Some have started to use the terms “Big T” vs “little t” to describe traumatic stress reactions like PTSD vs legitimate difficult stressors that do not involve threat of physical harm (e.g., breakups, losing a job). However, trauma researchers and major treating organizations (e.g., veterans institutions) that drive our understanding of trauma have purposefully not used this distinction.
Everyone agrees that things like breakups, job loss, and other valid stressors are very difficult and important topics for therapy. We all welcome clients and participants with open arms to explore, validate, and help with these! Heck, we have all worked so hard to be in that helping role.
Calling something that is very stressful a form of “trauma” (e.g., a “little t”) may be appealing to help a client label how difficult an experience was. But the reasons that researchers and professional organizations do not use “Big T” and “little-t” is a question of kind (vs degree). Big and little implies differing degrees of the same experience. However, major stressors like job loss and breakups do not bring about many of the same psychological experiences as events that threaten physical health or basic survival do. So they are much different experiences in kind, whether or not they are different in intensity.
A good analogy is the difference between strep throat vs the common cold. Strep occurs because of a bacterial infection while the common cold occurs due to a viral infection. They may have some symptoms that are different and some that are similar (especially sore throat and cough). However, doctors do not refer to the sore throat and cough from a common cold as “little strep”.
This difference in kind has importance for “discriminant validity”. This type of validity is conceptual and does not refer to how emotionally valid an individual’s experience is. Discriminant validity refers to what an experience or phenomenon we describe really is and is not in the world. For example, major depression involves it’s own key symptoms, but it is not the same as experiencing borderline personality disorder.
Trauma and PTSD have been found to involve very specific symptoms that increase fight or flight reactions to boost our survival potential (but have major distressing downsides). They occur in response to an event(s) involving physical threat to self or others. This is why DSM has that required Criterion A1 in place. These are not the same experiences as depression, anxiety, grief, or valid high stress occuring from non-physically threatening events.
Discerning these differences in kind greatly informs our understanding of the different underlying causes of an experience. It also improves how we assess and identify it in therapy, and how effective our different therapy approaches will be.
For instance, evidence shows prolonged exposure is extremely effective for trauma and PTSD. However, evidence does not show the same for nontraumatic loss or breakups. In fact, recent evidence has found that purposely reliving or “processing” a grieved loss can actually make things worse.
If any valid experience (e.g., stress, depression, anxiety, or grief) can be called a form of trauma, then we lose effectiveness in how we best understand and help clients who come to us in need. Precision makes us more “on point” as clinicians to be ready and open to help with any difficult client experience!
