“Capital T” vs. “Lower Case t” Trauma: An Introduction to Traumatic Invalidation

The Problem: Confusion about “Trauma”

During intake, we ask clients if they have a history of trauma. Many of our clients struggle to answer this question. When we ask, they get a “deer in the headlights” look about them, express uncertainty, or offer a “no” in a hesitant way. Often, they say that medical professionals have told them they look like somebody with a trauma history, but express, somewhat sheepishly (even ashamedly) that they don’t have a history of trauma. Most often, they then go on to say something like, “I don’t know why I’m like this. My life is good. Nothing bad has happened to me.” 

Similarly, when we first meet with parents of clients in the program, parents often tell us that their kids have given them feedback that they (the parents) traumatized them (the clients), and the parents go on to express absolute dismay, confusion, hurt, and often (quite understandably) anger about this. “We gave her everything she needed. We were present, available, supportive. We tried our best.” Often, these parents express that they themselves were raised in traumatic circumstances – physical, sexual, and/or emotional abuse, food insecurity, or unstable environments. For these parents, who have worked their entire lives to offer their kids a better life, and have worked so hard not to perpetuate cycles of trauma and abuse, to be told by their kids that it wasn’t enough, and to be criticized and blamed is heartbreaking. 

So, what’s going on with these clients who look and feel traumatized but tell us they have no discernable trauma history? And what about the families where parents worked so hard to be there for their kids, but are then told by their kids that their parenting was traumatic, or even that they are to blame for their kids’ difficulties? What is going on here? 

As you may have guessed, the answer (or “synthesis,” as we say in DBT,)  is traumatic invalidation. 

Quick Review: Invalidation

To review, invalidation is feedback that a person’s experience is too big, doesn’t make sense, isn’t important or acceptable, or otherwise doesn’t make sense. Most of the time, when a person experiences invalidation, it drives their emotional experience up – it makes them feel worse. If you’re really upset and someone tells you, “relax, calm down, it’s not that big a deal,” nine times out of ten, you’ll feel more upset instead of “calming down” as they suggested. See this post for more on validation and invalidation.

What is Traumatic Invalidation? 

The technical definition of traumatic invalidation, first laid out by Marsha Linehan in 2015, is “the extreme or repetitive dismissal of an individual's significant private experiences, deeply held traits, or emotional realities.” Invalidation becomes traumatic when it is especiallysevere or repeated. 

Where Does Traumatic Invalidation Come From?

Traumatic invalidation can come from important individuals in your life (e.g., friends, parents, other family members, religious leaders, coaches, mentors) or from systems (e.g., schools, religious institutions), or even cultural/societal  influences. For example, severe or repeated invalidation based on your unchangeable personal characteristics or aspects of your identity (e.g., race, ethnicity, gender, sexual orientation, physical appearance, ability status, neurodivergence, religion) is an especially corrosive form of invalidation. Invalidation and thus, traumatic invalidation, are especially impactful for individuals who are highly sensitive. 

How Does Traumatic Invalidation Compare to Other Forms of Trauma?

Melanie Harned, PhD is a DBT clinician and researcher, who developed the first evidence-based trauma treatment for clients with severe emotion dysregulation, known as DBT-Prolonged Exposure, or “DBT-PE” (Harned, 2022). In her work developing DBT-PE, Dr. Harned observed that clients with traumatic invalidation often had PTSD symptoms that were as severe – or even more severe – than clients who had experienced what is known in the field as a “Criterion A trauma” or what’s known colloquially as a, “Capital T trauma.” This is consistent with my own clinical experience from years of working with clients who have experienced trauma. 

When a clinician starts DBT-PE with a client, they do a structured assessment known as the “Trauma Interview.” Part of the Trauma Interview involves identifying all of the traumatic experiences the client has experienced in their life and ranking them based on which causes the most ongoing symptoms of PTSD. This is a key step, because most people who have experienced trauma in their lives have experienced more than one trauma. In identifying the most bothersome traumatic experiences my clients have had, typically, clients rank their experiences of traumatic invalidation as most bothersome, above the “capital T” traumas they have also experienced. For example, my clients have ranked their experiences of traumatic invalidation above experiences of rape and physical abuse. 

I want to pause here to highlight how harshly our clients’ experiences conflict with the generally accepted understanding of post-traumatic stress among medical providers. To “officially” have a diagnosis of PTSD, you have to have experienced one of a very specific set of events that involves “exposure to actual or threatened death, serious injury, or sexual violence” (American Psychiatric Association, 2013). This is the first criterion – "Criterion A” for diagnosing PTSD. But clients who come to DBT who have experienced these “Criterion A” traumas and traumatic invalidation tell us the traumatic invalidation is more bothersome for them. Why might that be? 

The reason traumatic invalidation often bothers clients more than other traumatic experiences is because of what I like to think of as a kind of “meta invalidation.” When someone experiences an assault, lives in a war zone, or is in a life-threatening situation, those around them typically recognize the impact of those experiences on them. Those people receive support and compassion. However, for our clients with traumatic invalidation, the medical establishment, like most of society, doesn’t understand or recognize the profound impact traumatic invalidation can have. Thus, clients are told that their trauma isn’t trauma at all. This leads them to think they are overreacting and to interpret that they themselves are the problem. The logic goes like this: If I feel like I’ve experienced trauma, but everyone else tells me I haven’t, well, I must be the problem, right? Invalidation about the nature of the trauma exacerbates the traumatic effects. 

Blame and Polarization 

Let’s go back to the disconnect between loving parents who worked hard to provide for their children’s physical and emotional needs and their children’s reports that they experienced their upbringing as traumatic. How does traumatic invalidation help us understand this? In my experience, in families with this type of polarization, there is often a lot of blame. And it’s so understandable. 

• Clients blame their parents because they feel truly traumatized. 

• Parents, who met their kids’ basic needs, tried so hard to be supportive of their kids, and often faced traumatic experiences themselves growing up, feel hurt, confused and angry at being blamed. These parents blame their children in turn. Often, parents have often been told by providers that their children are indeed “the problem,” leading to further blame.  

• Clients, who are often aware of their parents’ own trauma histories, and have been given feedback that their experiences aren’t trauma, blame themselves, as well as their parents. 

None of this blame helps anyone, but it does make everyone feel more hurt, resentful, and confused. 

Understanding Instead of Blaming 

Traumatic invalidation gives us a way to understand what happened in a way that allows us to let go of blame all together. For highly sensitive clients, traumatic invalidation means that experiences of everyday invalidation can accumulate to produce the full syndrome of PTSD for highly sensitive clients. This means that it can be true that clients experienced real trauma and that parents provided reasonable, loving, supportive parenting. What may have been sufficient and supportive for another child was simply not a fit for this child in a way that impacted them significantly. There is no way those particular parents could have known what precisely that child needed and there is nothing wrong with the child for needing something different than what was provided. 

Of course there are also forms of traumatic invalidation that are not the result of a simple mismatch between what was needed and what was provided. Severe criticism, blame, judgment, emotional neglect and abuse, and bullying are also forms of traumatic invalidation.

What About Treatment? 

At this point, parents and clients alike ask whether treatment is available for traumatic invalidation, as it is for other forms of trauma. The answer? Yes! The very same evidence-based treatment that we use to treat “Capital T” traumas (DBT-PE) is effective for treating traumatic invalidation. Talk to your/your child’s primary therapist if you’re interested in learning more about DBT-PE. One key thing to know is that DBT-PE is not recommended in Stage 1 DBT. It is important for clients to stabilize any life-threatening behaviors and build skills for tolerating emotions without avoiding prior to beginning DBT-PE.