In How PTSD Disrupts Relationships – Part 1- The Relationship Foundation we looked at some ways PTSD may affect the foundation, the basement and floor, of a relationship. Now I want to look more at how PTSD affects the “relationship house” that two people build on the foundation. The relationship house consists of the day-to-day relating, activities, growth, intimacy and connection that the couple creates. This is the metaphorical house they will live in together so they are trying to make it into something positive, healthy and supportive in their lives. But sometimes, sadly, things go wrong. And things go wrong easily if one partner has PTSD. (scroll past discussion to end of article for full list of 50 items)
In my experience, PTSD causes an extreme amount of stress, not only for the partner who has PTSD but for both partners as well as children and extended family members if there are any in the picture. 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!
Detachment and Avoidance
Boyfriend Speaks – My Detachment and Avoidance Impact him the Most. 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 A Lot. The first main issue is was how I sleep a lot, am frequently exhausted, can go into myself and be totally emotionally detached and absent. His words were, “How you sleep all day sometimes, retreat into yourself and spend a lot of time recovering.” That makes him feel “alone.” (makes sense, right?)
Scared to Do Stuff. The second thing he doesn’t like is that 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.”
Basically I am triggered so much of the time that 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. This is directly in relation to the injuries, so it invokes the terror of nearly dying, which makes it hard for my mind to put it into perspective in regards to all aspects of the experience.
I never consider it rationally as a cost / benefit ratio, with the cost being lung contamination and the benefits being the fun, sunshine (vitamin D), doing things together (increases good feelings of being in a relationship together), exercise for poor body makes it feel better, and experiencing something new (good for breaking out of PTSD and ingrained habit patterns). The triggers are magnified or exaggerated in my mind to become the entire potential experience and then of course I avoid 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
My Perspective… a Huge Wall
From my point of view, I just see all the symptoms of PTSD standing in-between my boyfriend and I like a huge wall.
The worst things are not being able to see who he is for real and feeling so terrified of him for no reason. 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 of how my brain is tuned powerfully into the bad, 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 very suicidal, I see how worried he looks and this hurts.
I feel bad that I have physical limitations and injuries due to the accidents, and lost my figure and the beauty of my appearance. I wish I could be my old self with my nice figure I used to have for my boyfriend. 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 The Main Things That Disrupt Our Relationship are my:
- distorted perceptions: inability to see who my partner is because of the past trauma eclipsing him
- triggers, hyperarousal: 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 brain is wired, not remembering to take care of practical 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 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 things that get in-between a person with PTSD and their partner. I left out a large number of things, but it shows some of the main ones.
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 that loss or those losses. The part of your heart lost in grieving will be a 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 (is “comorbid” with PTSD). 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.
50 Ways PTSD Undermines Intimate Relationships
Note that 16 of the items on this list (1,2,3,4,6,7,11,16,23,27,31,35,39,42,43,44) are inspired by this informative article on the subject – Relationships and PTSD – from the National Center for PTSD on the Veteran’s Affairs website. I have categorized them and elaborated on them much 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 without meaning to. This is just the nature of the illness/injury. This is not their fault.
Numbers 34-50 are a bit more related to amping up the stress in the relationship. These symptoms cause the person suffering from PTSD to increase the level of stress in the relationship without meaning to.
If you are with someone who has PTSD and you feel sad because they are somewhat “absent” and you feel stressed from their stress level, this list may explain why. People with PTSD may experience…
ISSUES THAT DISRUPT INTIMACY
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, sex may be triggering, that amount of closeness may feel foreign and intrusive if you are used to being numb and detached, may dissociate during sex and not be in their body, or may develop a sex addiction to cope
5. challenges with listening, focusing and concentrating on what is going on or what is being spoken about right now.
6. problems with communication
7. issues with unknowingly communicating in a way that comes across as demanding
8. difficulty knowing how to collaborate well with others
9. All their PTSD symptoms may lead the survivor feel a variety of challenging emotions regarding their partner: guilty, helpless, self-doubt regarding their own motives in the relationship, worry, confusion
10. All their PTSD symptoms may lead the survivor 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. trying to get a handle on all their symptoms may take the trauma survivor’s attention away from their partner and the relationship so they seem detached
13. They may have 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 and “gotten.” (mentalization is the ability to understand the mental state of oneself and others which underlies overt behavior. empathy is the ability to understand and share the feelings of another.)
16. the trauma survivor will try to avoid any activity that could trigger a memory which can be very difficult for their partner to handle
GENERAL PROBLEMS RELATING
17. problems with memory – can’t remember things in the past in general, 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. The 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 activation/ fight-flight-freeze reactions are triggers due to PTSD and not valid responses to the present situation
25. They may leave a healthy situation due to having too much activation/ fight-flight-freeze reactions that stem from past trauma and thinking they are responses to the present situation
26. develop addictive tendencies
27. engage in addictive behaviors to attempt to cope with all the intense emotions of PTSD. Addictions can destroy intimacy and relationships.
28. grief may stay buried/unrecognized/unresolved because trauma symptoms dominate
29. unresolved grief can take a toll on intimacy. One way to look at it is it takes up space in the heart and that space is not available to connect to a loved one
SLEEP ISSUES & EXHAUSTION
30. the various states of fear of PTSD consume tons of energy causing exhaustion
31. the survivor can experience trouble sleeping . As a result they may not be able to get enough rest and thus become exhausted all the time.
32. sleeping together may be more difficult due to sleep disturbances
33. health issues caused by constant stress in the body can lead to a higher need for sleep so the body can try to heal itself
34. a lot of time spent sleeping, rehabilitating and recovering can be seen as being lazy and carelessly abandoning one’s partner but it is actually a symptom of PTSD
STRESS & ACTIVATION
35. the trauma survivor can be in frequent states of hyperarousal and hypervigilance. They can be plagued by trauma memories, triggers, flashbacks, be overly stressed and tense, irritable, jumpy, always on guard, worried, nervous and 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. they may experience anxiety and perception of various kinds of danger associated with being in a close relationship
39. an increased need to protect their loved ones from danger
40. irrational panic if a loved one is out late, doesn’t call back right away etc. They are convinced something terrible has happened.
41. This level of 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. They may become violent (verbally and physically)
44. They may avoid closeness as a way to keep themselves away from situations in which they might get angry and lose control, lash out impulsively. In other words, they may push away loved ones to protect the people they care about from themselves.
45. possible urges to self-harm (may or may not be present)
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 – telling partner they want to die can cause partner high level of distress
50. making suicide attempts can be highly upsetting and traumatic for the partner
The Effect on Their Partner:
Due to the Problems 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
- like they lost their partner, who they were before
Due to the Problems that Increase Stress they may feel:
- stressed out
- they may develop health problems from the stress
- they may experience secondary traumatization. The 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 their partner is very suicidal this may be traumatic for them to manage
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 will be discussed in Part 3.
The good thing is that – if the person with PTSD goes to a therapist who knows Trauma Resiliency Model, 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 least they will emerge from the storm and be able to see clearly again.
by Heidi Hanson