, fear, and a sense of helplessness qualifies as trauma. And trauma can have serious mental, physical, and emotional impacts on young people, negatively influencing daily functioning and relationships. Traumatic stress is associated with a higher risk of suicide, as well as anxiety, depression, and co-occurring issues, including substance abuse and eating disorders.

Relational Trauma in Childhood: Big T or Little t Trauma?

Traumatic events that occur in early childhood are often referred to as Adverse Childhood Experiences (ACEs). One in every six adults experiences at least four ACEs, according to the CDC. These experiences can be particularly harmful, because they occur at such a vulnerable phase of growth. In early childhood, brain development and social-emotional growth are at a critical stage. Hence, the effects of trauma on children can carry over into adolescence and young adulthood. 

In addition to other acute and chronic traumas, relational trauma is a specific type of early childhood trauma. Relational trauma occurs when a child’s sense of being safe and loved within the family is disrupted. This may be a result of physical or emotional abandonment or neglect. For example, a parent or caregiver may be preoccupied with their own emotional needs, their partner’s needs, or the needs of a sibling. Hence, the child’s emotional—and sometimes physical—needs are not met. 

But relational trauma doesn’t necessarily involve abusive or neglectful parenting. “It can be just a few moments in which a child hears a criticism, or feels disappointed or unheard, and internalizes the idea that they can’t rely on their parents,” says Dr. Nosal. “It doesn’t really matter whether that experience of disconnection was objectively significant or not. What matters is how it was internalized by the child.”

So, is relational trauma small t trauma or big T trauma? Again, the big t/little T categories are not necessarily helpful or relevant. Trauma treatment needs to address each person’s individual experience, regardless of the catalyst. 

Know the Facts

Preventing childhood trauma could reduce the number of adults with depression by as much as 44%, according to the CDC.

Research on the Mental Health Effects of Big T and Little t Trauma

Research shows that trauma, whether big T and little t, can lead to a wide range of mental health challenges. Childhood trauma is a significant factor in both depression and anxiety. Furthermore, trauma in the form of abuse in childhood and adolescence often progresses to PTSD. In one study, 48 percent of the adult participants with PTSD had been victims of sexual abuse before the age of 18.

In addition, trauma and childhood trauma are often root causes of co-occurring behavioral disorders. For example, there is a strong association between traumatic childhood experiences and substance abuse. There is also a link between trauma and eating disorders. The vast majority of people with anorexia, bulimia, and binge-eating disorder report a history of interpersonal trauma.

How the Brain and Body React to Big T and Little t Trauma

The body and brain have a set of specific responses to traumatic experiences. These reactions are the body’s way of protecting us and preparing us to confront a threat. Experts often refer to these reactions as the “fight or flight” response or the “fight, flight, or freeze” response. However, trauma responses in adults and teens can have additional components as well, referred to as fright, flag, and faint. Here’s how each trauma response affects the body and brain:

  • Freeze: As the brain measures the extent of the threat, the senses heighten to expand awareness.
  • Flight: The muscles tense in preparation to flee if necessary.
  • Fight: Heart rate and respiratory function speed up, preparing the body to confront the danger.
  • Fright: Fear takes over in response to a sense of helplessness, reducing the ability to think clearly.
  • Flag: The body’s systems begin to shut down, resulting in a numbing of emotions.
  • Faint: In extreme cases, the body sometimes responds to trauma by fainting.

The reactions listed above, particularly the first three, might be useful or appropriate when an individual is facing a fire, a car accident, or a violent crime. However, our nervous systems can’t always distinguish between an actual threat to physical safety vs. an emotional threat. That’s why little t trauma can have a similar effect as large T trauma. Moreover, the nervous system of a trauma survivor may continue to react even when there is no immediate danger. This occurs because the brain and body have not yet found a way to process and let go of a traumatic event.

Symptoms of Young Adult Trauma

When the nervous system is constantly in fight-flight-freeze mode, both physical and mental health are negatively impacted. Therefore, symptoms of young adult trauma manifest on multiple levels. Some common symptoms of trauma responses in adults include the following:

  • Flashbacks
  • Confusion, difficulty focusing, and not being able to make decisions
  • Feeling nervous and overwhelmed in everyday situations
  • Having a hard time sleeping
  • Difficulty enjoying activities that were once pleasurable
  • Guilt and shame
  • Panic attacks
  • Irritability or aggression, sometimes escalating to rage and threats of physical violence
  • Nightmares and other night terrors
  • A sense of emotional numbness
  • Being always on edge
  • Depression and grief
  • Avoidance: staying away from people, places, or situations that trigger symptoms of trauma
  • Suicidal thoughts.

Without treatment, traumatic stress can progress into PTSD. For trauma to be considered PTSD, symptoms must last more than a month and be severe enough to interfere with daily functioning.

Treatment for Big T and Little t Trauma

The most effective way to help young adults heal from big T trauma or small t trauma is through a combination of evidence-based therapeutic modalities. Somatic approaches that involve the body as well as the mind, like yoga and EMDR, help the brain release traumatic memories and associations. In addition, they help restore balance to the nervous system.

Cognitive approaches are also proven to be effective for young adults dealing with big T or little t trauma. Trauma-focused Cognitive Behavioral Therapy helps young people build healthy coping skills and reframe trauma-related thoughts and beliefs. Dialectical Behavioral Therapy increases stress tolerance and emotional regulation skills. Together, these modalities provide a whole-person approach to healing from trauma.

Trauma-Informed Care at Newport Institute

Each young adult at Newport Institute has a tailored treatment plan that takes into account their history and specific needs, and includes a wide variety of modalities. While processing underlying trauma, young people also build self-esteem and trusting relationships with peers and mentors. Academic advancement and life skills training support young adults to move forward with their goals as they heal.

At Newport Institute, trauma-informed care doesn’t focus only on an individual’s difficult experiences. We also help young people to remember and grow their strengths, resilience, and joy. To find out more about our philosophy of care and our specialized approach to young adult treatment, contact us today.

Sources

J Affective Disord. 2021 Mar; 283: 179–191.

Volume 283, 15 March 2021, Pages 179-191

Eur J Psychotraumatol. 2018; 9(1): 1510279

Australian & New Zealand J Psych. 2014; 48(6): 564–570.

Int J Eat Disord. 2012 Apr;45(3):307-15. 

Depress Anxiety. 2010 Dec; 27(12): 1077–1086.

J Child Sex Abus. 2010 Mar; 19(2): 156–170.

Mental Health / June 17, 2022

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