PTSD: How does trauma affect relationships?

The disorder involves symptoms that interfere with trust, emotional closeness, communication, responsible assertiveness and effective problem solving.

• Survivors may experience a loss of interest in social or sexual activities, they may feel distant from others, and they may be emotionally numb.
• Partners, friends, or family members may feel hurt, alienated, or discouraged because the survivor has not been able to overcome the effects of the trauma, and they may 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 may prevent both the survivor and partner from sleeping restfully, which may make sleeping together difficult.
• Trauma memories, trauma reminders or flashbacks, and the avoidance of such memories or reminders can make living with a survivor feel like living in a war zone or like living with the 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 similar to having PTSD.
• Reliving trauma memories, avoiding trauma reminders, and struggling with fear and anger greatly interfere with a survivor's ability to concentrate, listen carefully, and make cooperative decisions. As a result, 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 and survivors of rape, domestic violence, combat, terrorism, genocide, torture, kidnapping, and being a prisoner of war often report feeling a lasting sense of terror, horror, vulnerability, and betrayal that interferes with relationships.

• Survivors who feel close to someone else, who begin to trust, and who become emotionally or sexually intimate may feel like they are letting down their guard. Although the survivor often actually feels a strong bond of love or friendship in current healthy relationships, this experience can be perceived as dangerous.
• Having been victimized and exposed to rage and violence, survivors often struggle with intense anger and impulses. In order to suppress their anger and impulsive actions, survivors mayaboidaaa avoid closeness by expressing criticism toward 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, which can result from an attempt to cope with PTSD, can destroy intimacy and friendships.

In the first weeks and months following a traumatic event, survivors of disasters, terrible accidents or illnesses, or community violence often feel an unexpected sense of anger, detachment, or anxiety in their intimate, family, and friendship relationships. Most are able to resume their prior level of intimacy and involvement in relationships, but the 5-10 percent who develop PTSD often experience lasting problems with relatedness and intimacy.

Yet, many trauma survivors do not experience PTSD, and many people in intimate relationships, families, and friendships with individuals who have PTSD do not experience severe relational problems. People with PTSD can create and maintain successful intimate relationships by:

• Establishing a personal support network that will help the survivor cope with PTSD while he or she maintains or rebuilds family and friend relationships with dedication, perseverance, hard work, and commitment
• Sharing feelings honestly and openly with an attitude of respect and compassion
• Continually strengthening cooperative problem-solving and communication skills
• Including playfulness, spontaneity, relaxation, and mutual enjoyment in the relationship

What can be done to help someone who has PTSD?

For many trauma survivors, intimate, family, and friend relationships are extremely beneficial. These relationships provide:

1. Companionship and a sense of belonging, which can act as an antidote to isolation
2. Self-esteem, which can act as an antidote to depression and guilt
3. Opportunities to make a positive contribution, which can reduce feelings of failure or alienation
4. 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 PTSD and in treating couples or families. Many therapists with this expertise are members of the International Society for Traumatic Stress Studies, whose membership directory contains a geographical listing and an indication of those who treat couples or families and PTSD. Survivors find a number of different professional treatments helpful for dealing with relationship issues, including individual and group psychotherapy for their own PTSD, anger and stress management, assertiveness training, couples communication classes, family education classes, and family therapy.