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 RELATIONSHIPS
A National Center
Trauma survivors with PTSD often experience problems in
their intimate and family relationships or close friendships. PTSD involves
symptoms that interfere with trust, emotional closeness, communication,
responsible assertiveness, and effective problem solving:
- Loss of interest in social or sexual activities, and
feeling distant from others, as well as feeling emotionally numb. Partners,
friends, or family members may feel hurt, alienated, or discouraged,
and then become angry or distant toward the survivor.
- Feeling irritable, on-guard, easily startled, worried,
or anxious may lead survivors to be unable to relax, socialize, or be
intimate without being tense or demanding. Significant others may feel
pressured, tense, and controlled as a result.
- Difficulty falling or staying asleep and severe nightmares
prevent both the survivor and partner from sleeping restfully, and may
make sleeping together difficult.
- Trauma memories, trauma reminders or flashbacks, and
the attempt to avoid such memories or reminders, can make living with
a survivor feel like living in a war zone or living in constant threat
of vague but terrible danger. Living with an individual who has PTSD
does not automatically cause PTSD; but it can produce "vicarious"
or "secondary" traumatization, which is almost like having
- Reliving trauma memories, avoiding trauma reminders,
and struggling with fear and anger greatly interferes with survivors'
abilities to concentrate, listen carefully, and make cooperative decisions
-- so problems often go unresolved for a long time. Significant others
may come to feel that dialogue and teamwork are impossible.
Survivors of childhood sexual and physical abuse, rape,
domestic violence, combat, or terrorism, genocide, torture, kidnapping
or being a prisoner of war, often report feeling a lasting sense of terror,
horror, vulnerability and betrayal that interferes with relationships:
- Feeling close, trusting, and emotionally or sexually
intimate may seem a dangerous "letting down of my guard" because
of past traumas -- although the survivor often actually feels a strong
bond of love or friendship in current healthy relationships.
- Having been victimized and exposed to rage and violence,
survivors often struggle with intense anger and impulses that usually
are suppressed by avoiding closeness or by adopting an attitude of criticism
or dissatisfaction with loved ones and friends. Intimate relationships
may have episodes of verbal or physical violence.
- Survivors may be overly dependent upon or overprotective
of partners, family members, friends, or support persons (such as healthcare
providers or therapists).
- Alcohol abuse and substance addiction -- as an attempt
to cope with PTSD -- can destroy intimacy or friendships
In the first weeks and months following the traumatic
event, survivors of disasters, terrible accidents or illnesses, or community
violence often feel an unexpected sense of anger, detachment, or anxiety
in intimate, family, and friendship relationships. Most are able to resume
their prior level of intimacy and involvement in relationships, but the
5-10% who develop PTSD often experience lasting problems with relatedness
Yet many trauma survivors do not experience PTSD, and many couples, families,
or friendships with an individual who has PTSD do not experience severe
relational problems. Successful intimate relationships require:
- Creating a personal support network to cope with PTSD
while maintaining or rebuilding family and friend relationships with
dedication, perserverance, hard work, and commitment
- Sharing feelings honestly and openly with an attitude
of respect and compassion
- Continual practice to strengthen cooperative problem-solving
- Infusions of playfulness, spontaneity, relaxation,
and mutual enjoyment
For many trauma survivors, intimate, family, and friend
relationships are extremely beneficial, providing companionship and belongingness
as an antidote to isolation, self-esteem as an antidote to depression
and guilt, opportunities to make a positive contribution to reduce feelings
of failure or alienation, and practical and emotional support when coping
with life stressors.
As with all psychological disturbances, especially those that impair social,
psychological or emotional functioning, it is best to seek treatment from
a professional who has expertise in both treating couples or family issues
and PTSD. Many therapists with this expertise are members of the International
Society for Traumatic Stress Studies, whose membership directory contains
a geographical listing indicating those who treat couples or family issues
and PTSD. Types of professional help that survivors find helpful for relationships
- Individual and group psychotherapy for their own PTSD
- Anger and Stress Management, and Assertiveness Training
- Couples Communication Classes and Individual and Group
- Family Education Classes and Family Therapy
- John N. Briere and Diana M. Elliott, "Immediate
and Long-Term Impacts of Child Sexual Abuse," Future
of Children 4:2 54-69 (1994).
- Rebecca Coffey, Unspeakable Truths and Happy
Endings: Human Cruelty and the New Trauma Therapy (Sidran
Press, 1998, ISBN 1-886968-04-7 or 1-886968-05-5)
- 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)