PTSD is classified in the DSM-IV as an anxiety disorder. I prefer to think of it as being in a class by itself. I would name that class "Reactivity Disorders". The characteristic of people with PTSD that is most prominent, most troublesome and most resistant to change is reactivity. By reactivity I mean the tendency to have an inappropriate and/or exaggerated reaction to events that occur in the ordinary course of daily life. Reactivity includes both involuntary and voluntary behaviors. Involuntary behaviors include startle response, clenching, tensing, a pit in the stomach, a lump in the throat, or even a full-blown panic attack. Voluntary behaviors are those behaviors that we have at least some conscious control over. They are the things that we say and do when we are in a reactive space. It is this latter category of behaviors that I wish to address.

I have said it before, but it bears repeating over and over again. We need to question our reactivity. In fact I want now to state that even more strongly. We need to doubt the appropriateness of our reactivity. We need to doubt it with extreme prejudice. We need to doubt it just as much as an alcoholic needs to doubt the advisability of taking that first drink. For acting on our reactivity is just as destructive for us as taking that drink would be for the alcoholic. Acting on the impulses that stem from our reactivity can and will destroy our lives. And it starts by destroying our relationships.

Some people, maybe even most people, feel that they have a right to their feelings and they have a right to act on them. Let us say that this is true. So what? Just because I have the right to do something or the ability to do something doesn't me that I should do it. I believe that a person should do what is in their best interest. It is not in our best interest to destroy our relationships. We wouldn't be in these relationships if we didn't want them. And, if we want them then it is certainly in our best interest to take the best possible care of them. And this means curbing our tongue, staying our hand and otherwise restraining ourselves from acting on impulse when we are in a reactive space.

So how do we do this? As with the alcoholic, the first step is to admit that we have a problem. We have a problem with reactivity. We react. We overreact to many many things. We call these things triggers. But there is no way to know and no way to avoid all the things that can trigger us. So although learning our triggers and trying to avoid them where practicable is useful, it is not practical to make this our main defense against the harmful effects of our PTSD. Our main defense must be to doubt all of our reactions and to refrain from acting out any of our impulses.

You may feel that this is not fair. You may think that it is not fair for me to be the one who always has to make changes, to always have to curb his impulses. Let us say that you are right, that it is not fair. But if you insist on acting out your impulses by saying and doing things that are counter productive to your personal growth and to the preservation of your relationships, is that fair. If you insist on saying and doing things that prevent you from keeping your relationships close and healthy and satisfying, is that fair. There are degrees of fairness. Your goal should be to do that which is the most fair to you and to those around you, that which is the most fair to your pursuit of happiness.

Having PTSD is like having diabetes. We did not choose it. We do not want it. It is a major inconvenience. But the solution is not to refuse insulin and eat whatever we want. The solution is to manage it in such a way that it interferes the least with our potential for having a long, productive and satisfying life.

Desired Outcome:
To learn to recognize reactivity as such, to question it and to redirect our behavior whenever we are triggered into a reactive space.

Discussion Starters:
Do I see how my reactivity has taken me into behaviors that I have regretted? How could I make myself more aware of my reactivity when it happens? What devices can I use to prevent myself from acting on my impulses when I am in a reactive space? What mnemonic devices might I use to help remind me to question my reactivity?
 

John C Flanagan, LCSW
818 NW 17th Avenue, Suite 7
Portland, OR 97209-2327
503-228-7574
www.johncflanaganlcsw.com

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