For people with post-traumatic stress disorder (PTSD), every day can feel like a fight to survive. Loud noises, crowds, flashing lights–any of these everyday occurrences can trigger debilitating symptoms.
So can someone saying the wrong thing.
You may not always know that a person has PTSD, but you might know they’ve been in combat or lived through a fire or flood. There’s not necessarily a “right” thing to say–but being empathetic about the trauma they’ve experienced is a good place to start. “The more understanding there is, the easier it is for patients, and treatment goes better for those patients,” says Jack Nitschke, PhD, associate professor of psychiatry and psychology at the University of Wisconsin School of Medicine and Public Health.
“My boss yelled at me. I think I have PTSD too.”
No, you don’t–or at least not from that.
In order to have PTSD, you have to have survived a life-threatening event, not just a bad day at work. That means you’ve been raped, you’ve been to war, or you’ve survived a car crash. You can also develop PTSD if you’ve witnessed someone else going through one of these or other traumatic events.
“Using the term almost in jest is a disservice to those who have a real medical condition and need help for that,” says Emily Blair, manager of military and veterans’ policy at the National Alliance on Mental Illness.
“Shouldn’t you be over it by now?”
“People seem to think that there’s a timeline and there isn’t,” says Lea Grover, 33, who was raped when she was 14 and again when she was 20. She did not know she had PTSD until about 18 months after the second assault. She had her first flashback while in pain after dental surgery.
There are treatments for PTSD, but none that heal right away. Antidepressants are usually taken for months or years. Handling triggers can be a life-long challenge. “There is no universal timeline for when triggers get easier to deal with,” says Grover.
“Poor thing, you got triggered! You must be really sensitive!”
“A lot of people think that only sensitive, entitled people use this word,” says Grover. “Being annoyed and being triggered are not the same things.”
Her first sexual assault happened to the soundtrack of Prince’s 1999. When he died, the song was replayed relentlessly; it was an incredibly difficult week for her. “There was no getting away from it,” she says. A PTSD trigger like this is not merely bothersome; it can set off an intense reaction, in some cases leaving people with the disorder unable to function.
“When we think someone has PTSD we might treat the person as really fragile and broken,” says Sonya Norman, PhD, director of the PTSD consultation program at the National Center for PTSD and a psychiatry professor at the University of California San Diego. “You can have PTSD and be a strong person and, I would say, given what they’ve been through, they are very strong.”
“How many people did you kill?”
Many people with PTSD have feelings of guilt and shame. A veteran may have survivor’s guilt for living when others didn’t or feel they could have done something differently that would have saved a life. This is a symptom, not a fact–and can be made worse by probing for details.
“Be sympathetic and understanding, and if the person wants to talk, let them,” says Elspeth Cameron Ritchie, MD, MPH, a retired military psychiatrist and member of the American Psychiatric Association. “If not, don’t push them.”
For Mackenzie, a 24-year-old survivor of sexual assault, the wrong question is: “What do you mean you were raped?” “When people question [my] experience, they’re disqualifying the way I was assaulted,” she says.
A better question to ask is: “What was your experience like?” This way, a person with PTSD can share only the details they are comfortable talking about. Or, you can always say, “I’m sorry.”
“You have PTSD, you must be a veteran.”
PTSD is relatively common among veterans. About 12% of Gulf War vets and 15% of Vietnam vets have PTSD, compared to about 8% of the general population, according to the National Center for PTSD.
As the stats show, not everyone who serves has the disorder. Don’t assume that someone has PTSD just because they fought in a war. “This assumption is actually creating more stigma,” Blair says. Keep in mind that veterans can come home with physical scars and other psychological consequences, not just PTSD, she says.
But not everyone with PTSD has experienced military conflict. The National Center for PTSD estimates that around 30% of all rape victims develop PTSD at some point in their lives. People can also develop PTSD after mass shootings, natural disasters, armed robbery or mugging, road accidents, terrorism, a diagnosis of a potentially fatal condition, the unexpected death of a loved one.
Grover finds assumptions that she is a veteran easier to deal with than many other remarks. “It’s just ignorance,” she says, on the part of people who don’t realize PTSD occurs among survivors of many kinds of traumatic experiences.
One of the worst things you can do to a person with PTSD is sneak up on them and surprise them. A common symptom of PTSD is hypervigilance, which is when a person is easily startled and constantly on the lookout for threats.
Such heightened awareness can be crucial to survival in combat, but outside of a life-threatening incident, it can set off a catastrophic chain of PTSD reactions, including paranoia and panic.
People with PTSD may respond similarly to unexpected physical contact. A small Croatian study published in 2016 found that war veterans with PTSD preferred more personal space than people without PTSD, especially behind them. “Physical contact is a big issue,” Nitschke says. “Somebody who has PTSD generally is not going to appreciate being touched on the shoulder. It really aggravates their very heightened startle response.”
“Why are you so uptight?”
Feeling edgy or jittery is not a choice for people with PTSD. Even with effective treatment, some people with PTSD still have symptoms, and the symptoms can erupt unexpectedly. If you’re thrown off by the way a person with PTSD reacts to you being in their space or to something you said, give them the benefit of the doubt. “Cut them some slack, give them space, and don’t challenge them on it,” says Nitschke. Instead, he recommends, simply say, “I’m sorry. I didn’t mean anything.”