What Not To Say To Someone With PTSD

For people with post-traumatic stress disorder (PTSD), every day can feel like a fight to survive. For some people, loud noises, crowds, and flashing lights can trigger debilitating symptoms. For others, PTSD triggers may be subtler, including smells or locations that remind the individual of the traumatic experience.

Saying the wrong thing can also trigger someone with PTSD.

PTSD Is Invisible

You may not always know that a person has PTSD, but you may know they've been in combat, lived through a fire or flood, or experienced a traumatic event. In addition, people can 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, sexual assault, or many other causes.

For example, nearly a third of women who have experienced sexual assault will develop PTSD, according to the U.S. Department of Veterans Affairs National Center for PTSD.

What Not To Say

Of course, there's not necessarily a "right" thing to say, but being empathetic about the trauma a person has 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," Jack Nitschke, PhD, associate professor of psychiatry and psychology at the University of Wisconsin School of Medicine and Public Health, told Health.

To show understanding, here are some insensitive remarks to avoid.

"My Boss Yelled at Me. I Think I Have PTSD, Too"

Such an interaction could likely cause stress. And yelling can be a trigger for PTSD. However, if you do not have PTSD, making this comment can be insensitive to those with the condition.

According to the U.S. Department of Veterans Affairs National Center for PTSD, PTSD is a disorder in the DSM-5. The DSM-5 is the Diagnostic and Statistical Manual of Mental Health Disorders and provides diagnostic information for clinicians. This means that PTSD is a serious condition, and it is insensitive to joke about it.

To have PTSD, you endured a traumatic event. For example, a run-of-the-mill bad day at work will likely not cause PTSD. Traumatic events include experiences such as but are not limited to, sexual assault, war, car crashes, and domestic violence. You can also develop PTSD if you've witnessed someone else go through a traumatic incident.

"Using the term almost in jest is a disservice to those who have a real medical condition and need help for that," Emily Blair, health policy advisor for the Senate Veteran's Affairs Committee and former manager of military and veterans policy at the National Alliance on Mental Illness (NAMI), told Health.

"Shouldn't You Be Over It by Now?"

There are treatments for PTSD, but none are quick fixes. According to the U.S. Department of Veterans Affairs National Center for PTSD, there are a number of treatment options, including various therapies and medications. People often work on treatment throughout their lives, possibly taking medications such as antidepressants for months or even years. In addition, handling triggers can be a life-long challenge.

"There is no universal timeline for when triggers get easier to deal with," Lea Grover, a sexual assault survivor, told Health. Grover experienced sexual assault when they were 14 years old and again at 20 years old. Grover said they didn't know they had PTSD until about 18 months after the second assault. Grover had their first flashback while in pain after dental surgery.

"Poor Thing, You Got Triggered! You Must Be Really Sensitive!"

Grover's first sexual assault happened while the soundtrack of Prince's 1999 was playing. The song replayed relentlessly when Prince died; it was a tough week for Grover. "There was no getting away from it," Grover said.

A PTSD trigger like this is not merely bothersome; it can set off an intense reaction, sometimes leaving the person unable to function. "Being annoyed and being triggered is not the same, " Grover said.

"When we think someone has PTSD, we might treat the person as really fragile and broken," 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, told Health. "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. For example, a veteran may have survivor's guilt for being alive when others didn't or may feel they could have done something differently that would have saved a life. The guilt and shame are symptoms that can worsen when others probe for details.

"Be sympathetic and understanding, and if the person wants to talk, let them," Elspeth Cameron Ritchie, MD, MPH, a retired military psychiatrist and member of the American Psychiatric Association, told Health. "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 the experience, Mackenzie said, "they're disqualifying the way I was assaulted."

If the person is open to discussing the event(s), a better question is: "What was your experience like?" This way, a person with PTSD can talk about the details they are comfortable sharing. Or, you can always say, "I'm sorry this happened to you."

"You Have PTSD; You Must Be a Veteran"

According to the U.S. Department of Veterans Affairs National Center for PTSD, PTSD is relatively common among veterans. About 12% of Gulf War veterans and 15% of Vietnam veterans have PTSD, compared to about 8% of the general population. The data from Vietnam veterans diagnosed with PTSD is from the 1980s when clinicians just began diagnosing it. As we have learned more about PTSD, it is estimated that closer to 30% of Vietnam veterans have experienced it.

However, as the stats show, not everyone who has served in the military has PTSD. So don't assume someone has PTSD just because they fought in a war. "This assumption is actually creating more stigma," said Blair. Also, keep in mind that veterans can come home with physical scars and other psychological consequences, not just PTSD, Blair said.

"Surprise!"

One of the worst things you can do to a person with PTSD is sneak up and surprise them. According to Johns Hopkins Medicine, one of the symptoms of PTSD is being on edge and easily startled.

For veterans who experience PTSD, such heightened awareness can be crucial to survival in combat, but outside of a life-threatening incident, it can trigger PTSD symptoms, including paranoia and panic.

People with PTSD may respond similarly to unexpected physical contact. For example, a small Croatian study published in 2016 in the journal Psychiatria Danubina found that war veterans with PTSD preferred more personal space than people without PTSD, especially in the space behind them.

"Physical contact is a big issue," Nitschke said. "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?"

For people with PTSD who experience feeling edgy or jittery, it's essential to understand these symptoms are not a choice. Even with effective treatment for PTSD, some people continue to have symptoms, and the symptoms can happen unexpectedly. So, if you're thrown off by how a person with PTSD reacts to your words or actions, give them the benefit of the doubt.

"Cut them some slack, give them space, and don't challenge them on it," Nitschke said. Instead, Nitschke recommended simply saying, "I'm sorry. I didn't mean anything."

Seeking Help

Many sensitive topics pertaining to sexual assault and mental health are addressed in this article. If you or someone you know is struggling, please see the resources listed below for help.

If you or a loved one are struggling with PTSD, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

If you are a survivor of sexual assault, you can contact the RAINN National Sexual Assault Hotline at 1-800-656-4673 to receive confidential support from a trained staff member at a local RAINN affiliate.

Additionally, If you or a loved one are a Veteran or Service member in crisis, you can call the Veterans Crisis Line at 1-800-273-8255 to speak with a specially-trained VA responder. If there is immediate danger, call 911.