The Truth and the Triggers Behind PTSD

The Flight Attendant is a typical pop-culture portrayal of PTSD (or Post-Traumatic Stress Disorder). Cassie Bowden, played by Kaley Cuoco in the HBO Max series, is deeply disturbed, haunted by daily flashbacks, and self-medicating with alcohol. Without giving away any spoilers, let's just say that Cassie is not handling her past trauma very well. Instead, she's drowning in it.

While this is often how the media portrays PTSD, it isn't the most accurate depiction. Not everyone who suffers from the disorder struggles with rage, substance abuse, or even debilitating flashbacks. Sure, some do, and some more than others. But it’s also true that many people with PTSD also go on to lead happy and fulfilling lives.

Since June is PTSD Awareness Month, we asked two trauma specialists to help us better understand the disorder, its stereotypes, its triggers, and why those triggers can be utterly unattached to the trauma itself.

Misconceptions around PTSD

By now, most people are pretty familiar with Post-Traumatic Stress Disorder. But 40 years ago, it was somewhat taboo. Steven Gold, Ph.D, Professor Emeritus at Nova Southeastern University (NSU) College of Psychology, has been studying PTSD and working with patients since before the disorder had an official name. Gold was finishing graduate school when PTSD first became an official diagnosis in 1980. For almost a decade, he said even professional therapists questioned whether PTSD was real. However, Gold said we've come a long way since then.

"I don't think I've heard anybody question the reality of PTSD in recent years, but it was fairly common when it became an official diagnosis," Gold said. Even though we've busted through some significant stereotypes, Gold says one remains relevant: that PTSD is isolated to combat exposure.

Mindy Mechanic, Ph.D., a counselor and Professor of Psychology Emerita has been studying and working with PTSD patients since 1992. She said many misconceptions about PTSD still linger.

"Here are some misperceptions: PTSD is only a result of combat exposure, PTSD is hard to treat, people with PTSD will become violent," Mechanic wrote in an email. "Most people are not exposed to research. Instead, relying on anecdotal observations or what they come across in movies, TV, and social media."

Mayo Clinic describes PTSD as being triggered by a terrifying event — either experiencing it or witnessing it. The mental health condition can be brought on by a traumatic event like war, rape, abuse, physical violence, or murder. There are many different symptoms of PTSD, but the most common ones are flashbacks, nightmares, anxiety, blackouts, insomnia, and depression. Not everyone who experiences trauma develops PTSD, but there are certain factors that put you at a higher risk.

Who is at risk of developing PTSD?

Gold said two significant factors play an essential role in one's probability of developing PTSD: geographic proximity (for example, witnessing a violent crime) and emotional closeness (for example, a mother losing a child to a horrific accident). But Gold said those at highest risk are the ones directly affected by trauma. "You're most likely to develop PTSD if [the traumatic event] actually happens to you," Gold said.  

When it comes to PTSD, not all traumas are created equal. For example, Mechanic pointed out that the odds of developing PTSD are less likely when the trauma was an accident or natural disaster rather than an intentional crime like murder or rape.

"When trauma is understandable, makes sense, and has a context, it is less pernicious than when trauma is caused by human design, because it shakes our foundation and core beliefs about the safety, trustworthiness, and benevolence of other people," Mechanic wrote.

PTSD triggers are widespread.

Gold explained that a PTSD trigger is "a reminder of the trauma. Someone who's been sexually assaulted is likely to be triggered when they are in sexual situations. Someone who was violently attacked is likely to be triggered when they see violence on TV," Gold said.

A typical trigger for a combat veteran might be a car backfiring, fireworks, or anything that sounds like shots fired. Most of the time, a trigger doesn't necessarily mean that the person's life is in danger. However, Mechanic said, a PTSD victim's brain doesn't understand that at the moment.

"If the triggered response is extreme, it can result in a flashback," Mechanic wrote. "They feel as though they are back in the original trauma and might not have an awareness that they are safe, and not in immediate danger."

Both experts explained that all humans possess a reaction in response to danger called the fight-flight-freeze reflex. Gold said that, in any hazardous situation, this reflex is likely to be set off; it's there for that purpose. But it's different for trauma victims, more predominantly for ones suffering from PTSD.

"What happens in PTSD is that the reflex never fully turns off, or it easily gets set off in response to a trigger," Gold said. "It's possible that any situation that spells danger could be a trigger, because now the reflex that responds to danger is that much more active."

Many people with PTSD suffer from hypervigilance, a state of increased alertness.

Most of us don't like to be caught off guard, like unexpected loud noises or getting surprised in the hallway as a practical joke. But these situations can have a significant emotional impact on someone with PTSD.

"Hypervigilance activates a variety of physiological responses because the person perceives a threat, or potential danger, even when there is no realistic basis for it in the present moment," Mechanic wrote. "The idea being, if you let your guard down, you will be re-traumatized or re-victimized. Therefore, by being hypervigilant, you can prevent future trauma/victimization."

But Mechanic said, no matter how hard we try to prevent trauma, it's out of our control most of the time. And, in addition to feeling in danger, people with PTSD can be triggered by emotional situations. This is because after one's been traumatized, they've been exposed to a sense of vulnerability.

"That vulnerability isn't necessarily about physical well-being and survival, but can also extend into emotional vulnerability and interpersonal vulnerability," Gold said. For example, this means that someone with PTSD could also be triggered by something that makes them feel ridiculed, bullied, or even left out, leading them to overreact in specific situations.

Life might never be the same for someone with PTSD, but it can still be fulfilling.

"I don't think that people can 'erase' the trauma. When people suffer from the harmful effects of unresolved trauma, that trauma holds them hostage and can cause all sorts of disruptive cognitive, emotional, and physiological responses," Mechanic wrote. "But when people have healed from trauma, it doesn't hold the same kind of power over a person. It's like you are in charge of the trauma instead of it being in charge of you."

Gold believes that, with proper therapy, a person with PTSD can become a healthier version of the person they were before the trauma. "I've worked with people who grew up in hell," Gold said. "People whose childhoods were steeped in trauma. And, with successful therapy, they don't just end up at the level of functioning where everybody else is, they very often end up head and shoulders above the rest."

Gold and Mechanic both believe in the power of therapy and encourage anyone who has PTSD to get help now. It could make the difference in a happy life versus a life filled with pain and anguish.

PTSD therapies include, but are not limited to EMDR (Eve Movement Desensitization and Reprocessing) therapy, PE (Prolonged Exposure) therapy, present-focused therapy, and CPT (Cognitive Processing Therapy). Find a local therapist specializing in the disorder or visit the American Psychiatric Association online to find the proper treatment for you.

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