Nobody can look at me and know my struggle with complex PTSD. Because I choose to stay silent, people don’t associate me with sexual assault, or physical, emotional, or psychological abuse. I choose to keep far from that association even with family and close friends. So how could my dentist know that painful treatment would trigger me and pull me deep into my past? How could a dentist know to treat me any differently? Is there truly even a link? Can a painful dentist appointment be a trauma trigger?
trying to understand my triggers
I recently spent time with a good friend, but instead of enjoying our visit I spent all my energy hiding the depression that had set in. I hoped I could snap out of it and had no clue what caused me to spiral into this for the past few days.
My friend asked, “What’s going on with you?” I felt myself collapse inside and heard my mouth blurt out, “I went to the dentist.” I immediately felt ashamed of such a stupid answer. I didn’t know where it came from! I hated myself for being so weird.
Why did the emotions feel so familiar? Can a painful dentist appointment connect somehow with all the other pain in my past? It is such a strange concept! Yet I was seeing a pattern emerge
Triggered
I had an emergency dental appointment last week and it was painful. As I lay on the table, the anger and emotions began to build yet I was unaware of them. My whole body was tense as I willed myself to endure it, waiting for it to be over before anything could be felt. My brain knows to release no emotion until I am alone.
It felt like my insides were shaking. My vision blurred at times. I was confused about who was in the room with me. The dentist asked me questions and I stumbled for words. My brain basically takes a hiatus to get me through emotional pain.
Once it was over I ran to my car and locked the doors. Then the emotions flooded my body with intensity – overwhelming fear, sadness, and hopelessness. I began sinking into depression and the tears would not stop. It all felt terribly familiar.
I texted my husband: “The appointment was awful, and I am so sad!!!” As I sent it, I realized I’ve sent the same text after many other dentist appointments.
Why did it never register with me before that this is a pattern? Why am I sinking into depression from a freaking dental appointment?!?
Confinement and Enduring Pain Can Trigger PTSD Symptoms
I have learned now that pain (including dental pain) can be a traumatic stimulus for PTSD symptoms. And those with a lifetime of PTSD report significantly greater current bodily pain than others, as well as major depression and psychosocial factors often correlated with chronic pain.2
As usual, the vulnerability of saying something out loud to a friend I trust, (despite feeling stupid and weird), caused me to recognize something was not right. That night I emailed my therapist and explained to her what I was experiencing. She responded that I had discovered a link, a trigger.
What I have learned with the help of therapy, is that I am not having a classic anxiety attack in regard to the dentist. Dental appointments are invasive, not only painful. Being confined and feeling I must endure my body being manipulated or invited by another person – triggers a deep sense of helplessness inside me.
With PTSD, when the body, deep inside, is triggered, it reacts to the past, even if the situation is different now.
My brain senses I am confined, I am helpless, and someone is hurting me. Anytime I essentially have to grit my teeth and endure a situation to get to the end, I will likely be triggered. And because this is a dentist appointment, my brain’s strategy of gritting my teeth to endure this is not even an option!
Dissociation Allows Me to Not Feel Until I am Alone
Because of my past, my brain has been trained to not respond during painful events, to essentially not process any of it while enduring it.
My brain knows that it must get me through the event without feeling or showing any emotion. From experiences of childhood sexual abuse to adult sexual assaults, I learned that I would receive far greater pain and repercussions if I showed emotion. Thus, I make it through appointments like this one, only to be flooded with the emotion when I am safely alone.
Cognitive Reframing Does Not Work
Reframing is a technique used in therapy to help create a different way of looking at a situation, person, or relationship by changing its meaning (Clark DA. Cognitive restructuring).3 My therapist told me that dentist and doctor visits are situations in which I must learn to reframe. She said my brain needed to be told that this invasiveness and pain is for a good end. She told me to use mindfulness techniques to keep my brain grounded in what is happening and reframe as much as necessary.
Two weeks later I had a follow-up dental appointment and I felt ready. I repeatedly reminded my brain I was just fine! I was ready to rock this – confident and ready to do exactly what I had learned.
I talked myself through it many times during the 90-minute appointment. I felt the pain, the invasion of my space, and I kept reframing what was happening.
I wish I could say it was a magical solution and I had no difficulties afterward. I was so sure that being knowledgeable, educated, and incredibly confident would make all the difference.
Reframing did not alleviate any trauma triggers.
I told myself I was doing it wrong…or else my brain was too broken, but reframing did not fix anything. I left the dentist with a body that felt disconnected and attacked. I was deeply triggered again and I ached. I cried. As I drove past people on the streets I tensed, as if they too wanted to hurt me. All the familiar feelings of deep distrust returned and was back to my strong desire for isolation.
I was too humiliated to admit my defeat and managed a smile for my husband, telling him all was fine. I did it! I washed the dishes and cooked dinner, longing to crawling into bed and disappear. Reframing was not the magic it was promised to be.
I wish more dentists and doctors knew how helpless it feels to sit in a chair or lie on a table and have instruments pushed into our bodies.
They probably have no idea the utter feeling of being powerless while in pain. I wish they thought to ask if this is a trigger or at least if it is uncomfortable because I do not know if I will ever have the courage to be my own advocate. I wish they didn’t look at me in judgment when I admit sometimes to going years without a dental cleaning or a gynecology exam because of a deep-rooted fear that I do not fully understand.
My friend tells me, “You are not broken and in need of fixing. You are hurt and in need of care.”
Because this time I understood the source of my dark mood, I was able to better care for myself. I took several short naps during the day. I made blueberry cobbler for lunch. I sat on my front porch swing and enjoyed the breeze and the quiet. I allowed myself to feel the big emotions.
Someday I Will Find My Voice
Although the trauma remains in my body, the awareness is helping. My triggers may never completely disappear but one day I won’t be hijacked by my big emotions. Someday I will find my voice. I will have the self-worth to create boundaries and speak up when I feel invaded…to ask for a break when I need it. Perhaps I will be able to ask my husband or a friend to be with me when I need someone most…without feeling ashamed.
REFERENCES
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, Virginia: American Psychiatric Association; 2013.
2. Bryant RA. Posttraumatic stress disorder and traumatic brain
injury: can they co-exist? Clin Psychol Rev. 2001;21(6):931- 48.
3. Clark DA. Cognitive restructuring. In: Hofmann SG, Dozois D, eds.,The Wiley Handbook for Cognitive Behavioral Therapy, First Edition. New York: John Wiley & Sons, Ltd; 2014. doi:10.1002/9781118528563.wbcbt02