What Is the Fight or Flight Response and How Does It Relate to PTSD?


What is the fight or flight response and how does it relate to PTSD?


Click here to see other video Q&As with Lt. Col. Holcombe.

Click here to return to our BrainLine Military Ask the Expert feature.

[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.
Posted on BrainLine May 8, 2013.

Produced by Victoria Tilney McDonough and Erica Queen, BrainLine.

Comments (1)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

I feel that the mental aspect of "fight or flight" is only a small part of the issue. My veteran usually chooses the fight path despite me staying very calm, lowering and slowing my voice, and listening to his objections, and avoiding conflict. He does say threats and things he regrets. It is not only the mental but the physical, in a fight your epinephrine and cortisol increase and this floods the body not by his choosing but because his brain and body chemistry has changed from ptsd and tbi. Following this "fight" his whole body aches, he is drained of energy, needs a nap, and is despondent, uncaring, and depressed, or worse. I actively try to avoid triggers I am aware of such as large public gatherings, loud abrupt noises, certain topics, and so on but it is impossible to shield a veteran from all triggers at all times, but I also hate him going through this cycle and wish not to see him go through it. I will seek further help as a caregiver, and he seeks counseling as well, but I think more could be elaborated on with this topic and advice on how caregivers can assist veterans through the difficulties of the fight or flight response.