Understanding the Link: How PTSD Affects Relationships and Intimacy
Posttraumatic stress disorder (PTSD) is a complex mental health condition that can occur after experiencing an intense, and even life-threatening, traumatic event (DSM-5, 2013). Although traditionally thought of as individually experienced, PTSD also impacts relationships, especially with a romantic partner.
PTSD manifests with various combinations of symptoms, including flashbacks, intrusive thoughts and memories, nightmares, avoiding contexts that trigger re-experiencing of the event, emotional detachment, irritability, substance abuse, and hopelessness. Classic symptoms like flashbacks can present problems for close relationships, as the other person may fear for their own safety and feel unsure of how to help.
However, certain symptoms are most associated with relationship dissatisfaction, particularly difficulty with experiencing positive emotions, irritability, insomnia, and concentration problems. For example, trouble sleeping or nightmares can lead couples to sleep apart. The partner with PTSD may struggle to enjoy routine positive activities, such as going to see a movie, causing pleasurable experiences within the couple to decline or cease altogether. Because of the partner’s altered emotional state, they may feel unable to experience positive feelings altogether, which will naturally reduce those in the relationship.
Communication Challenges: Navigating PTSD's Impact on Relationship Dynamics
Trauma undermines the ability to trust and consequently disrupts relationships by causing a cycle of distance and disconnection (Monson et al., 2010). Both partners tend to report less emotional and physical intimacy.
This is partially due to the fact that PTSD can lead to a reduced desire to communicate in general or to share your struggles with significant others. Partners with PTSD may feel a range of emotions when they are unable to meet their partner’s bid for connection, such as sadness, fear, and guilt. The partner without PTSD may experience a phenomenon called ambiguous loss (Boss, 1999) that results in a lack of clarity about roles and responsibilities due to their partner’s psychological absence. This may lead to partner burden, which can further strain the relationship.
Significant others and family members may go to great lengths to manage or reduce symptoms of PTSD (Fredman et al., 2014). For example, partners may attempt to decrease noise levels, avoid intense conversations to avert conflict, or limit social engagements (Monson et al., 2010). It is not uncommon for partners to encourage the person with PTSD to share details of the traumatic event and attempt to provide an empathic, safe space to process. In some cases, this can be beneficial if the person with PTSD feels understood; however, it could backfire if they react negatively to the receiving partner’s response or if the receiving partner is traumatized from hearing about the details.
Rebuilding Trust: Healing Wounds and Restoring Connection in PTSD-Affected Relationships
In general, relationships have the most satisfaction when the person with PTSD is actively seeking help from a mental health professional, especially early in the progression of the condition (Monson et al., 2010). Partners may also seek support to manage distress that may arise.
Overall, PTSD disrupts several key aspects of relationship functioning: safety, trust, respect, and intimacy. Evidence-based treatment for PTSD, in part, addresses unhelpful emotional processing. Working through challenging emotions like anger, shame, and grief may allow a person with PTSD to engage in difficult conversations that may evoke those emotions. While individual therapy may also serve in healing the couple, there are also evidence-based treatments that focus on healing the relationship.
Supporting Your Partner: Strategies for Providing Emotional and Practical Support
The progression of PTSD is most favorable when the person has enough perceived support immediately after the event. Social support affects one’s emotional state and promotes coping, which aids in recovery.
It is important to note that support that is perceived in a negative way is more harmful than positive support is positive. Given the challenges that come with a relationship in which one partner has PTSD, it is of utmost importance for the partner without PTSD to have an adequate support system to prevent burnout.
Research has shown that a romantic partner’s perception of the severity of PTSD can be healing in and of itself. That is, believing in and expressing your understanding of the severity of your partner’s PTSD symptoms and the event that caused them can promote positive feelings in your partner, which benefits the relationship as a whole.
Partners can also provide support for specific symptoms, such as flashbacks. If your partner freezes during a flashback, understanding the nature of PTSD can help you normalize the response for your partner and increase their experiential awareness of alternative responses.
Seeking Professional Help: Therapy Options for Couples Dealing with PTSD in Relationships
When dealing with PTSD in a relationship, it is critical to seek help sooner rather than later. Research shows a clear link between chronic PTSD and declining relationship satisfaction over time as partners miss out on having critical needs met and experience burnout.
Couple interventions have been designed to address the impact of PTSD on the relationship. Cognitive-behavioral conjoint therapy (CBCT) for PTSD addresses both individual symptoms for each partner, as well as relationship problems (Monson et al., 2008). The treatment consists of three phases: teachings about PTSD and relationships and cultivating safety; communication skills and exercises to promote healthy approaching; and cognitive interventions to change interpretations and beliefs related to the trauma that negatively affect the relationship.
Structured Approach Therapy (SAT; Sautter et al., 2015) provides information about PTSD, strategies to enhance motivation for treatment, and skills to reinforce positive emotions and intimacy. Partners are also given resources for helping those with PTSD approach rather than avoid difficult situations. At the end of the treatment, the couple is guided in a discussion about the traumatic event and thoughts, emotions, and memories that may challenge the patient or relationship.
Emotionally Focused Couples Treatment (EFCT) focuses on understanding and processing emotions pertaining to the event and overall attachment styles that impact relationships and communication (Johnson, 2005). Three main stages focus on stabilizing the couple and sharing negative interaction patterns; using acceptance and communication to build skills; and developing coping skills and more helpful interaction patterns.
Get Started on Your Healing Journey Today
At Madison Park Psychological Services, we are here to walk alongside you on that path. Whether you’re in New York City or seeking therapy online, our psychologists are ready to help you heal at the root and reconnect with yourself. Contact us today to schedule a consultation and take the first step toward a more fulfilling life.
Author:
Jennifer Gittleman, Ph.D.
Life can be hard; you don’t have to navigate it alone. You should feel proud for making the leap to help yourself. My goal as your therapist is to reduce your distress and help you live the life you desire. I will provide you a safe space to heal. You deserve a life filled with meaning rather than suffering – I can help you get there.
Jennifer Gittleman, Ph.D.
Life can be hard; you don’t have to navigate it alone. You should feel proud for making the leap to help yourself. My goal as your therapist is to reduce your distress and help you live the life you desire. I will provide you a safe space to heal. You deserve a life filled with meaning rather than suffering – I can help you get there.
