Possible Signs Of PTSD: Why Do I Avoid….?
By Nadia Khan
Updated January 02, 2019
Reviewer Laura Angers
Most associate Post Traumatic Stress Disorder (PTSD) with war. In fact, the first known studies of PTSD were conducted on WWII veterans and the phenomenon was then called shell shock. To date most of the research conducted on PTSD has been on veterans ("Post Traumatic Stress Disorder," n.d.). However, trauma is something that can occur to anyone at any time. In fact, trauma itself can be very subjective and depending upon the individual and to what he or she is accustomed. For example, an individual who watches violent films may not be as traumatized by witnessing a shooting of a stranger, or even someone known. However, for some this might be an event that could bring on weeks or even months of not only nightmares, but also avoidance of the area in which the traumatic event occurred.
Post-Traumatic Stress Triggers and Avoidance
A post-traumatic reaction can be brought on by triggers that revive the experience through the senses. Colors, noises, words, phrases, each of these and more can take a person back to a traumatic event (Hopper, Frewen, van der Kolk, & Lanius, 2007). For some people the reaction to specific triggers is so severe they will avoid any possibility of trigger exposure. Although avoidance of re-experiencing or remembering an unpleasant or traumatic event may seem completely understandable, there is evidence that avoidance prolongs or completely prevents healing(Pineles et al., 2011a). Others propose that avoidance to a traumatic event is an early symptom of PTSD (Levin, 2012), other symptoms might include numbing, or a feeling of deadness. These are the mind's way of protecting itself(Pineles et al., 2011b), but prolonged avoidance could prevent the individual from dealing with the trauma and moving forward.
To delay thoughts, or dwelling as some might suggest of a traumatic event is a common psychological defense to protect the psyche from the trauma(Margolies & Read, 2016). For some, to think of an event means to fully re-experience it, and this can bring on crying, shaking, angry outbursts, and violence. While for others, there is only intense sadness or fear, with no extreme external reactions. The levels of discomfort range from the very intense to avoidance altogether of places, people, and dates that trigger emotional reactions.
To be clear, most people will react to a traumatic event with symptoms of shock, and these symptoms may remain or recur over a period of time; however, most often these reactions to discussions or memories of the event will dissipate over time. One key factor in normal shock is that it does not generalize, and cause reactions to the generalized objects.
For most, reactions to seeing something that is a reminder of a sad or traumatic event from childhood would not mean a great deal. We all have memories of our childhood, and many of them may be repressed or dormant memories. Repressed memories are typically those that are traumatic to a degree, while dormant memories are typically benign in nature and can be brought to the forefront of the mind by most anything, and then as quickly forgotten.
PTSD is often associated with the sensory experience of the trauma (Stewart & White, 2008). Our cognition can generally handle the realization of a trauma; what is relived is re-hearing, re-seeing, re-smelling, etc., elements of the event. It is that connection with the sensory experiences that aids in the re-experiencing of the event. The senses revive the memories and put the individual back in the moment of the original occurrence. According to Stewart and White, it is due to the over stimulation of sensory detail that is at times unrelated to the trauma that can trigger a reaction. Some individuals who have avoided thoughts or feelings of an event for a long period of time may never wish to experience anything that brings about reminders. For example, a woman wearing a particular dress on the day she caught her husband cheating may throw the dress out, and never wish to even wear that particular color again. This is a form of generalization in which the individual associates related colors, sounds, or people with the trauma. This is quite different from the individual who may have been a victim or a witness to a gun shooting who has a post-traumatic reaction to a car backfiring. When this occurs, it is because the sounds are very similar and both are very sudden.
Someone injured in an automobile accident in which the automobile was totaled may go for weeks and even years avoiding that particular street or stretch of road. Women who have been victims of rape react to smells and sounds associated with the rape. The sensory reminder could be the smell of cologne, a particular alcohol on the breath, or any other odor present during the attack. These reminders can cause reactions to innocent people that leave them feeling confused, and sometimes frightened.
The mind is quite complex, and avoidance is a means of self-preservation(Levin, 2012). We all use it, whether we recognize that fact or not. The individual with PTSD avoids people, places, and things that are reminders of a stressful or tragic event, even if facing any of these is necessary for closure. Avoiding situations and people related the precipitating event, while it may seem protective, may prevent the individual dealing with inevitable, often painful, emotions(Margolies & Read, 2016).
If post-traumatic symptoms are severe, exposure to triggers should not be done alone, or without the advice of a physician. With individuals who have experienced severe trauma, there are sometimes extremely violent reactions(Margolies & Read, 2016), a reliving the experiences that is akin to a hallucination. When an individual is caught up in a post-traumatic stress delusion, he or she may become violent and anyone around could become a perceived antagonist.
For persons who experience mild or severe post-traumatic stress symptoms, reality-based therapy, systematic exposures to sensory triggers, and cognitive therapy have proven very effective(Pineles et al., 2011c). Medications can help in relieving the anxiety, but as with many mood-altering medications, these may simply mask the symptoms, and prove to be just another form of avoidance.
Friends and Family
The one thing for friends, co-workers, and family members of the victim of post-traumatic stress disorder to remember, is that trauma is a subjective experience. Seeing your spouse in bed with another person could induce deep psychological trauma. So could seeing a pet hit by an oncoming car. Some may feel these are events that should be easy to get over, but according to others (Pineles et al., 2011b) the ability to move beyond a traumatic shock to the brain has a great deal to do with personality and resiliency.
It is important to provide support, understanding, and when requested either silently or with words, an ear to listen. The individual experiencing post-traumatic stress may find it difficult to articulate his or her feelings. It does require a great deal of patience on the part of those in his or her support system. It is also important to realize that what the individual experiencing post-traumatic stress may be difficult to articulate, this does not always indicate a lack of trust.
Conclusions and Recommendations
Post-traumatic stress is psychologically uncomfortable, and can be overwhelming to the individual. This is the reason many will take great pains to avoid situations or stimuli that trigger memories or reactions (Greenspan, Stringer, Phillips, Hammond, & Goldstein, 2006). Research does support that repeated exposure the stimuli will lessen the response over time (Badour, Blonigen, Boden, Feldner, & Bonn-Miller, 2012). There is no real measure of how much time; the key is to keep trying for as long as the symptoms last and until they begin to dissipate. However, this should not be done without guidance.
Recent research into the benefits of talk therapy with schizophrenic patients may provide insights into processing post-trauma reactions (Sue Holttum, 2014). By retelling the story, and having the story told back to the individual, it may prove an effective means of desensitizing the individual to the trauma. This may seem overly simplistic to anyone who has experienced the horrors of war; there is a reason that PTSD does not begin to manifest until individuals are away from the event- sometimes, as with military personnel, other side of the world.
Therapy can be very beneficial as the therapist only has one agenda, and that is to see the individual make progress at his or her own pace, unlike loved ones who are affected through living with or being with the post-traumatic sufferer. The individual experiencing PTSD may find it difficult to open up with family or friends, and sometimes they may become frustrated; again, because they are directly affected by behaviors. A therapist is skilled in the ways of therapeutic silence and sometimes that is what the person with post-traumatic stress needs - the space of silence in which to speak.
Therapy may not only be of benefit to the post-traumatic stress sufferer, but also the family of the individual. The family members may be grieving the way the individual or the family dynamic was prior to the trauma. They may also feel incredibly helpless and not know how to express this. Knowing just what to say to the individual experiencing post-traumatic stress can be, pardon the pun, like dodging landmines. Therapy can provide a forum in which each individual can feel safe to express his or her thoughts and feelings.
There may be times when schedules or other factors prevent individuals from seeking therapy. In these situations, there are online therapy options where qualified and licensed therapists are available to work with clients via email, video, or chat. This might be a very good option for those who are hesitant to begin counseling and could result in helping the client in ways meeting a therapist in an office cannot.
As with any emotional or mental health issues, if there is a crisis situation, call 911.
Badour, C. L., Blonigen, D. M., Boden, M. T., Feldner, M. T., & Bonn-Miller, M. O. (2012). A longitudinal test of the bi-directional relations between avoidance coping and PTSD severity during and after PTSD treatment. Behaviour Research and Therapy, 50(10), 610-616. https://doi.org/10.1016/j.brat.2012.06.006
Greenspan, A. I., Stringer, A. Y., Phillips, V. L., Hammond, F. M., & Goldstein, F. C. (2006). Symptoms of post-traumatic stress: Intrusion and avoidance 6 and 12 months after TBI. Brain Injury, 20(7), 733-742. https://doi.org/10.1080/02699050600773276
Hopper, J. W., Frewen, P. A., van der Kolk, B. A., &Lanius, R. A. (2007). Neural correlates of reexperiencing, avoidance, and dissociation in PTSD: Symptom dimensions and emotion dysregulation in responses to script-driven trauma imagery. Journal of Traumatic Stress, 20(5), 713-725. https://doi.org/10.1002/jts.20284
Levin, A. (2012). Postdisaster Avoidance, Numbing Could Indicate PTSD Risk. Psychiatric News; Washington, 47(20), 12,22.
Margolies, L., & read, P. D. ~ 3 min. (2016, May 17). Understanding the Effects of Trauma: Post-traumatic Stress Disorder (PTSD). Retrieved April 18, 2017, from https://psychcentral.com/lib/understanding-the-effects-of-trauma-post-traumatic-stress-disorder-ptsd/
Pineles, S. L., Mostoufi, S. M., Ready, C. B., Street, A. E., Griffin, M. G., &Resick, P. A. (2011a). Trauma Reactivity, Avoidant Coping, and PTSD Symptoms: A Moderating Relationship? Journal of Abnormal Psychology, 120(1), 240-246. https://doi.org/10.1037/a0022123
Pineles, S. L., Mostoufi, S. M., Ready, C. B., Street, A. E., Griffin, M. G., &Resick, P. A. (2011b). Trauma Reactivity, Avoidant Coping, and PTSD Symptoms: A Moderating Relationship? Journal of Abnormal Psychology, 120(1), 240-246. https://doi.org/10.1037/a0022123
Pineles, S. L., Mostoufi, S. M., Ready, C. B., Street, A. E., Griffin, M. G., &Resick, P. A. (2011c). Trauma Reactivity, Avoidant Coping, and PTSD Symptoms: A Moderating Relationship? Journal of Abnormal Psychology, 120(1), 240-246. https://doi.org/10.1037/a0022123
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Stewart, L. P., & White, P. M. (2008). Sensory filtering phenomenology in PTSD. Depression & Anxiety (1091-4269), 25(1), 38-45. https://doi.org/10.1002/da.20255
Sue Holttum. (2014). Research Watch: talking therapy for anxiety and social difficulties may improve social inclusion after diagnosis with schizophrenia. Mental Health and Social Inclusion, 18(1), 7-12. https://doi.org/10.1108/MHSI-11-2013-0035