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Author Topic: PERSPECTIVES: What is PTSD and how do you define "trigger"?  (Read 9555 times)
blackandwhite
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« on: July 18, 2010, 12:24:35 AM »

From the United States Department of Veterans Affairs National Center on PTSD
(http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp)


What Is PTSD?

Posttraumatic stress disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening.

Anyone who has gone through a life-threatening event can develop PTSD. These events can include:

    * Combat or military exposure
    * Child sexual or physical abuse
    * Terrorist attacks
    * Sexual or physical assault
    * Serious accidents, such as a car wreck.
    * Natural disasters, such as a fire, tornado, hurricane, flood, or earthquake.

After the event, you may feel scared, confused, or angry. If these feelings don't go away or they get worse, you may have PTSD. These symptoms may disrupt your life, making it hard to continue with your daily activities.

How Does PTSD Develop?

All people with PTSD have lived through a traumatic event that caused them to fear for their lives, see horrible things, and feel helpless. Strong emotions caused by the event create changes in the brain that may result in PTSD.

Most people who go through a traumatic event have some symptoms at the beginning. Yet only some will develop PTSD. It isn't clear why some people develop PTSD and others don't. How likely you are to get PTSD depends on many things:

    * How intense the trauma was or how long it lasted
    * If you lost someone you were close to or were hurt
    * How close you were to the event
    * How strong your reaction was
    * How much you felt in control of events
    * How much help and support you got after the event

Many people who develop PTSD get better at some time. But about 1 out of 3 people with PTSD may continue to have some symptoms. Even if you continue to have symptoms, treatment can help you cope. Your symptoms don't have to interfere with your everyday activities, work, and relationships.

What Are the Symptoms of PTSD?

Symptoms of PTSD can be terrifying. They may disrupt your life and make it hard to continue with your daily activities. It may be hard just to get through the day.

PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go over many years. If the symptoms last longer than 4 weeks, cause you great distress, or interfere with your work or home life, you probably have PTSD.

There are four types of PTSD symptoms:

   1. Reliving the event (also called re-experiencing symptoms):

      Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. You may have nightmares. You even may feel like you're going through the event again. This is called a flashback. Sometimes there is a trigger -- a sound or sight that causes you to relive the event. Triggers might include:
          * Hearing a car backfire, which can bring back memories of gunfire and war for a combat Veteran.
          * Seeing a car accident, which can remind a crash survivor of his or her own accident.
          * Seeing a news report of a sexual assault, which may bring back memories of assault for a woman who was raped.

   2. Avoiding situations that remind you of the event:

      You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. For example:
          * A person who was in an earthquake may avoid watching television shows or movies in which there are earthquakes.
          * A person who was robbed at gunpoint while ordering at a hamburger drive-in may avoid fast-food restaurants.
          * Some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event.

   3. Feeling numb:

      You may find it hard to express your feelings. This is another way to avoid memories.
          * You may not have positive or loving feelings toward other people and may stay away from relationships.
          * You may not be interested in activities you used to enjoy.
          * You may not be able to remember parts of the traumatic event or not be able to talk about them.
  
4. Feeling keyed up (also called hyperarousal):

      You may be jittery, or always alert and on the lookout for danger. This is known as hyperarousal. It can cause you to:
          * Suddenly become angry or irritable
          * Have a hard time sleeping.
          * Have trouble concentrating.
          * Fear for your safety and always feel on guard.
          * Be very startled when something surprises you.

What Are Other Common Problems?

People with PTSD may also have other problems. These include:

    * Drinking or drug problems.
    * Feelings of hopelessness, shame, or despair.
    * Employment problems.
    * Relationships problems including divorce and violence.
    * Physical symptoms.

Can Children Have PTSD?

Children can have PTSD too. They may have the symptoms described above or other symptoms depending on how old they are. As children get older, their symptoms are more like those of adults. Here are some examples of PTSD symptoms in children:

    * Young children may become upset if their parents are not close by, have trouble sleeping, or suddenly have trouble with toilet training or going to the bathroom.
    * Children who are in the first few years of elementary school (ages 6 to 9) may act out the trauma through play, drawings, or stories. They may complain of physical problems or become more irritable or aggressive. They also may develop fears and anxiety that don't seem to be caused by the traumatic event.


What Treatments Are Available?


When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But treatment can help you get better.

There are good treatments available for PTSD. Cognitive behavioral therapy (CBT)appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. A similar kind of therapy called EMDR, or eye movement desensitization and reprocessing, is also used for PTSD. Medications can be effective too. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.

****

A member on the coping with relatives board, Emmy24, started an interesting thread called "triggers list" at http://bpdfamily.com/message_board/index.php?topic=124151.0. I think this is a great topic to explore. We use the word "trigger" a lot on the Coping and Healing Board, sometimes rather loosely. Emmy defined it as "things that trigger feelings of FOG, anxiety, or those bad memories/disappointments in ourselves," which is a nice definition, but I find it can be a bit of a squishy word and be used in different ways. In particular, in the context of PTSD, "trigger" is something that leads to PTSD symptoms. That's a pretty specific use of the term. More generally and out of a PTSD context, "trigger" may have other meanings for some of us. It can help to be clear about what we mean.

How do you define "trigger"?

B&W
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« Reply #1 on: July 18, 2010, 01:50:33 AM »

I would say that for me anyway, I use the word "trigger" to mean something that instantly generates a strong negative emotional response in me.  For me a "trigger" bypasses the more rational, logical parts of my brain and instantly presses some negative emotional button or other.

Sometimes it takes a LOT of effort to pull back the reins and stay in the moment and realize that its not OK to act on the triggering event/words/situation, even if I'm feeling the emotion strongly.  I can't help my lightning-fast emotional feeling RE a trigger, but I can help how I act.  Unlike my bpd/NPD momster, I can put on the emotional brakes.  I can leave.  I can count to ten.  I can maintain self-control (most of the time.)

For example, having someone crowd me in line to the point of bumping me with their cart, or touching me with their body or breathing on me will trigger my irritation. (But I react by repositioning myself, such as placing my cart between me and the pushy person.  That usually works.)   A sudden, loud, unexpected noise near me can trigger my startle reaction and a brief but mindless fear.   (I just try to breath slowly, let the pain pass, and not let it ruin my day.)  Seeing some adult physically assault a child triggers my anger.   (This one is hard, but I try to switch into "investigator" mode and not sound angry or upset.  Instead I try to find out what's going on first.)  Discovering that I'm about to drive over a tall, long bridge can trigger a panic attack. (This one is hard, too.  If I can turn around, I will.  If I'm stuck with no options, I have a few techniques that can help distract me from focusing on the height and the edge of the bridge, but they don't last very long.)

Me personally, I don't think of a "trigger" in association with positive emotions, although a good joke will actually "trigger" a laugh, I suppose.

-LOAnnie
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MagentaOrchid
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« Reply #2 on: July 18, 2010, 08:00:02 AM »

I just started using the word because I just started noticing them.  But I am with LOAnnie in definition. 

Sometimes its like a tiny thing, like hearing someone who breathes like my father, and I feel a panic triggered.  I know it isnt him.  I know he isnt going to hurt me.  But panic takes over.

Then other times its kind of pulling me into a flash back or into a specific time/moment.  Triggering a memory or set of feelings.  Like my niece texting me when her parents were fighting. 
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« Reply #3 on: July 18, 2010, 10:35:06 AM »


I agree blackandwhite that the word 'trigger' can mean different things but I use it when I'm referring to something that's caused a negative emotional response for me. The degree or intensity can be different and the response can come on in an instant and be strong and terrifying or it can come on slow and be uncomfortable but not a 'matter of life and death' .   

I may have made the decision to go and visit my mother and it's a nice day and I feel that I can handle it but slowly I begin to feel anxious and may react to someone's driving or that the light turned red just as I got there and sometimes it seems that all the traffic lights are turning red on me or I need to stop and get gas or do some chore for my mother and I start feeling 'closed in.'   These small, barely noticeable things seem to keep increasing and my anxiety too is increasing so now by the time I've arrived at my mother's, I've changed from the calm and happy person who I was when I started out to be irritable, angry, and already exhausted with feelings of doom.
 
Then there is the instant triggers that send me into a panic. I didn't mention the problems I have with necklaces/chains or something that is around my neck.  It's not that I can't wear this kind of jewelry or even certain clothes but at the second that I feel it has to come off, it has to come off or I freak out. I usually don't have the time nor can I find the clasp without some fumbling around and I end up pulling it off in a panic, breaking/tearing it.

 At this point anyway, I'm not able to control that panic because all rational thought just stops and it's like this blindness to everything else comes over me and nothing, absolutely nothing else is important but stopping the feeling.  This is when I 'run' or 'escape' to get out of the situation in what ever way I can and some of my 'exits' have not been pretty.  I have not been able to find any other way of lessening, soothing or calming the terror I feel when the panic sets in other then getting myself away physically.

justhere

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« Reply #4 on: July 18, 2010, 11:10:10 AM »

Great question!
I agree with the others:  definitely a negative thing for me.
It's an overreaction on my part to something going on around me.
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« Reply #5 on: July 18, 2010, 12:35:56 PM »

Interesting observations on the term "trigger" so far. I'm seeing as some factors:

*negative
*overreaction
*varying in degree and intensity (from mild anxiety to full panic, perhaps along other feeling scales as well?)
*being pulled into a past experience (flashback), memory, or set of feelings

Here's one definition, from wikipedia:

http://en.wikipedia.org/wiki/Trauma_trigger
Quote
A trauma trigger is an experience that triggers a traumatic memory in someone who has experienced trauma. A trigger is thus a troubling reminder of a traumatic event, although the trigger itself need not be frightening or traumatic.

Triggers can be quite diverse, appearing in the form of individual people, places, noises, images, smells, tastes, emotions, animals, films, scenes within films, dates of the year, tones of voice, body positions, bodily sensations, weather conditions, time factors, or combinations thereof. Triggers can be subtle and difficult to anticipate, and can sometimes exacerbate post-traumatic stress disorder, a condition in which trauma survivors cannot control the recurrence of emotional or physical symptoms, or of repressed memory. A trauma trigger may also be referred to as a trauma stimulus or a trauma stressor.

I'll try to find other formal definitions. The term is used quite extensively in relation to PTSD/trauma recovery.

B&W
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« Reply #6 on: July 18, 2010, 02:32:56 PM »

from dictionary.com

nanything, as an act or event, that serves as a stimulus and initiates or precipitates a reaction or series of reactions

vto initiate or precipitate (a chain of events, scientific reaction, psychological process, etc.): Their small protest triggered a mass demonstration.


also, from www.psychcentral.com

What is a Trigger?
By U. of Alberta

A trigger is something that sets off a memory tape or flashback transporting the person back to the event of her/his original trauma.

Triggers are very personal; different things trigger different people. The survivor may begin to avoid situations and stimuli that she/he thinks triggered the flashback. She/he will react to this flashback, trigger with an emotional intensity similar to that at the time of the trauma. A person’s triggers are activated through one or more of the five senses: sight, sound, touch, smell and taste. ...


http://psychcentral.com/lib/2008/what-is-a-trigger/
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« Reply #7 on: July 18, 2010, 03:07:56 PM »

A trigger for me, is any person, place or situation that invokes the "fight or flight" impulse within.
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« Reply #8 on: July 18, 2010, 04:44:31 PM »

In the context of experiences with a  less-than-entirely-functional FOO (and no FOO is *entirely* functional), I'd say that a trigger is an action, pattern of speech, etc., that "pushes a button" -- instigates a longstanding negative-thought loop -- that the FOO installed/originally created in the individual in question (who said, "they know how to push our buttons; they installed them"?; it was somebody here).  The FOO doesn't have to be present for the button to be pushed/trigger to be triggered, the situation, wording of a comment, thinking underlying the comment, etc. just has to resemble the one from the FOO.  I suspect the same can be true for people who experienced trauma (war, rape, etc.) not associated with a FOO. 

Interestingly, my uBPD stepmother rarely does things, accidentally or on purpose, that trigger me.  She doesn't know or understand me well enough to really hurt me (except by separating me from my father), nor do her values, frames of reference, etc., overlap much with mine. My father, on the other hand, can definitely trigger me, as can situations, professional or personal, that in some way resemble those in my FOO (e.g. high expectations combined with not-so-benign neglect; the suggestion that my preference for spending considerable amounts of time alone means there's something wrong with me; other forms of diagnosing/psychologizing of disagreements). 

I think there's also a related but somewhat different meaning associated with addiction: in that context, a trigger is a situation that creates or strengthens the impulse to behave in an addictive/self-destructive way.  E.g. an alcoholic might realize that he/she typically coped with a fight with an SO by going on a drinking binge (i.e. that fighting was one of the triggers for his/her drinking), and would resolve to call a sponsor or head for a meeting after a fight instead. 

For FOO or other trauma-created triggers, I think the issue is not so much to avoid the reaction that usually follows (partly because that's impossible; as others have suggested above, these reactions have often become "built in" biochemically), but to recognize that the reaction, because it's associated with past experiences, may be disproportional or even inappropriate to the actual present situation, and to try to delay any response long enough to allow the more rational part of the mind to kick in and play a role in assessing what's actually going on in the present.  I think it also makes sense to share triggers with people we care about and interact regularly with (at least the sane ones), since it can help them understand our reactions and, when possible, avoid triggering us unnecessarily (on the other hand, I'm a pretty strong believer that each of us is responsible for managing his/her own emotions, and reactions to them; a completely trigger-free environment, even among intimates, is probably not possible or even, perhaps, desirable). 
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« Reply #9 on: July 18, 2010, 04:51:40 PM »

allergic to drama summed up my triggers. I do need to tell the difference between trigger and legitimate fears. 
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