PTSD & Relationships: Supporting a Partner With PTSD

What Is PTSD?

PTSD is a mental health condition that results from experiencing a traumatic event or being in a situation with prolonged exposure to traumatic events. Events include experiencing abuse, experiencing natural disasters, or traumatic accidents which led to serious injuries.

Symptoms of PTSD

Symptoms of PTSD can include:

• Distress when around or hearing about a traumatic event
• Night terrors and insomnia
• Flashbacks
• Intrusive thoughts
• Changes in sleep and appetite
• Avoidance tendencies
• Easily startled by certain sensory stimulation
• Risky behaviors
• Expressing rage, guilt, and shame in extreme ways
• Feeling numb, withdrawn, and depressed
• Feelings of hopelessness and low self esteem
• Dissociating
• Suicidal thoughts

PTSD & Relationships

Having a partner with PTSD can be difficult. Your partner may feel unpredictable to you, and maybe even to themselves, due to their constant feeling of being alert or on edge as a result of their trauma. It’s important for you and your partner to discuss PTSD and the symptoms that come along with it so that both of you are on the same page.

Being able to recognize your partner’s symptoms can help both of you heal from PTSD and improve your relationship. Important considerations for you to discuss with your partner include any changes you’ve noticed in your partner, the triggers that impact them, and what helps them feel calm and safe. If your partner’s changes go unaddressed, your relationship might become confusing, hurtful, and difficult to navigate together.

“Because PTSD affects all kinds of emotions, even positive emotions like warm, attachment-related emotions, people with PTSD can seem like they have changed,” says Dr. Royce Lee, MD, Associate Professor of Psychiatry and Behavioral Neuroscience at the University of Chicago. “But we know that when PTSD gets better with evidence-based psychotherapy, the whole range of human emotions improves. So, yes, be prepared for new challenges in the relationship. Be realistic about expectations that things stay the same. The good news is that treatment works.”

Why Is Understanding PTSD Important for Partners?

It’s vital to recognize changes in your partner as it can cause changes to the relationship. Therefore, managing the effects of PTSD reaches beyond just the person with the diagnosis.² Even if your partner does not have an official PTSD diagnosis, they can still exhibit many symptoms of PTSD.¹ This can be even more difficult to navigate depending on the type of trauma they’ve experienced – for example, if they had PTSD from a past relationship, they may be having trouble trusting you. Women experience additional risk factors for developing PTSD, which is also important for a partner to understand.

How Does PTSD Affect Relationships?

PTSD impacts relationships in several areas due to its wide range of symptoms. PTSD can affect your partner’s physical health, mental health, emotions, and behavior.³ Couples can fall into negative patterns, have difficulty expressing emotions, or create a downward spiral where PTSD symptoms and anxieties negatively affect relationship quality. This spiral, in turn, intensifies your partner’s symptoms.⁴

Here are eight ways that PTSD may affect your relationship:

1. Change, Loss, & Disappointment

It’s common for the partner of a trauma survivor to feel disappointed, particularly if the trauma occurs during the course of your relationship and your partner changes. You may feel disappointed that your partner no longer seems to be fully themselves or that your relationship isn’t turning out the way you’d hoped.

Prolonged disappointment can often lead to resentment as well, doubling down on the difficult aftereffects of trauma in your relationship.⁵ The immense changes that occur in your partner as a result of trauma often feels like a loss to you – loss of the person you loved and aspects of their personality that you loved about them.⁵

2. Difficulty Communicating

When your partner’s trauma first occurred, their brain did a lot all at once. One of the first actions it took was to shut down the Broca’s area, which is the part of the brain that puts thoughts and feelings into words.⁶ Your traumatized partner may literally be unable to communicate with you, either about the traumatic event or at times when they become triggered and feel unsafe, leading to a lack of communication in relationships.

Frustrated by their own inability to describe anything accurately, your partner may look for someone to blame or become angry that you can’t just “get it.”⁵ In turn, it can be easy for you to feel irritated by your partner’s blame-shifting or think that your partner doesn’t trust you with intimate information. This downward spiral can lead to conflict and overthinking that, without healthy communication skills, can sour a relationship quickly.

3. Withdrawal Leading to Detachment & Avoidance

The trauma survivor in your relationship may withdraw from you and from themselves. Often, their brain may feel disconnected from their body because the trauma feels like too much to handle.⁷ As a result, the person with PTSD may feel shame, embarrassed that they’re unable to cope with their feelings, or feel out of control over their own behaviors.⁵

4. Difficulties With Intimacy & Sex

When you feel intense emotions, whether fear or intimacy, the same regions of your brain light up and are activated. Your brain isn’t able to differentiate between whether it’s experiencing positive or negative emotional intensity.⁸

For the trauma survivor, sexual arousal becomes difficult to achieve because that response is so closely paired with the fear and horror associated with the traumatic event that led to their PTSD.⁸ Thus, as a protective measure, their brain begins to shut down, abruptly ending an otherwise romantic moment.⁷

5. Trust Issues

Intimacy requires trust. During a traumatic event, the trauma survivor’s sense of self often becomes shattered as the intensity of the fear of abandonment rises.⁹ The trauma survivor craves trust and safety from others but has a hard time believing that they can be safe, so they often go back and forth between engaging in intimacy and withdrawing completely.⁹

Given that relationships, and especially sexual intimacy, are built on a foundation of trust and emotional vulnerability, those suffering from PTSD often have less satisfaction in their relationships.¹⁰

6. Numbing Behaviors

Overwhelming feelings that result from PTSD can cause someone to do anything at all to escape from the present moment, and they may resort to numbing tactics. Numbing can look different for different people. Numbing tactics can span an entire spectrum, from obviously harmful like an eating disorder or substance misuse, or it can manifest as a hyper focus on things that seem benign, like developing a compulsive need to exercise – anything that can keep the painful feelings away.

However, because they cannot stay fully in the present, it remains impossible to feel “fully alive.”⁷ This cycle can keep your partner living in their head or in the past. Numbing in the present moment can make both happy occasions, like a wedding or graduation, and devastating occasions, like attending a funeral, all part of the same dull hum of emotions.

In turn, the constant numbness your partner may be feeling can further lead to shame about having felt nothing at important events and gatherings.

7. PTSD and Anger

It’s been hypothesized that anger in trauma survivors is a result of ruminating over the traumatic event, how it could have been prevented, or how it has changed life for them.¹¹ Anger can be directed internally, towards the self in the form of shame, or externally in the form of yelling or physical aggression.¹² Your partner may experience one or both of these forms of anger, perhaps even at the same time.

8. Hypervigilance

Trauma survivors, having had their foundation of basic safety in the world shattered, are usually in a state of high-alert afterwards, often called hypervigilance. For the trauma survivor, it is as if the traumatic event were “continually recurring in the present.”⁹

Thus, they may be easily startled, always on edge, and have difficulty sleeping. The body is on high-alert during both sleep and wakefulness, so your partner may have become a light sleeper or have intense dreams as their brain attempts to process the trauma.⁹