What Not To Say To Someone With PTSD

Many people experience trauma and develop PTSD. Knowing what to say, and also what not to say, is important.

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 such things as smells or locations that remind the individual of the traumatic experience.

Saying the wrong thing can also trigger someone who suffers from PTSD.

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 some kind of traumatic event. 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, or sexual assault. 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.

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 that are best avoided.

"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 who do have 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. What this means is that PTSD is a serious condition, and it is insensitive to joke about it.

To have PTSD, you endured a traumatic event. A run-of-the-mill bad day at work does not constitute trauma and is likely not going to cause PTSD. Traumatic events include experiences such as sexual assault, war, car crashes, and domestic violence. You can also develop PTSD if you've witnessed someone else going 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, and people sometimes suffer throughout their lives, taking antidepressants for months or even years. 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. She experienced sexual assault when she was 14 and again when she was 20, and she said she didn't know she had PTSD until about 18 months after the second assault. She had her 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. When he died, the song was replayed relentlessly; it was a tough week for her. "There was no getting away from it," she said.

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

"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 living 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, which can be made worse 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 her experience, she said, "they're disqualifying the way I was assaulted."

If the person is open to discussing the event(s), a better question to ask 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 the condition is from the 1980s, when clinicians just began diagnosing the condition. 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 the disorder. So don't assume that someone has PTSD just because they fought in a war. "This assumption is actually creating more stigma," said Blair. Keep in mind that veterans can come home with physical scars and other psychological consequences, not just PTSD, she said.

"Surprise!"

One of the worst things you can do to a person with PTSD is sneak up and surprise them. A common symptom of PTSD is hypervigilance, when a person is easily startled and constantly on the lookout for threats.

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 important 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, he recommended simply saying, "I'm sorry. I didn't mean anything."

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