7 Things to Avoid Saying to People with PTSD – and What To Say Instead

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1. Get over it
Other variations on this are ‘why aren’t you better yet?’ and ‘But that was years ago.’ This is commonly said to abuse survivors, who often seem to be judged negatively compared to ‘wounded warriors’ who have PTSD as a result of military combat. Nobody chooses to have PTSD and it doesn’t disappear on demand, or when it becomes inconvenient for another person. Some people have PTSD for over 50 years despite working hard to heal, for others PTSD disappears by itself in a matter of months: even a trauma which seems ‘minor’ to another person, or happened decades ago can trigger severe PTSD symptoms. If a person could just ‘get over it’ in an instant, they would have already done so. Healing from PTSD doesn’t have a fixed timeframe, but support from others is known to help.

2. Everything happens for a reason
This view puts pressure on trauma survivors of find a positive reason behind their suffering, and can feel like the horror of the trauma is being minimized and was somehow ‘justified’. Some people do manage to find a positive outcome from the trauma, but it needs to be in their own time, and normally only happens late in the healing process. Healing PTSD involves dealing with loss, including the loss of a person’s former sense of safety, their former way of living (because PTSD symptoms often have a major impact on someone’s lifestyle), possibly losing their job or home, family, partner or friendships, and even sometimes their sense of identity. Would you say ‘everything happens for a reason’ to someone about bereavment? Then don’t suggest this to someone with PTSD.

3. It takes the same amount of effort to behappy as it does it be depressed
The exact opposite is true: lack of energy and lack of motivation are key symptoms of the depression, but a happy overall mood leaves you feeling energized and ready to face the world. Almost as bad is the phrase ‘If you act happy, you will become happy.’ The “persistent inability to experience positive emotions” affects many people with PTSD. Depression (and anxiety) often come as a result of PTSD, so rather than dealing with just one mental health disorder, a person can quickly find they are dealing with two or three. All people with PTSD regularly re-live the trauma, through flashbacks, nightmares or intrusive thoughts: with a mind that won’t stop replaying the worst moments of your life it would be hard to avoid feeling depressed. Severe depression makes it extremely difficult just to get out of bed, and willpower alone is not a known cure for depression. Disturbed sleep caused by PTSD or depression zaps energy levels further. Pressuring someone who is struggling to put on a fake smile or look on the ‘bright side’ in order to make you more comfortable isn’t helpful to them. Thinking or acting positively can help some people, but it can’t be forced. The pressure to ‘be positive’ can increase someone’s sense of isolation and any feelings of failure that depression brings.

4. All you need to do is…
‘You will feel better if you…’ is another version of this. There is no ‘quick fix’ or simple, easy solution to a complex condition like PTSD. It’s natural to want to help someone you care about, but unless you have been asked for advice, or have had a substantial battle with your own PTSD, resist any temptation you may have to offer solutions or well-being/mental health advice. Also be aware that news stories about new PTSD treatments are often misleading and not worth sharing: it is common to find out later they promote unavailable drugs, refer to clinical trials on mice rather than humans, involve a single study only, mention types of therapies which are not widely available, are only effective treatments for a different form of PTSD or PTSD caused by a different type of trauma – and they don’t mention risks (e.g., addiction and paranoia resulting from cannabis use, high drop-out rates, that it’s not advised for certain people, etc).
There is no single treatment or combination of treatments that everyone will respond to. Avoiding seeking professional help does not mean ‘not wanting to recover’ – it can simply be the result of the major PTSD symptom of ‘avoidance’ – which means avoiding anything that reminds the person of the trauma, including trauma professionals. Time does heal a proportion of people with PTSD, so a person’s mind may in fact already be healing by itself.

5. I know how you feel
It’s not possible to know exactly how another person feels, or what their thoughts are, unless you ask them. In PTSD symptoms often go from one extreme to another rapidly: from being emotionally numb to being anxious and ‘on edge’, or depressed and teary, then back again. One moment someone can be unable to stop talking about the trauma, and another time they will avoid conversations about PTSD or trauma and even the slightest reminder of it. Even after asking, you might not be aware of how strong particular feelings are.

6. Why didn’t you… during (or after) the trauma
You may want to keep your belief in a ‘just world’ where bad things don’t happen to good people – or if they do, good things later happen as a result – but trauma can affect anyone, and questioning someone’s actions or blaming them for a trauma is insensitive and judgemental. Unless you were in the same situation, at exactly the same time, and with the same personal history, you don’t know how you would reacted then – or how it would be impacting you now. Trauma responses are instinctive and biologically driven rather than logical decisions, and both ‘freeze’ responses and complying with (rather than resisting) a threatening person are common. Questioning someone’s actions, or rather reactions, during or after trauma is likely to feel like adding blame to someone who may not yet understand their own reactions.

7. It wasn’t that bad
Many people with PTSD will minimize their trauma, or may not mention the extent of what happened at that time (or shortly after the trauma). Some people have amnesia for some or most of the trauma’s details as well. This is the mind’s way of protecting itself from the full horror of the trauma, and the fact it could not be avoided or escaped. Don’t fall into the same trauma-related pattern of thinking and support their belief that ‘nothing really that bad happened’, ‘it was all my fault’ or ‘it was just an auto accident’, etc. The minimization (or even total denial) may later be followed by speaking out the reality of the trauma, which can sound contradictory, confusing and be judged as ‘exaggerating’ or ‘untrue’ because it doesn’t match the previous statements – or just because it sounds too horrible to accept. This pattern of minimizing (or denying) and then re-stating the trauma is not a measure of a person’s honesty, it can simply be the result of PTSD’s symptoms: either “distorted cognitions” about the trauma and/or an “inability to remember” major parts of the trauma (amnesia). A clearer picture of the trauma will emerge in time. If a person has developed PTSD that means the trauma has had a devastating impact and was too much for the mind to handle at the time. PTSD itself is a sign that the trauma was that bad, and even worse is the fact the person is reliving parts of the experience every day.

What To Say Instead
1. I’m here for you
But only say this if you really do mean it, over the longer term.

2. I’m sorry it happened to you
Nobody ‘deserves’ to be traumatized. Nobody makes that choice.

3. How can I help?

4. I can’t fix it, but I can listen.
Remember: listening doesn’t mean offering unsolicited advice.

5. Do you have the details of a helpline you can contact if you need to?
This shouldn’t be said as a way to avoid listening, but as a backup for when nobody is available or things are very hard. Helplines often offer text message or email help, some also offer online chat too.

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Binge Eating Disorder is the most common in America – Facts you should know about it

Binge Eating Disorder is far more common that both Anorexia Nervosa and Bulimia Nervosa in both men and women. It is also strongly linked to other mental health disorders and over half of people with it don’t seek psychological help. Post-traumatic Stress Disorder is common in people with all these forms of Eating Disorders.

Binge Eating Disorder linked to Other Mental Health Conditions

Lifetime co-morbidity of eating disorders with other core DSM disorders. Shows PTSD affects over 12% of those with Anorexia, over 45% with Bulimia, and over 26% with Binge Eating Disorder. Binge Eating Disorder is strongly associated with Specific Phobia, Social Phobia, major Depression, and Substance Use disorders. Image license: CC-SA-4.0

Lifetime co-morbidity of eating disorders with other core DSM disorders. Shows PTSD affects over 12% of those with Anorexia, over 45% with Bulimia, and over 26% with Binge Eating Disorder. Binge Eating Disorder is strongly associated with Specific Phobia, Social Phobia, major Depression, and Substance Use disorders. Image license: CC-SA-4.0

Binge Eating Disorder Myths De-bunked

Eating Disorder Awareness: You can't diagnose by appearances. Image license: all rights reserved, you are welcome to link to it instead.
Sources:
Hudson JI, Hiripi E, Pope HG, Jr., Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry. 2007;61(3):348–358. PMC1892232

Uher R, Rutter M. Classification of feeding and eating disorders: review of evidence and proposals for ICD-11. World Psychiatry. 2012; 11(2):80-92.

Related links:

Complex PTSD and PTSD – Do you know the differences?

PTSD and Complex PTSD

PTSD and Complex PTSD are both caused by trauma. PTSD can be caused either by a single traumatic event (e.g., earthquake, sexual assault, or serious auto accident) or by multiple traumatic events (e.g. several traumatic events during war). Complex PTSD can only be caused by multiple traumatic experiences which have a wider range of symptoms than those in the PTSD criteria. Typical causes involve the person being in a prolonged, and normally continuous, set of traumatic experiences over a considerable period of time. For example, child abuse lasting several years or prolonged captivity with severe mistreatment, e.g. in a concentration camp. [2] This related interpersonal abuse causes problems in many future relationships.

Complex PTSD has additional symptoms

Complex PTSD and PTSD: differences in symptoms
Complex PTSD involves all key components of PTSD, plus :

  • Interpersonal difficulties, meaning relationship problems
  • Negative self-concept, for example persistent beliefs that you are ‘evil’, that good things won’t happen to you or aren’t ‘deserved’
  • Affect dysregulation, meaning being unable to manage the intensity of your own emotions

Recent research from the European Journal of Psychotraumatology described these differences, and showed clearly that they were not simply related to the presence of Borderline Personality Disorder, which is fairly common in people traumatized as children.[1] The DSM-5 manual for diagnosing mental disorders didn’t include Complex PTSD (despite the diagnosis first being proposed in 1992). [5]

The other key guide for diagnosing mental disorders is the International Classification of Diseases (ICD), which is published by the World Health Organizations in multiple languages. The next revision of the ICD should be published within 2 years and does include Complex PTSD.[4]

Sources

  1. Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. European Journal of Psychotraumatology, 5(0). doi:10.3402/ejpt.v5.25097

  2. Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. J Trauma Stress, 5(3), 377–391. doi:10.1007/bf00977235

  3. World Health Organization. (December 9, 2014). ICD-11 Beta Draft (Joint Linearization for Mortality and Morbidity Statistics).

  4. Cloitre, M., Courtois, C.A., Ford, J.D., Green, B.L., Alexander, P., Briere, J., Herman, J.L., Lanius, R., Stolbach, B.C., Spinazzola, J., Van der Kolk, B.A., Van der Hart, O. (2012). The ISTSS Expert Consensus Treatment Guidelines for Complex PTSD in Adults. Retrieved from December 10, 2014 http://www.istss.org/ISTSS_Complex_PTSD_Treatment_Guidelines/5205.htm

  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, D.C.: American Psychiatric Association. ISBN 0890425558.

Related links

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PTSD, Veterans & Suicide: This Bill Could Help – SPAV Act

Veterans & Suicide: This Bill Could Help.

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PTSD is not a mark of shame

PTSD, however, is not a mark of shame… no matter whether if comes from childhood sexual abuse, rape, war, motor vehicle accident or anything else.

Time to pass the shame and guilt of abuse back onto the abusers (military vets – if you were mistreated and abused by the VA or military, it’s time to pass that back too).

War Wounds.

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