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View a Clip from our DVD:

"Living with PTSD: Lessons for Partners, Friends and Supporters"

PTSD and Family Members: The Hidden Face of PTSD

© Dr. Amy Menna & Gift From Within

Introduction

Post Traumatic Stress Disorder (PTSD) is an injury that disrupts many areas of life. It reaches within and can create inner turmoil and confusion. There are exterior layers of symptoms reaching various aspects of survivors' lives from their places of employment to where they gather with friends. These symptoms have the potential to interfere with daily living activities without invitation. This leads to a stress level that is out of the ordinary and can cause an imbalance in the system surrounding the survivor.

Survivors' loved ones are not immune to the reverberations of trauma. This article is meant for those living with or supporting an individual with PTSD. Specifically, it will focus on the family. Although it focuses on this particular diagnosis, it can also be generalized to anyone supporting someone with a history of trauma. Examples include individuals with a history of childhood abuse, sexual assault, experience with a natural disaster, veterans, or any number of other traumatic experiences. It is not meant to be an exhaustive description of the journey of every family member. Each survivor living with PTSD has different experiences. This article speaks to those who experience a different side of PTSD. It is meant to illuminate what may go on behind closed doors; to speak of that which may not be spoken; and to validate those who may feel as if they are alone.

Overview of PTSD

PTSD may be an all too familiar phenomenon for family members. At times, they may be even more acquainted with it than the survivor. However, some family members may not be able to easily identify it. Below is a general overview of the symptoms of PTSD.

When something traumatic occurs, the event or the circumstances surrounding it may leave remnants within the memory of the one who experienced it. As with many fragments, they are often noticed at different times and a recollection of when it happened often resurface. Memories can sometimes unexpectedly intrude upon the survivor's life often when he or she is doing something unrelated to something which can be directly tied to the trauma. Although at times the trigger may be easily recognizable, there are times that the impetus to memory may be so subtle that it goes unnoticed.

An example of this is when a veteran may become reactive when a plate is dropped and makes a clanging noise in the kitchen. This may spark memories of the sounds of war and images, even in the form of smells. This is known as a flashback. Another scenario is when these recollections manifest themselves as feelings without the specific images or memories to accompany them. In this case, the survivor may feel anxious "for no reason" thus leading to an increase in arguments or unrest in the home.

These memories in the survivor's life arise at unpredictable times. This can lead to a great deal of anxiety. Heightened anxiety may result in the inability to sleep, increase suspicion often known as hypervigilance, irritability, difficulty concentrating, or becoming more easily reactive than before the trauma. At times, this anxiety is attributed to the other family members reactions instead of being symptoms of PTSD. For example, survivors may suggest that they are angry because their spouse is doing something which causes them to be irritable. In contrast, the spouse may take the blame for the increased anxiety believing that if they only did _____ better, the survivor may be less irritated with him or her.

Naturally, when survivors have thoughts and feelings intruding upon their lives and their anxiety is at a heightened state, they want to escape the situation. This causes the survivor to have a tendency to stay away from reminders of the trauma. As such, he or she may withdraw from friends and family. The survivor may feel the need to numb their emotions or become void of them completely as they may feel overwhelming should they be fully present. They may attempt to numb their emotions with the overuse of drugs and/or alcohol. This creates distress in families because it causes distance for which the family members may take the blame. In addition, the family member may experience frustration with trying to have an intimate relationship with someone who is detached from his or her emotions.

Impact on the Family

The effects PTSD has on the relatives can be as complex as the family dynamics themselves. Many had their own sets of challenges prior to having PTSD enter the home. With this, a new set of challenges often arise on the heels of previous family challenges. Although there might be a great deal of resiliency, there are also ways of coping with stress that may be less than useful. Unfortunately, these unhealthy ways of dealing with issues may become more pronounced when the stress levels are high. For instance, if a husband and wife had a difficult time with communication prior to PTSD entering the home, relating and connecting may be especially challenging after the traumatic event. If there is a mismatch in parenting styles, there may be even more bitter disagreements.

When someone experiences a trauma, it alters his or her world often knocking it out of balance. This is true also for the family. Families develop over time and settle into a routine that is familiar to everyone. When someone is suffering from PTSD, the routine is altered and the members have to take on new roles and learn new coping skills. What used to be safe is now unsafe territory. The territory which once was a place to take solace in is now unfamiliar and, at times, can be unpredictable.

Many of the symptoms of PTSD in the home create an environment where safety is hidden behind a double edge sword. The survivor may be driven by maintaining psychological safety which may require limiting one's activities to create a sanctuary of safety with minimal complications. For example, one may not want to move out of the comfort zone of the living room or even out of the boundaries of known places in the neighborhood as it may cause increased anxiety. Having more power over his or her environment allows one to increase feelings of security and control over one's own world. This is something that was absent during the time of the trauma. The more control one has, however, the less control the loved ones may feel. At times, this may lead to resentment. This is the double edge sword. The family members want to help the survivor feel safe, however, they may have to relinquish some of their own sense of control to do so.

Other competing agendas may also be present in the home. For instance, if the survivor is a parent, the partner may have to suspend themselves between two roles; one of which is a spouse and the other is a parent. Protecting the children from the stress of PTSD symptoms can be a challenge. Protecting the survivor from the stress of children can be another.

This balancing act illustrates an issue often present with family members. The issue of the secrets behind closed doors. While protecting the privacy of the survivor, family members often lose some of the support they may be able to receive from others outside the family. Family members may feel as if they cannot disclose what is happening for fear that they are betraying the survivor's confidence. Many fear that others simply won't understand or may judge the situation. Family members may feel protective of the survivor and feel as if discussing what is happening is talking negative about him or her.

When an individual experiences trauma, safety is compromised. One of the hallmark symptoms of PTSD is a feeling of not being safe. When a family member is living with someone with PTSD, the family member's own feelings of safety may be compromised. A feeling of coming home to a predictable environment may be substituted for fear of anger, aggression, flashbacks, or avoidance symptoms such as drinking or locking oneself in the bedroom. The ability to turn to the particular family member as a source of strength may be temporarily suspended. Often family members will have feelings of anger towards the survivor for the instability in the house then feel guilty for having such emotions. However, compassion for the struggle may overshadow feelings of resentment for the symptoms. At this point, the family member may abandon their own needs and focus more on the individual with PTSD.

PTSD in the home can produce a myriad of feelings in family members. Due to the instability of some of the PTSD symptoms, some family members may feel alone in their fight against things they cannot control such as flashbacks and avoidance symptoms. They may feel powerless, as if they are somehow failing as a support person. This experience of powerlessness may contribute to feelings of depression and other emotions.

Family members may also find themselves experiencing some similar PTSD symptoms. They may have difficulty concentrating at work because they are distracted by thoughts of what the night may bring. They may have memories of the night before or things that may have happened in the past with the survivor when they do not want to be thinking about it. Family members may have constant questioning of their own safety and stability.

The unpredictability and instability in the home may bring on feelings of anxiety. Because PTSD symptoms may be provoked by seemingly benign triggers, the family members may feel on edge. When things are good, they may be wondering when the "other shoe's going to drop." A sense of peace and safety may be replaced by a sense of dread for when things will again be volatile.

Family members may find themselves avoiding the survivor. Being in the home may be too painful and they may find excuses to leave more often. They may avoid talking about the PTSD directly or stay away from situations where symptoms presented themselves in the past. This is where PTSD becomes the "elephant in the room." The family may build up a facade to the outside world that everything is ok while in reality, each individual is having their own personal struggle.

Shifting the focus

When a loved one is suffering, it is a natural response to want to alleviate that suffering. However, family members can get lost in finding a cure for an injury that creates disruption in their loved one. When doing so, family members can lose sight of themselves. Caregivers often get burned out on providing understanding and support and benefit from finding some of their own. There are resources that illustrate specific aspects of self-care which will not only enrich the lives of the family member, but will ultimately enhance the support provided to the survivor. By doing so, the family can begin to re-establish balance and move towards a common goal of healthy communication and peace within the walls of their home.

Speaking the unspeakable is difficult. It may feel as if the family member is breaking a "code of silence" within the family. However, the entire family (including the survivor) cannot get support if others are not aware of the burdens they carry. Talking among family members is as important as self-care. In many families, they share common secrets. Family members may share the same fears and feelings. However, unless one steps forward to speak their truth therefore breaking the silence, they will never know what is in the others heart.

An injury such as PTSD is difficult for the entire family. The disruption of balance in the individual whom receives the injury is often so pronounced that there is concern on many levels. Treatment is available and compassion may flow naturally. Family members may suffer the hidden injuries of PTSD. However, with support and self-care, they too can avoid or recover from the effects loving someone with PTSD.

Dealing with the effects of PTSD can be tiring. It takes strength and courage. It also takes strength and courage to be supportive and love someone through difficult times. It takes selflessness, understanding, and compassion. PTSD affects the individual as well as the family at many levels. It brings many secrets, strains, and struggles. However, with self-care and the support of others, family members can remain true to themselves in their own quest for balance and serenity. In doing so, feelings of safety in the household will increase and this is where the healing really begins.

Amy Menna has a Ph.D. in Counselor Education and Supervision, is a Licensed Mental Health Counselor, and Certified Addictions Professional. She is in private practice and lives in Tampa, Florida. She is available by email at amymenna@aol.com.

Resources

Gift from Within - Partners with PTSD http://www.giftfromwithin.org/html/partners.html

National Center for PTSD - Resources and Links for Family Members http://www.ptsd.va.gov/public/web-resources/web-families.asp

National Center for PTSD - "Helping a Family Member with PTSD" http://www.ptsd.va.gov/public/pages/helping-family-member.asp

National Center for PTSD - "When a Child's Parent has PTSD" http://www.ptsd.va.gov/public/pages/children-of-vets-adults-ptsd.asp

American Academy of Experts in Traumatic Stress - "Children of Veterans and Adults with PTSD" http://www.aaets.org/article188.htm

Gift From Within - Webcasts related to Compassion Fatigue http://www.giftfromwithin.org/html/webcasts.html#compfatigue

Books

"When Someone You Love Suffers from PTSD" - Zayfort, C. & Deviva, J.

"Shockwaves: A Practical Guide to Living with a Loved One's PTSD" Cynthia Orange

"Thirty Days with My Father" - Christal Presley

"Why Are You So Scared?" - Andrews & Kirkland - Children's book about parents with PTSD


What do you say if your spouse says to "Get over it."

Dr. Frank Ochberg gives tips for survivors on how to talk to their spouse or significant other about PTSD.

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Page created on 18 June 2013
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