Everyone diagnosed with post-traumatic stress disorder will by definition have some avoidance symptoms. They're covered in section C of the diagnostic criteria found in the DSM-5 (the current version of the "psychiatry bible", the diagnostic and statistical manual of mental disorders), and are required for diagnosis.
Avoidance symptoms are, basically, exactly what they sound like. As the DSM-5 explains, they can manifest as avoiding, or efforts to avoid:
- Internal stimuli related to the trauma — distressing memories, thoughts, or feelings.
- External stimuli related to the trauma — places, people, situations, objects, or any other trigger that exists outside of your own mind.
- Or, of course, both.
Some would say that the emotional numbing common in PTSD sufferers is yet another manifestation of avoidance (of painful emotions, this time), but research has found emotional numbing to be a separate symptom.
If you think avoiding things that remind you of something traumatic is a common-sense coping mechanism, and actually a pretty neat thing your brain does all on its own to keep you semi-functional in the aftermath of trauma, you're not alone. Avoidance got me, as someone diagnosed with PTSD, through some times I wouldn't have been able to manage.
In the long run, however, avoidance can become a real problem — and reducing avoidance behaviors is a worthwhile goal for people suffering from post-traumatic stress disorder. Let's take a look at why, as well as what you can do to face the music in a way that helps rather than further destroys your mental health.
PTSD: Why are avoidance symptoms a problem?
Avoidance symptoms — that is, avoiding reminders of the trauma in one way or another — may serve mental health in the immediate post-trauma stages, when you're not yet ready to process what happened and just need to make it through another day. Avoidance becomes more and more of a problem over time, and here's why.
That is, beyond obvious facts like:
- Avoiding physical situations can really limit your life if you're staying away from an extensive list of things.
- Emotional numbing can turn you into a practical zombie (not feeling the bad stuff comes at a cost of not feeling the good stuff, either).
- If you're using substances like alcohol to help you avoid your own thoughts and feelings, that has negative physical consequences as well as potentially reeling you into an addiction.
Trauma-related memories aren't processed in the same way as other memories, which are processed and inegrated into your personal chronological timeline. Instead, they stick around your brain's subcortical and primary perceptual areas, from which they can come to haunt you when you're presented with a trigger.
To give an example, if you were in a car accident and avoid driving or even getting in a car for years after, your brain doesn't get the chance to associate driving and cars with new and safe memories — like safely getting to many destinations, listening to your kids having fun talking to each other in the car, or seeing friends from out of town thanks to your car. Instead of helping you overcome both your apprehension around road safety and processing your trauma, your fear of driving and cars only grows.
What can you do to reduce avoidance symptoms?
People with PTSD can make efforts to reduce avoidance symptoms on their own — they can, for instance, commit to getting into a car and driving a short distance on a quiet road, start journaling about their trauma, or attend a relatively busy party with lots of noise. There's a chance that these steps will help you process your trauma and achieve desensitization to certain triggers over time.
Specific types of talk therapy that have been shown to help people with PTSD include:
- Exposure therapy, which helps you confront your trauma (in a polar opposite to avoidance) in a safe and controlled setting.
- Cognitive behavioral therapy, which can help you recognize thought patterns and behaviors that don't serve your wellbeing, and change them.
- Stress management to help you better cope with situations and thoughts that you currently do your best to avoid.
- Eye movement desensitisation and reprocessing (EMDR), which helps desensitize you to situations and thoughts you currently find too triggering to deal with.
The avoidance symptoms seen in PTSD can make up a bigger or smaller part of a person's total symptomatic picture, but they're ultimately just one aspect of a disorder with many interconnected symptoms. Treating the underlying post-traumatic stress disorder will help you reduce avoidance symptoms, or even overcome them entirely.