August 14, 2020

How Trauma Survivors can Tell the Difference between Panic Attacks & Flashbacks. 

On Wednesday, I had a medical procedure that I’d been waiting for since March.

I knew it would be invasive, so I tried to stay in the present and talk myself through it.

However, I wasn’t able to complete it awake. An alternative choice was offered to me when I spoke plainly and candidly to the surgeon: “I have a history of trauma. You cannot put anything down my throat. I cannot do this without sedation. Is there another way?”

I am grateful she respected my wishes. I am also grateful she acknowledged why it would be so hard for me and that I wasn’t alone. In fact, many patients might express similar sentiments with much regularity.

I think when people hear the word “flashback,” they often think it means remembering something bad.

But it’s more than that. A flashback is a reaction to a memory that has often manifested for years in the body.

For me, a flashback reaction begins with ringing in my ears, tunnel vision, a lump in my throat, difficulty swallowing and breathing, feeling light-headed, nauseous, profuse sweating, an accelerated heart rate akin to being on a treadmill, restless legs, and trouble remaining seated (a prompt from my primal brain to fight, flee, or freeze). But these are only the physical manifestations.

Mentally, the fear often becomes so intense that people dissociate and are unsure of where they are or what they are doing and will forget what they were doing before it happened. It can be hard to distinguish between a time of trauma and the present when a flashback is occurring. The brain experiences something that connects the dots.

In my own experience, this happens when there is someone who looks like a past offender (or may be related to them), the smell of certain alcoholic beverages on someone’s breath, certain air fresheners (or a person’s cologne), the color yellow, and so on. For me, these can open up a carefully secured file in my brain of old memories that make it feel like my trauma is happening now all over again.

A flashback is not just remembering a traumatic event. It is being forced to relive and reexperience it over and over again. It is not the same as anxiety or a panic attack—I’ve experienced both as well.

The key difference is that generalized anxiety is the fear of the unknown, and post-traumatic stress disorder (PTSD) is the fear of what we already know.

A lot of people confuse panic attacks with flashbacks.

Panic attacks can evoke almost all the same physiological responses and they are scary as f*ck, but they are not always associated with memory or past trauma. Often, they are stress-induced or the reason could be subconscious and the person is unaware of the trigger.

Panic attacks can also come out of nowhere, usually in the worst places possible, such as events and in the checkout line at the grocery store.

Thankfully, they often pass faster than flashbacks, but it sure as hell doesn’t feel like it at the time. Many people compare a severe panic attack to what dying might feel like—I concur.

Here are a few ways to tell the difference between panic attacks and flashbacks, and how we can deal with them:

>> In a panic attack, people tend to need to reduce their amount of external stimuli. They may feel the need to leave where they are and get to a safe place like a bedroom, their car, or a washroom.

They often need a quiet space where they can use deep diaphragmatic breathing—deep enough to pull the belly in and exhale long enough to puff the belly out. Some use a grounding object like a ring they spin on their finger or a rock in their pocket to run their fingers over its edges. They can also implement self-talk as assurance: “I’m in the Walmart parking lot, and I’m safe. It’s just a panic attack. This will pass. Breathe. Relax your shoulders. Open and close your fist. Focus on your safe place.”

Some close their eyes, some don’t, as it can increase dissociation from the present—I don’t. My safe place is on a beach, at sunset, hearing the waves kiss the shore. If none of those things work and you have medication, you may or may not need to take it. If you do, take it with zero shame.

>> Flashbacks often (not always) require the opposite approach: the need to increase external stimuli to bring one back into the present. The mind has dissociated and does not know the day nor the hour. It is reliving an event that already happened and believes we are back there; frozen in time.

Many people during severe trauma go blank, and their mind leaves their body and completely dissociates from the experience (this is the “freeze” response and a highly adaptive brain response in order to survive such fear or threat of danger). Later in flashback mode, some will freeze again, feel immobilized, and paralyzed once more.

Others will have the need to do the opposite of what they did in trauma time: they fight or flee, and this can range from an angry outburst to stripping off layers of clothing that feel confining (been there, done that; bra in the mandarin at the table) to anything in between.

We might also feel the need to escape, whether that is literally leaving the triggering situation or using substances to do so (flee and freeze can become familiar ways to cope, but they’re not functional and can be maladaptive when we are not in imminent danger). We end up running and hiding from any experiences, places, or people that might remind us of that trauma and eventually become afraid of things we do not need to fear.

It can also become an automated response to want to numb and separate from those thoughts by always doing and filling our mind, which keeps us from being mindful. Often, sensory overload can help bring someone out of a flashback. It is something external and it activates our senses to bring us back to the present.

(If you have people in your life who know you have PTSD, tell them ahead of time what works for you and what doesn’t. It can be frightening for them as well if they don’t know what is happening; ask my friend who found me hiding and crying inconsolably like a child when I was 45, under a kitchen table, clinging to its legs for protection.)

Here are a few examples of what can bring us back to the present moment:

>> Sound: Turning on the radio and cranking up the volume brings people back into the present.

>> Smell: Some people carry aromatherapy or use strong aromas, like basil or lavender, to smell something in the moment that can overrride the smells associated with a traumatic experience.

>> Taste: Carry disgusting cough drops and suck on something unfamiliar or sour like a lemon drop or something salty like a pretzel (something you didn’t taste during the time of the traumatic event). I don’t know a single soul who hasn’t been so sick after eating something or drinking something that they never ate or drank again. Taste is a powerful resource.

>> Touch: When I did my PTSD program, nurses and doctors would often use an ice pack on the back of the neck to bring someone into the present. It is using the startle reflex in reverse. I’ve heard that some consider this barbaric. I’m not suggesting throwing someone in a bathtub of ice cold water, but a freezie or an ice cube in the hand, or splashing your face with cold water can work wonders.

>> Sight: Try and get back to the moment by counting the number of things around you that are a certain color. Then your focus shifts to the location you are in—in the here and now. This is probably the easiest way to reorientate if we are out in public. Choosing to find and scan for a certain color or item engages the cognitive parts of our brain and diminishes the activity in our fear response centre. Logic and fear exist in different parts of the brain.

Enlist the help of those you trust, and be honest about the best ways to help you if you have a panic attack or a flashback. It’s no different than what you might tell someone to do if you had diabetes, seizures, or a severe allergic reaction to peanuts.

The more knowledge people have, the more they know and the more they can help you. Also, be honest: if you don’t want them to speak to you or touch you, but just be there, then say so (just like I would hope someone would share where their EpiPen, medications, or inhalers are, so that if something happens, they wouldn’t have to go looking frantically and have a panic attack of their own).

We need to start normalizing these conversations about mental health.



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