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September 25, 2018

An Unwelcome Guest: When Traumatic Anniversaries hit us Hard.

Some anniversaries are not celebrated with confetti and wine.

In fact, we wished the day had never happened. This 11th anniversary, I did not eat cake, drink spirits, and share in laughter, reminiscing.

Every morning for the past several weeks, the weight of my heavy legs rolls me out of bed and into a morning routine I have been mastering for years: hydration, yoga, meditation.

But these days, I loathe this routine. My body feels like the weight of a ton of sandbags used to resist the flood, my thoughts are stagnant as if caught in a riptide of molasses, and there’s a pain so deep and dense in my chest that it penetrates to my thoracic.

Am I tumbling into a depression? Don’t think so. Am I anxious about something in particular? Probably not.

Then, why has fatigue traveled to the deepest calcium pockets of my bones, despite my committed self-care habits?

Wait. What is the date? Ah, yes.

The anniversary of my sister’s murder.

I am experiencing what many of us go through on the anniversary following a tragic loss or traumatic event. It is called “anniversary reaction or distress.”

For the months following my sister’s death, I felt a grief so physically debilitating, I was unable to walk for sustained distances and shelved running for several months.

Have you ever felt your physical body reject the idea of living, coping, or healing? Like, its only purpose was to serve as armor against the outside world?

Well, that is what physical grief can feel like. And now, 11 years later, that same physical grief returns once again, yet thankfully, with much less intensity, taking up residence in my home, my body, for the late summer/early fall season, like an unwelcome and overstayed guest.

We may wonder why anniversary reactions occur.

The anniversary date may trigger a reaction because it’s associated with a traumatic memory. For example, the extraordinary attacks and trauma associated with 9/11.

Foa and Kozak suggest that traumatic memories contain information about the dangerousness of an event and our need to seek safety and protect ourselves from something similar happening. So on the anniversary date, we may have strong negative emotions, physiological stress, distressing thoughts about our world, and the need to engage in protective coping responses.

We actually feel threatened even though we’re perfectly safe.

Common symptoms of anniversary reaction are: apathy; grief; sadness—which, if prolonged, can become clinical depression; and anxiety—which can become a constant state of worry and in its more extreme state, lead to panic attacks.

For me, I experience more physical symptoms such as intense fatigue, headaches, muscle achiness, and upset stomach.

Other symptoms experienced can be an exacerbation of PTSD symptoms:

>> Intrusion: This is the most common symptom around a traumatic anniversary—the re-experiencing of the emotional, cognitive, and physical feelings at the time of the trauma. For example, on the anniversary of a sexual assault, the survivor may experience intense and upsetting memories of the rape, which lead to negative emotions and thoughts, and distress in their physical body.

>> Avoidance: We may avoid the places, people, or events that may reactivate the feelings associated with the trauma. For example, war veterans may stay home on Veterans Day, and minimize communication with social media, friends, and family.

>> Negative mood and thoughts: The approaching date may activate feelings of sadness, as well as guilt or shame, making it difficult to spend time with family or friends.

>> Arousal and reactivity: Feelings of nervousness, edginess, or irritability may impact sleep quality, the ability to concentrate, and may place others on guard.

A longitudinal study conducted with military veterans who served in Operations Desert Storm and Desert Shield (1990 to 1991) found that 38 percent of veterans’ “worst month of functioning” coincided with the months in which their worst military trauma occurred.

It is safe to say that if we experience PTSD symptoms following a traumatic event, it is more likely we will experience anniversary reactions in subsequent years around the time of the actual trauma or loss.

It is important to remind ourselves that we are all unique in our bodies and minds, as is the trauma and loss we endured, so symptoms may present differently amongst us.

For all of us, though, it is helpful to know our minds and bodies well enough to catch any changes that occur and create distress in us, and respond in healthy ways.

Here are some tips on how to best manage it:

1. Prepare: The first few years following a loss or traumatic event, we may not know what to expect or how we will respond. During this time, try to avoid extra stressors—refrain from making big decisions or big changes, such as moving or changing jobs. Spend as much time with your community of family and friends as possible. Consider seeing a therapist or schedule extra sessions if you already have one.

2. Commemorate or distract: Go toward the reminder of the loss or trauma, and be proactive as a way to avoid ruminating over it. Visit the cemetery of the lost loved one, make a donation to a related nonprofit organization, sign up for a related charity event, write about your feelings, or plan a pleasurable activity with friends and family. We want to feel empowered or liberated in our healing process.

3. Remember it is temporary: Anniversary stress reactions typically last a few weeks to a month; and some have reported experiencing their reaction for an entire season. When we acknowledge this is a normal reaction and it is temporary, it helps make the process less scary.

4. Watch for the “Birthday Effect”: Survivors of trauma sometimes believe they will die young or face a dark future ahead and birthdays may remind the survivor that the end is near, or of the time lost with no self-improvement. In this case, we want to direct them to #5.

5. Get support: It is absolutely okay to be dealing with our trauma years after the event or loss. Many people start therapy 10, 20, or 30 years after their trauma and can still reclaim their lives. Trauma-specific therapies and support groups exists, and the option for medication to alleviate debilitating nightmares or sleep disturbance in the midst of an anniversary reaction are an option. Speak with your primary care physician regarding treatment options.

Most often, we have no control over the negative life events and traumatic experiences we face. However, we can cultivate and incorporate healthy coping strategies to help us re-engage with our lives and lessen the recurrence of trauma.

~

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Megan Swan

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