Based on increased scientific understanding of Post Traumatic Stress Disorder (PTSD), the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) removed PTSD from the “anxiety disorder” category and instead added a new category of “trauma and stressor-related disorders.”[1] The DSM-V identifies the source of PTSD as exposure to actual or threatened death, serious injury or sexual violation. A PTSD episode, regardless of its trigger, causes clinically significant distress or impairment in the individual’s social interactions, capacity to work, and other important areas of functioning. It is not the physiological result of another medical condition, medication, drugs or alcohol.[2]

 

Judith Herman suggests that symptoms of PTSD fall into three categories: hyperarousal, the persistent expectation of danger, intrusion, reliving the event, and constriction, a numbing, dissociative response.[3] PTSD episodes often take the form of a panic attack or a flashback. If you have never experienced a PTSD episode, it can be hard to imagine their impact. Flashbacks are frequently described as unavoidable, intense, overwhelming, and taking people off guard. These experiences could be likened to a drill sergeant; thunderous with a large, inescapable presence; when they are near, life beyond them becomes a soft hum; in their absence, energy is consumed by averting further interactions with them; sometimes they come continuously, and with treatment they come less and less often over time, but they follow one through ones’ life and studies, always threatening to reappear.[4]

 

PTSD episodes usually arise through triggers.[5] A “trigger” in psychology references a stimulus such as a smell, sound, or sight that brings on feelings of trauma. In the strictest sense of the term, trigger refers to experiences that “re-trigger” trauma in the form of flashbacks or overwhelming feelings of sadness, anxiety, or panic, because the brain has formed a connection between a stimulus and those feelings. Some triggers are quite innocuous. For example, a person who smelled incense while being raped might have a panic attack when he or she smells incense in a store.[6] Sensory memory can be extremely powerful, and sensory experiences associated with a traumatic event may be linked in the memory to this event, causing an emotional reaction even before a person realizes why he or she is upset.[7]

 

Sometimes students will be triggered by a law school case, a news account, a comment by someone in class, or even the scent of someone they pass in the hall who reminds them of someone who harmed them; they then relive the traumatic event. Their heart may start racing, their breath may come faster, and their mind might replay the events of what happened. PTSD episodes often spark the body’s nervous system to experience an extreme adrenaline rush, intense fear, problems processing information, and a severe reduction or shutdown of cognitive capacities, leading to confusion and a sense of defeat.[8] While they may be remembering just a fragment of what happened to them – a few seconds, even – their body still responds as if the whole thing is happening all over again. Post-traumatic responses are how the body assists the brain in developing coping mechanisms to help it recover. When this happens in public, such as in a classroom, people become panicked, overwhelmed, and ultimately depressed.[9]

 

An end goal of trauma-related treatment is to interact with potential triggers without having a PTSD episode, but until that happens it is helpful to be in a trauma-supportive environment.[10] Trouble focusing, insomnia or nightmares, acute anxiety and hyper vigilance, a sense of powerlessness, depression and anxiety, disrupted concentration, and flashbacks are all common manifestations of trauma that particularly impact education.[11] It is impossible to predict and avoid all triggers because so many of them are innocuous, but common triggers such as images of violence, substance abuse, or weapons can be targeted for more sensitive framings.

 

[1] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (2013).

[2] Id.

[3] Judith Herman, Trauma and Recovery 35 (1997).

[4] Athena H. Phillips, Anthropomorphizing PTSD Symptoms, Part I: Flashbacks and Nightmares, GoodTherapy.org, (Jun. 13, 2012), http://www.goodtherapy.org/blog/ptsd-symptoms-normalization-flashbacks-0613125.

[5] Understanding PTSD, PTSD: National Center for PTSD, http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp.

[6] What is a Trigger?, University of Alberta Sexual Assault Center, (2008) http://psychcentral.com/lib/2008/what-is-a-trigger/.

[7] The Psychology of Triggers and How They Affect Mental Health, GoodTherapy.org, (Aug. 28, 2015), http://www.goodtherapy.org/blog/psychpedia/trigger.

[8] B. Van der Kolk, D. Pelcovitz, S. Roth, F. Mandel, A. McFarlene, & J. Herman, Dissociation, Affect Dysregulation and Somatization: The Complex Nature of Adaptation to Trauma, Am. J. Psych., 153, 83–93 (1996).

[9] Id.

[10] Maddy Myers, Saying Trigger Warnings “Coddle the Mind” Completely Misses the Point, The Mary Sue, (Aug. 11, 2015), http://www.themarysue.com/trigger-warnings-arent-coddling/.

[11] Claudia Black, The Triggering Effect, Psychology Today, (Sep. 22, 2009), https://www.psychologytoday.com/blog/the-many-faces-addiction/200909/the-triggering-effect.