Brief presentations of information on aspects of PTSD:

• PTSD and Community Violence
  
  
• PTSD in Children
  
  
• PTSD and Problems with Alcohol Use
  
  
• PTSD and Relationships
  
  
• PTSD and the Family

  
  

• Physical Health and PTSD

• Survivors of Natural Disasters
  
  
• Epdimological Facts About PTSD --How many people exposed to traumatic events have PTSD?
  
  
• Disaster and Rescue Workers and PTSD
  

• Warning Signs
  Warning signs of trauma-related stress, from Los Angeles County Department of Mental Health.
  
  
• Warning Signs from APA
  Warning signs of trauma-related stress, from the American Psychological Assn.
  

• Victim Emotional Health
  Emotional health issues for victims, from the American Red Cross.
  
  
• Coping Suggestions
  Coping suggestions, from Los Angeles County Department of Mental Health.

• Normalizing Emotions
  You are not alone! description of normal emotions following a disaster, from the American Red Cross.
  

• Post-Traumatic Stress Disorder: An Overview" Matthew J. Friedman

The Peniston Protocol
PTSD Treatment

Dendrite Forest Home

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 PTSD.
  
  
• 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 and intimacy.

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 and communication
  
  
• 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 include:

• Individual and group psychotherapy for their own PTSD
  
  
• Anger and Stress Management, and Assertiveness Training
  
  
• Couples Communication Classes and Individual and Group Therapies
  
  
• Family Education Classes and Family Therapy
  
  

SUGGESTED READINGS

• 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)