Other Common Problems
PTSD is just one of the possible effects of trauma. People experience a range of reactions following a traumatic event. This section will help you to learn more about other common problems and reactions related to experiencing trauma.
Specific to PTSD Symptoms
What is avoidance?
Avoidance is a common reaction to trauma. It is natural to want to avoid thinking about or feeling emotions about a stressful event. But when avoidance is extreme, or when it’s the main way you cope, it can interfere with your emotional recovery and healing.
What are the different types of avoidance?
Emotional avoidance is when a person avoids thoughts or feelings about a traumatic event. For example, a rape survivor may try to force herself to think about other things whenever thoughts about the rape arise. Or, she may stop herself every time she begins to feel sadness about the rape, or focus on something else that makes her feel less sad. She may say things to herself like, “Don’t go there,” or “Don’t think about it.”
Avoiding reminders of a trauma is called behavioural avoidance. For example, a combat Veteran may stop watching the news or reading the newspaper because of coverage of the war. Assault survivors might go out of their way to stay away from the scene of their attack.
What are the consequences of avoidance?
Growing up, you may have heard advice like, “just try not to think about it” or “don’t dwell on it.” But if you avoid thoughts and feelings of the trauma all of the time, your symptoms may get worse. Using avoidance as your main way to cope can make it harder to move on with your life.
Is all avoidance bad?
Not all avoidance is bad. It can be helpful to learn ways to focus your thoughts and feelings on things that are not related to the trauma. Distraction is a useful skill that can help you to get on with your daily life after a trauma. It can allow you to go to school or work, or buy groceries, even in the face of difficult life events. Although distraction and avoidance can be helpful in the short-term, they should not be your primary way of coping.
How can you learn to cope with difficult thoughts and feelings?
You may be afraid that if you let yourself feel difficult emotions, they might overwhelm you. You may be afraid that if you start crying, you’ll cry forever. Or you may worry that if you experience the anger inside you, you might lose control. Therapy can help you learn to deal with your thoughts and feelings about the trauma instead of being afraid of them.
Reminders of Trauma: Anniversaries
On the anniversary of a traumatic event, some survivors have an increase in distress. These “anniversary reactions” can range from feeling mildly upset for a day or two to a more extreme reaction with more severe mental health or medical symptoms.
Why do people have anniversary reactions?
The anniversary date itself may trigger a memory. For example, in a case such as the September 11, 2001 attacks, the date serves as a strong reminder. Since people refer to those attacks with the date on which they occurred, it is hard for anyone who knows about that event to go through that day without being reminded of what happened. Triggers may also seem to come from out of the blue around the time of an anniversary. They may happen while you are at work, home, or relaxing.
Anniversary reactions may occur because of the way a traumatic experience is saved in memory.
Memories of trauma contain information about the danger that the event involved. The memory helps us be aware of when we should be afraid, how we should look at such situations, how to feel in that situation, and what to think. The trauma memory gives information that may help us stay safe.
For example, a memory of a rape might include the information that it’s important to beware of strangers at night and to run away if one comes near. The memory might tell survivors to feel fear in this situation and to think that they are in danger and need help. Such memories may produce strong feelings as well as bodily reactions.
What symptoms go along with anniversary reactions?
Anniversary reactions usually make symptoms that are common reactions to trauma or part of PTSD get worse.
- Reliving the event (or re-experiencing). Perhaps the most common reaction on the anniversary of a trauma is a repeat of the feelings, bodily responses, and thoughts that occurred at the time of the event. For example, on the anniversary of a rape, a sexual assault survivor might have unusually intense and upsetting memories.
- Avoidance. Another type of PTSD symptom is the avoidance of anything related to the trauma. Sometimes the feelings that are triggered by the anniversary are so strong that people try to avoid events, places, or people that are connected to that event. For example, a combat Veteran may choose to stay home on Remembrance Day to avoid parades, Veterans, and other reminders of military service.
- Negative changes in beliefs and feelings. When the anniversary of an event is near, it can lead to sadness. Some people may find it hard to connect with friends and family. Old thoughts of guilt or shame may come back.
- Feeling keyed up (or hyper-arousal). A fourth kind of reaction is to feel nervous and on edge. As the anniversary comes, the trauma memory might be so intense that it is hard to sleep or focus on things you need to do. Some people become more jumpy or quick to anger. Others feel like they have to be more on guard.
Around an anniversary, survivors may have panic attacks, be afraid to go certain places, or find that they worry more about safety for themselves and their loved ones. For example, a car accident survivor may avoid getting in a car on the anniversary for fear they will be hit again. Others may have physical or medical symptoms such as fatigue and pain. They may complain of headaches and stomach aches.
A common type of anniversary reaction is feeling grief and sadness on the anniversary of the death of someone close to you. In fact, this is so common that most major religions have special services to support those who feel increased grief at these times. If the reaction is extreme, the survivor may become depressed or even think about suicide. For most people, though, the feelings of sadness at the anniversary do not last more than a brief time.
What becomes clear is that there is not one classic anniversary reaction. The anniversary reaction will differ among trauma survivors. It may depend on the type of trauma, how much time has passed since the trauma or loss, the qualities of that person, or other factors.
What can I do to feel better?
Most people will feel better within a week or two after the anniversary. Over time, the stress symptoms will become less frequent and less severe. You may find it helpful to make special plans for the anniversary day. It can help to have other things to occupy your time besides memories of the event. You may choose to take part in a special activity. Some ideas include:
- Visiting a grave
- Donating to charity
- Giving blood
- Helping others
- Spending the day with family
Good help is available if the stress response continues. You should contact your doctor or a mental health provider to seek support. It is common for people who did not seek help when they first went through the trauma to feel ashamed that they are still suffering months or years later. The fact that someone did not seek help may itself be a sign that they are avoiding reminders of the trauma. Such behaviour can be viewed as a signal that the survivor needs the help of a professional.