Just like any mental health condition, the way my PTSD presents itself will be different than how it presents itself in someone else, and there are nuances to every symptom and generalization about PTSD that are specific to my experience. Something I've found important in my PTSD journey is sharing accurate information about what my mental health condition looks like in clinical terms, and for me personally. These are 5 questions I wish people would ask about my PTSD, instead of just assuming they know the answers:
1. What is PTSD?
PTSD stands for Post-Traumatic Stress Disorder. It is a mental health condition that affects some (but not all) people who have experienced trauma.
Our bodies are designed to protect us, and it is natural for your body to respond in high-stress situations. Think of it like the progression in the chart below: you experience a trauma, your body reacts to that trauma, and once the danger passes, your system calms back down to baseline.
But for people with PTSD, they get stuck at the top of the hill. Their bodies don't settle back down to baseline after a trauma, and in many situations continue to respond to perceived threats even when they are not in danger. Their bodies are stuck in fight or flight mode. And while it may take some time for anyone to come back down to that baseline after a traumatic event, people who get diagnosed with PTSD have experienced symptoms like nightmares, flashbacks, avoidance, sleep issues, hypervigilance, or mood or memory changes for over a month, and those symptoms are severe enough that they're impacting daily functioning.
2. What is a PTSD trigger?
These days, "triggered" has taken on a more colloquial usage, for example, joking about being triggered when something is minorly inconveniencing, like not getting enough guac on your Chipotle burrito bowl. As it relates to PTSD, however, a trigger is a clinical term that is used to identify the event/place/moment/sound/feeling etc. that elicits a trauma response. And although it's used in a joking manner colloquially, it's a drastic misrepresentation to equate humor with a genuine mental health trigger. When my PTSD has been triggered, my body is in severe mental and physical distress.
3. How will I know if you've been triggered?
If you're someone I feel safe with, most of the time I can tell you I'm having a trauma response - but not always. Sometimes, it's not until later that I realize that my reaction was instigated by my trauma. And even if I can identify my reaction as a trauma response, it's really important to remember that I cannot control my reaction. My brain and body are in survival mode, and they are doing the best they can to protect me from the danger they are perceiving.
There are several indicators that I'm having, or starting to have, a trauma reaction. These indicators layer and build on each other, instead of being standalone symptoms. You might notice changes in my physical behavior, like changes in my breathing (sometimes having a PTSD episode can feel very similar to having a panic attack, so I might have shallow breathing with difficulty catching my breath); shaking; difficulty eating, even if my body is hungry; crying, or, usually, uncontrollable, intense weeping - the kind of crying that is so hard on your body that it makes your lungs hurt.
The physical changes might be easier to spot, but there are significant mental and emotional changes when I'm having a trauma response, too. For me personally, a trauma response is compounded when I feel trapped in my situation. So if I feel trapped, even if it's just a perceived threat, you might notice that I'm unfocused and restless, that I can't make eye contact with you, or that my eyes are constantly darting around the room. I might seem flighty, or have a manic or panicked energy - I'm looking for a way out of a situation I'm perceiving not to have an exit.
Some other common signs that I'm in distress are if I start to shut down, or display atypical behavior for me, like yelling, or abruptly cutting off conversations. A big indicator is when I'm inappropriately emotional in response to a situation that doesn't warrant it - like if I'm experiencing a small frustration that I'm responding to with extreme anger, or when something sad or heartwarming happens and I respond with several minutes of streaming tears. This is actually one of the biggest ways I identify in myself that I'm experiencing trauma symptoms - if I'm sitting on the couch and a touching commercial not only brings tears to my eyes, but really changes my emotional mood, it lets me know that something bigger is going on.
To share an example of what this looks like - I was on the phone with my partner one evening after work, and the call dropped as he was heading into the grocery store to grab something for dinner. I wept the entire time he was in the store, because he'd lost service before he said, "I love you," at the end of our call. I knew he would call me back when he left the store, and I knew that he would tell me he loves me once he had service again. But those things weren't enough to change my physical reaction.
And sometimes, I'll just simply be "not there." We'll talk more about what dissociation is in future posts, but when I am dissociating, one of my most common PTSD reactions, my brain has determined that the situation I'm in is too much, and has mentally removed me from it. Physically, I may be right in front of you. But mentally, I am fully detached.
As I get to know my PTSD, these indicators might change, or I might start to recognize additional signs of a trauma reaction. Instead of considering this an exhaustive list of PTSD response indicators, think of it as a collection of samples of how PTSD can show up for me when I'm in distress.
"Showing me compassion is the most important way you can help me when I'm in traumatic distress."
4. When you're having a trauma response, what can I do to help?
The biggest thing you can do for me when I'm having a PTSD reaction is remember that I'm not in control of my body right now, and my response is not personal to you. And whatever reaction I'm having, even if it feels like an unnecessary reaction to you, don't invalidate my experience. Showing me compassion in these situations is the most important way you can help me when I'm in traumatic distress.
Another way you can show compassion when I'm having a PTSD reaction is to let me let out what I'm feeling. If you're emotionally available and willing to, be a safe person for me to share with about what I'm experiencing. Having a PTSD episode is really scary, and it helps to have someone to go through it with. Letting it out might be as simple as letting me cry for as long as I need to, or helping me leave a situation if I need a break. In a gentle and loving way, you can remind me that I am safe, even if it doesn’t feel like it, and that you’ll be there with me while my body works through the reaction.
5. When you're not having a trauma response, is there anything that makes your PTSD better?
A BIG help for me is consistency, predictability, structure, and routine. My PTSD has been triggered in situations where I have fully lost control (even in ways completely unrelated to my trauma), so setting up systems for myself that help me be prepared for what to expect has been really important. Changes to my routine can really throw me off, and surprises - even good ones - are very difficult. Giving me the time and space to process new information or changes in group plans is a great way to support my mental health. And, maybe most importantly, if my response to your surprise/conversation/situation is not the one you expected, try not to take it personally. My brain is trying to make sense of what's happening in ways that have nothing to do with the situation itself.
"You can be a safe person for someone who has PTSD without knowing about their trauma."
Did you notice how none of these five questions included sharing what my trauma was or talking about my traumatic experiences? You can be a safe person for someone who has PTSD without knowing about their trauma. And if or when they choose to, let them come to you about their experience. Don’t let not knowing the details of their trauma get in the way of your support for them - love and safety and support do not rely on the details of their trauma, but on your willingness to sit with them in their hardest moments.
What questions do you wish you got asked about your PTSD?
What questions do you wish you got asked about your PTSD?
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