According to the National Center for PTSD (2018), trauma survivors with post-traumatic stress disorder (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. These problems might include:
- 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 also negatively impact and even destroy partner relationships 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 percent to 10 percent who develop PTSD often experience lasting problems with relatedness and intimacy.
Not every trauma survivor experiences PTSD. Many couples, families, or friendships with an individual who has PTSD do not experience severe relational problems.
Successful partner relationships require ongoing work and dedication. Good communication skills — learning to open up and clearly ask for one’s needs or expressing one’s emotions — is usually a key component of successful relationships.
Additionally, many people suffering from PTSD find that creating (or expanding upon) a personal support network to cope with PTSD is helpful. Maintaining or rebuilding family and friend relationships often takes perseverance and hard work over a period of time. It can take a person months or even years to feel “normal” again in such relationships.
Another important component of good relationships is each partner learning to share their feelings honestly and openly with an attitude of respect and compassion. This often takes continual practice to build this skill, and related skills that strengthen cooperative problem-solving and communication. Good romantic relationships often include playfulness, spontaneity, relaxation, and mutual enjoyment of each other’s company and shared interests as well.
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 mental health concerns, especially those that impair social, psychological or emotional functioning, it is best to seek treatment from an experienced mental health 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 (ISTSS), 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 most often includes individual or couples counseling. Sometimes counseling might include group therapy, but it depends on the person’s individual situation and needs. Topics covered and addressed in such therapy might include: anger management, stress management, coping skills, communication skills training, and parenting skills training. Since each individual is different, the therapist will help arrive at a treatment plan with the individual that makes the most sense for them.