The Internal and External Triggers of PTSD

The physical and emotional strain of PTSD can become a struggle for some people and it can linger in the form of panic attacks and other behavioral manifestations that interfere with daily life.  The residual effects of a shocking or scary event can continue for months (or even longer,) and make people feel stressed and frightened when their PTSD is triggered, despite not being in danger.  Although danger is a common element for bringing about PTSD in the first instance, not everyone with PTSD has been through a dangerous or scary experience.

Working through PTSD is possible, but requires consciousness about its triggers along with developing behavioral discipline consisting of adaptations and specific exercises that can ameliorate and eventually eliminate its bad effects.  In a perfect world it would be ideal to altogether avoid PTSD stimuli.  Since this is not practical, there are excellent strategies for managing both the internal and external stimuli that can bring about an attack.

ptsd triggers

Assessing PTSD

NIH guidelines indicate the following conditions for having PTSD, all lasting longer than one month:

  • At least one re-experiencing symptom
  • At least one avoidance symptom
  • At least two arousal and reactivity symptoms
  • At least two cognition and mood symptoms

The severity of the symptoms must also be considered to be severe enough to interfere with relationships.

Coping Strategies for PTSD

PTSD symptoms can be triggered by internal and external stimuli.  Gaining awareness of the specific thoughts, feelings, or environmental factors that bring about PTSD is the logical first step in protecting oneself.

Triggers falling into the internal category encompass a wide spectrum of emotions: anger, anxiety, sadness, loneliness, vulnerability, and a lack of trust are representative of feelings that can bring about PTSD.

External triggers like anniversaries, seeing a particular place or person, or even a holiday can promote a PTSD incident as well.

Patient education and social support are important initial factors in managing PTSD.  Beyond learning about specific triggers and either avoiding or mitigating them, developing a protocol that addresses the components of the Cognitive Triangle: thoughts, feelings, and actions, is the key to managing the disorder.

For thought management, techniques that incorporate mindfulness, relaxation, and self-soothing are helpful.  Deep breathing, and to the extent a sufferer can learn it—meditation, are superb ways to get back to a more relaxed baseline.  Relatively recent therapeutic techniques that address PTSD include EMDR (eye movement desensitization and reprocessing,) that uses eye movements to overcome the negative effects stemming from traumatic life events. A 1998 study (Scheck that studied 60 women provided early support for the efficacy of EMDR in treating stress disorders.

For those with a loved one suffering from PTSD, it is important to talk to them about the incident, but it is not advisable to pressure them to much; if a person resists talking about it, it is alright to step back and suggest that they talk at a time when they feel more comfortable.  Always be aware for signs that someone has resorted to self-medicating, or is exhibiting suicidal tendencies so that professional help can be sought out immediately.

For additional information, please feel free to email our office at   To schedule an appointment, call our offices at 917-609-4990.

Be Well,

Dr. Amanda Itzkoff

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