“Trauma is a vortex”, Billy Crystal’s character, Eli, says in the 2024 television show Before, and it is perhaps one of the best descriptions of untreated trauma that exists. Most people who survive a trauma do not ultimately develop posttraumatic stress disorder (PTSD), but for those who do experience such symptoms, the gold-standard treatments that exist today often help. They are cognitive processing therapy, prolonged exposure, and eye movement desensitization and reprocessing. So what is traumatic avoidance, and why does it keep PTSD going?
What traumatic avoidance looks like
People who have survived a traumatic experience may put off seeking help, fuelled by avoidance, one of the major symptoms of PTSD, which can mean steering clear of reminders of the trauma. They are also likely to practise avoidance in many other areas of life that relate to what happened. A woman who was assaulted may decide she will no longer go to bars, on dates or to parties, or she may avoid going out at night at all. A veteran with PTSD may stay away from places where he expects a crowd, and a survivor of a car accident may avoid driving.
Humans are built to survive and their minds are built to protect, so avoidance would appear to serve an important protective function, shielding people from anticipated harm. Avoidance has long been recognised as a core feature of post-traumatic stress, but the problem is that people who develop PTSD see danger where none exists. They begin to overestimate risk and to believe its probability is greater than it is in reality.
How avoidance keeps PTSD going
Avoidance does not give survivors the chance to prove to themselves that their estimates of danger are wrong and their beliefs about harm are false. Worse, the more they avoid, the more those false beliefs are reinforced. The woman who skips parties so that she will not be assaulted may conclude, “I was able to stay safe because I did not go to any parties; therefore, parties must be dangerous and the only way I can stay safe is to continue to avoid parties”. That way of thinking is not aligned with reality. No one is ever 100% safe in life, safety is never guaranteed and certainty is an illusion, and not all parties are dangerous. Statistically speaking, she is more likely to attend parties where she is not harmed. By restricting herself and never going out to socialise, she does not get the chance to see that she would, in all likelihood, have been safe and may even have had a good time.
Why a life without risk is not the answer
Every day, people take risks. We take them when we leave our homes and drive to work, and there is never a 100% chance that we will not be in a car accident on the way to the office. We also use aeroplanes, even though we do not know the pilot. We trust that he has a licence, has been vetted and is competent, which entails a great deal of trust and faith, and most of us hardly give it a thought. There is a risk in getting on that plane, but we do it because that is living.
The cost of waiting for help
Perhaps the most heartbreaking thing about avoidance in people with post-traumatic symptoms who delay therapy is that, if they had come into treatment years earlier rather than staying in the avoidance cycle, they would often have found relief much sooner. While they were suffering, they undoubtedly missed out on so many things that make life worth living, such as opportunities to meet new people, trips to new places and job promotions. For survivors, confronting the trauma may be intimidating, but living with post-traumatic symptoms while avoiding it will often keep them in the ongoing “vortex” of chaos, discomfort and fear.
FAQs
- What is traumatic avoidance? It is steering clear of the people, places and situations that might bring a trauma back, and it is one of the major symptoms of PTSD.
- Why does avoidance keep PTSD going? Avoiding a danger that is not really there never lets survivors prove their fears wrong, so each avoided situation reinforces the belief that they were safe only because they stayed away.
- Is avoidance ever protective? The mind is built to protect, so avoidance can look protective, but people with PTSD tend to overestimate risk and see danger where none exists.
- Which treatments help with PTSD? The gold-standard treatments are cognitive processing therapy, prolonged exposure, and eye movement desensitisation and reprocessing.
Takeaway
Avoidance feels like protection, but for a person with PTSD it stops them learning that the danger they fear is far less likely than they believe. Seeking treatment earlier, rather than waiting, is what gives survivors the chance to break the cycle and get back to the things that make life worth living.
Dr Bonnie Thurston-Snoha is a psychologist at the Anxiety and Behavioral Health Center in Maryland. She works mainly with trauma and PTSD.
