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What is Trauma?

By Dr. Patty Williams on January 24, 2024

Bright Insight Support Network founder and president Dr. Patty Williams is a trauma therapist and coach who specializes in EMDR, ND-Affirmative DBT, and IFS modalities. Through Bright Insight she works to counsel, coach, and advocate for gifted, twice-exceptional, and neurodivergent persons, along with other marginalized populations.



What is Trauma?


Trauma, a powerful and far-reaching force, casts a profound shadow over the human experience. By delving into its depths and exploring the intricate nature of trauma, its various forms, and the imprint it can leave on individuals, I seek to illuminate the complex ways in which trauma shapes lives, disrupts emotional well-being, and impacts development. Through this exploration, I aim to foster a deeper comprehension of the multifaceted nature of trauma, laying the groundwork for previous and subsequent posts about the intersection of giftedness and trauma as discussed more thoroughly in my book Intersection of Intensity: Exploring Giftedness and Trauma (released Fall 2024).


 

Trauma is a common enough term, used in everyday conversation. Calling something traumatic allows us to express intensity such that a person may readily recognize the severity of a situation. What exactly is trauma though? How do we define this term? How do we apply an understanding of trauma in our daily lives?

 

There are different types of trauma and different ways to define it. According to the American Psychiatric Association (2013) fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), to receive a post-traumatic stress disorder diagnosis, for example, a person must have a history of “exposure to actual or threatened death, serious injury, or sexual violence” (p.271). However, according to the Center for Health Care Strategies’ (2021) Trauma-Informed Care Implementation Resource Center, trauma can result from exposure to a single incident or series of events and can be identified as “emotionally disturbing or life-threatening.” And while not all emotional events are considered traumatic, it is suggested by this resource that significant trauma can impact a person’s mental, physical, social, emotional, and spiritual functioning and well-being. 

 

Historically, society and the medical profession associated PTSD with soldiers or persons in war-torn communities, later extending the application and understanding of trauma and its impact on first responders and victims of violent crime. However, per the Trauma-Informed Care Implementation Resource Center, other traumatic experiences may include abuse, childhood neglect, having a family member with mental health or substance use disorders, ambiguous separation from loved ones, poverty, racism, discrimination, oppression, community violence, or terrorism. Additionally, according to the International Society for Traumatic Stress Studies (2023), other types of traumas include medical trauma, firearm violence, grief and bereavement (particularly in children and adolescents), refugee trauma, climate change trauma, pandemic (COVID-19) trauma, and traumatic stress related to substance use. 

 


Why We Worry about Trauma

 

However it is defined, one thing trauma experts and researchers maintain is that exposure to trauma can result in a host of different mental health and medical conditions (Center for Health Care Strategies, 2021; Felitti et al. 1998). Additionally, regardless of a person’s motivations and development, trauma can impact their sense of well-being. In relation to Maslow’s (1943) hierarchy of needs for example, displayed below, a person could be at a level such that they have physiological, health and safety, and belongingness needs met and are therefore motivated mostly by securing self-esteem. However, significant trauma can cause a person to descend to lower-level motivations to meet lower-level needs when they are seemingly placed at risk. For example, if a person with a strong sense of belongingness was in a destructive earthquake that destroyed their home, they may be motivated rather, by a drive to secure housing, food, health, and safety rather than working on their self-esteem. 

 

Maslow’s Hierarchy & Trauma



So, any trauma, at any point in a person’s life can disrupt how they think, feel, and behave. When trauma happens during development, it can have additional, unfavorable impacts. Specifically, per the hallmark ACEs Study, researchers Felitti et al. found a correlation between the number of adverse childhood experiences a person had, identified as their ACE score, and negative mental and physical health outcomes. That is, the higher a person’s ACE score, the higher the likelihood of certain conditions such as anxiety, depression, suicidality, PTSD, substance use, sexually transmitted disease, COPD, and relationship distress. 

 

Indeed, as a trauma therapist and individual who also assists clients with chronic health conditions, I never met a person with fibromyalgia or temporomandibular joint (TMJ) disorders who did not also have a significant trauma history. Particularly, those who seemed to hold trauma in their bodies had generally experienced developmental or complex trauma, types of trauma profiles that I also explore in the book, Intersection of Intensity.

 

In addition to identifying ACE scores, it is beneficial to understand how trauma impacts minorities and marginalized populations. Some of this can understandably be related to the identified presence of racial and historical traumas experienced by minorities. However, as documented by the American Psychiatric Association (2023), gender, sexual, racial, and ethnic minorities often endure poor mental health outcomes for a variety of reasons including issues with access to quality mental health care, cultural and social stigmas surrounding mental health support, discrimination and oppression, and a lack of awareness about mental health needs and resources. 

 

Persons with disabilities have also endured a lack of support in society. According to Thomas-Skaf and Jenney (2021) in their publication about remaining trauma-informed while engaging children with disabilities, it was identified that individuals with a divergent ability profile experience trauma differently than those without disabilities. Additionally, while it was recognized how trauma may result in impairment for disabled persons, it was mostly seen in the research findings that those with disabilities are more likely to be exposed to trauma in the form of mistreatment, vulnerability, social stigmas, and discrimination. 

 

When we consider gifted and neurodivergent persons as also a minority group, it allows us to wonder if there has been a lack of attention and resources offered to them as well. Certainly, gifted, twice-exceptional, and neurodivergent peoples have not had their needs fully catered to, such as with any marginalized or misunderstood population. The goodness of fit mismatch between population needs and environments is also further discussed in Intersection of Intensity. For this blog post, however, it is helpful to simply ponder this possibility as we consider different types of trauma that people endure. 

 


Types of Trauma

 

As attended to earlier, there are different types of trauma as understood by those who work to be trauma-informed, such as educators, therapists, community volunteers, and first responders. For this post, we will consider three types of trauma: big T trauma, little t trauma, and complex trauma. It should be noted that there is not one trauma that is worse than another and they are not hierarchical in nature. Rather, the terms big, little, and complex, are used to help us conceptualize different occurrences and phenomena. The concepts of big and little traumas I use here are adapted from Dr. Francine Shapiro’s primary 2001 text about Eye Movement Desensitization and Reprocessing (EMDR) therapy, used to process trauma (Shapiro & Maxfield, 2002). 

 

According to Shapiro, big T traumas are events that are immediately intensive and more singular in nature. For example, war, school shootings, a serious car crash, an injury or attack, being involved in a natural disaster, or experiencing a major loss/death… these are big T traumas. Big T trauma is often associated with soldiers, victims of violent crime, and those who endured a single event or clustering of events, and they are also most associated with a traditional PTSD diagnosis per the DSM-V. However, any person can experience a big T trauma at any time, and some individuals may be at higher risk of doing so.

 

Little t traumas are those that can be grouped under the umbrella of adversity though they are not lesser in any way. According to Shapiro, little t trauma refers more to undesirable life experiences such as chronic criticism, shaming, neglect of emotions or physiological needs, lasting health impairments, frequent discrimination and oppressive actions, chronic harassment or bullying, and so on. Dr. Maggie Crastnopol (2015) refers to some of these experiences as resulting in cumulative relational trauma and seemingly minor, inconspicuous psychic wounds that are collected gradually, eroding an individual's self-esteem, distorting their character, and compromising their ability to connect with others. Often, we also refer to little t trauma in childhood as developmental or complex trauma. Developmental trauma according to Abrams (2021) in their American Psychological Association publication, refers to disruptions in development resulting from ongoing trauma during childhood. This trauma is typically classified as little t trauma and typically occurs in the context of relationships. 

 

Complex trauma is often identified as a mix of both big T and little t trauma or different types and combinations of little t trauma, resulting in a complex developmental profile and trauma history. When treating complex trauma with EMDR, I will generally identify developmental trauma with clients that then impacts how more recent big T or little t traumas are affecting them. For example, if a client is enduring workplace harassment and is struggling to set boundaries or assert themselves, it may be because of the impact of earlier, developmental traumas in their childhood home where they learned to avoid conflict as a means of survival. Here, the complexity of developmental trauma impacts current behavior and little t experiences. Any mixture of trauma that adds to the complexity of one’s psychological profile can result in complex trauma and therefore complex post-traumatic stress disorder (cPTSD). 

 

Types of Trauma


 

Developmental trauma disorder (DTD) and complex post-traumatic stress disorder (cPTSD) diagnoses are not in the fifth edition of the DSM. However, as per Abrams, the World Health Organization added cPTSD to the International Statistical Classification of Diseases and Related Health Problems (ICD-11) in 2019. And while professionals such as psychologist Joseph Spinazzola, Ph.D., trauma psychiatrist Bessel van der Kolk, MD, and clinical psychologist Julian Ford, Ph.D., ABPP championed the inclusion of DTD in the DSM, it was identified in 2011 as lacking evidential support. In the past decade and beyond, however, these professionals and others have amassed substantial scientific evidence about the occurrence of DTD, further supporting the knowledge of how trauma accounts for developmental disruptions. 


It is my hope that we continue discussing trauma such that we can become more trauma-informed as we interact with others. Being trauma-informed and reducing bias in general, stands to help us bridge communication and experiential gaps such that we might show greater compassion for others while fostering deeper understanding and support for those who need it most.



PS... all of us need it MOST

 

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Feb 12

This is awesomely insightful. Thank you Dr. Patty for the work you do.

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