Symptoms can be more physiological than psychological.
By: Steven Stosny, Ph.D.
Posted Jun 14, 2020
The most familiar type of post-traumatic stress (PTS) — the one that gets most of the press — is caused by an acute stressor, a life-threatening event that exerts an extreme reaction in the central nervous system (CNS). Examples are military combat, rape, mugging, a gun held to your head, a serious car crash — anything life-threatening.
Another type of post-traumatic stress is caused by less intense but longer-lasting stressors, often suffered by people who are sued, put on trial for crimes, investigated by the IRS, persecuted, discriminated against, or ridiculed at work or school. It doesn’t evoke significant fear of harm or annihilation. Instead, it brings a terrible dread of shame, humiliation, isolation or loss of status and resources, if not personal freedom. It keeps the CNS at a chronic level of heightened stress. Intimate betrayal typically evokes this kind of PTS response.
A Physiological Model
Suppose there are four columns holding up the ceiling of the room you’re in right now. No one else is in the room. Suddenly the column near the door and window buckles, blocking your path of escape. If it falls, the ceiling will collapse. The only way to save yourself is to prop up the column with your shoulder, until help arrives. About 24 hours later, help comes to secure the column and prop up the ceiling, safely relieving you of the burden.
When you try to walk away, you’re unable to straighten up and walk normally. The over-exerted nerve endings in your shoulder, side, and leg muscles have paralyzed the tissue around them, temporarily rendering key muscles nearly immobile. The condition gradually eases. Within about three days, you can finally stand up straight and enjoy full mobility. But for another three days or so you would experience occasional muscle spasms in your shoulder, side, and legs, where most of the stress was concentrated. These are rough estimates of recovery time that do not allow for variations in age, health, muscle tone, flexibility, etc. But you get the idea. There is a prolonged recovery process from prolonged stress.
A similar condition occurs with emotional stressors that go on for a long time, such as walking on eggshells in your home, living with continual criticism or contempt, or suspicions of deceit, infidelity, or embezzlement by an intimate partner. Once the stressor has finally passed — the betrayal is exposed and the subsequent free-fall condition has abated — the CNS does not return to normal for quite some time. (Precisely how long depends on the duration of the stressful conditions and the determination to focus on healing, repairing, and improving.) Instead of localized spasms of nerves and muscles trying to return to normal functioning, the entire CNS must re-calibrate to find a normal range of arousal, without the chronic stressor “pressing” against it.
The mental equivalent of muscle spasms during the CNS re-calibration process is experienced as waves of negative emotion, which seem to come out of nowhere. Often with no discernible trigger, waves of emotion seize control of your body — which becomes tense, rigid, and agitated. They dominate your consciousness and make it seem like you’re incapable of thinking about anything other than how terrible you feel or how awful your partner is for making you feel so bad. They typically start with a flash point — an abrupt awareness that you’re about to experience something horrid. A physical marker sometimes occurs with the flash point, something like a pit in your stomach, a sharp pain, muscular weakness, or blurred vision.
Here are the most common symptoms that come in waves during the recovery process:
- Vivid flashbacks of painful incidents from the past (often from childhood)
- Intense anxiety or fear
- Utter confusion and impaired decision-making
- Sorrow, hopelessness, depression, or despair
- High impulsivity
- Aggressive or violent fantasies
Triggers and Timing of the Symptoms
PTS symptoms have triggers, but they are often difficult and sometimes impossible to discern. Once again, physical pain is a more useful model of how the triggers work and why they’re so hard to figure out.
The brain seems to process pain on a dedicated neural network that gets priority processing. If you doubt that, imagine this: During a soulful, mutually-validating talk with your best friend, you spill hot coffee on yourself. What do you think your brain will regard as more important, paying attention to your friend or attending to your injury? After the burn, priority neural networks become hypersensitive. You flinch when your hand gets near a hot cup of coffee, because the pain has been associated with the heat. This involuntary reaction persists until repeated experience over time demonstrates that pain caused by the hot coffee is unlikely to recur, as long as you’re careful.
Just as sensing heat triggers the flinch in the burn victim’s hand, the reinstatement of intimacy, trust, love, or compassion can trigger the same kind of involuntary “flinch” — waves of negative emotions — after intimate betrayal. It is intimacy that led to betrayal, and the betrayed brain will likely associate pain with intimate exposure. Because feelings of intimacy are often vague, with a wide range of associated memories (from toddlerhood, all the way through your most recent experience), specific triggers of PTS responses are hard to pinpoint. But you can bet that in the months following intimate betrayal, the alarm will sound at the most inopportune time — during a warm embrace with a friend or in a moment of enjoyment with your children or in the midst of pleasant thoughts or enjoyable activities. Out of nowhere, the waves of negative emotions crash upon you.
You Are Not Your Symptoms
PTS symptoms are not part of your personality. They are merely a delayed, mostly physiological response to past stressors. They are a perfectly natural stage of recovery from a prolonged period of stress.
The most damaging aspect of PTS symptoms are secondary symptoms or symptoms about symptoms. Secondary symptoms are triggered by the meaning you give to primary symptoms. If you think the abrupt waves of emotion mean that you’re crazy, or that you will never be well or happy or that you’re defective or dying, then the effects are horrible, as you get flooded with adrenaline and cortisol from the secondary symptoms on top of the primary ones.
To heal and grow, as you so richly deserve, you must control the meaning of your emotional experience, what it means to you and about you. That’s the secret of managing intrusive PTS symptoms following intimate betrayal.
How to Manage the Symptoms
Handle the waves of PTS feelings with gentleness and care. There is good news in them. Their very existence means that the stressor has been removed. No one has nightmares about bombs dropping during the war. While stressors are active, the CNS goes into survival mode, with no mental resources allotted to “getting back to normal.” Only after the stressor is over does the CNS begin to re-calibrate to normal. That is why a diagnosis of PTSD cannot be made until at least three months after the stressor has been removed.
More good news:
- The symptoms are temporary. Unless you feed them with speculation about why they’re occurring or what they mean about you or your present relationships, they will last no more than a few minutes.
- They are a sign of healing, of how the CNS heals itself.
- They’re not about now; they’re residual effects of something that happened in the past.
The best way to handle the waves of negative emotion is to sit back and let them wash over you. “Oh, here’s one of those temporary waves. It doesn’t mean anything, and it will soon pass. I’m okay now, and I’ll be better in a few minutes.”
The symptoms are a lot like waves at the beach. If you try to stand up to crashing ocean waves, they can grind you into the sand. But if you dive under them, you’re aware of only a force whooshing quickly over you. Allow the PTS symptoms to wash over you like the sensation of swimming under waves at the beach. Then they will last no more than a few minutes, with minimal discomfort. Managed in this way, they will most likely diminish in frequency and intensity, until they stop altogether.