Is there a general or common arc or pattern to PTSD flashbacks?
June 14, 2013 2:09 PM Subscribe
I understand how PTSD flashbacks can occur (based on mild reading on the subject), but how do they end if the subject is all alone? Do sufferers generally have a slow climb out of dissociation? Can it end in passing out from stress? Surely there are variations, but are there common symptoms/patterns?
This is for a fictional piece with a lot of suspension of disbelief, so it doesn't have to be 100% accurate... but I'd like to do at least some justice to real-world patterns.
I have a character who has a combat-related flashback in the middle of an evening college class. The lecture/presentation is loaded with triggers he didn't expect, and this is his first actual flashback experience. He winds up leaving and hiding in a bathroom until... well, until the scene ends. I need to figure out what he would do when/as he comes out of it.
The most helpful thing in terms of plot would be for him to get on his motorcycle and ride across town to find his girlfriend and buddies out playing pool. (Picking up his cell phone and calling for someone to get him doesn't really move the plot forward.) I figure a little irrational behavior is understandable, but I don't know if that's just completely unrealistic.
Suggestions?
I have a character who has a combat-related flashback in the middle of an evening college class. The lecture/presentation is loaded with triggers he didn't expect, and this is his first actual flashback experience. He winds up leaving and hiding in a bathroom until... well, until the scene ends. I need to figure out what he would do when/as he comes out of it.
The most helpful thing in terms of plot would be for him to get on his motorcycle and ride across town to find his girlfriend and buddies out playing pool. (Picking up his cell phone and calling for someone to get him doesn't really move the plot forward.) I figure a little irrational behavior is understandable, but I don't know if that's just completely unrealistic.
Suggestions?
I know someone who had PTSD with flashbacks. I was never there for one of them, though I did spend like 6 hours or something on the phone with them on one of the anniversaries of the trauma so they didn't have to be "alone" with it and I did get some verbal descriptions of the flashbacks.
In case you do not get a better source of feedback, I would have some of the actual events and flashback events correspond in a way that makes for some interplay, such as the noise of a crowded classroom corresponding to the noise of war, and when class break ups, the battle in his mind moves on and he feels able to escape and evade. I would leave it ambiguous in his mind, like he might still be feeling like he was there but had gotten a break in the battle and opportunity to bug out.
Also, I will note the person I knew bought a car with leather seats because the smell of the leather made the car "real" to them during a time when they had trouble telling what was real and what was not. Smell is a powerful emotional sense, one often overlooked in fiction.
Hth and best of luck.
posted by Michele in California at 2:46 PM on June 14, 2013
In case you do not get a better source of feedback, I would have some of the actual events and flashback events correspond in a way that makes for some interplay, such as the noise of a crowded classroom corresponding to the noise of war, and when class break ups, the battle in his mind moves on and he feels able to escape and evade. I would leave it ambiguous in his mind, like he might still be feeling like he was there but had gotten a break in the battle and opportunity to bug out.
Also, I will note the person I knew bought a car with leather seats because the smell of the leather made the car "real" to them during a time when they had trouble telling what was real and what was not. Smell is a powerful emotional sense, one often overlooked in fiction.
Hth and best of luck.
posted by Michele in California at 2:46 PM on June 14, 2013
I don't exactly have PSTD but one time, I had a pretty scary tumble down an entire flight of stairs, during which I sort of blacked out. I wasn't badly hurt and I didn't think much of it until a year later, when out of the blue, I had a flash back, triggered by having to use a challenging set of stairs. In this one-time experience, I was taken out of my current setting so completely that I don't think it would matter if I were alone or in public. (I wasn't, and completely freaked out the group of tourists closest to me). Once the flashback ended and I was "back", I was just really disoriented for a bit, maybe 5-10 minutes. Now, I am not the type to run to a bar or a boyfriend at the first sign of emotional discomfort, but if I were, I would certainly have done what you are describing. In fact, I think getting to a familiar and comfortable environment would have been my first choice. Making a phone call and waiting for someone to come get me would have been weird, since I was perfectly myself once it was over.
posted by rada at 3:08 PM on June 14, 2013 [1 favorite]
posted by rada at 3:08 PM on June 14, 2013 [1 favorite]
Hi! I have PTSD flashbacks (not from combat). The character of them has varied a bit over the course of my having them, but right now they go something like this:
1) Start feeling detached and dizzy in the presence of some triggering factor
2) Feel bodily sensations of things that are not actually occurring (these used to be aaaalmost like auditory hallucinations, but now it is more like I have the strong feeling of a physical sensation, but the detachment from #1 kind of screws with my ability to figure out that it's not actually happening right away)
3) Figure out that it is a flashback
4) Go somewhere quiet and alone if possible
5) Pick at least one and preferably more sense to ply with some stimulus: I carry mints and my iPhone/headphones in my purse everywhere I go, so I can taste something strong and listen to something loud if necessary. If I'm at home, a cup of strong coffee in a hot shower in the dark is a good strategy. If in public, a corner or a bathroom or something with music, and I just breathe and count to twenty over and over for as long as it takes, which is sometimes ten minutes and sometimes an hour. This is always pretty boring in retrospect.
6) The VA made an app for iOS and Android for tracking and managing PTSD symptoms, which is pretty great! It has some audio things that are five- or ten-minute relaxation exercises, and text prompts for relaxing and getting centred and calmed down from a flashback or panic attack.
6) I am often a little weird afterward, and sometimes want quiet alone time but other times want social engagement or a hand to hang on to. I would jump on my motorcycle and find my girlfriend and buddies where they were playing pool about 60% of the time, but I would be a little socially off, not talking as much as usual and talking louder than usual when I do talk.
posted by bewilderbeast at 3:17 PM on June 14, 2013 [2 favorites]
1) Start feeling detached and dizzy in the presence of some triggering factor
2) Feel bodily sensations of things that are not actually occurring (these used to be aaaalmost like auditory hallucinations, but now it is more like I have the strong feeling of a physical sensation, but the detachment from #1 kind of screws with my ability to figure out that it's not actually happening right away)
3) Figure out that it is a flashback
4) Go somewhere quiet and alone if possible
5) Pick at least one and preferably more sense to ply with some stimulus: I carry mints and my iPhone/headphones in my purse everywhere I go, so I can taste something strong and listen to something loud if necessary. If I'm at home, a cup of strong coffee in a hot shower in the dark is a good strategy. If in public, a corner or a bathroom or something with music, and I just breathe and count to twenty over and over for as long as it takes, which is sometimes ten minutes and sometimes an hour. This is always pretty boring in retrospect.
6) The VA made an app for iOS and Android for tracking and managing PTSD symptoms, which is pretty great! It has some audio things that are five- or ten-minute relaxation exercises, and text prompts for relaxing and getting centred and calmed down from a flashback or panic attack.
6) I am often a little weird afterward, and sometimes want quiet alone time but other times want social engagement or a hand to hang on to. I would jump on my motorcycle and find my girlfriend and buddies where they were playing pool about 60% of the time, but I would be a little socially off, not talking as much as usual and talking louder than usual when I do talk.
posted by bewilderbeast at 3:17 PM on June 14, 2013 [2 favorites]
My first PTSD flashback made me very action-oriented - not fleeing, but taking steps to resolve the situation that I was immersed in once again. I learned during treatment that this is a more common response than actual fleeing, which tends to be more likely part of the come-down or as an accidental side-effect of the decisive action attempted while in the flashback's long moment. Because it was my first, I didn't know what was going on and was totally lost in my mind and nervous system's responses. Because of the reactions of other people around me, I felt beset and kept trying to find an advantageous place for my defense, which luckily put me into a place where my back was covered, was away from external stimuli, and couldn't really get anywhere else without thinking things through.
That's when my reorientation began, which was a truly brutal reawakening from flashback-land to the real world, and I immediately had a major anxiety attack - also not uncommon. Passing out is unlikely during a flashback, but someone could hyperventilate during reorientation, and that could cause it. The anxiety attack following the flashback brought the hypervigilance up to level 11, and I felt torn between finding a protected place to hunker down or finding my "tribe" and making sure they were safe. Because I was afraid of being alone for more of that mess, I went in search of my tribe, but I don't remember most of the trip, as it was done largely through trained memory.
When I found them, I wasn't very good company (I still felt a combination of sharp, brittle, abrasive, terrified, and wraith-like), but I was so pathetically glad to be around real people in a solid environment, I found a place to nestle back and just watch them, very occasionally interacting and saying, "No, no, I'm fine - just a weird day" when asked if something was wrong.
I found out later I'd busted my lip during the flashback, and the uncontrollable snot & tears fest of the anxiety attack combined with that to make me look as if I'd...been in a fight for my life. Needless to say, no one believed me but they figured I had some reason for denying the obvious and decided to just accept it for what it was.
After a few days of shame, terror, and panic, I finally was more solidly "in" myself and I was so grateful they'd not pressed it and just allowed me to be around them while looking so crazy.
If any of that helps you with your character's actions, I'm all for PTSD experiences sounding more realistic, so have at.
posted by batmonkey at 8:29 PM on June 14, 2013
That's when my reorientation began, which was a truly brutal reawakening from flashback-land to the real world, and I immediately had a major anxiety attack - also not uncommon. Passing out is unlikely during a flashback, but someone could hyperventilate during reorientation, and that could cause it. The anxiety attack following the flashback brought the hypervigilance up to level 11, and I felt torn between finding a protected place to hunker down or finding my "tribe" and making sure they were safe. Because I was afraid of being alone for more of that mess, I went in search of my tribe, but I don't remember most of the trip, as it was done largely through trained memory.
When I found them, I wasn't very good company (I still felt a combination of sharp, brittle, abrasive, terrified, and wraith-like), but I was so pathetically glad to be around real people in a solid environment, I found a place to nestle back and just watch them, very occasionally interacting and saying, "No, no, I'm fine - just a weird day" when asked if something was wrong.
I found out later I'd busted my lip during the flashback, and the uncontrollable snot & tears fest of the anxiety attack combined with that to make me look as if I'd...been in a fight for my life. Needless to say, no one believed me but they figured I had some reason for denying the obvious and decided to just accept it for what it was.
After a few days of shame, terror, and panic, I finally was more solidly "in" myself and I was so grateful they'd not pressed it and just allowed me to be around them while looking so crazy.
If any of that helps you with your character's actions, I'm all for PTSD experiences sounding more realistic, so have at.
posted by batmonkey at 8:29 PM on June 14, 2013
My flashbacks often happen in company, but I am usually able to internalise it enough - it is more an emotional/sensory thing than an action thing. So when I am triggered into a flashback it's almost like my vision goes; I know I am sitting at a table with friends and there is a conversation happening and laughing but simultaneously I am going through something else, with all of those feelings as real as they were ten years ago, and as raw. Same with hearing, it flattens out as well; there is the conversation and I may be able to participate but mostly I'm reacting to what is happening inside my head.
I guess the most recent is probably the most like what you're wanting to descrive. I was roleplaying with friends and we got into a bit of a back and forth joke about ritual sex and one of them said something about "you're clean, right?" and at that point I was triggered into a flashback about testing for STDs and pregnancy after I was raped. So the conversation (completely consensual) went on but I stopped talking for a while, stopped reacting properly. My heart rate was through the roof, my breathing up and I felt nauseous. I went from sprawling in my chair to having my feet pulled right up on the chair with my knees to my chest*. I knew I was sitting at a table roleplaying with friends but I was also on the phone making the appointments for the tests, I was getting the pap smear, I was answering the questions, I was getting the exam, I was waiting for the phone call afterwards, I was still worrying years and years later that something was missed and I have infected my husband and my ex. It wasn't a straight-forward action flashback (that usually happens during sex but hasn't happened for a while) but very much about the emotional context and the guilt/shame part of my trauma response. The people I was with didn't really notice anything other than me being a bit 'off' which can happen for non-PTSD reasons. I did finish off my drink though, and begin on another, but I didn't go an hide in the bathroom simply because I know it can exacerbate the issues. I used to, every time, but the acoustics often irritate my hyperarousal and going to the actual bathroom after a PTSD flashback is a terrible ordeal for me anyway. Afterwards I talked to my partner but at this point, from the outside, it doesn't look that much different to either a mild anxiety attack or being upset or being angry or not paying attention.
*previous flashbacks have seen me hide in cupboards, wardrobes, under beds and tables - anywhere quiet, dark and safe.
posted by geek anachronism at 9:22 PM on June 14, 2013 [1 favorite]
I guess the most recent is probably the most like what you're wanting to descrive. I was roleplaying with friends and we got into a bit of a back and forth joke about ritual sex and one of them said something about "you're clean, right?" and at that point I was triggered into a flashback about testing for STDs and pregnancy after I was raped. So the conversation (completely consensual) went on but I stopped talking for a while, stopped reacting properly. My heart rate was through the roof, my breathing up and I felt nauseous. I went from sprawling in my chair to having my feet pulled right up on the chair with my knees to my chest*. I knew I was sitting at a table roleplaying with friends but I was also on the phone making the appointments for the tests, I was getting the pap smear, I was answering the questions, I was getting the exam, I was waiting for the phone call afterwards, I was still worrying years and years later that something was missed and I have infected my husband and my ex. It wasn't a straight-forward action flashback (that usually happens during sex but hasn't happened for a while) but very much about the emotional context and the guilt/shame part of my trauma response. The people I was with didn't really notice anything other than me being a bit 'off' which can happen for non-PTSD reasons. I did finish off my drink though, and begin on another, but I didn't go an hide in the bathroom simply because I know it can exacerbate the issues. I used to, every time, but the acoustics often irritate my hyperarousal and going to the actual bathroom after a PTSD flashback is a terrible ordeal for me anyway. Afterwards I talked to my partner but at this point, from the outside, it doesn't look that much different to either a mild anxiety attack or being upset or being angry or not paying attention.
*previous flashbacks have seen me hide in cupboards, wardrobes, under beds and tables - anywhere quiet, dark and safe.
posted by geek anachronism at 9:22 PM on June 14, 2013 [1 favorite]
This thread is closed to new comments.
I'm imagining it like this: in the bathroom, the shakes, nauseous, hyperventilating, maybe crouching on the ground. Deep breaths for a few minutes. As reality sets back in he realizes someone might come check to make sure he's okay and so he needs to get the hell out of there. Walks outside, paces or sits down somewhere secluded. Smokes a cigarette or some pot, eventually gets on the motorcycle and drives aimlessly. My thinking is he'd go to the bar alone, not necessarily knowing his friends are there- he just needs a drink. He needs to get out of his head. He goes to the bar, orders a shot, starts drinking. Then maybe when his buddy or girlfriend texts wondering where he is, he tells them, they come to the bar. Or maybe they just run into each other there- they see him storm in but he didn't notice they were there. Maybe earlier she'd mentioned she was going there, but he had forgotten about it and ended up there subconsciously. He probably wouldn't tell them what happened, but she'd notice something was off. He's edgy and distracted, seems kind of out of it. Either he doesn't tell her, or with a lot of coercing he eventually does but tries to tell it quickly and minimally, as he's embarrassed but mostly he just wants to push it out of his mind. Maybe he makes something up to explain his behavior- he got in an argument with a classmate. He failed his exam. It doesn't matter, any excuse to justify why he is out drinking instead of finishing his class.
The thing about PTSD and flashbacks is you don't want these thoughts/ feelings, they feel terrifying and invasive so they need to be dealt with quickly and effectively (drugs/ alcohol are common) and then I think in general people don't want to dwell on it or have to relive it by telling someone else what happened. Just push it out of your mind as fast as possible.
But getting some air, pacing, etc are definitely important as it IS a physical reaction. Image the feeling of a huge, uncomfortable adrenaline rush. And pretty much any possible way to distract from what you were just thinking about is the goal. Despite not wanting to talk about what just happened, you'll probably be edgy, jumpy and distracted. It's embarrassing and bewildering-why the freakout?
I don't think he'd pass out. It wears off slowly and is replaced by that shaky feeling of WTF just happened?
posted by Argyle_Sock_Puppet at 2:38 PM on June 14, 2013