There are several main symptoms that make up this disorder: intrusions (memories that appear involuntarily), negative changes in thoughts and mood, and avoidance. Of these symptoms, avoidance is the most paradoxical. If memories of the trauma interfere with your daily life, make you feel tense, and change your emotions and thoughts, it's more than normal to want to avoid those memories. However, those who rely heavily on avoidance as a way to cope with stress are at greater risk for worsening PTSD symptoms over time. Here's why this happens.
Our body is equipped with an alarm system that helps us react quickly when our brain perceives a danger. When this alarm goes off, the nervous system goes into action and triggers what is often called the "fight, flight or freeze" response. The heart begins to beat faster, breathing becomes faster, adding oxygen to the limbs to prepare them for an attack, to flee to a safe place or to withstand an inevitable blow.
In PTSD sufferers, fear conditioning causes the nervous system to activate in situations that are not actually dangerous. Something that is harmless in itself becomes a "trigger" of the stress response, as it becomes associated in the mind with the memory of the traumatic event. Anything can become a trigger: places, situations, people, sounds, smells, objects. The problem is that most of these triggers are not really dangerous. For example, by watching a car accident scene on TV from home, there is no real risk that you will be involved in an accident. Also, bumping into someone at a crowded station doesn't mean you're in danger of being attacked. But your body and mind can react as if these dangers are real and imminent.
It is understandable that many people with PTSD try to avoid or run away from the "triggers" that shock them. "Avoidance behaviors" include strategies to avoid any stressful situation that evokes trauma. For example, some people avoid traveling as a passenger in a car, so as not to experience the feeling of losing control. Others avoid supermarkets during peak hours to avoid large, unpredictable crowds.
"Escape behaviors" are actions intended to end an unpleasant situation that has begun; for example, they may ask the driver to stop and change seats out of fear, or abandon the shopping cart because the supermarket is crowded.
Why is avoidance problematic?
There are two main reasons why avoidance, escape, and safety behaviors create a problem. First, they prevent you from living the life you want. It's hard to feel free when you have to plan your life around every possible trigger. And asking loved ones to support you in your safety behaviors can make them feel trapped and over time can damage your relationship with them.
Second, these behaviors reinforce the idea that triggers are dangerous. Every time you engage in an avoidance, escape, or safety behavior, your anxiety is temporarily relieved. Check the security camera, see that no one suspicious has come near the house, feel better. However, the discomfort may return after an hour and you feel the need to check the camera again. Over time, it feels like the anxiety will never go away unless you control the camera. And by checking it, you don't give yourself the opportunity to learn that nothing bad will happen even if you don't check it.
Imagine that your trauma is like a plastic beach ball and fully inflated. Obviously, you want to keep it underwater, out of sight. If you use all your weight and strength, you can hold it for a short time, but you will tire, get distracted, or be swept away by a wave. And what happens the moment your hand slips off the smooth surface of the ball? It will explode upwards with force equal to what you used to hold it down.
This is also how avoiding traumatic memories works. Yes, you can sometimes successfully avoid memories for a short period. You may be distracted by work, a relationship, things that help you forget, or a calendar full of activities. You can avoid major roads to avoid crossing highways or order food online to avoid crowded supermarkets. But the harsh truth is that avoidance never fully works long-term.
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