What is trauma?

Trauma is often misunderstood. Many people think of trauma only as major catastrophic events: war, serious accidents, assault. While these certainly can cause trauma, this narrow definition misses much of what trauma actually is.

‘Trauma is not what happens to you, but what happens inside you.’

— Gabor Maté, The Myth of Normal

A broader definition

Trauma is the lasting impact on your nervous system of experiences that overwhelmed your capacity to cope.

It occurs when:

• Something happens that is too much, too fast, or too intense for your system to process
• Your survival responses are activated but cannot complete
• You are left in a state of ongoing nervous system dysregulation
• The experience remains ‘undigested’ in your body

Key insight

Trauma is not defined by the event itself, but by the impact on your system. The same event might be traumatic for one person and not for another, depending on many factors including resilience, support, previous experiences, and nervous system capacity.

‘Big-T’ and ‘small-t’ trauma

You may come across practitioners who distinguish between ‘big-T’ trauma (events most people would recognise as traumatic, like assault or accidents) and ‘small-t’ trauma (events that might not be recognised as traumatic but still overwhelm your capacity, like humiliation, being chronically misunderstood, or seemingly minor but repeated stressors).

We don’t find this distinction useful. Your nervous system doesn’t care about labels. It doesn’t distinguish based on whether others would validate your experience as ‘traumatic enough’. What matters is the impact on your system, not how the event would be classified by others. There’s no hierarchy of suffering worth respecting here.

Types of trauma

There are several ways trauma can occur, each with different characteristics. If you’re curious, expand the sections below to learn more.

Type	Description
Acute	Single distressing event (accident, assault, sudden loss)
Chronic	Repeated or prolonged exposure (ongoing violence, bullying)
Collective	Experienced by groups or across generations
Developmental	Occurs during development, often with caregivers
Medical	From medical experiences and procedures
Vicarious	From witnessing others’ trauma

Acute trauma

Results from a single distressing event: car accident, natural disaster, assault, medical emergency, or sudden loss.

What it looks like

• Has a clear beginning and end
• Often comes with clear memories of the event
• Symptoms may show up immediately or be delayed
• Can often be processed with appropriate support

Chronic trauma

Results from repeated or prolonged exposure: ongoing domestic violence, living in conflict zones, repeated medical procedures, extended bullying, or chronic neglect.

What it looks like

• Builds up over time
• May create lasting changes in how your nervous system operates
• Can lead to expecting future threat
• Often needs a longer healing process

Collective and historical trauma

Experienced by groups, communities, or across generations: genocide, slavery and its aftermath, colonisation, war affecting entire populations, or natural disasters affecting communities.

Trauma can be passed through generations via parenting patterns, family beliefs, and possibly epigenetic mechanisms. Children of trauma survivors may carry impacts even without direct exposure.

Developmental trauma

Occurs during critical developmental periods, often in relationships with caregivers: childhood abuse (physical, sexual, and/or emotional), neglect, witnessing domestic violence, or repeated abandonments.

What it looks like

• Affects your core sense of self and how you relate to others
• Shapes how your nervous system develops
• May not come with clear traumatic memories
• Often involves both what happened (abuse) and what didn’t happen (lack of attunement)
• Typically needs long-term, relationship-based healing

When complex trauma leads to specific symptom patterns, it may be diagnosed as Complex PTSD (C-PTSD), which includes not only PTSD symptoms but also difficulties with emotion regulation, self-concept, and relationships.

Medical trauma

Results from medical experiences: painful or frightening procedures (especially in childhood), life-threatening illness, surgery (especially emergency), birth trauma, or being restrained for medical procedures.

Why medical settings can be traumatic

• Loss of control
• Pain without ability to escape
• Being held down (which activates survival responses)
• Violation of body boundaries

These can all create trauma, even when medically necessary.

Vicarious or secondary trauma

Results from witnessing or learning about traumatic events happening to others.

Who it affects

• Healthcare workers
• First responders
• Therapists working with trauma
• Journalists covering traumatic events
• Family members of trauma survivors