Big T trauma usually means DSM criterion A: a direct threat to life, serious injury or sexual assault. The event needs to be reasonably objective, but PTSD grows out of the subjective experience, so clinically you want both. Exposure is broader than being there yourself, and includes hearing it happen and handling traumatic material at work.
What it is
When people say big T trauma, they usually mean DSM criterion A trauma. In DSM-5 that means direct threats to life, serious injury, or sexual assault.
“big T trauma. I think that most people, when they refer to that, they're talking about DSM criterion A trauma and trauma. At least in the fifth edition, what we're thinking about, what we're considering meets that is going to be direct threats to life, serious injury, or for sexual assault”
3:49Trauma and PTSD: How the DSM Criteria Actually Help Us Understand What’s Going OnOct 2026 Also said in 1 more episode
“Now, big T trauma, I think that most people, when they refer to that, they're talking about DSM criterion A trauma”
3:40Understanding Trauma and PTSD, Diagnosis and Dissociation | Episode 21Apr 2025
How we diagnose it
You need something reasonably objective, but there also has to be a subjective experience that matches it.
“while we need something reasonably objective, there still needs to be that subjective experience to match that thing that's reasonably objective”
6:12Trauma and PTSD: How the DSM Criteria Actually Help Us Understand What’s Going OnOct 2026 Also said in 1 more episode
“So I do think that while we need something reasonably objective, there still needs to be that subjective experience to match that thing that's reasonably objective”
6:01Understanding Trauma and PTSD, Diagnosis and Dissociation | Episode 21Apr 2025 For clinical purposes, it helps to add that the event happened in a manner that shocked or scared the person. That is closer to DSM-IV and not strictly in the current criteria, but it makes a useful distinction.
“I like to add in a manner that shocked or scared you, and I know that's a little bit more like DSM-IV, but I think that that's helpful to make that distinction, even though I understand it's not strictly in the DSM criteria. This is for clinical purposes”
4:16Understanding Trauma and PTSD, Diagnosis and Dissociation | Episode 21Apr 2025 Encountering traumatic material in electronic form as part of your work counts. It is a small carve-out for people such as those who work child abuse cases.
“if you encounter traumatic material in an electronic format through your work as part of your work, that counts. It's a little carve out for people who, for example, work with child abuse cases”
4:54Trauma and PTSD: How the DSM Criteria Actually Help Us Understand What’s Going OnOct 2026 Also said in 1 more episode
“if you encounter traumatic material in an electronic format through your work as part of your work, that counts. It's a little carve out for people who, for example, work with child abuse cases”
4:45Understanding Trauma and PTSD, Diagnosis and Dissociation | Episode 21Apr 2025 Being a witness does not require seeing it. Many people in prison hear others being sexually assaulted, killed or badly injured in another cell, and that can still cause it.
“just a witness um learning of um a lot of people in prison will hear people being sexually assaulted or killed or severely injured in another cell still can cause”
9:16Understanding Trauma and PTSD, Diagnosis and Dissociation | Episode 21Apr 2025
It also comes up on
- PsychoeducationMost people with a criterion A trauma do not develop PTSD, so recognize the PTSD syndrome specifically. When it is accurately recognized and you tell people what is happening to them and how to solve it, they get better a lot faster and a lot better.
- TraumaMost people who experience a criterion A trauma do not develop PTSD. Recognize the PTSD syndrome specifically, then give the psychoeducation and treatment recommendations for it.
- PTSDMany clinicians diagnose PTSD without going through the criteria: they see a persistent fear or mood problem plus a criterion A trauma and call it PTSD. Walk the criteria.
From these episodes
- Trauma and PTSD: How the DSM Criteria Actually Help Us Understand What’s Going OnOct 2026 · 3 points
- Understanding Trauma and PTSD, Diagnosis and Dissociation | Episode 21Apr 2025 · 5 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.