Trauma, Healing and Gaming Part 2: Triggers and Trigger Warnings

Liana Kerzner

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Trauma, Healing and Gaming Part 2: Triggers and Trigger Warnings

In part two of our four-part series, we dig into the triggers and trigger warnings of PTSD and how they apply to the gaming community.

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GabeZhul

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Oh damn, the title has the word "trigger" in it. Quick, I have to reverse-jinx this thread!
*cough*
Oh no! This thread is going to become a huge shitstorm with people shouting at each other! Oh the humanity! It will surely be horrible... Aaaaaany minute now!
...
*phew*
There it is guys, crisis averted. Seriously though, am I the only one who noticed that the number of people in a thread crying "This is going to turn into a shitstorm soon!" is inversely proportional of the chances of the thread actually becoming one?

Other than that it's a good article. I mostly agree with what's said, and what I don't agree with is subjective enough that starting an argument over it would be pointless.
 

Silentpony_v1legacy

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What do we do when someone is "triggered" but they don't have PTSD?
Are they just upset and that's that? I've seen trigger warnings used as shields against judgement, criticism and the like, not as a thoughtful and considerate way to help people with PTSD
 

wrightguy0

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The problem I've had with trigger warnings is that a trigger is personal, and specific to each trauma case. and usually people try to use the trigger warnings as a catch all, or a "look how sensitive to people's emotions we are" type statement, while not giving a shit about the people who suffer through PTSD. It's a blanket solution to a growing mental health problem that's deeply rooted in the realm of personal trauma, and blanket solutions do not address the core mental health issue, and instead of talking with someone and trying reach some mutual understanding you instead slap some giant "Fragile, Handle with care" sign on them instead of actually caring about them.

Trigger warnings are being increasingly used to absolve people from the responsibility of actually caring and empathizing with people who have PTSD. I'm not 100% against trigger warnings, Like PTSD it's a complicated issue, but it should NOT be used as a catch all like it is now.
 

IamLEAM1983

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Silentpony said:
What do we do when someone is "triggered" but they don't have PTSD?
Are they just upset and that's that? I've seen trigger warnings used as shields against judgement, criticism and the like, not as a thoughtful and considerate way to help people with PTSD
That's the problem. A lot of Tumblrites react to criticism with Allcaps rants along the lines of "DUDE YOU HAVE NO IDEA HOW THIS FEELS YOU TRIGGERED ME OKAY YOU FUCKING INSENSITIVE DOUCHEBAG", but push a little and you realize you just addressed an issue they don't agree with or voiced an opinion they don't want to support. They're not nervous wrecks, they aren't crying and they aren't in the throes of an anxiety attack. They might *think* they are, but I know one when I see one, having been an anxious type for a long while and still having occasional relapses. Being offended and suddenly feeling like your chest is going to explode are two very different things.

If everything is a "trigger", then you can't live. Not normally, at least. So a lot of folks should actually be put in contact with PTSD sufferers to realize that being exposed to shit that offends you personally doesn't mean you've been triggered. It means you're having a discussion, and the real world doesn't come with a guarantee of tacit agreement in all future discussions.

Considering, if someone tells you they've been "triggered" but they're clearly abusing the term, I'd say your best bet is to walk away. Anyone who uses that excuse to close off a debate or a discussion isn't worth addressing on the long term.
 

cainejw

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wrightguy0 said:
The problem I've had with trigger warnings is that a trigger is personal, and specific to each trauma case. and usually people try to use the trigger warnings as a catch all, or a "look how sensitive to people's emotions we are" type statement, while not giving a shit about the people who suffer through PTSD. It's a blanket solution to a growing mental health problem that's deeply rooted in the realm of personal trauma, and blanket solutions do not address the core mental health issue, and instead of talking with someone and trying reach some mutual understanding you instead slap some giant "Fragile, Handle with care" sign on them instead of actually caring about them.

Trigger warnings are being increasingly used to absolve people from the responsibility of actually caring and empathizing with people who have PTSD. I'm not 100% against trigger warnings, Like PTSD it's a complicated issue, but it should NOT be used as a catch all like it is now.
To start, I'm a social worker and clinical therapist. Liana has actually consulted me on this article.

PTSD in itself does not demand triggers. One can have triggers without PTSD. The hallmark of PTSD is re-experience AND avoidance after a life-threatening or integrity-threatening event. If you just have re-experience, that's a memory. If you have re-experience of a traumatic memory, that's not distressing in itself. Many victims/survivors of said events re-experience the event (are "Triggered") without distress.

The issue at play here with the "trigger warnings" is often that they explicitly state what the content creator thinks could be triggering. It is, at its core, very presumptuous. As I told Liana (I'm not sourced on this, but I did provide this info), anything can be a trigger. Anything.

So a rape victim may actually not be triggered by the depiction of rape. In fact, it very well could be the red-colored shirt of one character. It could be the race of a participant. It could be a national store chain where an assault took place or refuge was sought. The trigger is a generalized manifestation of trauma. Someone was traumatized and generalized that experience to a completely unrelated item. Prediction of that item is impossible.

I've had people who were triggered into a traumatic remembering by a shirt I was wearing. As a professional, I am trained to help someone process through that and break the association in time. This is quite different from the intent of the trigger warnings colloquially as warnings and signals of items to avoid. Trigger warnings actually seek to engender the generalized trigger -- the depiction of the event, the color of the shirt, the race of the character. All become psychologically reinforced by the avoidance that trigger warnings often seek to provide.

This is why trigger warnings become useless and paradoxical as they warn someone based solely on the experience of the warning party. It serves their sensibilities and assumptions about the reaction of the traumatized person. It assumes the trigger and the resulting experience that the trauma and trigger are internalized, assimilated, and forever etched as a stimulus to avoid; trigger warnings do so at the detriment of the traumatized while privileging the view of the content creator.
 
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I think the biggest point of this entire debate can be boiled down to this:

The ESRB rating system is basically terrible and needs a ton of improvement.

Regardless of how you feel about trigger warnings, we should all be able to agree on that.
 

ThriKreen

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Silentpony said:
What do we do when someone is "triggered" but they don't have PTSD?
Are they just upset and that's that? I've seen trigger warnings used as shields against judgement, criticism and the like, not as a thoughtful and considerate way to help people with PTSD
In some cases, yeap. It's being diluted to the point that in some areas, it means "I don't like what you're saying, but I have no counter so I'd rather you shut up and stop talking to me."

I've seen extreme body (re:fat) acceptance bloggers saying they're triggered when someone orders water at a restaurant.

Wat?
 

Imperioratorex Caprae

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Silentpony said:
What do we do when someone is "triggered" but they don't have PTSD?
Are they just upset and that's that? I've seen trigger warnings used as shields against judgement, criticism and the like, not as a thoughtful and considerate way to help people with PTSD
PTSD does not have a monopoly on the word "trigger". There's a whole host of disorders that "trigger" can apply to. Addicts have triggers, actually almost any mental disorder can have a trigger.
I'm bipolar, with schizoaffective tendencies and also may have PTSD (I'm not 100% on that and I'm working on getting that diagnosis confirmed or denied) and I definitely have triggers for my disorders. I've been through many forms of therapy, and a lot of that has been working on identifying the triggers that set off those disorders and can lead to a psychotic break.
Personally I find it insulting that people without mental disorders use the term as a shield to avoid topics they don't want to talk about. If those people have undiagnosed disorders, I'd happily retract my feeling of being insulted but honestly it really is a problem to me because I actually have a medically recognized disorder that can be triggered by certain things and people who do not have any mental issues using the word pisses me right the fuck off. Notice that I don't say it "triggers" me, because I know the difference between getting legitimately pissed off and being "triggered".
 

vagabondwillsmile

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Liana Kerzner said:
Trauma, Healing and Gaming Part 2: Triggers and Trigger Warnings

In part two of our four-part series, we dig into the triggers and trigger warnings of PTSD and how they apply to the gaming community.

Read Full Article

[...] no one should be forced to confront upsetting things before they're ready [...]
I agree. But is the assumption that the lack of a warning then can be expected to force the confontation? To be clear there is no lack of empathy from me towards anyone that has suffered a trauma. Wheather in war, at home, at school - life changing trauma's can happen to any of us and those who have suffered are in need of help, understanding, and most of all respect. But I see a major difference between someone being in a situation where others around them know of their trauma, subsequently throwing that in their face or otherwise revisiting/confronting the trauma, on the one hand -- and on the other, a person who has sustained a psychological trauma and has the potential to be triggered into reexperiencing that trauma, just happening to watch a gaming conference and seeing something - it could be ANYTHING - that sends them into a crippling anxiety attack. Of course, no one should be forced into that state. That's torture. But I can't reconcile that the world simply carying on, necessarily forces a confrontation. Or maybe your meaning in this portion of the article wasn't clear to me, or I missed something?

You also mentioned the ESRB. I understand the connection you are making. But I would counter that we can reasonably anticipate and make generalizaitons about what people may find to be objectionable subject matter. Sex is touchy accross the board and most parents aren't interested in their preschooler watching porn. We know there are sensitivities, stemming from stigma, religion, laws, concerning drug and alcohol use. And it's a given that we should predict seizures from flashing lights and such. Sensibilities, moral stances, adherances to law, and physical conditions are easy to generalize, categorize, and anticipate in this context.

However, the inner workings of the human phyche - our response to trauma, our personal (not general) fears and reactions are infinitely more complex and unpredictable. Would you agree that it may be impossible to have any confidence in making the same kind of predictions concerning triggers as we would have in assuming offenses to one's "moral" sensibilities?

cainejw said:
wrightguy0 said:
To start, I'm a social worker and clinical therapist. Liana has actually consulted me on this article.

PTSD in itself does not demand triggers. One can have triggers without PTSD. The hallmark of PTSD is re-experience AND avoidance after a life-threatening or integrity-threatening event. If you just have re-experience, that's a memory. If you have re-experience of a traumatic memory, that's not distressing in itself. Many victims/survivors of said events re-experience the event (are "Triggered") without distress.

The issue at play here with the "trigger warnings" is often that they explicitly state what the content creator thinks could be triggering. It is, at its core, very presumptuous. As I told Liana (I'm not sourced on this, but I did provide this info), anything can be a trigger. Anything.

So a rape victim may actually not be triggered by the depiction of rape. In fact, it very well could be the red-colored shirt of one character. It could be the race of a participant. It could be a national store chain where an assault took place or refuge was sought. The trigger is a generalized manifestation of trauma. Someone was traumatized and generalized that experience to a completely unrelated item. Prediction of that item is impossible.

I've had people who were triggered into a traumatic remembering by a shirt I was wearing. As a professional, I am trained to help someone process through that and break the association in time. This is quite different from the intent of the trigger warnings colloquially as warnings and signals of items to avoid. Trigger warnings actually seek to engender the generalized trigger -- the depiction of the event, the color of the shirt, the race of the character. All become psychologically reinforced by the avoidance that trigger warnings often seek to provide.

This is why trigger warnings become useless and paradoxical as they warn someone based solely on the experience of the warning party. It serves their sensibilities and assumptions about the reaction of the traumatized person. It assumes the trigger and the resulting experience that the trauma and trigger are internalized, assimilated, and forever etched as a stimulus to avoid; trigger warnings do so at the detriment of the traumatized while privileging the view of the content creator.
Thank you for your input. I have a few questions for you, if you would indulge me. First, where do you think we draw the line between what we lable and do not lable? Take the logic to its terminus and any given game, film, song, advert, could warrant a litany of warnings. And all or none of them may be successfull. Let's say a woman has been raped. There is a violent game that she is interested playing in that contains a rape scene and - as has been aluded - that scene in and of itself may or may not affect her. Let's go a step further and say that she knows of the scene, and is aware that dramatisations of the crime don't affect her personally in any negative way. But later in the game there is a random stuffed animal on a dresser that closely resembles her own as a child; and THAT triggers a horrible anxiety attack - maybe she even hyperventilates and has to be hospitalized. All of the warnings in the world for that scene would not have spared her suffering. Likewise, no-one on the developement or marketing side could have guessed what would.

Second question, could one make the argument that there is a misunderstanding in the effort to prevent the reexperiencing of a trauma? That misunderstanding being, an assumption that a game about war is likely to trigger a veteran's PTSD simply because of the game's subject matter. She can adore games about war and never fear an ill affect from playing. But she can't take her car to get serviced because the sound of the pneumatic wrench can all but break her. I'm not a clinician of any kind. But I would postulate that for people who ginuinely suffer from psychological trauma, there can be a disconnect between the activity, context and circumstances of the innitial trauma and the seemingly random, or removed elements of the subject's past that subsequently "trigger" the reexperiencing of that trauma. Actually, I met a vet not long ago who was accompanied by his assistance dog. We struck up a brief conversation and I asked if he minded me asking about his dog. Her primary role in aiding him is walking ahead as they approach a blind corner, or the end of an ilse in the market so he isn't surprised by someone being right there as he makes the turn. The circumstances of his innitial trauma (which he didn't detail at any length and which I won't even mention out of respect) have nothing to do with people behind corners.

Final question(s): What would you say of the value of basic comunication and research in the context of gaming and entertainment consumption? Gamers - for the most part, I would say - have family, friends, co-workers, internet access. If a person has suffered a trauma, and continues to suffer the psychological affects of that trauma in real and practical ways - would that person not feel compelled to inquire about this game, or that movie from someone they trust and who is aware of the condition and information relevant to it? In your experience as a clinician, how many subjects are you aware of that had played a game, or seen a movie relevant to their condition that had not been vetted to be reasonably free of elements that would innitiate a reexperience of their trauma? Could it not even be healthy for a subject to approach entertainment consumption and how it relates to their trauma in such a way?
 

iller3

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Heard an interesting piece on NPR today talking about how Longterm war PTSD is often being misunderstood as not stemming specifically from the events that took place in combat, but rather from a failure to integrate back into society properly BECAUSE society is so chaotoic and seemingly at war with itself. They claimed that a cohesive society reduces the prevalence of longterm PTSD 20-fold.

Which brings up another good question: What if..... the groups who are "triggered" but didn't serve in the military ... are effectively triggering themselves or IOW; the whole reason symptoms seem to be accelerating lately is because of hypnotic suggestion and the constant warring Social-Media-Bubble injecting conflict in a way that prevents a Cohesive online supposition? I'd love to see a study on this where the control group was people with traumatic past events who've never been exposed to either side of this Social justice culture war.
 

jklinders

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wrightguy0 said:
The problem I've had with trigger warnings is that a trigger is personal, and specific to each trauma case. and usually people try to use the trigger warnings as a catch all, or a "look how sensitive to people's emotions we are" type statement, while not giving a shit about the people who suffer through PTSD. It's a blanket solution to a growing mental health problem that's deeply rooted in the realm of personal trauma, and blanket solutions do not address the core mental health issue, and instead of talking with someone and trying reach some mutual understanding you instead slap some giant "Fragile, Handle with care" sign on them instead of actually caring about them.

Trigger warnings are being increasingly used to absolve people from the responsibility of actually caring and empathizing with people who have PTSD. I'm not 100% against trigger warnings, Like PTSD it's a complicated issue, but it should NOT be used as a catch all like it is now.
/thread

Seriously. I only heard about trigger warnings and whatnot fairly recently but what I have heard is that a trigger in many cases is very personal and individual. it often has so little to do with the initial trauma as to make the concept of a trigger warning nearly meaningless as literally anything can trigger someone. If everything needs to be labelled as such then labeling becomes pointless.
 

cainejw

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First, where do you think we draw the line between what we lable and do not lable?
Honestly? I am of the personal belief that you cannot label everything that could theoretically be a trigger. As I said, anything is a trigger. It could be as heavy as a rape depiction or allusion to something as simple and light as a clown. A good example of this is 9/11. There is evidence of PTSD among people who watched the events of that day unfold in person and on television. They can be triggered by something falling from the sky, the sound of a plane, or the mere mention of the date.

The trigger here, as Liana puts forth, is the thing that causes a stress reaction of reliving the event. That stress reaction is programmed to the response of that day. So anything that person associates with that day and that experience becomes the trigger.

Can we really alert everyone to every trigger? No.

Should we? In my opinion, no. We should encourage people to be mindful of their triggers and, as they become more generalized and cause more distress in life, encourage treatment to minimize those triggers. Encouraging avoidance through a litany of warnings only reinforces (read: encourages, makes stronger) that stress reaction and sets it in stone. Eventually, that reaction could become just part of everyday functioning.

Second question, could one make the argument that there is a misunderstanding in the effort to prevent the reexperiencing of a trauma?
Human beings have this natural reaction to stressful events. Professionally and biologically, it's the sympathetic nervous system. Commonly, it is known as fight or flight. When we have a fight or flight reaction, resolution of that promotes the neurological chemicals to be sent. When stressed, your body sends chemicals to dull the pain. When resolved, you get the chemical that makes you feel somewhat happy and resolved as you've evaded trouble.

There certainly is a misunderstanding, but it's in the human condition. People simply want to avoid uncomfortable things. When you add in the cultural component--America's reluctance to deal with emotional and psychological pain--you get a really staunch sense of trauma avoidance. If someone is raped, the usual response is to rush to their aid and help them, but sometimes that is harmful to recovery as a rape victim may wish to have people far away.

With PTSD, we tend to want to avoid that trauma experience. It makes people uncomfortable. For example, a prisoner may develop PTSD from seeing murders in a prison. Does the average populace want to sit and discuss the gruesome disemboweling of another human being as a necessity of survival?

Does a "normal person" want to hear the grueling detail of slaughtering people in war? How about watching your friends and near family being destroyed by an IED? No, they typically want to mask it to paint over the discomfort of the listener and the reliving of trauma of the traumatized.

Digressing a tad, there is also the assumption of the trauma. As you said, someone may assume a combat veteran has trauma because they saw death and destruction. This may not be the case. They actually may have survived an IED with no deaths. This causes them to become hypervigilant and wary of others.


What would you say of the value of basic comunication and research in the context of gaming and entertainment consumption? Gamers - for the most part, I would say - have family, friends, co-workers, internet access. If a person has suffered a trauma, and continues to suffer the psychological affects of that trauma in real and practical ways - would that person not feel compelled to inquire about this game, or that movie from someone they trust and who is aware of the condition and information relevant to it? In your experience as a clinician, how many subjects are you aware of that had played a game, or seen a movie relevant to their condition that had not been vetted to be reasonably free of elements that would innitiate a reexperience of their trauma? Could it not even be healthy for a subject to approach entertainment consumption and how it relates to their trauma in such a way?
Very few. The trauma experience tends to be based upon something that was present when the trauma happened. Additionally, the DSM-5 actually excludes digital traumas. You cannot develop PTSD from Twitter, video games, etc based on the DSM-5. You have to experience it directly or have someone close to you experience it. However, I cannot say it does not happen. I can just say that it's rather rare in my experience.

I've also yet to have any woman say video games are the cause of their problems. Mostly women seek mental health services due to the stigma of weakness associated for men. I work primarily with the poor, and I've yet to have any woman tell me that video games are the cause of their problems.
 

Roysten

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Excellent couple of articles, I look forward to reading the next two.

I went undiagnosed with PTSD for thirty years and during that time computer games happened. Books, music, films, but mostly computer games provided escape for me over those years. I will always chalk up computer games as a force for good in my world, and I tend to view the many waves of controversy that crash against games with a little contempt.

Talking about PTSD is hard.

Since I have been diagnosed I have found that its about at the point I need say my PTSD was caused by a car crash when I was a child.

People are curious and fairly often ask before they even think about it. When they don't ask then odds on you have the joy of watching someone not really listening while they mentally try fit you into a PTSD pigeon hole. This for me, and a fair few folks I have talked to is a "trigger" (stupid stupid label).
This curiosity and inquisitiveness is not bad behaviour it's just human nature.

Talking about PTSD is hard.
Talking about it to a trained professional or another sufferer can be a life changing and healthy thing.
Talking about it to anyone else can be pretty horrible, so I don't as a rule do it.

So I looked up what this trigger warning thing was, because while I had heard it buzzworded on a few youtubes, I don't think it has caught any mainstream traction in the U.K.
I was left with the impression that it's conceptually the work of well meaning idiots who have absolutely no understanding at all of PTSD, probably encouraged by vile games publishers who would very much like to get a "rape scene" warning label slapped on their game to help sales to the emotionally stunted.
In the U.K. these sort concerns and protections only ever come up for "lowbrow" arts, never for "highbrow". A good play, book, or painting is just as probable to contain an individuals trigger. These are generally thought to be consumed by a better sort of chap who doesn't need the utterly patronising protection the unwashed masses with their megacube playdrive games needs.

The information isn't easy to find out there. It's tucked away in specialised forums and academic texts because it's hard to talk about. Misinformation floods all forms of media with very rare exceptions (one episode of the West Wing and the end of The Pacific are the only ones I can come up with). So more power to the author of these articles for having the courage to write about this stuff.

P.S. Hypervigilance is bloody useful for a FPS, not that I recommend it.
 

murrayb67

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Another excellent article, I'm really enjoying this series. Thanks for writing something of such substance.

That said, I'm all for informed consumers. I don't see that there's any benefit to literally labeling content disclosures as trigger warnings as I think the term has become toxic. The ESRB rating system needs to be improved, but even then they can't hope to catch everything. I'm sure there's a point where most reasonable people can agree. At some point consumers need to vote with their wallets if they feel that a particular vendor is doing a poor job of disclosure. I also have no problem with content disclosures in reviews. While I may not benefit personally from having the extra information, it certainly can't do me any harm.

My problem, as others have stated, is with the people who abuse the term and use it as a cudgel, which is what has turned the term toxic.
 

SecondPrize

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Silentpony said:
What do we do when someone is "triggered" but they don't have PTSD?
Are they just upset and that's that? I've seen trigger warnings used as shields against judgement, criticism and the like, not as a thoughtful and considerate way to help people with PTSD
I like mocking them. Probably not the best reaction, but hey, life's too short to worry about people who would do that.
 

Silence

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SecondPrize said:
Silentpony said:
What do we do when someone is "triggered" but they don't have PTSD?
Are they just upset and that's that? I've seen trigger warnings used as shields against judgement, criticism and the like, not as a thoughtful and considerate way to help people with PTSD
I like mocking them. Probably not the best reaction, but hey, life's too short to worry about people who would do that.
My classic response is:

"Are you one of these real life tumblr parodies? I never knew they existed.

And well, please don't use "trigger" in a way that diminishes the real impact those have on people with PTSD."
 

iller3

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The Dude Abides said:
The main problem with trigger warnings is just how counterproductive they are for someone that legitimately has PTSD and how Tumblr has basically co-opted them to basically mean anything that gives them marginal discomfort.
Yeah this is what I was questioning earlier... in that if it's indeed a "feedback loop" of sorts, then they're actually doing themselves more harm than they are helping themselves in their "Coping" mechanics. And by this I mean that "Cognitive conditioning" is a real science which explains how our brains can reform neural pathing. It's how Soldiers with PTSD are able to eventually overcome PTSD without prescription Drugs. It's how I was counseled to no longer need drugs myself to deal with ADHD symptoms. But if the the person's social validation COMES from ramping up the frequency of "triggered" anxiety attacks, or in convincing themselves and those around them through psychosomaticism, then it stands to reason that it will also start to affect their health. Also because their actual body can't always tell the difference and it may release opiod endorphins that lead to compulsive behavior based on that social validation.