Traumatizing Your Characters Part 6 Intrusive Recollection

We've discussed a lot of aspects of trauma at this point! If you'd like to catch up, here you are:

Part 1: General facts

Part 2: Types of trama

Part 3: Aspects of trauma that make it more or less likely to have lingering psychological effects

Part 4: Individual factors that make it more or less likely a person will develop PTSD after a trauma
Part 5 A and B: Developmental trauma (some thoughts on Nobody But Us by Kristin Halbrook) and an interview with Kristin herself

Are you all primed and ready now? Awesome. We'll start talking about symptoms. PTSD has a set of diagnostic criteria that I suggest you go read. There are three primary symptom clusters in PTSD:

• Intrusive Recollection
• Avoidance/Numbing
• Hyperarousal

We're going to talk about each symptom cluster separately, and today we'll go over intrusive recollection. Here are the symptoms--you have to have at least one of them to "qualify" for a diagnosis of PTSD (from the DSM-IV-TR):

1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
2. Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content
3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes,including those that occur upon awakening or when intoxicated). Note: in children, trauma-specific reenactment may occur.
4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

In literary and movie portrayals of PTSD, this is the symptom cluster that gets the most attention. Lots of people primarily think of flashbacks when they talk about this type of symptom, but that's only one type (symptom #3).

Let me offer you a brief example from SANCTUM, in which Lela is in the fight of her life, and a memory hits her sideways and makes it impossible for her to stay in the moment:

"Intrusive" is a term that basically means unbidden and interfering. These are ambush memories that strike when the person isn't *trying* to recall the event. It's incredibly upsetting, because it's like your mind is operating all on its own, jabbing you with these images and noises and sensations you'd really like to never experience again, thank you very much. 

Nightmares are a common recollection symptom as well, but for adults, they would need to be associated with the trauma or memories of the trauma to be included as a symptom of intrusive recollection. 

And finally, symptom #4 ... we've all heard the word "trigger", right? That's essentially what those "internal or external cues" are. Things that instantly remind the person of what happened to them, and sometimes result in a cascading physiological reaction--panic. 

In my next post, we'll discuss triggers. But before we do that, if you're writing a character who's experiencing PTSD, what symptom(s) of intrusive recollection are you trying to portray? How are you showing the character's experience? Or, if you're not writing a character like this, but you've read books that do this well, tell us about them!

One more day to enter to win a copy of the excellent NOBODY BUT US by Kristin Halbrook! I'll announce the winner on Wednesday.

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Traumatizing Your Characters Part 10 !!! Writing PTSD treatment thats true to life

This is getting comical. But never fear! I think this is pretty much it. Next Tuesday, I'll be posting at YA Highway, a kind of summary about things to consider when writing traumatic events and characters exhibiting PTSD symptoms.

Up to now:

Part 1: General facts

Part 2: Types of trama

Part 3: Aspects of trauma that make it more or less likely to have lingering psychological effects

Part 4: Individual factors that make it more or less likely a person will develop PTSD after a trauma
Part 5 A and B: Developmental trauma (some thoughts on Nobody But Us by Kristin Halbrook) and an interview with Kristin herself

Part 6: Intrusive Recollection
Part 7: Understanding Triggers
Part 8: Avoidance and Numbing
Part 9: Hyper-arousal

Okay ... so you have a traumatized character, and you want to depict him/her going to treatment. This post is for you.

It is widely accepted that treatment for trauma really can't begin until the person is safe--you can't recover from trauma if you're still IN that trauma. Of course, there's a lot of debate about what "safety" means, and whether we're just talking about physical safety (e.g., not still living in the home with an abuser) or both physical and psychological safety (e.g., is living with a temporary foster family a psychologically safe place to deal with traumatic memories?). We have to use our best judgment and keep doing research on that one.

I'm going to describe prolonged exposure therapy in VERY general terms (that often apply to other research-supported treatment approaches as well, such as EMDR). PE is one of the most well-researched and effective treatments for PTSD in existence. There are other treatments like it, such as trauma-focused cognitive behavioral therapy, which is often used with traumatized children and their parents. These are not the only treatments--but there is SOLID evidence to show they work. And I don't like to waste time talking about stuff that I don't believe has a reasonable chance of working. If you're going to apply another model of therapy, it might be cool to see if there's any research support to show it's effective in treating PTSD.

A two-minute video on prolonged exposure therapy: