June is PTSD Awareness Month.
Warning: This story discusses PTSD, triggers, and trauma.
Post-traumatic stress disorder (PTSD) can play painful tricks on the mind. This disorder is a mental health condition triggered by experiencing or witnessing a traumatic event. And, even if that event is in the past, living with PTSD can feel like someone is experiencing that pain in the present. Though people with PTSD can usually carry on with day-to-day life, certain triggers can bring overwhelming emotions associated with a specific traumatic event to the surface like reopening a painful wound.
This experience of being “triggered” has gotten misconstrued in recent years. Amidst conversations about the use of trigger warnings in classrooms, the concept of this experience became more mainstream, and some started using the term more casually, disconnected from conversations of trauma. Some political figures have even weaponized the word “triggered” as an insult, implying that a person is weak for having an emotional response to upsetting and potentially traumatic content. This is simply not the case. Being triggered is a very real experience, and using this mental health terminology—whether in an intentionally hurtful way or not—is harmful, because it can further stigmatize PTSD and invalidate the experiences of those living with it.
We talked with board-certified psychiatrist Dr. Margaret Seide—who specializes in depression, anxiety, addiction, trauma, and PTSD—to better understand what PTSD triggers look like, how to cope with these triggers, and how current events—like the coronavirus (COVID-19) pandemic and systemic racism—could lead to PTSD.
To understand what can trigger someone with PTSD to re-live traumatic events, it’s first important to know what can cause PTSD in the first place. Dr. Seide explains that she and her colleagues break the causes of PTSD into three categories: being the direct victim of a traumatic event or violent act, being witness to a traumatic event or violent act, or feeling constantly under threat.
This first category, in which someone is the direct victim—like a survivor of sexual assault or a veteran of war—is the most commonly known form of PTSD, but the others are just as valid. Though PTSD is often thought of as a response to a specific and singular past instance, the last category—”feeling constantly under threat”—also encompasses chronic stressors, such as poverty or racism.
It’s also important to note that not everyone who experiences traumatic stress will develop PTSD. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specific criteria for this disorder to be diagnosed by a medical professional. One differentiating criterion between PTSD and more general traumatic stress is the duration, stating that symptoms must last for more than a month to be classified as this particular disorder. Another, which relates more specifically to triggers, is the experience of “intrusion symptoms.” Intrusion symptoms refer to different ways that a traumatic event is re-lived through unwanted upsetting memories, nightmares, flashbacks, and emotional distress or physical reactivity after exposure to traumatic reminders.
These traumatic reminders, or triggers, can vary greatly depending on the source of trauma and the person experiencing it. The most well-known example is of a war veteran hearing a car backfiring and associating that sound with a gunshot and their time in war. Other triggers may be less direct or intuitive. For example, a person who smelled incense or heard a certain song when being sexually assaulted may be triggered to relive that experience when smelling the same scent or hearing the same song somewhere else.
Because these triggers can be present in various everyday ways, PTSD can interfere with someone’s ability to engage in daily life, so it’s important to find effective coping methods.
Dr. Seide advocates that those living with PTSD pay careful attention to their environment and the things that elicit negative emotional responses. However, she’s found that it’s uncommon for people to be completely unaware of their triggers. More commonly, she’s seen many people with PTSD reconstruct their lives to try to avoid engaging with anything that could be a trigger. “This can be concerning because then their life can become really small,” Dr. Seide says. “They don’t want to go on bridges, or they don’t want to ride an elevator, or they don’t want to be around a certain smell because it reminds them of something.” In trauma psychology, this response is sometimes referred to as the narrowing of someone’s “window of tolerance,” which is the zone where a person can function most effectively. According to GoodTherapy.org, “A narrowed window of tolerance may cause people to perceive danger more readily and react to real and imagined threats with either a fight-or-flight or freeze response.”
While it’s important that people with PTSD don’t push themselves dangerously far outside their window of tolerance, complete avoidance of triggers isn’t always the best answer or even an option to live a healthy life. Instead, there are ways to better cope with and subdue the effects of these triggers so that they don’t hinder a person’s ability to live. Dr. Seide finds talk therapy useful, which can help people process their trauma by talking about it with a licensed mental health professional. “The more they talk about [their trauma], the more their body calms down in the face of it instead of being extremely avoidant,” Dr. Seide says. Exposure therapy offers a similar coping method, working to minimize the effects of someone’s trauma through strategic exposure to something related to the source of that trauma. For medication, Dr. Seide also says that antidepressants and medical marijuana (where it’s legal) have shown positive effects for those living with PTSD.
However, when learning to cope with triggers, it isn’t realistic to strive to get rid of them completely, Dr. Seide says. “Once your nervous system is triggered in this way, it might be that when working with someone like a therapist or getting the right treatment, [the PTSD symptoms] subside—but that doesn’t mean that you’re good for the rest of your life,” she explains. PTSD can come and go, sometimes existing more in the forefront of someone’s life and other times more in the background. So instead of striving to “cure” PTSD, Dr. Seide advocates that you may want to strive to “manage” it to be as “functional as you need to be,” she says. That way, “there isn’t a whole bunch of things like, ‘I can’t go here. I can’t do this. I can’t do that.’ [Not avoiding these things] will help your life be as full as it can possibly be.”
With overwhelming rates of death and sickness, a widespread state of financial instability, and, overall, a threatened sense of safety and security, the coronavirus pandemic can trigger various elements of a person’s existing PTSD or traumatic stress. Dr. Seide believes that the chronic stress of living during a pandemic could also lead someone to develop PTSD for the first time—though she notes that, by the definition she follows, the condition doesn’t start until three months after the initial trigger. “So, therefore, it would be hard to technically define PTSD for the pandemic right now,” she explains. “But I am absolutely seeing people have the chronic stress response of sleep disturbances, needing to emotionally eat to make themselves feel better, and needing alcohol to almost medicate the anxiety that they’re feeling.”
Dr. Seide has also noticed that, as some areas of the world open back up, some of her clients are experiencing social withdrawal, which can be a symptom of PTSD. She’s finding that some clients are less inclined to want to be around groups of people. This is not specifically for the fear of getting sick but because the idea of being around people is extremely anxiety-provoking for them. “I would put that as a category of PTSD because there’s the trauma from quarantining and social isolation, and then there’s the product—the emotional scar of ‘the idea of being in a room with a bunch of people is terrifying to me,’” she says.
Dr. Seide also hones in on the financial insecurity that the pandemic is causing for so many. “That feeling of hanging by a string financially is also a chronic stressor and can really whisk away any sense of safety that you had,” she says. Because of this, and the various reasons above, Dr. Seide is expecting to see many cases of PTSD develop as a result of the pandemic.
For Black and Indigenous individuals and people of color, the experience of racism can be traumatizing. The American Psychological Association explains that “racial trauma can result from major experiences of racism, such as workplace discrimination or hate crimes, or it can be the result of an accumulation of many small occurrences, such as everyday discrimination and microaggressions.”
By these definitions, racial trauma can apply to all three of the categories that Dr. Seide uses for triggers of PTSD: BIPOC can be direct victims of racial trauma, be witnesses to racial trauma, and live in racist societies as BIPOC, which can create feelings of being constantly under threat. Dr. Seide explains that the third category is especially true for Black people living in America. “It’s like the threat is everywhere and anywhere and going to jump out from the bushes and get you,” she says. “And I think that feeling of being so unsettled, of feeling like you don’t know how a trip to the store is going to end for you, is very mentally destabilizing.”
Right now, with police brutality, killings, and racial violence against Black people spread across the media, this can be a particularly traumatizing time for Black people specifically. Many have said that there are two pandemics happening at once: coronavirus and racism. The former is disproportionately affecting Black people, while the latter has been going on for over 400 years. And in the past month, various videos have circulated in the media showing Black people being brutally abused or killed by the police. “All of that can be incredibly traumatic [for Black people] to watch on repeat on a regular basis, and so that will definitely, in my opinion, be associated with PTSD down the line,” Dr. Seide says.
She also notes that research has shown that the mental health impact from racism can cause a Black person’s health to deteriorate at a faster rate than a white person’s. “By the time a Black person reaches the age of 45, their body can show indications of wear and tear equivalent to a white person who is 60 years old,” Dr. Seide says. “This is thought to be due to the emotional burden that comes with Blackness.”
Because of this, it’s especially important that Black people have access to race-informed trauma care and that conversations surrounding trauma and PTSD address the mental health impact of racism.
If you are struggling with trauma or PTSD and need help, call the National Alliance on Mental Health Helpline at 1-800-950-NAMI (6264), or connect with a crisis counselor through the Crisis Text Line by texting HOME to 741741. Reference the National Queer and Trans Therapists of Color Network directory to find a QTPoC provider.
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