PTSD Guide. Lise Leblanc
what one woman said about this:
Intrusive thoughts pop out of nowhere. It’s completely involuntary. I often can’t relate it to anything that has happened in the past or to anything that is bothering me in real life. I am fully aware of it, don’t like it, and do my best to block it. But sometimes I can’t. It scares me, so I try to switch my thoughts to something else, but I get pulled right back into the intrusive imagery. Trying to control these thoughts is exhausting.
It is important to recognize intrusive thoughts as part of PTSD and to separate them from who you are. When you have intrusive thoughts, turn your awareness to the picture of PTSD that you drew in the last chapter and call it by its name (the name you gave your PTSD in Chapter 1). Recognize these thoughts as a PTSD episode and not as you.
“Hallucinations” can be another intrusive symptom of PTSD. We tend to associate hallucinations with psychosis, and as much as these experiences make you feel paranoid, in the case of PTSD, it is not a psychotic phenomenon, but rather a dissociative experience. This may happen because the amygdala is so primed for something bad to happen that it projects things externally and creates the sense perceptions to match the perceived or imagined threat. Sometimes these “hallucinations” are referred to as pseudohallucinations, nonpsychotic hallucinations, or parahallucinations to distinguish them from standard hallucinations where the person believes their hallucination to be real. In those with PTSD, although it feels very real, they know it is not actually happening in their objective reality and can usually recognize that their mind is playing tricks on them.
It is quite common in PTSD to have brief moments of vivid sensory perceptions that are not directly related to the traumatic event. Here are some examples:
• Hearing footsteps, creaking doors, buzzing, breathing, someone saying your name, or other strange sounds that no one else can hear
• Seeing a shadow, reflection in a mirror, or a person that’s not there
• Feeling someone’s presence or touch
You may have noticed that your intrusive symptoms can come and go and tend to increase when you’re stressed or when you come across reminders of your trauma. For example, you may hear sirens going by and be flooded with memories of your car accident, or perhaps you see fireworks and are brought back in time to the war. You may see, smell, hear, taste, or feel something that you don’t consciously associate with your trauma, and the next thing you know, you’re in full-blown fight-or-flight mode. For example, one paramedic said he had a flashback immediately after noticing an almost-dead turtle on the side of the road. Unable to catch his breath, he stopped on the side of the road to vomit. He couldn’t understand why roadkill — which he’d seen many times in the years since his traumatic event — would suddenly have such an effect on him. When asked to provide more detail about the event, he explained that the turtle’s body was completely crushed and that it was still gasping for air. Then it dawned on him: “That’s just like the boy,” he said, referring to his precipitating trauma where he’d been called to the scene of a motor-vehicle accident involving a four-year-old child whose body was completely crushed, but he was still breathing reflexively. Although he hadn’t made the conscious connection on the spot, he could easily see how the two were subconsciously associated and why he was triggered by the turtle.
Here’s another example: a woman who was assaulted in a park by a tall, dark-haired man with a beard wearing jeans and brown shoes. Although she only consciously remembers these specific details, there were also several things in the background that were not consciously noticed but that were nonetheless picked up by her senses. In this case, tall men, beards, parks, jeans, and brown shoes can become identifiable triggers, but there may be other more generalized triggers that are less easy to identify. Perhaps the smell of grass, the colours blue or brown, or other less obvious things like pavement or something in the distance that was barely noticed that became unconsciously associated with the trauma. All of these subconscious details can become triggers for her intrusive symptoms. These “triggers” will be further explained in chapter six, but for now, it is important to know that trauma can be stored deep in the unconscious mind, hidden even from ourselves, just waiting for a trigger to resurface. Sometimes these intrusive symptoms seem random, as though they are coming out of nowhere, but other times there is an identifiable trigger. Here is an example of a clear trigger:
My husband took his life in our bedroom while I was in the house. Now any loud sounds trigger a visceral reaction in me. Fireworks, sirens, car backfiring, anything loud will cause an intense emotional reaction. I start shaking, bawling, and completely losing emotional control.
Here is an example of intrusive symptoms that don’t have such a clear trigger:
I started having flashbacks several years after an abusive relationship. I don’t know exactly what triggered them, but I started having these flashbacks of specific moments — the worst parts — things I had totally forgotten about. They just sort of came out of the blue. It’s like they were suppressed memories. When a flashback comes on, I can feel the emotions and sometimes even the physical sensations. I really don’t know what causes them.
Although there isn’t always a clear trigger, sometimes a traumatic experience that has been completely blocked is reactivated years later when something happens to bring it back into awareness. This can also happen when under extreme stress, even when the person thinks they have moved past their trauma and believe it is no longer affecting them. Then intrusive thoughts, memories, flashes, and nightmares started plaguing them.
PRACTICAL EXERCISE — IDENTIFY YOUR TRIGGERS
See if you can determine which of your senses trigger your intrusive symptoms most: sight, smell, touch, taste, or hearing. For the next few days, notice what, if anything, has come in through your senses just before you experience intrusive symptoms. Note them in your workbook or journal.
REFLECTIVE QUESTIONS
• What are the sounds, smells, sights, tastes, and sensations that trigger flashbacks or intrusive memories?
• What are the internal things (thoughts, emotional states) that trigger intrusive symptoms?
• What external things (people, places, situations) trigger intrusive symptoms?
AVOIDANCE
Avoiding pain or other unpleasant emotions is a natural human response. Avoidance includes all actions aimed at avoiding thoughts, emotions, situations and reminders associated with trauma. This can include physical, mental, and/or emotional avoidance. Physical avoidance is avoiding people, places, and situations, while emotional avoidance is the avoidance of feelings, and mental avoidance is the avoidance of thoughts and memories associated with the traumatic event. Here are some examples of physical, mental, and emotional avoidance:
Physical Avoidance: Now that I have PTSD, I avoid social situations like the plague. I’m not comfortable in crowds or even in places where there will be other people (i.e., the grocery store). I was much more social before being sexually abused, but now I make excuses as to why I can’t go places, even if I really want to. Part of it is not knowing when I will be triggered, and not knowing whether I will be able to handle myself in those situations. Another part is a fear of human beings. When someone you know and trust traumatizes you in such a personal and intentional way, you lose almost all faith in humanity.
Mental Avoidance: When I start having bad thoughts, I often start sorting, cleaning, spending, and doing anything I can to keep me busy and distracted from my own thoughts. I just try to push it away instead of facing it. Why? I guess I’m afraid of thinking about it. I’m afraid to “go there” because it brings about negative thoughts and feelings that I can’t handle.
Emotional Avoidance: I started drinking to ease the pain. At first, a little shot of brandy did the trick. It calmed me down, allowed me to sleep, and eased my fears. In time, I drank more and more. When I’m drinking, I’m not feeling, and I guess I just don’t want to feel any of it because I’m afraid I might totally lose control and never be able to pull myself back together again.
In