Trigger

As defined by the American Psychological Association, any “stimulus that elicits a reaction” can be considered a trigger. However, in the context of mental health, a trigger often means a sensation, event, situation, or thought that prompts an individual to experience acute symptoms related to a mental illness. The nature of triggers may differ significantly depending on the psychological conditions involved. This is not to be confused with a trigger point, which is a spot in skeletal muscle that may produce localized pain.

In someone with post-traumatic stress disorder, a trigger is an event that reminds them of traumatic experiences that led to PTSD developing. The nature of the link may not be evident to the person’s conscious mind, especially before they receive treatment. Their reactions to triggers can be reflexive and involuntary but often highly distressing.

For those with obsessive-compulsive disorder (OCD), a trigger may provoke hard-to-control thoughts and emotions, which they may attempt to regulate using repetitive behaviors. Researchers believe that intense feelings of any kind can trigger various compulsions. Situational factors like disorganized surroundings or contact with potential sources of contamination may also be a factor.

In a person with substance use disorder, reminders of past experiences consuming substances might be considered triggers. These factors may elicit intense cravings for intoxicating substances. Evidence from research suggests that feelings like shame or guilt can be triggers of relapse.

Triggers can take many forms, and there’s no reliable way to predict which triggers may affect a particular individual. 

Trauma triggers 

Trauma triggers may be related to nearly any part of a person’s experience during the inciting event or immediately before or after. Common types of trauma triggers include:

• Sensory impressions, such as hearing a specific song or smelling a particular odor
• Locations or types of locations, such as hospitals or forests
• Particular people
• Types of people, such as tall men, police officers, or visibly intoxicated people
• Situations like being alone, stuck in a small space or surrounded by a large crowd
• Sudden movements from others
• Times of day like evenings or mealtimes 
• Times of the year, such as seasons 
• Anniversaries of traumatic events
• Unwanted touch

Certain triggers may be more or less common depending on the trauma type. For example, people who have PTSD related to military service often find fireworks and other explosive sounds triggering. 

Inciting factors for OCD 

Inciting events for OCD symptoms are often related to the content of a person’s obsessions. Common categories include:

1. Contamination and cleanliness: Inciting factors for a person with contamination OCD might be any stimulus that reminds them of illness or worry that they’ve become contaminated, infected, or unclean. These situations can vary, but some people may find shaking hands, being near a sick person, or accidentally touching a surface in a public area triggering. 
2. Symmetry and order: Someone with symmetry OCD may feel distressed when their environment is chaotic or disorganized. Examples of possible triggers are messy rooms, uneven numbers of objects, breaks in patterns, or people seated in an asymmetrical arrangement.
3. Morality or religiosity: An individual with moral or religious OCD may be excessively worried that they’re a “bad person” or that they’ve broken a religious commandment. Possible triggers could include misspeaking when praying, unintentionally making an untrue statement, or spilling a substance on a book they regard as sacred. Seeing a particular person when they’ve had intrusive thoughts about harming them might also trigger symptoms.

Inciting factors for substance use

For people with substance use disorders, events that might incite use can include those that relate to the emotional or social context in which they used to consume intoxicants. For example, the following triggers might cause one to want to use: 

• Parties, celebrations, or anniversaries
• Bars and restaurants
• Sensations associated with substance use, such as the sound of a can opening
• Movies, shows, or books depicting substance use
• Being around people using substances
• Times of the day or seasons of the year associated with heavy substance use

Researchers are still working to understand the neurological and psychological mechanisms underlying triggering events in mental illness. Some evidence suggests that trigger formation may involve the psychological mechanism of classical conditioning. Classical conditioning is the process in which the mind learns to associate an automatic reflex with an unrelated stimulus that occurs at the same time.

In PTSD, the nervous system may associate the physiological fear and pain experienced during trauma with other sensations present during the event. These sensations can then trigger similar responses when they occur in the future, even in the absence of danger. This process may represent a disruption or exaggeration of the body’s natural attempts to learn about and avoid risks. Some researchers have found that fear-related conditioning occurs more easily and strongly during intense stress. 

The opposite process could occur in the case of compulsive behaviors like gambling or substance use. Repeated exposure may cause the brain to associate pleasurable sensations like intoxication or excitement with other factors that are commonly present, such as the sound of ice clinking in a glass or the presence of a crowd of happy people. In the presence of these elements, the body may begin to anticipate the pleasant feelings to which it’s grown accustomed, inciting a craving.

Different people may react differently to their triggers, and even in a single individual, the same trigger may not produce the same response every time. Some reactions may take the form of involuntary physical changes or reflexes. Trauma triggers or OCD triggers often activate the sympathetic nervous system (commonly known as the “fight-or-flight” response), with potential results including:

• Sweating
• Racing heartbeat
• Shortness of breath
• Shaking or twitching
• Excessive alertness for danger
• Ducking for cover
• Freezing in place
• Fleeing or exiting a situation
• Vomiting
• Diarrhea
• Lack of appetite
• A sense of intense heat or cold

Other trigger effects can be emotional or cognitive. A person with aversive triggers might feel intense emotions of worry, dread, fear, shame, or sadness. They might also have unwanted, intrusive thoughts about possible dangers or adverse outcomes. Intrusive thoughts can also take the form of negative self-judgments such as “This situation is all my fault” or “There’s something wrong with me.” Triggers for substance or behavior cravings might induce a sense of excitement, anticipation, or desire, along with repetitive thoughts about relapsing.

In some cases, triggers may lead to flashbacks in which the person mentally returns to a previous event, experiencing it as though it were happening then and there. These incidents are often brief, encompassing a few seconds to a few minutes. They can lead to emotional reactions that may persist for a long time.

A trigger warning is a type of precautionary disclaimer that may be given at the beginning of a piece of media or informational content, such as a video, story, or lecture. It alerts potential viewers, listeners, or readers that the content in question includes subject matter that is commonly associated with trauma, including:

• Violence
• Sexual coercion or assault
• Child abuse
• Eating disorders
• Bigoted behavior (e.g., racism, sexism, homophobia)

The usual intent of trigger warnings is to ensure that people with conditions like PTSD or OCD can mentally prepare themselves to encounter potentially triggering material (or opt out of doing so). 

However, recent research indicates that these warnings may be less helpful than previously thought and could be counterproductive. A 2020 study reported that trigger warnings before a description of graphic violence had little to no effect on anxiety for most readers and slightly increased anxiety in those with the most severe PTSD symptoms. The researchers also found that people with exposure to trauma were more likely to rate their traumatic experiences as central to their life story after seeing a trigger warning, which could potentially hinder recovery.

Avoiding potentially triggering situations may also not be advisable for those with conditions involving trauma or anxiety. While it may sometimes be prudent for people to avoid the possibility of a trauma reaction in certain instances, repeated avoidance may strengthen the association between those triggers and the feelings of fear, worry, and panic they provoke.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.