What is the fight or flight response and how does it relate to PTSD?
[Army Lt. Col. Philip Holcombe] With regard to post-traumatic stress disorder,
one of the core criteria for diagnosis is avoidance.
So people will try—people with post-traumatic stress disorder
will try all kinds of strategies to escape whatever it is
that's making them feel keyed up and have that experience
in their body that they don't like.
So there's a response that we often talk about that's called fight or flight.
So if I can, I may just try to run away.
Now that may be physically, where I get up and I leave.
It may be that I run away without ever getting there
because I plan on not ever going there
because I can imagine that that's going to be uncomfortable for me.
So I may fly away by never even going there.
It can also be that the person is sitting with you,
and they have flown away.
Their body is there, but they are not.
They have numbed out.
Some patients with post-traumatic stress disorder
become very adept at numbing their internal experience.
So they may be there with you, but not there with you.
They have engaged in flight.
There's also fight.
Fight happens often when a person feels like flight is not an option.
That happens a lot in our culture today.
You could be in traffic, and you're stuck in traffic.
And the next thing you know, you're driving in ways that are not acceptable
because you had to drive like that when you were in the theater of war
because if you stopped, that could be really bad.
So you could have a military member who has post-traumatic stress,
they're driving, and they are ready to be an aggressive driver.
It can also happen in a family context.
Say a couple is having a disagreement.
The person with post-traumatic stress disorder starts to feel keyed up,
they've tried to withdrawal from the situation,
but the other spouse is a pursuer,
keeps chasing them, corners them,
and then boom.
They may say something that's hurtful,
they may say something that's harmful,
they may be aggressive in pushing their way through to escape,
or in some cases, they may be violent.
So flight or fight is a very important thing for providers,
for patients, and family members to be aware of.
And to be able to plan ahead of time,
how are we going to handle this when this happens,
while at the same time realizing that avoidance is
not a long-term strategy for a happy life.
Fight or flight can be an important method of coping,
but you can't use it for everything.
You have to get back to living life.
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Lt. Col. Philip Holcombe, PhD, Lt. Col. Philip Holcombe is an Army psychologist who serves as the chief of Clinical Recommendations at the Deployment Health Clinical Center at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.
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