Understanding the impact of PTSD on family & relationships
PTSD can take a heavy toll on friends and family members, and relationship difficulties are common. It can be hard to understand your loved one’s behavior—why he or she is less affectionate and more volatile. You may feel like you’re walking on eggshells or living with a stranger. You may even be afraid of the person. The symptoms of PTSD can also result in job loss, substance abuse, and other stressful problems that affect the whole family.
It’s hard not to take the symptoms of PTSD personally. When someone you love is distant, anxious, or angry all the time, your relationship suffers. But it’s important to remember that the person may not always have control over his or her behavior. Anger, irritability, depression, apathy, mistrust, and negativity are common PTSD symptoms that your loved one can’t simply choose to turn off. With time and treatment, they will get better, but it’s a gradual process.
Tips for coping with PTSD in the family
- Be patient. Getting better takes time, even when a person is committed to treatment for PTSD. Be patient with the pace of recovery. It’s a process that takes time and often involves setbacks. The important thing is to stay positive and keep at it.
- Educate yourself about PTSD. The more you know about the symptoms, effects, and treatment options, the better equipped you'll be to help your loved one, understand what he or she is going through, and keep things in perspective.
- Don’t pressure your loved one into talking. It can be very difficult for people with PTSD to talk about their traumatic experiences. For some, it can even make things worse. Instead of trying to force it, just let them know you’re willing to listen when they’re ready.
- Take care of your emotional and physical health. As the saying goes, put on your own oxygen mask first. You won’t be any good to your loved one if you are burned out, sick, or exhausted.
- Accept (and expect) mixed feelings. As you go through the emotional wringer, be prepared for a complicated mix of feelings—some of which you’ll never want to admit. Just remember, having negative feelings toward your family member doesn’t mean you don’t love them.
PTSD & the family: Social support is vital to recovery
It’s common for people with PTSD to withdraw from their friends and family. While it’s important to respect your loved one’s boundaries, too much isolation is unhealthy. Your comfort and support can help a person with PTSD overcome feelings of helplessness, grief, and despair. In fact, trauma experts claim that receiving love from others is the most important factor in PTSD recovery.
Knowing how to best demonstrate your love and support, however, isn’t always easy. You can’t be your family member’s therapist, and you can’t force him or her to get better. But you can play a major role in the healing process by spending time together and listening carefully.
Why someone with PTSD might be reluctant to seek support
- Being afraid of losing control
- Feeling weak or ashamed
- Not wanting to burden others
- Believing that others won’t understand
- Wanting to avoid thinking about what happened
- Fear that others will judge or pity them
How to be a good listener
While you shouldn’t push a person with PTSD to talk, you can let them know you’re available for them. If they do choose to share, try to listen without expectations or judgments. Make it clear that you’re interested and that you care, but don’t worry about giving advice. Leave that to the professionals. Instead, do your best to simply take in what they’re saying. Never underestimate how much the act of empathetic listening can help.
A person with PTSD may need to talk about the traumatic event over and over again. This is part of the healing process, so avoid the temptation to tell your loved one to stop rehashing the past and move on. Instead, offer to talk as many times as needed. And remember, it’s okay to dislike what you hear. Some of the things your loved one tells you might be very hard to listen to. But it’s important to respect their feelings and reactions. If you come across as disapproving, horrified, or judgmental, they are unlikely to open up to you again.
Communication Pitfalls to Avoid
- Giving easy answers or blithely telling the person everything is going to be okay
- Stopping the person from talking about their feelings or fears
- Offering unsolicited advice or telling the person what he or she “should” do
- Blaming all of your relationship or family problems on the person’s PTSD
- Invalidating, minimizing, or denying the person’s experience
- Telling the person to “get over it” or “snap out of it”
- Giving ultimatums or making threats or demands
- Making the person feel weak because they aren’t coping as well as others
- Telling the person they were lucky it wasn’t worse
- Taking over with your own personal experiences or feelings
PTSD & the family: Tips for rebuilding trust and safety
Trauma alters the way a person sees the world, making it seem like a perpetually dangerous and frightening place. It also damages people’s ability to trust others and themselves.
Anything you can do to rebuild your loved one’s sense of security will contribute to recovery. This means cultivating a safe environment, acting in a dependable and reassuring way, and stepping in to help when needed. But it also means finding ways to empower the person. Smothering someone with PTSD or doing things for them that they’re capable of doing for themselves is counterproductive. Better to build their confidence and self-trust by giving them more choices and control.
Things you can do to increase your loved one's sense of safety
- Express your commitment to the relationship. Let the person know you’re here for the long haul.
- Create routines. Structure and predictable schedules will enhance the person’s feelings of security. You can also help create a safe place.
- Be aware of things that can make a person with PTSD feel unsafe, such as new places, crowds, confusion, or being physically constrained or ordered around.
- Try to minimize stress at home and make sure your loved one has time alone for rest and relaxation.
- Speak of the future and make plans. This can help counteract the common feeling among people with PTSD that their future is limited.
- Keep your promises. Help rebuild trust by being trustworthy. Be consistent and follow through on the things you say you’re going to do.
- Tell them you believe they are capable of recovery. Emphasize their strengths. Help them (and others) see their positive qualities and successes.
PTSD & the family: Encouraging and supporting treatment
Despite the importance of your love and support, it isn’t always enough. Many people who have been traumatized need professional PTSD treatment. But bringing it up can be touchy. Think about how you’d feel if someone suggested that you needed therapy.
Wait for the right time to raise your concerns. Don’t bring it up when you’re arguing or in the middle of a crisis. Also be careful with your language. Avoid anything that implies that he or she is “crazy.” Frame it in a positive, practical light: treatment is a way to learn new skills that can be used to handle a wide variety of PTSD-related challenges.
- Emphasize the benefits. For example, therapy can help them become more independent and in control. Or it can help reduce the anxiety and avoidance that is keeping them from doing the things they want to do.
- Focus on specific problems. If your partner shuts down when you talk about PTSD or counseling, focus instead on how treatment can help with specific issues like anger management, anxiety, or concentration and memory problems.
- Acknowledge the hassles and limitations of therapy. For example, you could say, “I know that therapy isn’t a quick or magical cure, and it may take awhile to find the right therapist. But even if it helps a little, it will be worth it.”
- Enlist help from people your loved one respects and trusts. He or she may be more open to counseling if the idea comes from someone else. Suggest the person see a doctor or talk with his/her pastor, rabbi, or spiritual leader.
- Encourage the person to join a support group. Getting involved with others who have gone through similar traumatic experiences can help your loved one feel less damaged and alone.
PTSD & the family: Anticipating and managing triggers
A trigger is anything—a person, place, thing, or situation—that reminds your family member of the trauma and sets off a PTSD symptom, such as a flashback. Sometimes, triggers are obvious (for example, a military veteran might be triggered by seeing his combat buddies or by the loud noises that sound like gunfire). Others may take some time to identify and understand. For example, maybe a song was playing when the traumatic event happened, and now that song or even others in the same genre of music are triggers. And triggers aren’t just external. Internal feelings and sensations can also trigger PTSD symptoms.
| Types of PTSD triggers
|Common external triggers
- Sights, sounds, smells, or touches associated with the trauma
- People, locations, activities, or things that remind you of the trauma
- Significant dates or times, such as anniversaries or a specific time of day
- Nature (certain types of weather, seasons, etc.)
- Conversations or media coverage about trauma or negative news events
- Situations that feel confining (stuck in traffic, at the doctor’s or therapist’s office, in a crowd)
- Relationship, family, school, work, or money pressures or arguments
- Funerals, hospitals, medical treatment or procedures
|Common internal triggers
- Physical discomfort, such as hunger, thirst, fatigue, sickness, and sexual frustration
- Any bodily sensation that reminds you of the trauma, including pain, old wounds and scars, or a similar injury
- Strong emotions, especially feeling helpless, out of control, trapped, or unprotected
- Feelings toward family members, including mixed feelings of love, vulnerability, and resentment
Talking to your family member or partner about triggers
Ask your loved one to sit down with you and make a list of triggers that have previously led to flashbacks or other PTSD symptoms. If you're aware of the triggers that may cause an upsetting reaction, you can take steps to minimize or avoid them.
You can also talk about things he or she did in the past in response to a trigger that seemed to help (as well as the things that didn’t). Then you can come up with a joint game plan for how you will respond to a flare-up of symptoms. Ask your loved one what he or she would like you to do during a nightmare, flashback, or panic attack. Having a plan in place will make the situation less scary for both of you. You’ll also be in a much better position to help your loved one calm down.
How to help in the middle of a flashback or panic attack
During a flashback, people often feel a sense of disassociation, as if they’re detached from their own body. Anything you can do to “ground” them will help.
- Tell them they’re having a flashback and that even though it feels real, it’s not actually happening again
- Help remind them of their surroundings (for example, ask them to look around the room and describe out loud what they see)
- Encourage them to take deep, slow breaths (hyperventilating will increase feelings of panic)
- Avoid sudden movements or anything that might startle them
- Ask before you touch them. Touching or putting your arms around the person might make him or her feel trapped, which can lead to greater agitation and even violence
PTSD & the family: Dealing with volatility and anger
PTSD can lead to difficulties managing emotions and impulses. In your loved one, this may manifest as extreme irritability, moodiness, or explosions of rage. In fact, anger is so common in people with PTSD that it is considered one of the prime symptoms of hyperarousal.
Understanding anger in PTSD
People suffering from PTSD live in a constant state of physical and emotional stress. To make matters worse, they usually have trouble sleeping. They are exhausted, on edge, and physically strung out—which increases the likelihood that they’ll overreact to situations and stressors in their day-to-day life.
For many people with PTSD, anger can also be a cover for other feelings or a defense against grief, helplessness, guilt, or shame. They’d rather be mad than sad. Anger makes them feel powerful, instead of weak and vulnerable. For others, their anger is so intense that they’re afraid of letting it out. Instead, they try to suppress it. But it simmers under the surface, like an active volcano, and can erupt when you least expect it.
- Watch for signs that your loved one is angry. Their face may get red, they may clench their jaw or fists, talk louder, start pacing or getting agitated. Take steps to defuse the situation as soon as you see the initial warning signs.
- Try to remain calm. During an emotional outburst, do your best to stay calm (or at least pretend to be). This will communicate to your loved one that you are “safe.” It will also help keep the situation from escalating.
- Give the person space. Don’t come closer unless asked and avoid crowding or grabbing the person. This can make a traumatized person feel threatened.
- Ask how you can help. For example: “Do you want me to help you calm down?” or “What can I do to help you right now?” You can also suggest a time out or change of scenery if you think that might help.
- Put safety first. If the person gets more upset despite your attempts to calm him or her down, stop what you’re doing and go for help. Leave the house or lock yourself in a room if necessary. Call 911 immediately if you fear that your loved one may hurt himself or others.
Learning how to control anger
Anger is a normal, healthy emotion, but when chronic, explosive anger spirals out of control, it can have serious consequences on a person’s relationships, health, and state of mind. But anger doesn’t have to hijack your (or your family’s) life. You can get anger under control by exploring the root issues and learning healthier ways to express your feelings.
Read more: Anger Management: Tips and Techniques for Getting Anger Under Control
PTSD & the family: The importance of self-care
As previously mentioned, if a loved one has PTSD, it’s essential that you take care of yourself and get extra support. Looking after your own well-being isn’t selfish—it’s necessary. In addition to putting a lot of time and energy into your family member’s problems, you’re probably taking on a bigger share of the household responsibilities as well. That’s a big caregiver burden that can lead to emotional strain and physical exhaustion if you don’t take steps to recharge and find balance.
Letting your family member’s PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout. In order to have the strength to be there for your loved one over the long haul, you have to nurture and care for yourself. Like proper maintenance on a car, it’s what will keep you going.
Tips for taking care of yourself
Self-care begins with taking care of your physical needs: getting enough sleep, exercising regularly, eating properly, and looking after any medical issues. From there, it extends to your mental, social, and emotional needs.
- Cultivate your own support system. This can include other family members you know you can rely on, trusted friends, your own therapist or support group, or your faith community.
- Make time for your own life. Don’t give up friends, hobbies, or activities that make you happy. It’s important to have things in your life that you look forward to.
- Spread the responsibility. You can’t do it all. Ask other family members and friends for assistance so you can take a break. You may also want to seek out respite services in your community.
- Set boundaries. Be realistic about what you’re capable of giving. Know your limits, communicate them to your family member and others involved, and stick to them.
- Talk to someone about your feelings. It can be a therapist, a friend, or your religious leader. Expressing what you’re going through can be very cathartic, making it easier to get through tough times.
Trauma can be "contagious"
Another reason why self-care is so important is because of the potential for secondary traumatization. What that means is that the spouses, partners, and family members of people with PTSD can develop their own symptoms. This can happen from listening to trauma stories or being exposed to scary symptoms like flashbacks. The more depleted and overwhelmed you feel, the greater the risk that you yourself may become traumatized.
Support for people taking care of veterans
If the person you’re caring for is a U.S. military veteran, home health care coverage, financial support, nursing home care, and adult day care benefits may be available. Some Veterans Administration programs are free, while others require co-payments, depending upon the veteran’s status, income, and other criteria. Visit VA Caregiver Support to explore your options, or call Coaching into Care at (888) 823-7458 for free, confidential advice about how to help your veteran.
Resources & References
Helpguide’s Yellow Pages
Resources for public assistance, social services, and other health and human services.
General help for people with PTSD and their family members
National Suicide Prevention Lifeline – This 24-hour hotline for anyone in emotional distress: 1-800-273-TALK (8255).
SIDRAN Institute– A nonprofit organization that helps people understand, recover from, and treat traumatic stress. Includes a referral list of therapists for PTSD.
National Alliance on Mental Illness (NAMI)– Call the Helpline at 1-800-950-NAMI (6264) or check out the Family-to-Family Education Program for caregivers of people with severe mental illness.
Help for veterans and their family members
Coaching Into Care – Call (888) 823-7458 for free, confidential coaching designed to help family members learn how to talk to their veteran about their concerns and about treatment options.
Veterans Crisis Line – A confidential, free hotline for veterans and their families and friends. Call 1-800-273-8255 (Press 1) or connect via chat or text (838255).
Military OneSource– Call 1-800-342-9647 for confidential counseling, non-medical services, and other resources for veterans and their family members. The line is open 24/7.
Help for Veterans with PTSD – Learn how to earn how to earn how to enroll for VA health care and get an assessment. (National Center for PTSD)
National Resource Directory – Explore services and resources that support recovery, rehabilitation, and reintegration for service members, veterans, and their families.
Give an Hour– A nonprofit organization that offers free mental health services to U.S. military personnel and their families affected by the ongoing conflicts in Iraq and Afghanistan.
24/7 Outreach Center for Psychological Health & Traumatic Brain Injury– Get help for traumatic brain injury and other psychological health issues. Call 1-866-966-1020 or connect through chat or email. (DoD's Defense Centers of Excellence)
A Guide to VA Mental Health Services for Veterans & Families (PDF) – Comprehensive guide to VA mental health services, including programs and resources for PTSD.
General Information about PTSD in veterans and the family
Effects of PTSD on Family – When someone in the family has PTSD, everyone feels the effects. Learn about common feelings and reactions among family members. (National Center for PTSD)
About Face – Hear the stories of veterans who live with PTSD. Listen to personal experiences about how PTSD affected their families and how treatment turned things around.
Returning from the War Zone (PDF) – Learn about issues families face when a spouse returns from war and what can be done to prepare for the reunion and cope with the transition to civilian life.