Let’s Write PTSD

Updated in 2022

I touched a slight bit on PTSD in the Let’s Write Fear post, but I figure this is a complex emotional state and needs more detail.

This is a post about how traumatic events might influence characters, which means traumatic events will be mentioned. Not in detail, but they’re there. Please don’t stick around if you’re dealing with something tough, but here is a list of resources if you are struggling.

The post officially begins after this final trigger warning.

I’m not a mental health professional, just a writer, so this is in no way aimed to be an educational post for someone in the clutches of PTSD. Instead, the aim of this post is twofold.

One, trauma survivors are one of the most isolated, misunderstood, often judged, and ignored groups of people out there. So, I’ll always do my best to create a platform for survivors to make their voices heard.

Two, if authors dig deeper when it comes to writing more dimensional and realistic characters, survivors might finally be able to relate to someone, even if the relatable person is only fictional. As I said above, survivors are too often very lonely, and though it might not sound like much, reading about a character who faced similar adversity and survived can be extremely validating and inspiring. If stories about teenagers coming out, minorities changing the rules, or kids saving the world can give people IRL the courage to do the same, what could happen if trauma survivors read similarly inspiring works? Even if just one person finds the courage to seek out help or feels less alone for a while, that is a huge difference made.

Besides, too many stories out there neglect to touch on or remotely handle the trauma (both emotional and physical) that characters have suffered.

I personally believe it is crucial to work with sensitivity readers when we write about trauma or traumatic events–even when we have survived said events ourselves. Sensitivity readers help us add nuances to our writing that might make all the difference to connect with readers. Also, as I’ll repeat again below, each trauma response is unique and valid. Even when we write about things we know, others might have different perspectives, and their stories might enrich the tales we set out to tell.

Before we begin, I’d recommend you check out my posts on writing fear, sadness, nerves, and anger, as many of the physical sensations and behaviours of PTSD are similar. Also, I’ve written about my personal experiences with panic attacks, which might be useful to you if you’re writing those. And panic attacks will come up when you’re writing about PTSD.

So, are you ready? Let’s write.

Most Important

What is PTSD (post-traumatic stress disorder)?

When a person is caught in a traumatic event, their body goes into survival mode, and some of the functions non-essential to survival are shut down (such as digestion and bladder control).
One of the shut-down functions is short-term memory, which is why dissociation so often goes hand in hand with PTSD. This means the person being traumatised likely won’t be able to remember the details of the event (the colour of the car that crashed into theirs, what the assailant was wearing, etc).
In some cases, the person won’t remember anything about the trauma (which is distressing by itself). This can happen in various stages of intensity, from temporary memory loss to the point where they experience full-blown trauma amnesia. Some survivors might remember flashes from the event, sometimes years later, while others will never be able to remember what happened.
Once the danger has passed, brain functions resume and the memories of the trauma are stored as past events. But, with PTSD, the brain doesn’t store the memory as a past event, which means the person is continuously trapped in an ‘in danger’ state, and the mind handles the traumatic memory as if it’s an event in progress.
This means the person feels anxious even when they’re physically safe or around people who are safe.
PTSD can occur in people who lived through the trauma personally, people who witnessed the event, or people who aid in the trauma (first responders, doctors and nurses, etc). In some cases, people experience PTSD because of the trauma suffered by a loved one. They don’t have to live through it themselves to be affected.
Two people can live the exact same trauma at the same time, and react completely differently to it. While one might be able to continue with minimal distress afterwards, the other might experience PTSD.
PTSD can flare up at later stages. Some survivors walk away from the trauma totally fine (or seemingly fine) only to develop symptoms of trauma later (sometimes years later). Flare-ups can manifest in the form of nightmares, remembering, or flashbacks.
A flashback literally puts the person back at the scene of the trauma because the brain is still in ‘in danger’ mode (even if the flashback takes place years after the traumatic event, even if the person was fine up until the moment of the trigger, or even if they’re unable to fully remember the event). They smell the smells, feel the sensations, the panic, the heart palpitations, etc, until the flashback ends.
Though flashbacks might be the key to unlocking suppressed memories for some survivors, they don’t necessarily mean everyone will be able to remember. Instead, not fully understanding memories, dreams, or flashbacks, being triggered by sensory input, or the process of piecing together fragmented memories often only adds to their anxiety. On the other side, some people are able to remember more after a flashback and might find themselves dealing with a set of confusing emotions and memories. The process of trying to make sense of the things they learn about themselves and their history is extremely distressing.
Similarly, some people don’t even realise the environment in which they operated before was traumatic (eg, emotional and physical neglect during childhood causes trauma and the lasting impact of a child’s needs not being met by their parents can cause PTSD). Learning about the trauma from the past can be extremely difficult to make sense of.
Finally, complex trauma can occur when someone is exposed to long-term or repeated traumatic events. The aftereffects of complex PTSD can devastate a person, and though many DM’s have requested I write more about this topic, I don’t at all feel equipped to do so. I’d recommend reading It’s Not You, It’s What Happened to You by Dr. Christine A. Courtois for more information on the topic.

Trauma Triggers

To understand flashbacks, we have to understand trauma triggers. This is not like the popular slang of expressing being triggered by anything that makes us feel offended, uncomfortable, or upset. Offended, uncomfortable, or upset DOES NOT equal triggered.
A trigger can be caused by external inputs such as senses (sight, sound, smell, etc), the anniversary/place of an event, holidays or gatherings, or anything internal like stress, illness, or physical pain. These triggers cause feelings or memories associated with trauma to arise in a person, which can result in overwhelming sadness, anxiety, panic, anger, or other emotions.
Internal triggers include physical pain, illness, thoughts and emotions (like anger, worry, sadness, remembering something, etc), or sensations (like a quick pulse, being touched in a certain way, etc).
External triggers can be anything. Sights, sounds, tastes, places. They come from books, articles, movies, and TV shows. People who resemble someone who played a part in the trauma, birthdays, anniversaries, holidays, family gatherings, and so much more.
Every trauma trigger will have a unique meaning for the person being triggered and will tie into the traumatic event in one way or another. They can happen at random, or the person touched by the trauma can know there’s a chance to be triggered and prepare for it (this is why so many books and movies etc include trigger warnings these days).
Once a person is triggered, they might have a panic attack, become depressed or enraged, disengage, or behave out of character (among other things).
Some triggers are obvious. For example, someone influenced by violence might react to scenes in movies or TV shows depicting violence. Others are subtle, and the person might not even know something could be a trauma trigger until they react.
The intensity of symptoms might vary. Sometimes, a survivor might be able to cope for a prolonged period of time, and a trigger might take them back seemingly out of nowhere. If they have been prepared to deal with the emotions in therapy or special training (eg military, medical professionals, caregivers, etc), they might be able to continue with minimal distress after the triggering event. It is important to remember that trauma responses are varied and unique, and each response is valid.
It’s also worth mentioning that some survivors will have no idea what actually triggered them. Sometimes, the trigger is so unexpected and random that it’s hard to pinpoint what it was or where it came from.

In an attempt to keep the nature of this post from becoming too real, I’ll refer to the subject of this post as ‘the character’ or ‘characters’ from here on out.

The Body Language and Speech of PTSD

The character might act numb. Slow reactions (if any), eg staring into space, not speaking, acting as if they don’t feel anything.
Characters might also be jumpy, overly anxious, or easily irritated. Looking around all the time, a clenched jaw, balled fists, tense muscles.
Because of heightened anxiety, these characters possibly have trouble concentrating, they might miss obvious information, make mistakes, or fixate on perceived threats (even where there are none).
Characters might either be unable to stop talking about their trauma, or might be unwilling to talk about it at all.
Many characters will act completely out of character. Struggles with PTSD can cause slow or overnight changes in personality. The leader-type might be fearful, the timid might take the lead, and the sweet one might be aggressive.
Some characters will isolate themselves from others, even their most trusted loved ones. These characters will act fiercely independently and though they might still trust certain individuals, this will likely be on a surface level. To protect themselves, they will rely exclusively on themselves (even to their own detriment).
Other characters will become overly dependent on their loved ones (or people who do not deserve their trust). They might fall over themselves to keep everyone around them happy and calm, at all cost (again, even to their own detriment). This character will probably have great trouble staying away from toxic people, even if they are aware of the other person’s toxicity. They will also frequently get caught up in thought spirals (dissecting everything another character said, replaying events in their heads, imagining every possible scenario, etc).
Another character might be seemingly erratic, and combine the last two points. Fiercely independent in some ways, while people-pleasing in others. There might be no pattern or reason for why or when they act in these ways.
The character might be hesitant to go to certain places, interact with certain people, eat certain foods, or partake in any activity that could remind them of their trauma.
They might also eat more, consume more (or begin consuming) alcohol or other mind-numbing substances, or take up other vices (like smoking), employed as coping mechanisms. Characters caught in a state of hypervigilance might face an uptake in physical activity, train harder, work out more, etc, in preparation of another emergency (do not want to be vulnerable or ‘unprepared’ again).
To feel in control, some characters might practise self-harm. BUT if this is something you’d like to write about, please consult more in-depth resources on the topic.
The character will likely have trouble sleeping, or become fearful of sleep because of nightmares. Characters who don’t have nightmares might still have trouble sleeping due to heightened anxiety (eg not being able to wind down, always feeling the urge to keep moving). As this character is caught in an ‘in danger’ state, they might see threats everywhere, which could also keep them awake at night. In this case, sleep deprivation might become an issue, which will probably result in even higher anxiety levels and emotions, hallucinating, nausea, headaches or migranes, pounding or dry eyes, etc.
This character might also be startled easily, or be on the constant lookout for danger.
In characters who are young children, the traumatic events might be relived in play (eg a character who was starved might constantly feed their toys, a character who was severely disciplined might destroy their toys or bully their friends, etc).
The above factors guarantee that characters will undergo physical changes. They’ll lose or gain weight or muscle tone, might not worry about their physical appearance or hygiene anymore, might dress differently, bags under their eyes, bloodshot eyes, etc.
Additionally, changes in nutrition will likely impact the character’s health in other ways. For example, iron deficiency might amplify feelings of depression and anxiety. If the character isn’t eating enough vegetables or focusing on their physical wellbeing, such deficiencies might be further exacerbated, which in turn will worsen the deppression/anxiety (and so morph into a loop of hell).
Recklessness and impulsivity are symptoms of PTSD, so some characters might drastically alter their appearance with tattoos, hairstyles, different clothes, etc. They might also adopt high-adrenaline hobbies, perhaps like skydiving or racing, or move beyond extreme sports into actively chasing danger.
Finally, suciadal tendencies may also be a symptom of PTSD, but again, if this is something you’d like to write about, please find more detailed references as this is a topic that must be approached with care. Also, once again, I’d highly recommend working with sensitivity readers.

What PTSD Feels Like

The character likely experiences constant negative thoughts, eg ‘everyone is an enemy’, ‘I am alone’, ‘I am responsible’, ‘I am broken’, ‘nobody can be trusted’, ‘I’m still in danger’ etc. Some of these might be recurring, others might be spontaneous.
It is worth emphasising that this character will very likely struggle with feelings of guilt, even if they were innocent. Many characters who survive trauma will be blamed for the event by others, or even if they are never personally blamed, they might’ve read about characters who were held responsible in the paper, for example. Guilt (unfortunately) often goes hand in hand with PTSD. They might blame themselves as though they could have prevented the trauma, blame themselves for not being able to save someone else, or blame other people for not getting to them in time, or saving them. This character might also be super critical on themselves or others for how they have handled the trauma.
Physical cues might include:
- Aches in the gut, nausea, upset stomach, heartburn, tight throat, the constant urge to urinate, feeling of pressure on stomach or bladder
- Hunger, aversion to food, being unable to truly taste/enjoy food
- The intense need to relieve the pain (physical or emotional), craving food or substances, craving adrenaline, etc
- Blurry vision, scratchy eyes, being unable to keep eyes open, yawning, rubbing eyes
- Muddy thoughts, slow mind, head in cotton, looping thought spirals (no matter how they try to suppress it.)
- Delayed responses, mistakes in their day-to-day, constantly asking for information to be repeated, rereading passages, losing belongings, reduced performance at work
- Being unable to stop moving
- Pain in the lower back, stiff neck and shoulders, hunched or too straight back and shoulders
- Pins and needles in the feet or hands, achy legs and rams
- Burning eyes, constant frown, downturned mouth
- Runny nose, sniffling, broken or bruised skin around the nostrils
- Clenched muscles, tight fists, flaring nostrils, clenched teeth
- Sallow, sweaty skin
- Bags under eyes, bloodshot eyes
- Numbness, feeling outside of the body, disconnect between emotions and thoughts, feeling like an impostor, uncertainty about identity and place, feeling like thoughts are not their own, being shocked by their thoughts
- Long-term anxiety and depression can also cause symptoms associated with colds and flu, so thick head, sinus or occular headaches, general fatigue and body aches, coughs (anxiety is tied to additional phlegm production–which is also the cause of additional heartburn) and sniffles
The character might not want to partake in actions they previously enjoyed. Everything feels like too much effort, or they might feel they don’t deserve things that had once made them happy (guilt). These feelings might also extend to their loved ones, ie, they don’t deserve to deal with the character’s baggage (and deserve better) or they don’t understand and it’s no use to include them, etc.
The character might try to keep constantly busy, anything to keep their minds from returning to the trauma. Or they might train/prepare/nest in case of another traumatic event.
Many characters will have big, uncontainable emotions. Some will be inexplicably angry (possibly to the point of violence). Others might often cry. Hopelessness might crash into this character in waves, or they might be caught in an unending state of adrenaline that makes them unpredictable.
This character most probably isn’t sleeping well. So, slower reflexes, inability to focus, intense headaches and muscle aches, hallucinating, etc.
Sensory overload will likely plague this character. They might struggle with any noisy, busy, or extremely lit situation. Do keep in mind that normal circumstances might be overwhelming for this character, and their senses might be overloaded by the simplest of things, eg coming into a dusky space after bing outside in the bright sun, or a group of friends laughing as they enter the character’s favourite coffee shop.
Sensory overload, being triggered, and panic attacks can have similar effects on a character, so I’ll list possible responses together:
- Everything is too loud, too bright, too smelly
- Everything is out of control
- Tight stomach, back, fists, clenched jaw
- Fast pulse, feeling of heart beating in ears, throbbing veins or muscles, pulse too loud
- Heightened irritability, snapping or crying for no reason, being unable to stop crying
- Sudden nausea or whooziness, being unable to remain upright, shaky hands or fingers, sometimes also heartburn
- Sweaty palms and pits, excess saliva, thick saliva, OR dry mouth and inability to swallow
- Going numb
- All sensations draining away
- Being unable to move or get to safety (feeling stuck)
- Not being able to talk, or in extreme cases forgetting what it feels like to talk, or being convinced the mouth is welded shut and cannot open
- Losing control of bladder (in extreme cases)
- Leaving the body, being in a different place, confusion upon return, disbelief that this could’ve happened, disorientation, the intense urge to get away
- Inability to trust anyone, even closest loved ones, self-isolation, feeling guilty or embarrassed (if they were seen in this state)

Sources:

As a final note, every person will handle their trauma in a unique way. Though certain symptoms might be similar, trauma is a deeply personal thing, and every brain will find its own way to navigate it. There is no right or wrong. The most important thing is to seek out help if you’re dealing with this. You’re not alone.

If you’ve found this post to write about PTSD, I hope this article helps. As I said above somewhere, I feel we need to write well-rounded characters who deal with their trauma so the stigma surrounding these issues is lessened. The more we talk about it, the more people will be willing to admit to and possibly begin to resolve their trauma. As someone who has to navigate the hell that is PTSD, I wish it had been normalised sooner. Let’s do what we can to make it better for generations to come.

Yolandie

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