PTSD and The Family

A National Center Fact Sheet

Living with an individual who has PTSD does not automatically cause PTSD, but it can produce "vicarious" or "secondary" traumatization. Whether family members live together or apart, are in contact often or rarely, and feel close or distant emotionally from one another, PTSD affects each member of the family in several ways:

• Family members may feel hurt, alienated, frustrated, or discouraged, if the survivor loses interest in family or intimate activities and is easily angered or emotionally isolated and detached. Family members often end up feeling angry or distant toward the survivor, especially if he or she seems unable to relax and be companionable without being irritable, tense, anxious, worried, distractible, or controlling, overprotective, and demanding.
  
• Even if the trauma occurred decades ago, survivors may act -- and family members may feel -- as if the trauma never stops happening. They may feel as if they're living in a war zone or a disaster if the survivor is excessively on-guard, tense, or easily startled or enraged. Family members can find themselves avoiding activities or people and becoming isolated from each other and from friends outside the family. They may feel that they have no one to talk to, and that no one that can understand.
  
• They may find it very difficult to have a cooperative discussion with the survivor about important plans and decisions for the future, because s/he feels there is no future to look forward to, because s/he has difficulty listening and concentrating without becoming distracted, tense, or anxious, or because s/he becomes angry and overly suspicious toward the family member or toward others (hypervigilant). They may find it very difficult to discuss personal or family problems, because the survivor becomes either controlling, demanding, or overprotective, or unreasonably anxious and fearful about problems becoming terrible catastrophes.
  
• Family members may become over-involved with their children's lives due to feeling lonely and in need of some positive emotional feedback, or feeling that the partner can't be counted on as a reliable and responsible parent. For the survivor, this "discounting" of the partner as a co-parent often is due to hypervigilance and guilt because of trauma experiences involving children The partner may feel s/he must be the sole caregiver to their children if the survivor is uninvolved with their children (often due to trauma-related anxiety or guilt) or is overly critical, angry, or even abusive.
  
• They may find their sleep disrupted by the trauma survivor's sleep problems (reluctance to sleep at night, restlessness while sleeping, severe nightmares, or episodes of violent "sleepwalking." Family members also often find themselves having terrifying nightmares, afraid to go to sleep, or difficulty getting a full and restful night's sleep, as if they are reliving the survivor's trauma in their own feelings and sleep.
  
• Ordinary activities, such as going shopping or to a movie, or taking a drive in the car, may feel like reliving of past trauma when the survivor experiences trauma memories or flashbacks. The survivor may go into "survival mode" or on "automatic pilot," suddenly and without explanation shutting down emotionally, becoming pressured and angry, or going away abruptly and leaving family members feeling shocked, stranded, helpless, and worried.
  
• Trauma survivors with PTSD often struggle with intense anger or rage, and can have difficulty coping with an impulse to lash out verbally or physically -- especially if their trauma involved physical abuse or assault, war, domestic or community violence, or being humiliated, shamed and betrayed by people they needed to trust. Family members can feel frightened of and betrayed by the survivor, despite feeling love and concern.
  
• Addiction exposes family members to emotional, financial, and (less often, but not uncommonly) domestic violence problems. Survivors experiencing PTSD may seek relief and escape with alcohol or other drugs, or through addictive behaviors such as gambling, workaholism, overeating or refusing to eat (bulimia and anorexia). Addictions offer false hope to the survivor, by seeming to help for a short time but then making PTSD's symptoms of fear, anxiety, tension, anger, and emotional numbness far worse. Addictions may be very obvious, such as when binge drinking or daily use of drugs occurs. However they may involve lighter or less frequent episodes of "using" that are a problem because the survivor is dependent ("hooked") on the habit and can't cope without it.
  
• When suicide is a danger, family members face these unavoidable strains: worry ("How can I know is suicide is going to happen, and what can I do to prevent it?"), guilt ("Am I doing something to make her/him feel so terrible, and should I be doing something to make her/him feel better?"), grief ("I have to prepare myself every day for losing her/him. In many ways I feel and have to live my life as if s/he's already gone."), and anger ("How can s/he be so selfish and uncaring?"). Trauma survivors with PTSD are more prone to contemplate and attempt suicide than similar people who have not experienced trauma or are not suffering from PTSD. For the family there is good and bad news in this respect. The good news is that very few trauma survivors, even those with PTSD, actually attempt or complete suicide. The bad news is that family members with a loved with PTSD often must deal with the survivor's feeling sufficiently discouraged, depressed, and even self- blame and self-loathing to seriously and frequently contemplate suicide.

What can families of trauma survivors with PTSD do to care for themselves and the survivor?

• Continue to learn more about PTSD by attending classes, viewing films, or reading books.
  
• Encourage, but don't pressure, the survivor to seek counseling from a PTSD specialist.
  
• Seek personal, child, couples, or family counseling if troubled by "secondary" trauma reactions such as anxiety, fears, anger, addiction, or problems in school, work, or intimacy.
  
• Take classes on stress and anger management, couples communication, or parenting.
  
• Stay involved in positive relationships, in productive work and education, and with enjoyable pasttimes.

If physical (domestic) violence actually is occurring, family members such as spouses, children, or elders must be protected from harm.

SUGGESTED READINGS

• Patience Mason, Recovering from the War: A Woman's Guide to Helping Your Vietnam Vet, Your Family, and Yourself (Viking, 1990, ISBN 0-670-81587-X; Penguin, 1990, ISBN 0-14-009912-3)
• Aphrodite Matsakis, Vietnam Wives: Facing the Challenges of Life with Veterans Suffering Post Traumatic Stress (Sidran Press, 1996, ISBN 1-886968-00-4)
  

A PDF version of this fact sheet, suitable for printing and reproduction, is available.