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The ptsd cup explanation

Nearly a decade ago (2006) I wrote The PTSD Cup Explanation, a simple view of how PTSD causes symptoms in day-to-day life. This article is an update to that original piece.

Regardless of the type of trauma endured, the PTSD Cup does not change, deviate or apply differently to your circumstance. The PTSD Cup is a basic representation of your capacity for tolerating stressors. As your cup fills, symptoms get worse. When your cup overflows, you may break down crying, become psychotic or manic, attempt to kill yourself, and many other possible outcomes.

The differences unique to each individual lay within their environment (exposure to daily life), their ability to manage stressors, and finally, the actions that occur upon overflow.

One example of this uniqueness is seen in a high functioning PTSD sufferer. They have the same cup as any PTSD sufferer; however, they may differ in their ability to manage work stressors. Their work may make them feel positive, good about themselves. Another area of their life may suffer, say... relationships. They feel good about their work, but a partner or friendship may cause stress they can't reconcile.


The above image contains one cup, through three stages. There is a fourth stage to the PTSD cup, applicable only to combat veterans. I will discuss that briefly at the end.


Each block within a cup is variable. Simply put, each block will move up or down with some predictability, based on your daily activities, how you feel, what you're thinking, and so forth.

Cup One (Left Cup)

Many people think good things don't cause stress. Well, they do! The difference is the net effect. When you get out of bed, have a shower, brush your teeth, comb your hair, drink your morning coffee, and so forth, you feel good after performing these daily tasks. This is called "good stress," and creates positive emotion.

These menial, often disregarded, tasks help reduce your bad stress. Positive and joyous interactions and feelings continuously counter negative stressors.

Cup Two (Middle Cup)

Here we've introduced bad stress. Bad stress is just that -- negative interactions that create negative emotion.

This cup represents everyone without PTSD. You can see how much room there is in that cup. Lots! People without PTSD have the capacity to deal with daily stressors. They balance their day with good stressors, and rarely overflow their cup.

When you go to sleep, sleep reduces negative stressors from your cup so you start the next day fresh. When a person ruminates overnight, they may awake with bad stress in their cup. An example is a teenager giving a presentation. They awake tired, grumpy and partially stressed, thinking they aren't prepared, or their presentation lacks something. When they deliver their presentation without incident, and obtain positive feedback, this creates positive emotion and removes the negative stress. That night, they will sleep better and remove all their remaining bad stress.

Think broadly when applying this to yourself.

Cup Three (Right Cup)

Now we introduce PTSD. The problem is that we still have the same good and bad stressors, but without the same overall capacity as a non-PTSD sufferer.

Who thought good stress could make you overflow? With PTSD, it can do just that - not to mention what bad stressors can do.

Think about it like this -- the reason you don't want to get out of bed, have a shower, do anything at all, is that your cup is full. Your brain tells you to stay in bed, otherwise you overflow. Place your own situation here; the model does not change.

The Obvious Question

It's easy to talk about a problem, ignoring its solution -- but this solution isn't rocket science.

Trauma is the problem. Trauma is full of bad stressors. Work through trauma and you reduce bad stressors. Make life changes where you're negatively stressed. Reduce your traumatic effect, you reduce your PTSD symptoms.

Depending on your level of trauma, this may take months, a year, or many years.

The Fourth Cup (Military Training)

The cup I didn't show is specific to those who have deployed within an operational zone where military training kept them alive. Add an additional block to the cup, call it "training." Now you have good and bad stress, PTSD, and training.

The above cup has little capacity already, so how does training fit? Well, it's squeezed and compresses all blocks. Part of the military training block is a lid with button. This lid and button is effective within a military environment, the cup is full, compresses, an order is given, the soldier explodes against the enemy.

Notice how overflow has been removed from the below image? Combat veterans have a lid and button. Everything builds-up, compresses, then explodes -- instead of overflowing.


This is useful in active service, but not very effective in regular society. The military used to control the button, for the most part; post-service, PTSD is in control. The cup can only take so much pressure before the button fails. With a constantly full and compressed cup, all it takes is for the toilet roll to be around the wrong way -- the veteran explodes at someone (spouse or child), or something (wall or door), and only then will the pressure be released.

This is behavioral conditioning that helped the veteran remain alive. When differentiating between a combat zone and civilian life -- the brain knows the difference, but still functions on instinct, in the ways that have been proven effective in order to stay alive.

The most obvious question is, why do combat veterans have this extra block and not all military?

When military are trained, they're trained to have some PTSD symptoms, especially Army, Marines, or Special Forces-type training. Hyper-vigilance, startle response, alertness -- these are all symptoms of PTSD. When leaving the military and without combat, this training quickly subsides and the person reverts to civilian behavior.

Once a soldier enters a combat zone the brain accepts that this training saved their life, or their buddy's life. This makes training a priority for survival. The training becomes instinctual, regardless of whether they are in a combat zone, or not. This block is one of the most difficult to lessen, and typically only diminishes from a combination of time, and decreasing the traumatic effect.


The PTSD cup is a simple representation that defines your internal stress. We all react differently when our cup overflows. Some may cry, some may dissociate, some may become angry. A soldier may explode with horrific rage and violence. To control the effect is to minimize the cup's content, where possible.

I might wish we could remove the PTSD block -- that would be ideal. Unfortunately, there is no cure. So, work with what is within your reach. What immediate stressors can you reduce or remove with the least amount of change? What did you used to do that made you happy? Remember, good stress counters bad stress, so do things that make you happy to create capacity within your cup.

Remember that this is, more often than not, a long-term process. Managing your internal stressor cup takes time, education, and skills learned for future improvement.
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Thank you for all your helpful information. I can understand a lot of my bfs behavior better. I want to be able to help him cope and overcome his ptsd. And those out there that feel disappointed about the no cure . The hope is that overcoming ptsd WILL make you a better version of yourself even better than before ptsd. Just like any other battles it requires courage and willingness and is possible l truly belive it!
I also thank you for all your information. Like Sammy, I feel like I was ‘trained’, not to be angry, to hold it in, to be passive in my communication and interactions with others. I understand the difference of military training, yet this seems a good word at this time to describe my childhood. And although I do not want divorce, I push away those I love. Recently I have started to be more open about my mental health with friends, but receiving mixed messages. I am so confused. I feel unloved, and fear now that I opened up, even more worthless, although there is nothing that anyone has said to indicate so. I just want to feel safe, and so far being in a relationship, albeit a non-satisfying one, makes me feel safe, because there is someone there. I feel bad about that, like I am faking it. It’s like that song, “I can’t get no satisfaction”, and fear that my partner is losing interest, or has just stopped putting effort in the relationship as am I, although I do love him. I don’t know what to do. I feel lost and confused.
Lagatha, don’t think on behalf of your husband, ask him, and ask for an honest answer. Ask, what can I do better to meet your needs? Decide whether that is right for you, and make a choice. Relationships are a two way street, if one or the other fall into bad times, it affects the dynamics of the relationship. Communication during such times is significantly important.

Sex is part of a relationship. My wife is going through menopause. Whilst she doesn’t have the urge for sex, she still understands that I want sex and thus we do so. Sure, less than before menopause, but she understands its a part of the relationship, and if she didn’t want to have sex at all, then that causes a relationship shift. With time… the relationship may then break down because both parties needs are no longer being met. Tough times are about communication, compromise, finding amicable solutions that meet both parties needs and wants so both parties are happy and thus, less stress, less issues, less confrontation within the relationship.

The shoe was on the other foot when my PTSD was out of control… I didn’t want to have sex, she did, a middle ground had to be found, and was. Both parties must communicate honestly and openly, and not say nothing as though being polite. That just causes issues and harbours negative emotion, stems problems and things typically get worse.
Thanks for your response,
We are at that point where we are honestly communicating. However it is certainly more difficult than saying nothing and being polite, as I feel that even a disagreement represents a slight or hurts my partner, as he acts upset. He says he will get over it, but it is alarming to me, as I don’t want to see him upset by my decisions or opinions. Of course it would be nicer and smoother if we agreed on everything, but what gives? What is the breaking point? How many disappointments (on both ends) does it take? How much compromise? I know a relationship takes work, but how much work?

Anyways, I know only these I can answer as it is subjective, and my previous traumas just kind of puts a damper on things and skews my perspective. Yet my spouse continues to listen, continues to be engaged, even when he is tired, or would rather do other things, and relax. This alone is enough for me at this time. Having been called ‘crazy’ by family and ex-partners in the past, he is the most loving, and understanding, and even manages to normalize my experiences, he understands the reactions. I know I cannot count on him for my happiness or total healing, but I attribute a lot of healing to him. Is understanding enough? I also fear about draining him.. I always fear the worst…
I just realized that I have been dealing with symptoms such as these. I do not feel in danger for myself but for my 2 adult sons who have and have had drug addictions. I mostly deal with it on my own. But i fear everyday something horrible will happen to one or both of them. I have realized that my back pain is associated with the stress of this. I am tense all the time. It doesn’t matter what I am doing brushing my teeth, doing dishes, taking a shower.I have tried many different things. Massage, accupuncture, Chiropractic, Meditating. I have been working extremely hard at recognizing when I am tense and trying to relax. Does anyone have tips that will aid in trying to keep from tensing up?

Also the fear is never quite gone. Everytime the phone rings, a car drives down my street, I see a vehicle that looks like my sons, I drive by a place my son was (one of which is on my way to work so I pass it daily.) If I don’t hear from them often enough. Or I hear from them too often! UGH it never goes away!!!
To the author:

Back up think and again, if you think the 4th cup is for only for combat vets.

I’m a first responder American stateside, and I take strong exception to this idea. Vets sometimes get PTST with only their shortest time in service.

Those of us with a career in Public safety, with at least one traumatic event a year. American Vets are not alone.

Public Servants get less respect and are being killed like combating flies, I’m one of those fallen though the cracks and down. I eat or do without meds. What is out here for our recourse, and assistance? I can tell you! Not Much of a Damned Thing!
I am an aid worker I have been exposed to life threatening disasters floods earthquakes and tsunamis, bombs, searches, killings, life like training exercises – i have replaced two people who were either killed prior to my employment or died shortly after my employment and in the line of duty and experienced six staff dying in one day and another a week later and been in theprocess of promoting peace talks when a terror attack resuted in revenge-like military operations killing and displacing millions . I have a shut down response which is about freeze and many combat vets who do UN peacekeeping get the PTSD from the having to watch atrocities and not take action, hopelessness, helpness and fear for others is our lot. I have the same HP dysfunction as found in vets – we have training and exposure but my explosions are verbal not physical or alternately when threatened I might think oh well this is bad maybe I should just lie down shut my eyes and at least get a rest. Other times confinement will cause severe muscle spasm- I agree I am not likely to be physically violent but verbally yes or tonic as needed. I am also a woman and my gendered social role means that while suicide might be a escape plan it is rarely taken because of our commitment to the care of others- we don’t get to stop the trauma merry-go-round for fear of how our getting off will impact others and on a really bad day…. I am not sure where we manage to put our overflow =perhaps our combat as carers never ends
Very well stated eloc. There are plenty of civilian roles, such as yours, that are near side by side with military troops and thus are exposed to exactly identical situations and stressors. Well done for what you do for others… I could only aspire to be similar to someone such as yourself. A role model for us all.
had to give it up due to PTSD – so I guess I am an ex aid worker – four years now and still too symptomatic to work and even just kids are too hard
Hi, I’m sort of at a strange place and it’s hard to explain. Its like I’m not really connected to anything or feeling or though I find myself getting very agitated at things, certain things will cause me to not sob but tears will run down my face. I started therapy with my psychologist over 2 years ago and have been working through things, my depression lead me there out of desperation, I never dreamed My life would include therapy and now the past year medication from a psychiatrist. I hide these things from most people as it feels wrong somehow, and this isnt the way my life is and I’m making a mountain out of a molehill.

Apart of me feels really pathetic and another feels like there’s this deep sadness in my gut. I wear a mask to most people and they probably wouldn’t really know me if i took it off. It’s very exhausting.

Stuff has happened through my life, and as one thing after the other got added ontop of the previous event it seemed to be too much. There was things as a child and I can’t trust the memories i have, to be real and i can’t remember much of what i feel to have happened, i could never stand up in court and say this person did this because I cant be sure and i feel like i would be lying, and along the way on different occasions things happened to family, friends, me from murders, attempted murders, hijackings, attempted hijackings, car accidents, gave birth to a special needs child, miscarried another other instances of men making me uncomfortable like they are taking something from me, suicides, rapes, this all sort of escalated to a place of heavy depression, and always on guard, guilt and having no pleasure in life and also bad thoughts and needing to fix things and very tired and stressed. The past few months I’ve had a few triggers and it’s like the 2 main triggers 3 months apart that particular subject of the trigger its like all the instances sort of converged into this tornado of emotion and then almost this numbish place where i almost don’t feel depressed but in a way it’s like a zero place? It’s so hard to explain, i battle to connect to the reality of things if I can say it like that. And not been able to trust myself and trust the memories that won’t leave me for the past almost 30 years makes me doubt the very core of who i am and makes me feel crazy.
After these past triggers, the one concerning that touch is not love, the other searching for someone that was missing and probably laying dead somewhere, it became so important for me to find him, i drove around looking and looking but there was just too much bush and ditches where they could have hidden his body, it’s like all those other violent things also converged into one and somehow i needed to find him to make some type of justice or something, i eventually just realised there was no way and cried in my car. The past couple of months I’m not myself, as i said above it’s like I’m numb but also not, i want to withdraw from people and block my psychiatrist and my psychologist I just feel weird. When does yourself whatever that is, come back after this almost switchoff? How will I ever remember the things that plague my mind from my childhood, is this considered ptsd? Or depression and stress?
I’m just tired but I also feel Im being pathetic, and overdramatic, I just don’t know how to get unstuck.