On Triggers

[rachelmanija]

This is about triggers in the technical sense, of the "cues" mentioned by the DSM-IV in its criteria for PTSD: "intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event."

I have a much more detailed explanation of triggers here. (Warning: uh, triggery in that it contains descriptions of PTSD and abuse.)

In LJ/DW culture, people often use "trigger" in a much more colloquial sense, to mean "a thing which is upsetting/disturbing/unpleasant." But in the technical, trauma-related sense, this is what a trigger is:

Triggers are not merely upsetting in general. They are things which bring back memories or feelings associated with trauma.

Triggers are highly, highly idiosyncratic. (There are exceptions to this, which I'll get into in a moment.) They don't have to directly relate to the general nature of the trauma. In fact, they are at least as likely to relate to some random thing associated with the trauma, not with the nature of the trauma itself.

For instance, a person who was raped in a car would be at least as likely to be triggered by hearing the song which happened to be playing on the radio during the rape, or by the feel of a vinyl car seat, as she would be by fictional depictions of rape, discussions of rape, or the word "rape." (Some people, of course, do end up triggered by all fictional depictions of rape, etc. I'm just saying, not all people, not always.)

I suspect that the reason for this is that "rape" is a very general thing. But a specific trauma is specific. A fictional rape may bear very little resemblance to one's real rape, and so not touch off any specific memories. But the song, the vinyl seats, the smell of the man's cologne, and so forth, are real things which get burned into the very cells of one's brain, and the fibers of one's nervous system. They may bring up reactions which happen before you even know why you're reacting.

ETA: Forgot about the exceptions to the "idiosyncratic" thing. There's two big categories of those:

1. Most people whose traumatic reactions reach the level of diagnosable PTSD will be physically triggered by sudden loud noises and unexpected touch. It has to do with how our nervous systems are wired. Those things are inherently startling, and if your startle reflex is cranked up past a certain point, inherently startling things will provoke the same level of physiological/emotional reaction people normally have when, say, someone suddenly leaps out of a dark alley and sticks a gun in their face.

2. When similar sorts of traumatic things happened at the same time, in the same space, to large groups of people, you can take a pretty good guess at what triggers will affect many or most of them simply by looking at notable features of the trauma or the area in which it took place. For instance, some insensitive landscape designer stuck a bamboo grove on the grounds of the Veteran's Administration. Unsurprisingly, you can tell who the Vietnam vets are by which ones are taking a very wide path around the bamboo. In the unlikely event that burning papers start fluttering down from the sky, the people who have very strong reactions are probably the ones who were present in New York during 9/11.

End ETA.

People often warn me about fictional depictions of child abuse. I am not triggered by that, or by fictional anything. I was tied up and abused. I'm not bothered by rope bondage in fiction. (Feel free to rec me rope bondage in fiction!) But I did have something trigger me yesterday, and I'm writing it up because it was such a great example of how triggers actually work - and can be dealt with.



We were all sitting on chairs in a semi-circle in class, with the professor at the front. She dropped her pen. No one was close enough to be able to easily reach over and pick it up, and she reached down and picked it up herself.

This completely innocuous moment reminded me of how, when I'd been a child and a teacher dropped a pen, every kid would dive forward to grab it and hand it back. If you didn't do that - if you were nearby, but didn't move fast enough, and the teacher picked it up herself - that would get you a beating.

Sitting in class yesterday, I registered that I hadn't moved to go for the pen. I registered that I'd had the dropping of the pen set off that memory. As the professor went on with her lecture, I let myself mentally check out for long enough to consciously evaluate what had just happened and how I was doing with it:

This thing just happened. This is a trigger. This is the memory. How am I doing right now? (Okay.)

Briefly review associations: the memories themselves. Don't go too deep, just a little "this is what that reminded me of."

Mentally check back into class. Do I need to be paying attention to the present? Should I be paying attention? Or should I take a little more time to mentally deal with myself? Decide to take a little more time.

Check in with myself physically. Breathing seems normal. Heartbeat seems normal. I can feel my body, the floor under my feet. (If I couldn't, or if my heart was racing or anything else was off, I'd have worked on that.)

Think that ten years ago, that pen dropping would have sent me into a physical and emotional tailspin. It didn't this time. I'm okay. I'm okay.

Set it aside for further review. Mentally check back into class.

That being said, I do think I was a bit off-kilter for the rest of the class. I got really defensive at something someone said to me, and I felt briefly tearful at something else - both reactions I might have had anyway, but stronger than they probably otherwise would have been.

I wrote the whole thing up because I don't usually go through that process that step-by-step, or that slowly. (I think I took three to five minutes with it.) It's normally a matter of seconds - That thing happened. It reminded me of that other thing. Am I okay? I'm okay. The pen was more of an intense, direct reminder than my triggers usually are, now. (Mostly they involve stuff like, What was that noise? Who's behind me?)

Written out in full, it sounds kind of laborious and like I'm still deeply damaged, etc. But it doesn't feel that way. It's certainly better than what I used to do, before I had these tools, which was generally to suddenly and, inexplicably to onlookers, burst into tears, flee the room, and be a depressed, jumpy mess for the next few hours or days.

I look forward to teaching these sorts of skills to others. It is amazing and wonderful how completely we can rebuild ourselves from what seems to us like rubble and ash.

Comments

[twistedchick]

Thank you for the step-by-step. It's very helpful.

[umbo]

It doesn't sound laborious or deeply damaged at all--it sounds like you have a very clear understanding of your own trigger(s) and are doing exactly what you need to do, which is pretty damned amazing, if you ask me.

[kore]

Yeah, I had to go into therapy to learn self-regulation like that!

[rachelmanija]

Thank you!

[mildred_of_midgard]

Seconded, sounded very self-aware and constructive.

[kore]

For instance, some insensitive landscape designer stuck a bamboo grove on the grounds of the Veteran's Administration. Unsurprisingly, you can tell who the Vietnam vets are by which ones are taking a very wide path around the bamboo

//facedesk

And wow, that was really interesting and detailed. Thank you.

I look forward to teaching these sorts of skills to others. It is amazing and wonderful how completely we can rebuild ourselves from what seems to us like rubble and ash.

Oh, yes.

[smw]

Thank you for sharing. Knowing these things is invaluable to me.

[vass]

Thank you for that description and explanation.

In LJ/DW culture, people often use "trigger" in a much more colloquial sense, to mean "a thing which is upsetting/disturbing/unpleasant." But in the technical, trauma-related sense, this is what a trigger is:

Just to check, since I don't actually know: are eating disorder, self-injury and addiction things also technically 'triggers', or not? Things closely associated with a behaviour or compulsion?

I use the term 'triggers' to refer to things that set off my OCD, and I know that's not the technical term, but it's a useful way of saying "if you talk about that in front of me, I will spend the next two days in a very exhausting fight with my own mind and possibly doing illogical and useless tasks to reduce my anxiety, and then getting more anxious if the tasks aren't actually possible."

Edited to add that I don't go around trying to stop people from discussing my OCD triggers. I do, however, sometimes excuse myself from the conversation.

[staranise]

In real life, I've gotten pretty bold about doing whatever it takes to not hear about my OCD triggers, even if it makes me pretty odd. I was recently at a party where I was seated in the far corner of a friend's apartment from the door, and someone began talking about a plot point of a horror movie that I knew was going to be really triggering. After protesting ("Aw, gross, can we not?") I told the person next to me to wave when he was done talking about it, just plugged my ears and began humming tunelessly--because of the hum of conversation, this kept me from hearing what he was saying. In the end I think he didn't draw his description out because he was kind of boggled at the severity of my reaction. But I just tell people, "I can't hear this," so if they really really want to talk about it one of us is going to have to move out of earshot.

[rachelmanija]

Just to check, since I don't actually know: are eating disorder, self-injury and addiction things also technically 'triggers', or not? Things closely associated with a behaviour or compulsion?

Yes, I think they are - they're cues which set off involuntary distress and/or compulsive reactions which are based on pre-existing conditions (other than trauma.) It's also very different than simply, "I find this thing upsetting and don't want to see it."

[lovepeaceohana]

Can you have triggers without having been traumatized?

(Er, possibly triggery content follows.)

I ask because, I DO ask that people warn me for violence against children, particularly graphic violence; I don't watch Law & Order: SVU anymore, or episodes of CSI that have kids in them. I spent the last half of Kung Fu Panda 2 in tears. And I don't know that it's a trigger, per se, but what it will do is that I will end up spending several minutes unable to stop imagining my own kids in awful, terrible situations (think Mrs. Weasley's boggart), minutes in which I am incapable of functioning normally - it feels a bit like the feeling I get when I wake up from a nightmare, actually, adrenaline up and blood pumping (I can actually feel myself getting worked up typing this). And then I have to distract myself with other, fluffier things. I've never been traumatized myself, so the strength of this reaction has been surprising and strange.

[rachelmanija]

I think that falls into the category of "extremely upsetting." Which is certainly real and important, just not the same thing.

Does Kung Fu Panda 2 have graphic violence against children? I also find that upsetting.

[marzipan-pig.livejournal.com]

Thanks for describing that out.

I'm having a really hard time with some stuff lately and sometimes I just want to be able to freak out WITHOUT evaluating it all and communicating about it blah de blah de blah.

Other times, blah de blah de blah.

[rachelmanija.livejournal.com]

I hear you. It can get pretty tiring.

I don't usually bother to communicate it to others, though. ;)

[rosefox]

Thank you for talking about this.

My mother and I once had a brief and extremely weird conversation where we both managed to agree, out loud, that I have all the hallmarks of being a survivor of childhood sexual abuse: expressions of kinky sexuality from a young age, hardly any memories of childhood (like, nothing before I was about 12), violent reactions to being startled or tickled or having anyone hold my wrist or put an arm around my shoulders, constant low-grade fear and distrust of men. But neither of us can figure out how or when it might have happened, or who might have abused me, because I was absolutely a mama's girl and she was the most protective mother ever, and had anyone done anything to me that I didn't want, I would have gone screaming to her, twice as loud if they told me not to tell. (When I was three or four years old, I got her to fire a babysitter because I didn't like the poor girl's long fingernails.) So... it is all a mystery. And I kind of envy you for knowing what memory is being triggered.

[rachelmanija.livejournal.com]

Suspecting but not knowing sounds enormously disconcerting. In your situation, I think I'd rather know, too.

That being said... given what I've recently learned about trauma, I can think of a several possible explanations. Want to hear them?

[sartorias.livejournal.com]

Wow, this is enormously helpful. A lot of this I'd already figured out, but not the specifics. Thanks for posting.

[rachelmanija.livejournal.com]

Glad it was helpful!

PS. I am currently procrastinating on stuff by re-reading the Inda series. It's so great! So hard to tear myself away!

[rikibeth.livejournal.com]

Thank you - not only for the description, but for clarifying the difference between the colloquial and the technical meanings of the word. The colloquial usage, honestly, is starting to get on my last nerve.

[rachelmanija.livejournal.com]

I find it annoying too, but upon reflection, I can't object so long as people are aware that there is also a technical meaning.

When I say, "My waffles burst into flames AGAIN, after I tried so hard to get the recipe right! It was so depressing!" I don't literally mean (and I know I don't literally mean), "I was clinically depressed."

[janni.livejournal.com]

Through the years I've met quite a few people who would explain their reaction to unexpected touches of any sort was to immediately go into fight mode and respond violently. In general, they've seemed angry that people didn't understand they were taking their life in their hands if they touched someone without warning, because what did they expect?

The thought that in most cases these were folks having PTSD reactions, but not knowing it was PTSD, instinctively normalizing it to something most sensible people would feel, is fascinating. It was the intensity of the reaction, and how it didn't take particularly boundary crossing (to me, anyway) touches to cause this reaction, that had always puzzled me.

If so, it means there's a remarkable amount of undiagnosed PTSD out there, too.

[loligo.livejournal.com]

Or a lot of undiagnosed sensory integration dysfunction -- but I think that's more an issue with kids. Some kids who seem belligerent and get in lots of shoving matches, etc., are just poorly calibrated when it comes to processing sensory information about touch, so touches that would be inconsequential to most kids come across as intrusive and threatening. But I think a lot of people with that issue do manage to understand it, verbalize it, and work around it as they get older.

[lyras.livejournal.com]

That is really helpful to read - thank you.

[trinker.livejournal.com]

Ah. Thank you.

[fourthage.livejournal.com]

Are idiosyncratic triggers consistent? I don't know that it rises to the level of a real trigger, but I occasionally get a fight or flight reaction to white vans, which I know is a hangover from the D.C. snipers. (The snipers were thought to be in a white van, which turned out to be completely wrong, but that's what was reported for several days running.)

[rachelmanija.livejournal.com]

Not necessarily, as you note.

I see people drop pens all the time; there was something about the particular combination of circumstances - identity of person who dropped it, plus where I was sitting, plus the nature of what was happening, plus the seat configuration - which boosted that particular instance up to trigger level.

[pameladean]

I just want to say, I read your depiction of the triggering incident, said aloud, "Oh, my God!" and rolled my chair back from the computer.

I think this is a testimony to your effectiveness as a writer in All the Fishes Come Home to Roost."

P.

[tanyahp.livejournal.com]

This is a very descriptive and useful post! I feel like I understand what can be done to empower oneself/clients in the event of exposure to a trigger. Sounds a bit like CBT, your internal dialogue I mean. Also, we must do lunch!

[rachelmanija.livejournal.com]

I'm always happy to talk about this stuff with you, so if you ever have any questions...

Lunch: are you free Monday or Tuesday?