PTSD Caused by Relational Trauma
An “Invisible” Disorder that Can go Undiagnosed
When I used to hear the term “Posttraumatic Stress Disorder,” I generally only thought of combat veterans and the trauma they experienced that could lead to PTSD. Combat can certainly induce PTSD. However, other types of trauma can also lead to PTSD. In both cases, when gone undiagnosed, it can have long lasting effects on a person.
The type of PTSD that I wanted to explore today is relational PTSD. Similar to combat-induced PTSD, this form of PTSD can also create long-term scars. Yet, it is still widely misunderstood. So, let’s look briefly at what PTSD is, how it manifests itself, and how we can all be better at recognizing and responding to it.
What is PTSD?
PTSD is a debilitating condition that attacks the victim in ways that only he/she can truly understand. The impact is profound and often on-going for the person living with PTSD. Yet, unlike some traumas where wounds may be visible to the survivor, the wounds of those that suffer with relational PTSD are rarely visible. The survivor of relational trauma may look and sound just the same as everyone else, but the impacts of their trauma are nevertheless profound.
So, what are the symptoms of PTSD. The DSM-V (American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author) describes PTSD as a disorder with 8 characteristics:
- Criterion A: The person experienced a traumatic event, which could involve death, threatened death, actual or serious injury, actual or threatened sexual violence
- Criterion B: The person re-experiences the trauma through nightmares, unwanted memories, flashbacks, emotional distress, etc.
- Criterion C: The person avoids trauma-related stimuli after the trauma
- Criterion D: Negative thoughts or feelings begin or worsen for the person after the trauma, such as: inability to remember the trauma, negative thoughts about themselves or the world, exaggerated blame of self or others, feeling isolated, etc.
- Criterion E: Reactivity that began or worsened after the trauma, including: Irritability or aggression, risky or destructive behavior, difficulty sleeping, heightened startle reaction, difficult concentrating, etc.
- Criterion F: Symptoms last for more than 1 month
- Criterion G: Symptoms create problems for the person
- Criterion H: These symptoms aren’t a result of medication, substances, or another illness.
How Does PTSD Manifest?
Now that we’ve looked at what PTSD is, let’s explore how these symptoms express themselves in those that experience relational PTSD.
First and foremost, trauma comes in many forms. A person may develop PTSD from traumas such as (but not limited to) combat, natural disasters, sexual assault, an accident, complex relational (or as we sometimes call “attachment-based”) trauma, or even from discovery of a partner’s sexual betrayal. These traumas are significant, as they completely alter the victim’s experience of themselves, others, and the world. For example, when partners of sex addicts discover the hidden life of their addicted spouse, in a moment the partner’s view of themselves, their spouse, their life, their past, their future, and their world comes crashing down.
The Invisible Scars of PTSD Caused by Relational Trauma
The scars relational trauma survivors hold are often invisible. The wounds are often psychological and internal. For example, a victim of emotional abuse such as gaslighting may come to profoundly doubt their own intuition and feel a sense of confusion in daily life. Or a victim may become severely depressed or become triggered all the time when around situations that remind them of the relational trauma. So, if you are reading this as a loved one of someone suffering from “invisible” PTSD wounds, please know that just because you can’t see the scars in your loved one doesn’t mean that they are not suffering greatly as a result of the trauma the experienced. These scars frequently manifest themselves in the form of triggers.
For someone with relational PTSD, triggers are emotional and also contain somatic reminders of the trauma the survivor experienced. These somatic reminders are the body’s response to a current event that reminds the survivor of the traumatic event. They may come at a moment’s notice, and they frequently come without warning. Some triggers are predictable, such as the anniversary of the traumatic event, sights, sounds, or other similar external events that mirror the original traumatic event. Yet other triggers may come unexpected. For example, the victim of relational trauma may become triggered when things are going “well” because they start to feel safe and trusting in their relationship. Yet feeling safe and trusting brings up fears of being harmed again by their loved one. This fear, then triggers the body into protecting itself.
How Can We Better Respond to a Loved One with PTSD Due to Any Traumatic Experience?
If you have a friend or loved one with PTSD, let’s spend a few moments exploring how you can better respond to them.
First, please be compassionate with your loved ones that are suffering with PTSD. They did not choose this disorder. They are responding the best they can after experiencing significant trauma in their lives. Getting defensive or personalizing their behaviors won’t help them or you. Think of it this way: Have you ever been really scared about something, even when that fear was “irrational” (e.g., spiders, needles, heights, etc.)? If someone got mad at you and told you that you’re being “crazy” and “overreacting” would that help you? Few of us are helped by others getting defensive, angry, or personalizing these threat reactions.
This brings us to a second way you can respond. If you have a loved one with relational PTSD, always remember that the reactions your loved one makes when triggered are survival responses that they are making to perceived threat. Their body is literally fighting for survival. PTSD creates an environment in the survivor’s body where they are hyper-aware of threat cues so that they can protect themselves from being re-traumatized. It’s actually a remarkable survival response to protect the survivor. Yet that may mean he or she becomes more sensitive to certain sounds, smells, memories, environments, etc. So be patient and exhibit compassion.
Understanding Their Triggers
If you’re taken off guard by your loved one’s trigger, just know that they are most likely caught off guard by it too. The more compassionate you can be will help defuse the threat that your loved one is experiencing. And again, remember times when you have felt threatened. If someone got mad at you and tried to “talk you out of” your threat, would that help? Be compassionate. Talk in a soft, calm voice. Respond, don’t react. Help bring your loved one back to the present moment by reminding them about where they are. Help them look around at their environment, get back into their bodies, and experience their different senses. Getting back into their senses will bring your loved one back to the safety of the present as opposed to the threat of the past.
Being Part of the Healing
Please don’t give clichés to your loved one. Saying, “this is just in your head” doesn’t help anyone. I’ve also heard situations of people who have even made “jokes” by triggering the startle response of someone with PTSD. This is not funny, it’s cruel.
Most of all, be compassionate. The safer you can be with the loved one in your life battling PTSD will help bring them back to the present moment. In conjunction with trauma work from a trauma therapist or somatic practitioner, your love and support can go a long way towards helping your loved one heal from trauma.
Whether you are suffering with relational PTSD or if you are the loved one of someone suffering, my heart is with you. Please be patient and kind with yourself.