Brief presentations of information on
aspects of PTSD:
Warning signs of trauma-related stress,
from Los Angeles County Department of Mental Health.
Signs from APA
Warning signs of trauma-related stress,
from the American Psychological Assn.
You are not alone! description of normal emotions following a disaster,
from the American Red Cross.
CENTER FOR PTSD
Research and Education on Post-Traumatic
PTSD and THE FAMILY
A National Center
The entire family is profoundly affected when any family
member experiences psychological trauma and suffers posttraumatic stress
disorder (PTSD). Some traumas are directly experienced by only one family
member, but other family members may experience shock, fear, anger,
and pain in their own unique ways simply because they care about and
are connected to the survivor.
Living with an individual who has PTSD does not automatically
cause PTSD, but it can produce "vicarious" or "secondary"
traumatization. Whether family members live together or apart, are in
contact often or rarely, and feel close or distant emotionally from one
another, PTSD affects each member of the family in several ways:
- Family members may feel hurt, alienated, frustrated,
or discouraged, if the survivor loses interest in family or intimate
activities and is easily angered or emotionally isolated and detached.
Family memers often end up feeling angry or distant toward the
survivor, especially if he or she seems unable to relax and be companionable
without being irritable, tense, anxious, worried, distractible, or controlling,
overprotective, and demanding.
- Even if the trauma occurred decades ago, survivors
may act -- and family members may feel -- as if the trauma
never stops happening. They may feel as if they're living in a warzone
or a disaster if the survivor is excessively on-guard, tense, or easily
startled or enraged. Family members can find themselves avoiding
activities or people and becoming isolated from each other and from
friends outside the family. They may feel that they have no one to talk
to, and that no one that can understand.
- They may find it very difficult to have a cooperative
discussion with the survivor about important plans and decisions for
the future, because s/he feels there is no future to look forward
to, because s/he has difficulty listening and concentrating without
becoming distracted, tense, or anxious, or because s/he becomes angry
and overly suspicious toward the family member or toward others (hypervigilant).
They may find it very difficult to discuss personal or family problems,
because the survivor becomes either controlling, demanding, or overprotective,
or unreasonably anxious and fearful about problems becoming terrible
- Family members may become overinvolved with their
children's lives due to feeling lonely and in need of some positive
emotional feedback, or feeling that the partner can't be counted on
as a reliable and responsible parent. For the survivor, this "discounting"
of the partner as a co-parent often is due to hypervigilance and guilt
because of trauma experiences involving children The partner may feel
s/he must be the sole caregiver to their children if the survivor is
uninvolved with their children (often due to trauma-related anxiety
or guilt) or is overly critical, angry, or even abusive.
- They may find their sleep disrupted by the trauma
survivor's sleep problems (reluctance to sleep at night, restlessness
while sleeping, severe nightmares, or episodes of violent "sleepwalking."
Family members also often find themselves having terrifying nightmares,
afraid to go to sleep, or difficulty getting a full and restful night's
sleep, as if they are reliving the survivor's trauma in their own
feelings and sleep.
- Ordinary activities, such as going shopping or to a
movie, or taking a drive in the car, may feel like reliving of past
trauma when the survivor experiences trauma memories or flashbacks.
The survivor may go into "survival mode" or on "automatic
pilot," suddenly and without explanation shutting down emotionally,
becoming pressured and angry, or going away abruptly and leaving family
members feeling shocked, stranded, helpless, and worried.
- Trauma survivors with PTSD often struggle with intense
anger or rage, and can have difficulty coping with an impulse to lash
out verbally or physically -- especially if their trauma involved physical
abuse or assault, war, domestic or community violence, or being humiliated,
shamed and betrayed by people they needed to trust. Family members can
feel frightened of and betrayed by the survivor, despite
feeling love and concern.
- Addiction exposes family members to emotional, financial,
and (less often, but not uncommonly) domestic violence problems.
Survivors experiencing PTSD may seek relief and escape with alcohol
or other drugs, or through addictive behaviors such as gambling, workaholism,
overeating or refusing to eat (bulimia and anorexia). Addictions offer
false hope to the survivor, by seeming to help for a short time but
then making PTSD's symptoms of fear, anxiety, tension, anger, and emotional
numbness far worse. Addictions may be very obvious, such as when binge
drinking or daily use of drugs occurs. However they may involve lighter
or less frequent episodes of "using" that are a problem because
the survivor is dependent ("hooked") on the habit and can't
cope without it.
- When suicide is a danger, family members face these
unavoidable strains: worry ("How can I know is suicide is going
to happen, and what can I do to prevent it?"), guilt ("Am
I doing something to make her/him feel so terrible, and should I be
doing something to make her/him feel better?"), grief ("I
have to prepare myself every day for losing her/him. In many ways I
feel and have to live my life as if s/he's already gone."), and
anger ("How can s/he be so selfish and uncaring?"). Trauma
survivors with PTSD are more prone to contemplate and attempt suicide
than similar people who have not experienced trauma or are not suffering
from PTSD. For the family there is good and bad news in this respect.
The good news is that very few trauma survivors, even those with PTSD,
actually attempt or complete suicide. The bad news is that family members
with a loved with PTSD often must deal with the survivor?s feeling sufficiently
discouraged, depressed, and even self- blame and self-loathing to seriously
and frequently contemplate suicide.
What can families of trauma survivors with PTSD do to
care for themselves and the survivor?
- Continue to learn more about PTSD by attending classes,
viewing films, or reading books.
- Encourage, but don't pressure, the survivor to seek
counseling from a PTSD specialist.
- Seek personal, child, couples, or family counseling
if troubled by "secondary" trauma reactions such as anxiety,
fears, anger, addiction, or problems in school, work, or intimacy.
- Take classes on stress and anger management, couples
communication, or parenting.
- Stay involved in positive relationships, in productive
work and education, and with enjoyable pasttimes.
If physical (domestic) violence actually is occurring,
family members such as spouses, children, or elders must be protected
- Patience Mason, Recovering from the War:
A Woman's Guide to Helping Your Vietnam Vet, Your Family,
and Yourself (Viking, 1990, ISBN 0-670-81587-X; Penguin,
1990, ISBN 0-14-009912-3)
Aphrodite Matsakis, Vietnam Wives: Facing the Challenges
of Life with Veterans Suffering Post Traumatic Stress
(Sidran Press, 1996, ISBN 1-886968-00-4)