Tag Archive: trauma

ptsd triggersKind of tongue in cheek title, but with all do seriousness, I made it that way in an effort to make you think. PTSD symptoms do not happen in a vacuum. They might fade, disappear for a time but they never truly go ‘away’ forever. Think of it this way, the brain is like computer with a CD Rom that is always recording what is going on. When a traumatic event happens that too gets burned onto the CD. A trigger is like a command prompt or a file connected to the original event which then gets replayed. Or more simply put, a trigger is like pushing the on button unintentionally.
The best way I can describe how a trigger works in the real world is lets say as a child, said child (now adult) was abused. One very bad beating occurred because they wouldn’t eat green beans or even the broccoli or it could be the beating occurred just after eating it. In this child’s mind, the beating becomes associated with the broccoli. In adulthood, the abused child may avoid eating anything green or even something that looks like the broccoli. This is called avoidance. However, one time, the adult attends a dinner meeting in which the menu is preplanned and guess what is on the plate that is put in front of him? Broccoli. The adult then abruptly becomes very upset and seeks away out of the meeting (avoidance) in order to protect themselves when just seconds before they were laughing and enjoying themselves. Broccoli is the trigger that makes the adult remember the pain of the beating, the feelings of helplessness of not being able to stop the beating or get away.
Lets say a combat veteran or first responder hits a deer driving home and the deer is mangled, and when checking on the car/deer they smell the blood and see the mangled deer. The smell of blood alone could be a trigger into anxiety, anger or some other PTSD symptom. Seeing the mangled body of the deer could trigger memories of seeing someone who was seriously injured or killed which in turn releases all the original trauma memories and symptoms of PTSD occur.

In other instances, such as in finding a loved one or close friend who committed suicide may find PTSD symptoms triggered when they are home alone or find a picture of them accidentally. An domestic violence survivor may ‘freak out’ (PTSD) if she gets into an argument (trigger) with a new partner. A runner who just ran his best time may experience a racing heart if he doesn’t cool down properly, which in turn ‘triggers’ PTSD symptoms. Like I said, its not about the broccoli. Triggers are internal and external ‘cues’ that takes someone back to the original trauma and cause symptoms of PTSD in that moment…out of the blue so to speak.

PTSD triggers may be all around you or your loved one. And typically they fall into two categories. Internal Triggers and External Triggers. Internal triggers are things that you feel or experience inside your body. Internal triggers include thoughts or memories, emotions, and bodily sensations (for example, your heart racing). External triggers are situations, people, or places that you might encounter throughout your day (or things that happen outside your body). Listed below are some common internal and external triggers.
• Internal Triggers
o Anger
o Anxiety
o Sadness
o Memories
o Feeling lonely
o Feeling abandoned
o Frustration
o Feeling out of control
o Feeling vulnerable
o Racing heart beat
o Pain
o Muscle tension
• External Triggers
o An argument
o Seeing a news article that reminds you of your traumatic event
o Watching a movie or television show that reminds you of your traumatic event
o Seeing a car accident
o Certain smells
o The end of a relationship
o An anniversary
o Holidays
o A specific place
o Seeing someone who reminds you of a person connected to your traumatic event

So we see, its not about what is happening RIGHT NOW its about what happened during the traumatic event. But in daily life we can only employ avoidance strategies so long and many times we cannot avoid what may trigger symptoms of PTSD to reoccur. So the question becomes, if we can’t avoid triggers entirely then how do we live without being reactive and in a constant state of PTSD?
Identification of Triggers
An important note on increasing your awareness of triggers: while it is important to do so, be aware that doing so may cause you distress and to be uncomfortable. Some people might actually become triggered by trying to identify their triggers. Before taking steps to identify your triggers please be sure to let someone know what you are doing and have support available to you just incase you are triggered. Never try to push yourself too far. A little at time is all it takes.

The first step to avoid being side swiped by a trigger is to try and identify what your triggers are. When you are in a good place, think about when your PTSD symptoms usually come up. To identify your triggers ask yourself these types of questions: What types of situations are you in? What is happening around you? What kind of emotions are you feeling? What thoughts are you experiencing? What does your body feel like? Get a notebook and write down as many internal and external triggers as you can. Sometimes it can be hard for those with PTSD to identify their own triggers, so you may even want to ask your family and friends about what they believe or see your triggers are.
How to Cope with Your Triggers
Of course the best way of coping with triggers is to avoid them altogether. However, this is almost impossible to do. Why? Well, you cannot really avoid your thoughts, emotions, and bodily sensations. Much of these are out of our control. In regard to external triggers, we can take some steps to manage our environment (for example, not going to certain places that we know will trigger us), but we cannot control everything that happens to us. For example, you might inadvertently come into contact with a news story or conversation that reminds you of your traumatic event.
Because we often cannot avoid triggers, it is important to learn ways of coping with triggers. After we figure out what the triggers are we are then free to ‘make a plan’ to effectively handle the symptoms of PTSD. Some effective and healthy coping strategies for lessening the impact of triggers include:
• Mindfulness- being in the moment
• Relaxation techniques
• Self-soothing techniques
• Grounding yourself
• Expressive writing (journaling)
• Social support
• Deep breathing
The more strategies you have the better off you will be in managing your triggers and the less likely you will turn to unhealthy coping strategies such as drugs, alcohol and isolating. Simply being more aware of what can trigger you can be of great help to you because you will have gained more awareness and thus, be more able to cope better. Awareness of your triggers allows you to begin to feel more in control and gives rise to better understanding of your emotional reactions which in turn validates them (understanding why) and allows predictability all of which can definitely impact your mood and well-being. More on coping strategies to come.

Stay safe and be prepared!



It is very natural and normal to have stress reactions after a traumatic or very upsetting event. Your behavior and emotions will change immediately afterwards and most people get better or find a ‘new normal’ after a few weeks. This is called acute PTSD. However, not everyone ‘gets over it’. As I discussed in the previous article PTSD, What is It? some people will have prolonged stress reactions to events and circumstances, most especially those that are more indicative of producing chronic PTSD. It is a real identifiable brain disorder (see picture).


Trauma causes REAL changes in the brain which can produce profound behavioral, emotional and physical symptoms. Please keep in mind as you read, the key to recognizing symptoms of PTSD is this: if it wasn’t there before a traumatic event happened and then appears, then there is a problem. If it was there before the traumatic event, then it most likely is not related to PTSD.

PTSD is generally diagnosed through presentation of 4 major types of symptoms that last longer than 3 months, cause you significant distress and disrupt your life and/or work.

Intrusion of the event into your life afterwards.
Recurrent recollections of the event. Memories coming back without warning with or without a ‘trigger’ (which I will discuss later)
These can make someone feel as though they are reliving the event in that MOMENT and can cause mental, emotional and physical symptoms. Some individuals with PTSD may experience and feel the same fears and horror as when the event took place.

Hyper Arousal/Feeling Keyed Up
Constantly on guard
On Alert
Can’t relax
Can’t sleep

Numbing or Negative Changes in Beliefs and Feelings
Distancing self from people/Can’t trust other people
Unable to feel emotions
Forgetting about parts (suppression) or all of the traumatic experience
Not able to talk about the event
World becomes extremely dangerous
Depression/Anger/Irritability/Impending sense of doom

Fear based and avoidance behavior typically involve all three of the above symptoms in order to avoid having to deal with the original trauma or prevent the above symptoms from occurring. Avoidance behavior is also another way of dealing with ‘triggers’. Often, people with PTSD will avoid people, places and things that remind them of the original trauma. Some people will get ‘super busy’ as way to avoid dealing with trauma.
Avoiding crowds
Avoiding driving
Avoiding all sorts of media (movie, news, video games)
Avoiding activities that are or could be associated with the trauma (ie an avid hunter may stop hunting to avoid particular triggers).

So this is the clinical take on what constitutes PTSD. But what can it really look like in someone’s life? It will vary from person to person obviously as everyone has different backgrounds, religious beliefs, personalities and different experiences in life. So lets look, in layman’s terms, what someone with PTSD may experience.

Panic Attacks or other anxiety problems including hypersensitivity to his/her surroundings….this is experience of INTENSE fear which most often is accompanied by shortness of breath, sweating, nausea, dizziness and racing heart. At the very least, discomfort may occur. This is almost directly related to hyper vigilance and may be ‘triggered’ by something totally unrelated to what is happening in that very moment.

Feelings of mistrust (could be specific or not)

Problems in daily living: not being able to function ‘normally’ at work, home and within relationships. This can include a decline in personal hygiene (or obsessiveness with it). Stopping doing daily household chores, organizational problems, etc. Emotional distancing of themselves towards other people, places and things in order to cope with feeling ‘unsafe’. This can come across as being cold, aloof, uncaring, demanding or otherwise socially unacceptable behaviors.

Substance Abuse: using drugs or alcohol to cope with emotional pain

Depression/Mood Swings: persistent sadness, anxiety, emptiness, loss of interest, guilt, shame, hopelessness about the future. Going from being happy to angry and back again for no real apparent reason. Isolating themselves. May become aggressive and angry for ‘no good reason’.

Memory problems are almost always present. Usually this shows up at first as ‘absent mindedness’ such as constantly misplacing things or loosing things. It can progress into forgetting names, appointments and other day to day things. Later on, someone with PTSD may even begin to forget past events that were important to them, or forget what they were saying in the middle of a sentence and may even say something and then repeat themselves a few minutes later.

Risk Taking Behavior such as driving too fast, multiple sex partners, starting fights and other behaviors that typically would be considered ‘risky’ with the potential to do harm to themselves or others.

Isolating from the world…many people with PTSD will in an effort to keep themselves safe begin to withdraw from people to the point that they may turn into ‘recluses’ who only go out when food or medicine is needed.

Obsessive/Compulsive Behaviors: check and rechecking that a door is locked, driving around and around in a parking lot, running to the doctor every time they sneeze. The point in obsessive/compulsive behavior to keep themselves ‘safe’ to prevent further trauma.

Super sensitivity to outside stimulation: this is directly related ‘triggers’. When the original traumatic event occurs, the brain basically ‘burns’ into the deepest part of the memories and cortex exactly what happened, how it happened and circumstances in which it occurred.

Checklist of PTSD symptoms:

Physical Symptoms:
Stomach problems
Changes in breathing patterns (shortness of breath/not breathing normally)
Lack of energy OR Hyper Activity
Sleep problems
Emotional pain never felt before
Anxiety problems
Hyper vigilance

Psychological Problems:
Mood swings
Memory problems
Addiction/Self Medication
Loss of personal hygiene/housekeeping
Risk taking behavior
Depression (“what’s the point?”)
Paranoid thoughts
Reliving the event(s) with accompanying emotions

Sleep Problems:
Insomnia (not being able to fall asleep or stay asleep)
Having nightmares
Waking up covered in sweat
Kicking during sleep
Constantly waking up and falling back asleep
Waking up and being easily startled and/or being confused about where you are
Irregular sleep cycles

It is my hope that you have found this information helpful in describing what PTSD ‘looks’ like symptomatically. Too often many seek help and a diagnosis of PTSD is not given because the full spectrum of what PTSD looks like isn’t known by many doctors and mental health professionals. Do not be afraid to print this off and take it with you if you choose to seek help (which I hope you will) so that you maybe appropriately helped and treated. PTSD is multi-faceted and can be difficult to diagnosis unless you and those around you know the facts about what it is and what it looks like. But it is treatable and can be overcome. There is hope.

In part 3 of this series on PTSD I will discuss ‘triggers’ which plays an important role in PTSD.


PTSDPTSD…Post Traumatic Stress Disorder. What is it? Technically it is an Anxiety Disorder. It is a complex response to extreme stress that is deemed life threatening by an individual that does not go away on its own over time. Some would have you believe that it is a psychiatric condition. But in reality, it is an adaptive response to keep someone (themselves or others or both) from harm and it may get worse overtime. This adaptive response stems from exposure to real or perceived life threatening situations that can be a one time event, series of events or on going events. Note that it doesn’t just have to be ‘events’ but also circumstances in which people can ‘see’ themselves in the same situation as the person who is actually going through the traumatic event or circumstances such as witnessing a murder or a grizzly car accident . This is an empathic response. There are those who witnessed the World Trade Center Towers come down who were not even there and displayed PTSD symptoms later on. People who know people who have been killed or seriously harmed or even just threatened have been known to develop PTSD. Almost ANY traumatic event can trigger high anxiety and what is traumatic to one person may not be to another. Each person is different and reacts differently to trauma/high stress situations and circumstances. PTSD can happen to anyone, children and adults alike. It cuts across all social, economic and racial lines.

The most common events that can trigger PTSD and put people at the highest risk of developing PTSD are those who have experienced combat exposure, domestic violence/abuse, rape/sexual assault, childhood neglect/abuse, physical attacks, being threatened with a weapon. However, car accidents, muggings, robbery, natural disasters, war/terrorism, prison stays, and accidents can also cause PTSD.

Other risk factors for developing PTSD include:
Living through dangerous and traumatic events
A history of mental health issues/problems (depression, anxiety)
Drug/alcohol abuse
Family history of anxiety conditions
Sleep disorders
Getting hurt
Seeing other get hurt or killed
Feelings of horror, helplessness or extreme fear.
Having little or no social support after the event(s)
Dealing with more stress after the event(s) such as loss of a loved one, loss of a job, divorce, etc.
Frontal Head Injuries
Those who are diagnosed with a life threatening illness or who have had major medical procedures.
Being a first responder
Being a combat veteran
Learning of an unexpected death of a loved one or close friend


One month after 9/11 approximately 7.5% of New York City’s population reported symptoms of PTSD. 6 months later it had fallen to .6%.

Approximately 5.6 million to 7.7 million people in this country have symptoms of PTSD during the course of a given year. (about 3.6 to 5% of the population)

It is estimated that 6-30% or more of trauma survivors develop PTSD with children and young people at the highest risk.

Women (10.4%) are twice as likely as men (5%) to develop PTSD.

It is estimated that at least 7.8% of Americans will experience PTSD at some point in their lives.

Approximately 30% of men and women who have spent time in war zones experience PTSD

An additional 20-25% of our Veterans have had partial PTSD.

More than half of all male Vietnam veterans and almost half of all female Vietnam veterans have experienced “clinically serious stress reactions”.

Estimates of PTSD from the Gulf War in Veterans are about 10%

Estimates of PTSD from the war in Afghanistan in Veterans are between 6 and 11%

Current estimates of PTSD in military personnel who served in Iraq range from 12-20%

When in danger, it is absolutely normal to feel afraid. Fear triggers many split-second changes in the body to prepare to defend against the danger or prepare to avoid it. This is called the ‘fight or flight’ response. Hormones and other chemicals flood the body. With PTSD, something changes within the brain and researchers are not quite sure exactly what it is that changes. Current research is looking at genetics, Stathin (a protein), GRP (gastrin-releasing peptide) and a version of 5-HTTLPR gene which controls the release and levels of serotonin. These three chemicals play major roles in the fear response and fear memory making. Scientists are also looking further into the role of the amygdale which is active in fear acquisition and plays a role in overcoming fear. They are also looking into the PFC (prefrontal cortex) which stores extinction memories (how you over come a fear) and is responsible for dampening the original fear response. It is believed that individual differences with the brain can predispose someone for developing PTSD, but no one knows for sure what ‘causes’ PTSD. Personally, I believe that it is a mix of biological, societal and individual coping mechanisms. Risk factors are just that…risk factors, not a sure bet.

PTSD is not some off the wall cop out, it is not as those in the medical and therapy world would have you believe a ‘mental illness’. It is not a disease and it doesn’t make you ‘crazy’ nor does it make those who have it incompetent in anyway and it is most certainly not a death sentence when properly dealt with. Those who suffer with PTSD are survivors of horrific and life threatening situations, circumstances and events. PTSD is a natural survival response that can be triggered within all of us given the right set of circumstances. All human beings have with them the will to survive. PTSD is merely a reflection of that will to survive that unfortunately becomes prolonged or ingrained into a person for an extended period of time. It is a serious issue because it can become debilitating and problematic to the individual experiencing the prolonged fight or flight response. It can be misunderstood and disruptive in their relationships with friends, family, co-workers and bosses. What was once a protective mechanism becomes a problem when it will not shut off. It simply human to experience fear and to try and avoid or fight a threatening problem or circumstance and those with PTSD should be looked upon as survivors who need help in returning to a state of balance within themselves.