Writer Heidi Hanson breaks down the symptoms of PTSD and how they have influenced her relationship.
Note: This is a three part article based on my personal experience recovering from PTSD. Much of it is theoretical, however it is material I consider worth being studied in a scientific manner. You can find part one here.
In part one, we looked at ways PTSD may affect the foundation of a relationship. Here we will look more at how PTSD affects the “relationship house” that a couple build on that foundation.
The relationship house consists of the day-to-day relating, activities, growth, intimacy and connection that the couple creates. This is the metaphorical structure they will live in together while trying to build into something positive, healthy and supportive in their lives. Sometimes, sadly, things go wrong. And things go wrong easily if one partner has PTSD.
Several of the items on this list are inspired by the informative article, Relationships and PTSD, from the National Center for PTSD on the U.S. Department of Veteran’s Affairs website. I have categorized them and elaborated on them more in this article.
Numbers 1-34 (roughly) can be considered to cause intimacy problems. These symptoms cause the person suffering from PTSD to abandon their partner and their relationship.
Numbers 34-50 are symptoms that cause the person suffering from PTSD to increase the level of stress in the relationship.
Following the list, I share examples of how these symptoms apply personally.
Trauma survivors may exhibit various combinations of these issues depending on their unique experience and coping skills. These behaviors are unintentional — it’s just the nature of the illness/injury. This is not their fault.
1. Problems with trust – can’t trust anyone anymore including their partner
2. Problems with closeness – won’t allow themselves to be vulnerable
3. Less interest in social activities – prefer to stay at home, may not care about other people, may fear social activities on some level
4. Less interest in sexual activities — may feel foreign and intrusive if they are used to being numb and detached, may dissociate during sex and not be in their body, may develop a sex addiction to cope
5. Challenges with listening, focusing and concentrating
6. Problems with communication
7. Unknowingly communicating in a way that comes across as demanding
8. Difficulty knowing how to collaborate well with others
9. PTSD symptoms may lead the survivor to feel a variety of challenging emotions regarding their partner: guilty, helpless, self-doubt regarding their own motives in the relationship, worry, confusion
10. PTSD symptoms may lead the survivor to feel a variety of challenging emotions regarding relationships in general: a sense that they are dramatically different from others, not worthy of love, impaired, a failure, doubts that they have anything to offer anyone, belief that they are damaged goods, low self-esteem and self-worth
11. Emotional detachment, feeling distant from others, numb, shut down
12. PTSD symptoms may take the trauma survivor’s attention away from their partner and the relationship so they seem detached
13. Dulled senses, as if the world is all gray and constricted
14. Can become dissociated
15. Lack of mentalization and empathy – they may not be able to sense the mental and emotional states underlying partner’s behavior, making it hard for their partner to feel understood (mentalization is the ability to understand the mental state, of oneself or others, that underlies overt behavior, empathy is the ability to understand and share the feelings of another).
16. Trauma survivor will try to avoid any activity that could trigger a memory which can be very difficult for their partner to handle
17. Problems with memory – can’t remember past experiences, such as things they did with their partner or family, making it seem like they don’t care but it’s actually just memory impairment
18. Problems with memory – can’t remember specifically anything good they did with their partner
19. Problems with memory – can’t remember day-to-day responsibilities and promises
20. Problems with memory – can’t remember moment to moment plans (e.g. why did I go into this room?)
21. Problems with processing information
22. Difficulties problem solving and making decisions, especially joint decisions
23. Trauma survivor may end up depending a lot on their partners, family and friends due to the overwhelming and disabling nature of their symptoms which can cause a number of related issues such as guilt, resentment, and strain in the relationship
24. They may stay in an abusive situation due to believing their fight-flight-freeze reactions are triggers due to PTSD and not valid responses to present situation
25. They may leave a healthy situation due to excessive fight-flight-freeze reactions that stem from past trauma, thinking they are responses to present situation
26. Develop addictive tendencies
27. Engage in addictive behaviors to attempt to cope with the intense emotions caused by PTSD
28. Grief may stay buried/unrecognized/unresolved because trauma symptoms dominate
29. Unresolved grief can take a toll on intimacy — emotional space is not available to connect to a loved one
SLEEP ISSUES & EXHAUSTION
30. Various states of fear of PTSD consume tons of energy causing exhaustion
31. Trouble sleeping — may not be able to get enough rest and thus become constantly exhausted
32. Sleeping with partner may be difficult due to sleep disturbances
33. Health issues caused by constant stress can lead to a higher need for sleep so the body can try to heal itself
34. Extended time sleeping — can be seen as being lazy and/or carelessly abandoning partner but it is actually a symptom of PTSD
STRESS & ACTIVATION
35. Trauma survivor can be in frequent states of hyper-arousal and hyper-vigilance — can be plagued by trauma memories, triggers, flashbacks, be overly stressed and tense, irritable, jumpy, always on guard, worried, nervous, unable to relax
36. Triggers cause distorted perceptions of their partner and the world
37. Triggers can cause a multitude of different fears of their partner
38. May experience anxiety and perception of various kinds of danger associated with being in a close relationship
39. Increased need to protect their loved ones from danger
40. Irrational panic that something terrible has happened if a loved one is out late, doesn’t call back right away, etc.
41. Chronic stress can lead to serious health conditions which can be huge ordeals for a couple to get through
42. Anger problems – the survivor may experience intense anger and aggressive impulses
43. May become violent (verbally and physically)
44. May avoid closeness as a way to keep themselves away from situations in which they might get angry and lose control, may push away loved ones to protect them from outbursts
45. Possible urges to self-harm
46. Risk taking behavior reflecting a lack of interest in life
47. Accidents due to risk taking behavior
48. Suicidal ideation – thoughts about suicide, feelings of desiring to commit suicide
49. Speaking of suicide/death – causes partner distress
50. Actual suicide attempts are traumatic for the partner
AFFECT ON PARTNER
Due to the symptoms that disrupt intimacy they may feel:
• cut off from their partner
• down, sad because their partner is suffering
• angry at their partner
• distant toward their partner
• sorrow that it seems like working as a team is impossible
• trapped by their partner’s dependencies
Due to the symptoms that increase stress they may feel:
• stressed out
• may develop health problems from the stress
• may experience secondary traumatization — indirect impact of trauma on the partner can make them also feel a sense of danger, edginess, fear as if they are living in constant threat of danger
• If survivor is suicidal this may be traumatic for them to manage
PTSD causes an extreme amount of stress, not only for the one coping with PTSD, but for both partners as well as any children and extended family that might be involved. Both partners may suffer from a sense of exhaustion because PTSD burns up energy like nothing else. They both may also suffer health problems due to this extremely high level of stress. I salute any relationship that is managing to survive PTSD.
When I asked my boyfriend what he thought the worst things were about being in a relationship with someone with PTSD he mentioned the following:
Sleeping — I sleep a lot. I am frequently exhausted, can go into myself and be emotionally detached and absent. His words were, “How you sleep all day sometimes, retreat into yourself and spend a lot of time recovering.” It makes him feel alone.
Scared to Do Stuff — I’m scared of so many things it makes it hard for us to do anything together. He said, “If you always assume something bad will happen, then you end up not doing anything. Most of the time bad things won’t happen but you can’t perceive that and miss out on a lot of experiences.”
I am triggered much of the time and I have trouble going out and doing anything fun, adventurous or interesting. For example, I didn’t go rafting with him because my lungs had been damaged and the river has a road with traffic next to it. I didn’t want to harm my lungs with contamination/exhaust fumes. The apprehension was directly related to the trauma of the injuries and it invoked the terror of nearly dying. It was hard for my mind to see the choice from a rational perspective.
My triggers exaggerated the threat to become the entire potential experience and then, of course, I avoided the activity.
When I don’t participate in things with my boyfriend, his needs for experiencing adventure, fun, discovery, and exploration with me do not get met. So boyfriend feels alone and abandoned by my:
• emotional detachment
• physical exhaustion
• avoidance behavior that prevents joint activities
I see all the symptoms of PTSD standing between my boyfriend and I like a huge wall. The worst is feeling terrified of him for no reason, not being able to see who he is truly. It’s like he is wearing a “past abusive partner” suit all the time and I can’t figure out how to take that off of him in my mind.
Also, not having memories makes it hard to be in a relationship. I can’t remember things we’ve done together. I especially can’t remember good things we’ve done together because my brain is still powerfully tuned to my past traumatic events in order to survive them successfully. I think I even turn good things we’ve experienced together into bad things without realizing it.
I also don’t remember simple things like taking care of something I said I would do. Seeing his face, the look of disappointment, when I am unable to remember something, is painful. I also feel really disabled and different when I realize my memory is damaged and I become afraid and sad.
When I realize how dependent I am on him for things like remembering stuff, or when I need him to comfort me when am triggered and feeling terrified, I can become really clingy. When I feel clingy I start to wonder if I’m using him. I wonder if I’m with him for the wrong reasons. I become mad at myself. This whole line of thought then starts to seed lots of fear, confusion and guilt when perhaps clinginess is just part of recovery.
I am not up to doing things a lot of the time. Seeing him look let down when I can’t go out, or when I break a promise is really hard.
Sometimes I get addicted to computer games to escape my intense feelings that are bubbling just below the surface. I feel really bad for abandoning my partner and my life.
When I am suicidal, I see how worried he looks and this hurts.
I feel bad that I have physical limitations due to injuries from accidents. I lost my figure and the beauty of my appearance. I wish I could be my old self with my nice figure. I wish I could turn back time. I wish I looked pretty again. I wish I could give him that. But I can’t…I know he likes me how I am but that is no consolation when the grief is still so strong. What else was lost? If I even begin to go down that road I feel I will be lost. The grief is so huge I feel like I can’t open my heart to him or else it will all pour out everywhere.
I notice that he looks stressed, like everything is taking a toll on him. I notice he has started to have some health issues, probably from stress. I know I’m creating a ton of stress for both of us, so I feel terrible when I see him suffering from stress related issues.
Most of the time, I wish I could be a better, normal partner. I feel a lot of guilt and helplessness.
I also feel like over time PTSD can destroy the love one genuinely has for their partner because it takes over emotionally and in the storm one can forget any of the positive, loving emotions they once felt towards their partner.
At the same time, certain dynamics in the relationship could be a way to play out past trauma that only the unconscious mind knows about (there are no conscious memories), in an attempt to alert the conscious mind that there is something that needs healing – like a beacon trying to get attention.
So, my list of things that disrupt our relationship are:
• Distorted perceptions: inability to see who my partner is because of the past trauma eclipsing him
• Triggers, hyper-arousal: feeling terrified of my partner for no reason
• Memory problems: not being able to remember things we’ve done together, blocking out all memories of good times due to how my brain is wired, not remembering to take care of day-to-day things, forgetting things from one moment to the next
• Clinginess, dependency
• Exhaustion and avoidance: letting down my partner so many times, breaking promises without meaning to
• Addictive tendencies
• Suicidality: talking about wanting to kill myself multiple times a week causes my partner fear, concern, worry, stress
• Grief: for loss of body image and other things
• Extreme stress: both of us experience stress related health issues from contending with PTSD symptoms
• Painful emotions: I feel pain, guilt, helplessness when perceiving the toll it takes on my partner
I created this illustration that shows a few of the main issues that get between a person with PTSD and their partner.
Grief may not be always considered in relation to PTSD. But what happens when you have PTSD and go to therapy? At a certain point, you come across a great loss that was sitting underneath the trauma all along. You lost someone you love. You lost your appearance due to injury. You lost an opportunity. You lost your innocence. You lost love. You lost the person who you used to be. You lost a dream. You lost your relationship with God. So I think grief is in there and if it is a profound grief, you may not be available to your partner, at least not fully, until you grieve those losses. The part of your heart lost in grieving is the part of you that is not there to love your partner.
Although not all people with PTSD feel suicidal, it is a symptom of PTSD. It can be very difficult for a relationship when one person is suicidal. It can be a challenge for the suicidal person’s partner to try to figure out how to handle the situation. They can feel worried, confused, scared and helpless. Even if the suicidal behavior is more passive, for example, if the person does not take care of their health, engages in risk taking behavior or has a cavalier attitude about living and dying, this still takes a toll on their partner.
Depression often accompanies PTSD (a term called “comorbid”). If a person has both PTSD and depression together (or any other mental illness) they will abandon their partner to an even greater degree than if they suffer from PTSD alone.
The good thing is that if the person with PTSD goes to a therapist who knows Somatic Experiencing or Sensorimotor Psychotherapy, they can, step by step, overcome their symptoms and restore a loving connection with their partner, or part ways with their partner, depending on which is most healthy for both people. At the very least, they will emerge from the storm and be able to see clearly again.
Beyond this list, there are a number of specific unhealthy dynamics that can develop in the relationship and inside the person with PTSD. These dynamics are discussed in part three.
This article was originally published on Heidi’s blog, The Art of Healing Trauma.
Photo/artwork credit: Heidi Hanson