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Not all trauma is the same

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Trauma has undoubtedly become one of the most frequently discussed concepts in mental health in recent years. As we talk about trauma in this way, it may seem as if trauma is a single entity. Perhaps it would be much easier if that were the case. If only trauma were something we could point to, healing might feel more contained, more straightforward. But trauma does not live in just one place. It shows itself in the memory, in the nervous system, in the stories we tell about ourselves. And because it does not reside in a single presentation, it does not take a single form. 

In that sense, the inner world is not so different from the body. The ways we are hurt psychologically are as varied as the ways we are hurt physically. Trauma can be a hit we receive from a single event, or it can be a pattern that spreads over a long period of time in our lives, becoming chronic. Perhaps it is like a complex web for some of us. Or, it has taken shape within a relationship or within a family. Maybe the traumatic event did not even happen directly to us, but we witnessed it happening to others. 

The types of trauma here are not official diagnoses in themselves. Most of the time, the mental health issues we experience or the difficulties in our lives do not occur in isolation. We often face hardships in intertwined ways, and our psychological responses are diverse and complex. Similarly, a traumatic experience can be defined by more than one of the qualities described here. Rather than providing a list of diagnoses, this therapy sketch aims to communicate certain aspects of our inner world and the challenges we face, and to offer more precise language for them, in the hope that it may guide us toward finding the help we need in our healing process. In this therapy sketch, we will explore the forms of trauma we might be referring to when we say “trauma.”

Trauma can come from a single event or happen repeatedly

Many diagnostic manuals try to define trauma by looking at both the characteristics of the traumatic event and how you respond to it. In simple terms, trauma can feel like a sudden surge of intense emotions and stress responses, such as denial, anger, shock, helplessness, fear, or a sense of losing control, after a catastrophic event. But our reactions to these events, including how they show up, how long they last, whether they turn into longer-term stress, or whether things gradually improve, can vary from person to person.

The events that trigger trauma can also vary widely. You might experience trauma from a single event, like a car accident, assault, natural disaster, a serious threat to your life, or the loss of someone you love. But trauma can also come from repeated or ongoing experiences. If you’ve faced abuse, neglect, or domestic violence over time, these situations can create lasting effects. Similarly, reactions to traumatic events may also unfold over time. You might feel intense emotions right after a traumatic event that gradually ease, or, in some cases, your responses may persist and become chronic, whether the trauma came from a single event or ongoing experiences.

From this perspective, trauma can be classified as acute or chronic based on whether the traumatic event is a single, discrete episode or a series of traumatic events spread over a long period, and whether our response to the traumatic event is experienced and resolved in a short episode or spread over a long period. When we look at the literature on this subject, researchers or clinicians may be referring to the distinction between single and multiple sources of the event when they say a trauma is acute or chronic, or to whether our response to it was acute or chronic.

Acute stress disorder and posttraumatic stress disorder (PTSD), as described in manuals like the DSM-5 (APA, 2022), capture this difference between acute and chronic trauma. If you’ve experienced a traumatic event, you might notice symptoms such as intrusive memories or flashbacks, a negative mood, trouble feeling positive emotions, dissociation, avoidance, or changes in your alertness, such as being easily startled, feeling irritable or angry, or having sleep and attention problems. These symptoms can interfere with your daily life. According to DSM-5, if they last less than a month, they might be considered acute stress disorder, reflecting the acute reaction. If they persist beyond a month, they may be part of PTSD, showing a more chronic pattern.

In addition to its acute vs. chronic nature, some researchers and clinicians also distinguish trauma that is prolonged and cumulative, especially during childhood or adolescence, which can have strong and lasting effects. If you grew up or spent your youth in situations where harm was repeated and ongoing, especially within close and intimate relationships, you may have experienced what researchers call complex trauma (Courtois, 2008). This type of trauma often comes from people you trusted, like caregivers or authority figures, and can involve repeated betrayal, loss, or disruption in important relationships. You may feel trapped, powerless, or unable to escape these experiences, and the effects can run deep and last a lifetime.

The need to define complex trauma goes hand in hand with the observation that the impact of repeated, interpersonal trauma often goes beyond conditions like PTSD and can cause significant changes in your personality. For example, complex posttraumatic stress disorder (cPTSD) has been proposed to describe cases where, in addition to common PTSD symptoms, you may experience disruptions in your self-concept (such as your beliefs about yourself), difficulties in forming and maintaining relationships, and problems with emotional regulation (Herman, 1992; Cloitre et al., 2014). Although the American Psychiatric Association’s DSM-5 does not formally recognize cPTSD as a separate diagnosis, the WHO’s International Classification of Diseases (ICD-11; WHO, 2022) includes cPTSD as a variant of PTSD with these additional symptoms.

Trauma, Context, and Relationships

The distinction between acute and chronic describes the duration and repetition of trauma, which defines the temporal characteristics of exposure. However, duration alone is not enough to understand the impact of trauma. Trauma is often defined by the context in which it occurred. Research increasingly shows that trauma is not just an event, but an experience shaped by context (culture, power, inequality) and lived within relationships, both those that cause harm and those that help healing (Vallières et al., 2021).

Context

What is considered ‘traumatic’ is not fixed or universal; it varies across cultures, life stages, and social circumstances. What may be considered ordinary or tolerable in one society may cause a profound loss of trust and trauma in another context. The impact of neglect in childhood is not the same as a similar experience in adulthood, because developmental needs and vulnerabilities are different. Similarly, conditions such as war, persistent violence, poverty, or discrimination may not be dramatic one-off events, but can function as chronic trauma, producing a constant sense of threat and uncertainty. Such structural and ongoing stressors can affect the nervous system over the long term and have traumatic consequences even without a single event. That is why definitions of trauma based solely on extreme and singular events (for example, accidents or natural disasters) can miss a significant part of the traumatic impact. Of course, trauma based solely on extreme and singular events also has profound and lasting effects. However, even in these singular events, ignoring the context will prevent us from seeing the whole picture (Vallières et al., 2021; Herzog, 2024).

For example, a traffic accident is commonly conceptualized as an acute traumatic event (Dai et al., 2018). However, the lack of justice or prolonged uncertainty may increase the traumatic burden. In this case, the person begins to carry not only the accident but also the experience of injustice and insecurity. Trauma ceases to be a singular event, but it can become a source of ongoing stress at the relationship and system level.

Relationships

The duration, repetition, and context help us understand what happened, yet are still insufficient to capture its complexity. The impact of trauma is also shaped by the individual’s relational world and their capacity to regulate overwhelming internal states, which can be protective or harmful (Zurbriggen et al.,2012; Daniels et al., 2021).

Trauma in Relationships

When trauma is experienced in close relationships (such as abuse, neglect, or betrayal), it brings many adverse emotions and effects, and also damages the feeling of trust in the long term. At this point, trauma is no longer just an event, but an experience embedded in a relationship system. In the literature, such traumatic experiences are addressed with different terminology. 

  • Interpersonal Trauma: If a traumatic event(s) experienced within close relationships is defined as interpersonal trauma. Being physically or emotionally abused by a partner can be an example of interpersonal trauma (Kouvelis et al., 2021).
  • Developmental Trauma: If these experiences occur repeatedly during the developmental period, especially in childhood, and affect self-regulation, self-perception, and relationship-building capacity, they are considered within the framework of developmental trauma. For example, being bullied for a prolonged period of time and afterwards experiencing difficulties in emotion regulation and self-development (Cruz et al., 2022).
  • Attachment trauma: If the trauma occurs directly within the attachment figure or leads to the disruption of the secure attachment, this is conceptualized as attachment trauma. For example, if the caregiver is emotionally unavailable or unpredictable, the child may struggle to develop a stable sense of safety and trust (Ford, 2025).

Protective effect of relationships

While the relationships can be a source of trauma, they are great healing sources as well (Daniels et al., 2021). Let’s explain this with examples:

Two children may be exposed to peer bullying at the same school. The location, duration, and nature of the incident may be similar. However, one child may have an emotionally accessible, supportive caregiver at home, while the other child’s home environment may be distant or critical. While the first child may be able to share, regulate, and make sense of the incident, the second child may feel alone both at school and at home. Clinical outcomes may therefore differ. 

A similar situation can be observed in adulthood. Two adults may experience a sudden layoff at the same workplace. We can say that it is an acute traumatic event, and the context is the same. However, the fact that one has a close, secure partner relationship and social support network while the other is in isolation may change the severity and permanence of the traumatic effect.

If the relational space offers acceptance, validation, and support, the experience of trauma can be reconceptualized, and the relationship can become a space of restoration and healing.

Takeaways

  • Trauma is a multilayered concept that cannot be understood from a single dimension
  • Duration (acute-chronic) explains the temporal nature of the exposure, while context indicates the social, cultural, political, and economic conditions in which the trauma occurs. 
  • Neither duration nor context alone can fully explain the consequences of trauma.
  • The impact of trauma is also shaped by one’s relational world, attachment security, and capacity to regulate intense internal states. 
  • Trauma is a developmental and systemic experience that affects multiple domains. 
  • If we focus solely on one event, context, or symptom, we risk overlooking the complex, multi-layered nature of trauma.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. European Journal of Psychotraumatology, 5(1). https://doi.org/10.3402/ejpt.v5.25097

Cruz, D., Lichten, M., Berg, K., & George, P. (2022). Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Frontiers in Psychiatry, 13, 800687. https://doi.org/10.3389/fpsyt.2022.800687

Ford, J. D. (2025). Conceptualizing Attachment Trauma: A Developmental Trauma perspective. pmc.ncbi.nlm.nih.gov. https://doi.org/10.36131/cnfioritieditore20250508

Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391. https://doi.org/10.1002/jts.2490050305

World Health Organization. (2022). ICD-11: International classification of diseases (11th revision). https://icd.who.int/

Vallières, F., Hyland, P., & Murphy, J. (2021). Navigating the who, where, what, when, how, and why of trauma exposure and response. European Journal of Psychotraumatology, 12. https://doi.org/10.1080/20008198.2020.1855903.

Herzog, P. (2024). Understanding trauma as contextualized adverse life events that threaten the individual: Commentary in response to Marx et al. (2024).. Journal of Traumatic Stress. https://doi.org/10.1002/jts.23048.

Dai, W., Liu, A., Kaminga, A. C., Deng, J., Lai, Z., Yang, J., & Wen, S. W. (2018). Prevalence of acute stress disorder among road traffic accident survivors: a meta-analysis. BMC psychiatry, 18(1), 188. https://doi.org/10.1186/s12888-018-1769-9

Zurbriggen, E. L., Gobin, R. L., & Kaehler, L. A. (2012). Trauma, attachment, and intimate relationships. Journal of Trauma & Dissociation, 13(2), 127-133.

Kouvelis, G., & Kangas, M. (2021). Evaluating the association between interpersonal trauma and self-identity: A systematic review. Traumatology, 27(2), 118.

Daniels, A., & Bryan, J. (2021). Resilience Despite Complex Trauma: Family Environment and Family Cohesion as Protective Factors. The Family Journal, 29, 336 – 345. https://doi.org/10.1177/10664807211000719.

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This page is also part of the Roamers Therapy Glossary; a collection of mental-health related definitions that are written by our therapists.

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