Relationship PTSD: Symptoms, Causes, & How to Heal

What Is Relationship PTSD?

Relationship PTSD, also referred to as post-traumatic relationship syndrome (PTRS), is a type of complex PTSD (CPTSD) that develops from experiencing a physically, sexually, and/or emotionally abusive relationship. Individuals who have relationship PTSD may experience intrusive thoughts, flashbacks, and nightmares related to memories of their intimate relationship.

What Is the Difference Between PTRS Vs. PTSD?

While PTRS is not currently defined as a diagnosable disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is classified as a type of complex PTSD (CPTSD). According to the DSM-5, PTSD typically results from a single-incident traumatic experience, whereas CPTSD, including PTRS, is caused by a chronic pattern of frequent traumatic events.

PTRS also differs from PTSD in reported symptoms. To qualify for a PTSD diagnosis, you have to exhibit symptoms from four different groupings: intrusive symptoms, avoidance, heightened arousal, and negative changes in thinking and mood. PTRS appears to have all of these except for avoidant symptoms and is often seen as a preoccupation or obsession about specific memories and experiences in the traumatic relationship.

Relationship PTSD Symptoms

Although relationship PTSD is not a formal subtype of PTSD, many of the symptoms are the same. Individuals with PTRS may have intrusive thoughts, memories, and nightmares regarding the emotional, sexual, and/or physical abuse they experienced. Some individuals may avoid people, places, or things that remind them of their relationship, but not all individuals experiencing PTRS will display avoidance behaviors.

Common symptoms of relationship PTSD include:^{1, 3}

• Intrusive thoughts about the trauma experienced in the relationship
• Feeling extreme distress when reminded of the trauma experienced in the relationship
• Night terrors about the trauma experienced in the relationship
• Increased irritability with little or no provocation
• Insomnia, particularly difficulty falling or staying asleep
• PTSD-induced flashbacks of the relationship
• Hypervigilance or being “on guard” at all times
• Difficulty trusting others or socializing
• Loneliness or isolation from loved ones
• Complete avoidance of dating or jumping into a new relationship
• Shame, guilt, or self-blame
• Sexual dysfunction
• Feeling that the world is unsafe
• Fawning to avoid conflict and ensure safety

Relationship PTSD can be difficult to recognize because it typically develops from extended betrayal trauma rather than from one traumatic event. Oftentimes, a person might not notice the symptoms until after the relationship ends. PTRS often feels like a pervasive sense of feeling unsafe and out of control. They may also experience extreme shame and guilt that feel like it come out of nowhere and is difficult to get rid of.

What Causes Relationship PTSD?

Relationship PTSD can develop from physical abuse, emotional abuse, and/or sexual abuse. PTRS does not typically develop after one incident of abuse but rather several incidents over the course of a relationship.

Relationship PTSD can be caused by:⁴

• Physical abuse: Defined as any “deliberately aggressive or violent behavior by one person toward another.” This can include pushing, punching, kicking, biting, slapping, or using physical size and stature to inhibit someone’s movements and free will.
• Emotional abuse: Defined as any non-physical behavior with the intent to control, manipulate, degrade, or create dependence on the abuser. These behaviors can be harder to identify as they can be subtle but can include jealousy, insults, yelling, obsessive monitoring, and threats.
• Sexual abuse: Defined as any unwanted and nonconsensual sexual contact or act. These behaviors have a wide range of appearances and are often done by forceful or coercive actions or communication. Sexual abuse is often seen in relationships where a power differential is present.

How to Heal From Relationship Trauma

Healing from PRTS can be difficult and multifaceted, demanding time, patience, and the willingness to release past pain. Healing from trauma usually begins with therapy, where a person can begin to understand what happened, challenge their negative beliefs, and develop coping skills for their symptoms. Prioritizing self-care and your physical and emotional health is essential. Additionally, activities such as journaling and mindfulness can help with functioning day-to-day.

Here are eight tips and some worksheets to help you heal from relationship PTSD:

1. Learn to say no: Individuals experiencing relationship PTSD often lose their sense of self and fear standing up for themselves and setting boundaries in relationships. Practicing advocating for yourself, including saying no to others, will help re-establish a sense of independence and increase your self-worth.
2. Increase or strengthen social supports: Social isolation and withdrawal are common symptoms of relationship PTSD and typically hinder a person’s healing process. Connecting with or strengthening friendships and other close relationships will improve your emotional health and support recovery
3. Engage in self-care: Guilt and shame tend to accompany relationship PTSD, which will decrease a person’s self-esteem and self-worth. Taking time to engage in activities that feel valuable and bring you comfort and joy will improve your view of self and overall mental health. Try establishing a bedtime routine, going on walks, exercising, or experimenting with a new hobby.
4. Focus on things within your control: When a traumatic relationship ends, anxiety can increase and lead us to be more rigid with our expectations of ourselves and others. Ask yourself, “Is this issue something I have control over?” If not, try to release yourself from the responsibility and return to the present, noticing what you can do for yourself.
5. Take a break from dating: Jumping back into the dating pool can feel like a quick way to heal, but it can also leave us feeling confused, distrustful, and low in self-worth. Take some time to reconnect with yourself and heal internally before getting into a new intimate relationship.
6. Seek out trauma therapy: Like all other forms of PTSD, relationship PTSD can be extremely difficult to heal from without clinical support. Look for a trauma-informed therapist who you feel safe with to add more resources to your recovery journey.
7. Start a journal: Getting thoughts out of your head and onto paper (or screen!) has been shown to help put things into perspective. If you’re not already a journaler, start slow and incorporate it in a way that’s not too difficult. You can find journal prompts for PTSD online if you need help getting started.
8. Practice self-kindness: We often internalize negative self-talk and judgmental messaging from a traumatic relationship. Try incorporating self-kindness practices, like positive affirmations and guided meditation for PTSD, to decrease self-judgment and increase gentleness toward yourself.

Impact of Relationship PTSD

According to Dr. McGee, “When we suffer abuse or neglect in relationships, our brain registers that relationships can be dangerous. If we don’t process and integrate what happened and heal our hurt and shame, relational trauma can cause us to avoid intimacy out of fear of being hurt again or a belief that we are not lovable and worthy of intimacy. Alternatively, some people retraumatize themselves by once again engaging with hurtful or neglectful people out of a compulsion to undo past trauma or because being hurt is familiar and something one unconsciously feels one deserves in relationships.”

However, healing from relationship PTSD can also open up the opportunity for post-traumatic growth. Dr. McGee explains, “If we process and integrate what happened to us, then trauma in relationships can make us wiser. It can help us learn to be more discerning, cautious, protective, and assertive. It can help us learn how to trust skillfully.”

When to Seek Professional Support

Individuals with relationship trauma often develop hyper-independence, which can make them afraid of asking for support from other people.² It is crucial to push past those feelings because rates of suicide attempts or ideation, self-harm, and substance abuse are elevated in people with PTRS. It’s important to seek appropriate help as soon as you recognize the issue.²

An online therapist directory such as Grow Therapy is a great way to find a trauma-informed therapist. It offers many detailed filters, so you can find a relationship trauma specialist in your area who takes your insurance. If you prefer to see a therapist remotely, Octave Health provides therapists who specialize in relationship trauma and healing from infidelity. If you are struggling with more intense depression, self-harm, or suicidal ideation, you may want to explore medication options. Talkiatry is an online psychiatry service that provides very comprehensive care for individuals with PTSD.

Therapy for Relationship PTSD

There are many different types of therapy for trauma and individuals with relationship PTSD. Every person is unique, and it is important to find the type of therapy that works for you.

Effective treatment options for relationship PTSD include:⁵

• Prolonged exposure therapy (PE): PE is typically provided over a period of about three months with weekly individual sessions,” each 60 to 120 minutes long.⁶ In PE, you will be exposed to trauma-related stimuli that are gradually more difficult. The goal is that you are able to approach trauma-related situations without triggering your body’s fear response.
• Cognitive processing therapy (CPT): CPT is a 12-week-long therapy protocol wherein your therapist will help you challenge the beliefs associated with your trauma.⁷
• Eye movement desensitization and reprocessing (EMDR): EMDR for PTSD works to reduce the intensity of trauma-related memories. In EMDR, your therapist will have you focus on the trauma briefly while using bilateral stimulation—this could be tapping, tracking the therapist’s fingers with your eyes, or a noise in one ear and then the other. The total number of sessions averages between 6-12.⁸
• Trauma-focused CBT (TF-CBT): Trauma-focused CBT is another treatment model that is typically used with children and adolescents suffering from the consequences of interpersonal trauma or PTRS. TF-CBT works with the child or adolescent and their caregivers to alleviate trauma symptoms over the course of 8-25 sessions.⁹

Helping a Partner Who Has Experienced Relationship Trauma

Dating someone with PTSD from a previous relationship can be very difficult. Their behaviors may seem bizarre to you, and they may lash out at you for no apparent reason. It is important to recognize that their reactions are about past traumas and not about the present scenario. Try to understand where they are coming from and not take their words and/or actions personally.

While being understanding is important, it is equally important to ensure that you set boundaries around their behaviors. If their behaviors are causing you harm, it is not ok. If you find that your partner’s PTSD is beginning to impact your relationship or well-being, you may want to explore couples counseling or begin individual therapy on your own.