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Relationship PTSD: Symptoms & How to Heal From PTRS

Published: May 17, 2022 Updated: January 19, 2023
Published: 05/17/2022 Updated: 01/19/2023
Headshot of Meagan Turner, MA, APC, NCC
Written by:

Meagan Turner

MA, APC, NCC
Headshot of Dr. Kristen Fuller, MD
Reviewed by:

Kristen Fuller

MD
  • What Is Relationship PTSD?Definition
  • What Does Relationship PTSD Feel Like?Signs
  • What Causes Relationship PTSD?Causes
  • Healing From Relationship TraumaHow to Heal
  • Final Thoughts on Relationship-Based PTSDConclusion
  • Additional ResourcesResources
Headshot of Meagan Turner, MA, APC, NCC
Written by:

Meagan Turner

MA, APC, NCC
Headshot of Dr. Kristen Fuller, MD
Reviewed by:

Kristen Fuller

MD

Relationship PTSD, or post-traumatic relationship syndrome (PTRS) as researchers have proposed calling it, refers to the response a person may have to one or more exposures to a traumatic event within the context of a relationship with an intimate partner.1 Within intimate partnerships, the types of relational abuse that have been shown to leave lasting marks are verbal, physical, emotional/psychological, or sexual.2

Recovering from Relationship PTSD isn’t something you have to do alone. BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $60 per week. Complete a brief questionnaire and get matched with the right therapist for you.

Choosing Therapy partners with leading mental health companies and is compensated for marketing by BetterHelp

Visit BetterHelp

What Is Relationship PTSD?

Relationship PTSD is a proposed subcategory of PTSD, where the main signifier is the type of stressor causing PTSD and the emotional reaction to it.3 In other words, PTSD that results exclusively from an abusive relationship that does not necessarily meet all of the diagnostic criteria for a PTSD diagnosis but may amount to post-traumatic relationship syndrome (PTRS).

PTRS results in some PTSD symptoms, but often with more intensely emotional reactions that often lead to negative social interactions.2 Due to the slow and insidious nature of PTRS, you might not notice symptoms until after the relationship ends. The relational patterns and relationship itself, rather than a single event, become the trauma. You may notice that you have lower self-esteem, blame yourself for relational troubles, feel more insecure than you once did, or overthink in relationships.2 PTSD and PTRS share their foundational impact: A belief after experiencing the trauma that the world is unsafe.

Dr. Michael McGee, Board Certified, General Adult Psychiatry, Addiction Psychiatry, Psychosomatic Medicine“When we suffer abuse or neglect in relationships, our brain registers that relationships can be dangerous. 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. 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.” – Dr. Michael McGee, Board Certified in General Adult Psychiatry, Addiction Psychiatry, and Psychosomatic Medicine

What Does Relationship PTSD Feel Like?

Relationship PTSD can be difficult to recognize because it typically happens over a long period of time instead of one traumatic event (the difference between Complex PTSD and typical PTSD). As a result, PTRS can include a pervasive sense of feeling unsafe, out of control, shame or guilt, and thoughts that feel like they come out of nowhere and are difficult to get rid of.

Intrusive Symptoms of PTRS

Intrusive symptoms are symptoms related to re-experiencing trauma, including:1,4

  • Thoughts about the trauma that feel like they come out of nowhere
  • Flashbacks or feeling like you’re reliving the experience(s) in the form of images, intrusive thoughts, or daydreams
  • Nightmares or dreams about the trauma, whether in the context of the dream or just consistent negative or scared feelings in the dreams
  • Feeling extreme distress when reminded of the trauma by either the person in the relationship or a reminder of the perpetrator
  • Emotional responses that are overblown considering the current emotional stressor

Arousal Symptoms of PTRS

Arousal symptoms are symptoms related to the fear response, including:

  • Increased irritability with little or no provocation
  • Insomnia, particularly difficulty falling or staying asleep
  • Hypervigilance or being “on guard” at all times but particularly when reminded of the trauma

Relational Symptoms of PTRS

Relational symptoms are symptoms that create stress in other relationships, including:

  • Difficulty trusting others or socializing
  • Loneliness or isolation
  • Jumping into a new relationship
  • Shame, guilt, or self-blame—all of which are common in trauma bonding
  • Sexual dysfunction
  • Feeling that the world is unsafe

Recovering From Infidelity Or A Betrayal Of Trust

Individual Therapy – Whether you’re trying to move on or rebuild a relationship, a licensed therapist from BetterHelp can guide you. BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. Visit BetterHelp


Relationship Guidance For Affair Recovery (Partner participation optional.) – You can rebuild trust and improve your relationship! Ritual combines video sessions led by a relationship expert, with short online activities. 14-day money-back guarantee. Start now


Couples Therapy – Work together to restore trust and rekindle loving feelings. Video and text based couples counseling start at $50 per week. Try Online-Therapy

Choosing Therapy partners with leading mental health companies and is compensated for marketing by BetterHelp, Ritual, and Online-Therapy.

What Causes Relationship PTSD?

The trauma that causes relationship PTSD could be from physical, emotional, sexual abuse, but unlike traditionally-diagnosed PTSD, occurs only with a partner within an intimate relationship rather than witnessing or experiencing a traumatic incident occurring outside of the context of an intimate relationship.

What constitutes a traumatic exposure that may result in PTSD from an abusive relationship? There is not just one incident, but rather several incidents over the course of time in an abusive relationship that lead to PTRS.

Any incidents of abuse or relationship trauma may lead to PTSD, including:

  • Unhealthy relational patterns: Belittling, gaslighting, controlling, or criticizing repeatedly can constitute emotional abuse.
  • Physical abuse or domestic violence: Punching, hitting, or any form of purposefully injuring or attempting to cause harm to a partner is abuse.
  • Sexual abuse: Even within the context of an intimate relationship, any form of nonconsensual sex, or sexual coercion, is considered abuse.1

With this in mind, everyone responds to traumatic exposures differently, and what you may experience as traumatic may not be traumatic for the next person.

Healing From Relationship Trauma

If anything you’ve read about relationship PTSD sounds familiar to you and your experience, know that there is help available. Because relational, interpersonal trauma is more likely to lead to a clinical PTSD diagnosis than non-interpersonal trauma such as a natural disaster, seeking out an appropriately trained and trauma-informed therapist is crucial.5 Rates of suicide attempts or ideation, self-harm, and substance abuse are elevated in studies of people with PTRS, so it’s important to seek appropriate help as soon as you recognize an issue.2

McGee also mentions, “The way to heal from relational trauma is to engage in safe, loving relationships with safe, loving people. It is true that ‘love heals.’ We heal our relational love wounds through a combination of loving ourselves and borrowing the love of others. When we engage in loving and being loved, we create the opportunities for ‘corrective emotional experiences’ that cause a revision of our emotional/relational limbic system. There is a revision of our sense of self as lovable people and a development of the capacity to feel safely and harmoniously connected to others.”

The model for treatment outlined by the author who coined the term “post-traumatic relationship syndrome” argues the best treatments for relationship PTSD are:6

  • Prolonged Exposure (PE): PE is “typically provided over a period of about three months with weekly individual sessions,” each 60 to 120 minutes long.7 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.8
  • 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 6-12.9
  • 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.10

Helping a Partner Who Has Experienced Relationship Trauma

McGee encourages, “If you are the partner of someone with a significant love wound or ‘relational PTSD,’ I recommend couples counseling. This creates a safe holding space for working through distortions, misperceptions, and miscommunications. It also creates a safe practice forum for developing the capacity for emotional intimacy. When dating someone with PTSD, they may misperceive you at times through a trauma-based negative schema. They may suffer extreme reactions to normal misattunements. Take their reactions seriously, but not personally. Practice patience, understanding, and compassion. Schedule times to talk about conflicts when you and your partner are calm and collected and not in the heat of the moment.”

Finding a Therapist

In PTRS, people are often afraid and alone but need support from other people.2 For help finding a therapist, an online therapist directory is a great way to search for a therapist with experience in your specific concerns. Not only can a therapist help to alleviate feelings of alienation, but a therapist can also support your healing process toward post-traumatic growth, resulting in seeing your own strength, cultivating more positive thoughts, and moving toward healthier interpersonal relationships.2

Final Thoughts on Relationship-Based PTSD

While no one’s story or trauma is the same, you’re not alone in what you’ve experienced. Reaching out to a therapist, or even a trusted friend or family member, is a great way to start feeling better and finding a path forward. There are trained professionals available who want to help you regain your sense of self and who are able to hold on to hope for you to heal.

Additional Resources

Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for marketing by the companies mentioned below.

BetterHelp (Online Therapy) – Whether you’re feeling uneasy in your relationship, trying to rebuild trust, or working on forgiveness – a licensed therapist from BetterHelp can guide you. BetterHelp will ask you about the things you want to work on and what you’re looking for in a therapist. Visit BetterHelp

Online-Therapy.com (Online Couples Therapy) – Do you and your partner want to work together to save the relationship? Are there children involved? Do you still love each other? Couples therapy will provide a supportive environment. Get Started

Ritual (Relationship Guidance) – Ritual provides guidance to individuals working to improve their relationship, or couples working jointly. Ritual combines video sessions led by a relationship expert, with short online activities. 14-day money-back guarantee. Try Ritual

OurRelationship (Free Couples Course) – OurRelationship has been proven to help couples improve communication, intimacy, and trust. 94% would recommend it to a friend. Get Started

Relationship Newsletter (Free From Choosing Therapy) – A newsletter for those interested in improving relationships. Get helpful tips and the latest information. Sign Up

Choosing Therapy partners with leading mental health companies and is compensated for marketing by BetterHelp, Online-Therapy.com, Ritual, OurRelationship, and Mindfulness.com

For Further Reading

  • If you are currently in an abusive relationship, please contact or view resources from the National Domestic Violence Hotline. They have resources from healthcare to legal help to someone to talk to 24/7.
  • If you’re interested in learning more about the effects trauma can have on you, read The Body Keeps the Score by Bessel van der Kolk. Take it in chunks, as it is a tough read, but it will help you better understand what you’re experiencing and why your body has reacted the way that it has.
  • If you’re more interested in listening to content than reading about it, check out the podcast Other People’s Problems. You can hear real therapy sessions with a therapist, and there are certain episodes where clients process interpersonal trauma. The therapist also uses some of the treatments discussed above in session, including EMDR, and teaches the listener about them.
  • Mental Health America
  • National Alliance on Mental Health
  • MentalHealth.gov
10 sources

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • Vandervoort, D., & Rokach, A. (2003). Posttraumatic relationship syndrome: The conscious processing of the world of trauma.Social Behavior & Personality: An International Journal, 31(7), 675–686. https://doi.org/10.2224/sbp.2003.31.7.675

  • Orzeck, T., Rokach, A., & Chin, J. (2010). The effects of traumatic and abusive relationships. Journal of Loss & Trauma, 15(3), 167–192.

  • Vandervoort, D., Rokach, A. (2004). Abusive relationships: Is a new category for traumatization needed? Current Psychology, (23), 68–76. https://doi.org/10.1007/s12144-004-1009-y

  • Carol A Lambert. (2016). Women with controlling partners: Taking back your life from a manipulative or abusive partner. New Harbinger Publications.

  • Bryant, R. A. (2019). Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges. World Psychiatry, 18(3), 259–269. https://doi-org.proxygsu-grl1.galileo.usg.edu/10.1002/wps.20656

  • Understanding PTSD Treatment. National Center for PTSD. (n.d.). Retrieved October 29, 2021, from https://www.ptsd.va.gov/PTSD/understand_tx/index.asp

  • Prolonged exposure (PE). American Psychological Association. (n.d.). Retrieved October 29, 2021, from https://www.apa.org/ptsd-guideline/treatments/prolonged-exposure

  • Cognitive Processing Therapy (CPT). American Psychological Association. (n.d.). Retrieved October 29, 2021, from https://www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapy

  • Eye movement desensitization and reprocessing (EMDR) therapy. American Psychological Association. (n.d.). Retrieved October 29, 2021, from https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing

  • About Trauma-Focused Cognitive Behavior Therapy (TF-CBT). Trauma-Focused Cognitive Behavioral Therapy (n.d.). https://tfcbt.org/about/

update history

We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.

  • Originally Published: November 10, 2021
    Original Author: Meagan Turner, MA, APC, NCC
    Original Reviewer: Kristen Fuller, MD

  • Updated: May 17, 2022
    Author: No Change
    Reviewer: No Change
    Primary Changes: Updated for readability and clarity. Reviewed and added relevant resources.

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Headshot of Meagan Turner, MA, APC, NCC
Written by:

Meagan Turner

MA, APC, NCC
Headshot of Dr. Kristen Fuller, MD
Reviewed by:

Kristen Fuller

MD
  • What Is Relationship PTSD?Definition
  • What Does Relationship PTSD Feel Like?Signs
  • What Causes Relationship PTSD?Causes
  • Healing From Relationship TraumaHow to Heal
  • Final Thoughts on Relationship-Based PTSDConclusion
  • Additional ResourcesResources
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