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Big “T” and Little “t” trauma

Most people associate trauma with harrowing events like war or a natural disaster. However, any distressing event that falls beyond the scope of normal human experience can be considered traumatic. Individuals who have experienced trauma are at a much higher risk of developing addiction and substance use disorders, so it is important to understand the overall health implications.


There are two main categories of trauma commonly referred to as Big “T” and little “t.” Big “T” traumas are the events most commonly associated with post-traumatic stress disorder (PTSD) including serious injury, sexual violence, or life-threatening experiences. Threats of serious physical injury, death, or sexual violence can cause intense trauma even if the person is never physically harmed. Witnesses to big “T” events or people living and working in close proximity to trauma survivors are also vulnerable to PTSD, especially those who encounter emotional shock on a regular basis like paramedics, therapists, and police officers.

Little “t” traumas are highly distressing events that affect individuals on a personal level, but don’t fall into the big “T” category. Examples of little “t” trauma include non-life-threatening injuries, emotional abuse, death of a pet, bullying or harassment, and loss of significant relationships. People have unique capacities to handle stress, referred to as resilience, which impacts their ability to cope with trauma. What is highly distressing to one person may not cause the same emotional response in someone else, so the key to understanding little “t” trauma is to examine how it affects the individual rather than focusing on the event itself.

Although little “t” traumas may not meet the criteria for a PTSD diagnosis, these events can be extremely upsetting and cause significant emotional damage, particularly if an individual experiences more than one event or if these traumas occur during important periods of brain development like early childhood and adolescence. Evidence now concludes that repeated exposure to little “t” traumas can cause more emotional harm than exposure to a single big “T” traumatic event. Empathy and acceptance for the impact of little “t” traumas can be harder to garner because of the common misconception that these events are less significant than life-threatening emergencies. Minimizing the impact of these little “t” incidents can create adverse coping behaviors such as bottling up emotions or attempting to manage symptoms without support. Failing to address the emotional suffering of any traumatic event may lead to cumulative damage over time.

Research shows that all forms of trauma have a strong correlation to substance abuse. Studies of adolescents in treatment for addiction demonstrate that over 70% cite histories of trauma exposure. Teens who have been sexually abused or assaulted are three times more likely to abuse substances than their peers. Hence, trauma, particularly early in life, is a clear risk factor for addiction.

One possible reason for the link between emotional suffering and addiction is that individuals with untreated trauma tend to bear a multitude of triggers for substance use. Emotional triggers can easily develop into addictive cravings. In the wake of trauma, people’s minds and bodies attempt to protect themselves from future harm by going into “fight or flight” mode resulting in symptoms like anxiety, flashbacks, dissociation, and panic attacks. To cope with the distressing symptoms of trauma, people may self-medicate, numbing their emotional pain with drugs and alcohol. Because addiction stems from the frequency and scope of substance use, there is a correlation between the severity of a trauma survivors’ symptoms and their corresponding levels of desire to numb their collective discomfort.

Individuals with trauma histories are more likely to require professional help and long-term support to overcome their addictions. Treatment centers that focus on dual diagnosis are recommended since treating addiction without addressing underlying trauma leaves clients ill-equipped to manage trauma symptoms on their own and can set the stage for relapse. Treatment and counseling aimed at overcoming trauma and addiction concurrently provides patients with the tools they need to address the serious effects of both big “T” and little “t” trauma.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051362/

http://www.nctsn.org/sites/default/files/assets/pdfs/SAToolkit_1.pdf

http://blogs.psychcentral.com/after-trauma/2014/02/the-big-deal-with-little-t-traumas/