How does PTSD affect family members?
Because the symptoms of PTSD and other trauma reactions change how a trauma survivor feels and acts, traumatic experiences that happen to one member of a family can affect everyone else in the family. When trauma reactions are severe and go on for some time without treatment, they can cause major problems in a family. This fact sheet will describe family members' reactions to the traumatic event and to the survivor's symptoms and behaviors.
It's no wonder that family members react to the fact that their loved one has gone through a trauma. It's upsetting when someone you care about goes through a terrible ordeal. And it's no wonder that people react to the way a traumatized family member feels and acts. Trauma symptoms can make a family member hard to get along with or cause him or her to withdraw from the rest of the family. It can be very difficult for everyone when these changes occur. Just as people have different reactions to traumatic experiences, families also react differently when a loved one is traumatized. In the section below, many different types of reactions are described. A family may experience many of these reactions, or only a few. All of the reactions described, however, are common in families who have had to deal with trauma.
One of the first reactions many family members have is sympathy for their loved one. People feel very sorry that someone they care about has had to suffer through a terrifying experience. And they feel sorry when the person continues to suffer from symptoms of PTSD and other trauma responses. It can be helpful for the person who has experienced the trauma to know that his or her family members sympathize with him or her, especially just after the traumatic event occurs.
Sympathy from family members can have a negative effect, though. When family members' sympathy leads them to "baby" a trauma survivor and have low expectations of him or her, it may send a message that the family doesn't believe the trauma survivor is strong enough to overcome the ordeal. For example, if a wife has so much sympathy for her husband that she doesn't expect him to work after a traumatic experience, the husband may think that she doesn't have any confidence in his ability to recover and go back to work.
One source of depression for family members can be the traumatic event itself. All traumas involve events where people suddenly find themselves in danger. When this happens in a situation or place where people are used to feeling safe, just knowing the event happened could cause a person to lose faith in the safety and predictability of life. For example, if a woman gets mugged in the parking lot of a neighborhood shopping center, her family may find they feel depressed by the idea that they are not really as safe as they thought they were, even in their own neighborhood.
It can also be very depressing when a traumatic event threatens a person's ideals about the world. For instance, if a man gets traumatized in combat by seeing someone tortured, it can be very depressing to know that people are capable of doing such cruel things to each other. Before the man was faced with that event, he may have been able to believe that people are basically good and kind.
Depression is also common among family members when the traumatized person acts in a way that causes feelings of pain or loss. There may be changes in family life when a member has PTSD or other symptoms after trauma. The traumatized person may feel too anxious to go out on family outings as he or she did in the past. The traumatized person may not be able to work because of PTSD symptoms. As a result, the family income may decrease and the family may be unable to buy things and do things the way they did before the traumatic event. A husband may feel unloved or abandoned when-because of her depression-his traumatized wife withdraws emotionally and avoids being intimate or sexual. Children whose father can't be in crowds because of combat trauma may feel hurt that their father won't come to see them play sports. When PTSD lasts for a long time, family members can begin to lose hope that their loved one or their family will ever get "back to normal."
Fear and Worry
Knowing that something terrible can happen "out of the blue" can make people very fearful. This is especially true when a family member feels unsafe and often reminds others about possible dangers. Very often, trauma survivors feel "on edge" and become preoccupied with trying to stay safe. They may want to get a guard dog, or put up security lights, or have weapons in the house in order to protect themselves and their family members. When one person in a family is very worried about safety, it can make everyone else feel unsafe too. However, something that helps one person feel safe-like a loaded weapon under the bed-may make another person feel unsafe.
Family members can also experience fear when the trauma survivor is angry or aggressive. As described above, trauma survivors can become angry and aggressive automatically if they feel they are in danger. Trauma survivors may also become angry and aggressive because they are frustrated that they have trauma symptoms, or because they learned to be aggressive as a way to protect themselves in the trauma situation. No matter what the reason for the anger and aggression, it naturally makes family members fearful.
Many trauma symptoms can cause family members to worry. A wife might worry that her traumatized husband who becomes angry and violent at the least provocation will be injured in a fight or get in trouble with the police. A daughter may worry that her mother will make herself ill by drinking heavily as a result of a traumatic event. A man's inability to keep a job because of trauma-related problems may cause his family to worry constantly about money and the future.
Just as trauma survivors are often afraid to address what happened to them, family members are frequently fearful of examining the traumatic event as well. Family members may want to avoid talking about the trauma or trauma-related problems, even with friends. People who have experienced trauma hope that if they don't talk about the problem, it will go away. People also don't wish to talk about the trauma with others because they are afraid that others won't understand or will judge them. Sometimes, if the traumatic event is one associated with shame, such as rape, family members may avoid talking about the event and its effects because of social "rules" that tell us it is inappropriate to talk about such things. Family members may also not discuss the trauma with others because they fear it will bring their loved one more shame.
Family members may avoid the things that the trauma survivor avoids because they want to spare the survivor further pain, or because they are afraid of his or her reaction. For example, the wife of a combat veteran who is anxious about going out in public may not make plans for family outings or vacations because she is afraid to upset her husband. Though she doesn't know what she can do to "fix" the problem, she does know that if the family goes to a public event, the husband will be anxious and irritable the whole time.
Guilt and Shame
Family members can feel guilt or shame after a traumatic event for a number of reasons. A family member may experience these feelings if he or she feels responsible for the trauma. For instance, a husband whose wife is assaulted may feel guilt or shame because he was unable to protect her from the attack. A wife may feel responsible for her husband's car accident if she thinks she could have prevented it if she had gotten the car's brakes fixed. A family member may feel guilt and shame if he or she feels responsible for the trauma survivor's happiness or general well-being, but sees no improvement no matter how hard he or she tries to help. Sometimes, after years of trauma-related problems in a family, a family member may learn about posttraumatic stress disorder and realize that this is the source of their family problems. The family member may then feel guilty that he or she was unsupportive during the years.
Anger is a very common problem in families that have survived a trauma. Family members may feel angry about the trauma and its effect on their lives. They may be angry at whomever they believe is responsible for the traumatic event (this includes being angry at God). They can also feel anger toward the trauma survivor. Family members may feel that the survivor should just "forget about it" and get on with life. They may be angry when their loved one continues to "dwell" on the trauma. A wife may be mad because her husband can't keep a job or because he drinks too much or won't go with her to social events or avoids being intimate with her or doesn't take care of the kids. Family members may also feel angry and irritable in response to the anger and irritability the trauma survivor directs at them.
Sometimes family members have surprisingly negative feelings about the traumatized family member. They may believe the trauma survivor no longer exhibits the qualities that they loved and admired. A person who was outgoing before a trauma may become withdrawn. A person who was fun loving and easy-going before a trauma may become ill tempered. It may be hard to feel good toward a person who seems to have changed in many ways. Family members may also respond negatively to behaviors that develop following a trauma. For instance, family members may be disgusted by a woman's over-drinking in response to a trauma.
Family members may also have negative feelings about the survivor that are directly related to the traumatic event. For example, a wife may no longer respect her husband if she feels he didn't behave bravely during a traumatic event. A husband whose wife was raped may feel disgusted about what happened and wonder if she could have done something to prevent the assault. A son may feel ashamed that his father didn't fight back when he was beaten during a robbery. Sometimes people have these negative feelings even when they know that their assessment of the situation is unfair.
Drug and Alcohol Abuse
Drug and alcohol abuse can become a problem for the families of trauma survivors. Family members may try to escape from bad feelings by using drugs or drinking. A child or spouse may spend time drinking with friends to avoid having to go home and face an angry parent or spouse. On the other hand, spouses sometimes abuse drugs or alcohol to keep their loved ones "company" when they're drinking or using drugs to avoid trauma-related feelings.
Sleep can become a problem for family members, especially when it is a problem for the trauma survivor. When the trauma survivor stays up late to avoid going to sleep, can't get to sleep, tosses and turns in his or her sleep, or has nightmares, it is difficult for family members to sleep well. Often family members are also unable to sleep well because they are depressed and/or they are worried about the survivor.
Family members of trauma survivors can develop health problems for a number of reasons. Bad habits, such as drinking, smoking, and not exercising may worsen as a result of coping with a loved one's trauma responses. In addition, many illnesses can be caused by trauma-related stress if it goes on for an extended period of time. When family members constantly feel anxious, worried, angry, or depressed, they are more likely to develop stomach problems, bowel problems, headaches, muscle pain, and other health problems.
What can families do to care for themselves and the survivor?
Trauma survivors and their families often don't know what to do to care for themselves. First, it is important to continue to learn more about trauma and its effects. Some books are listed below that may be helpful. For veterans, educational classes may be available through a local VA Medical Center or VA Readjustment Counseling Service Vet Center (see below).
Treatment for PTSD is available in most communities through psychologists and social workers in private practice. Insurance may help pay for this treatment. Community mental-health centers and private mental-health clinics (such as those run by charitable or church organizations) may also provide treatment, sometimes at low or reduced fees. To find phone numbers for mental-health professionals, you can look in the yellow pages of your local phone book under "Mental Health Services" and "Therapists."
Veterans can receive treatment at a local VA Medical Center or VA Readjustment Counseling Service Vet Center. Insurance may help pay for treatment at a VA center, and treatment for some veterans is provided at no cost (when their PTSD is determined to be service-related). To find phone numbers for local VA Medical Center or VA Readjustment Counseling Service Vet Centers, you can look in the "Government Pages" of your local phone book under "Veterans Affairs". In that section, look under "Medical Care" for a VA Medical Center phone number and under "Vet Center" for the Readjustment Counseling Service Vet Center phone number.
Family members of a traumatized person should find out as much as they can about PTSD and get help for themselves, even if their loved one doesn't seek treatment. Family members can encourage the survivor to inquire about education and counseling, but they should not pressure or try to force their loved one to get help. Classes or treatment may also be useful for stress and anger management, addiction, couples communication, or parenting.
While in the process of getting help, if family members feel comfortable, they should let their loved one know that they are willing to listen if the survivor would like to talk about his or her trauma. But the family should stop if anyone gets too upset or overwhelmed. If everyone is able, it is also important to talk about how the trauma is affecting the family and what can be done about it.
By Eve B. Carlson, Ph.D. and Joseph Ruzek, Ph.D.
MHC is grateful for the following information provided by the National Center for PSTD.
Allen, J. G. (1995). Coping with Trauma: A Guide to Self-Understanding. Washington, DC: American Psychiatric Press.
Mason, P. (1990). Recovering from the War: A Woman's Guide to Helping Your Vietnam Vet, Your Family, and Yourself
Matsakis, A. (1996). Vietnam Wives: Facing the Challenges of Life with Veterans Suffering Post Traumatic Stress (Sidran Press, 1996, ISBN 1-886968-00-4)