How to Handle and Manage PTS Triggers in Social Settings
One important way that you can support your PTS spouse is to understand and be alert to their triggers. This awareness can be especially valuable when you’re in social situations or out in public. Knowing that you “have your spouse’s back” can make the difference between your Vet choosing to stay home, or feeling safe to go out.
A trigger is anything that brings about the symptoms of PTSD. Triggers may include people, places, smells, words, situations and/or sounds. There are some very common triggers with Vets, such as the sound of a helicopter, loud noises such as gun shots, fireworks, a car backfiring, or a door slamming. Smells such as diesel, smoke, blood, and explosives are also typical triggers for Veterans and so are situations such as crowded places filled with strangers, rooms with no windows, or being unable to see the outside.
Many triggers are specific to your Vet and their particular experiences and memories. Talk to your Vet about their personal triggers. Let them know that you want to be able to better understand the things that can bring on their symptoms so you can help and support your spouse better.
Something as simple as knowing that your spouse needs to sit facing the door in a restaurant can make the difference between a calm, and enjoyable meal and an anxious, stressful one. Your Veteran will be appreciative of your understanding when you always choose a table that allows them to face the door.
Dining with a group can be problematic when it comes to seating. However, you can take the lead to do whatever quiet maneuvering is necessary for your spouse to sit where they feels safe. When this is accomplished without bringing attention to them, you will be their hero. It is also important that you pay attention to any changes in your surroundings. Noise levels increasing, a room becoming more crowded or chaotic, can quickly set off the trigger for your Vet.
Learn to recognize small changes in your Vets demeanor such as facial expressions, nervous gestures, and signs of agitation. Keep a watchful, loving eye on your Vet, and help your spouse to easily escape if the situation is becoming difficult for them. Simply suggesting that they step outside for some fresh air may be all that it takes. Asking them if they are ready to go, and removing them from the triggers can help to prevent an uncomfortable situation for everyone.
Learning to provide a safe and loving exit from social situations for your PTSD spouse is a valuable tool to support your Vet. When they feel safe that they can leave a social setting when the need arises without you becoming angry or making them feel guilty, this knowledge can go a long way toward opening your spouse up to accepting future social invitations.
Clinical Terms for PTS
Clinical terms for PTSD can be difficult to understand and even more difficult to explain to others. Here are some simple real word examples of what each “clinical” word means to help you to explain it to family members, children, and others in your community.
PTSD has three main sets of symptoms: psychological, behavioral, and physical.
Psychological Symptoms of PTSD
The Veteran is no longer able to look forward to events in the future. He or she may also have difficulty enjoying or being excited about things currently happening. There is no joy to be found in anything or if happiness is found, it’s in a very small amount – almost as if it's in a faraway dream.
The Veteran worries excessively over things you may not have even considered before. These worries can begin to take over their life and control their actions.
Veterans usually experience one or both of two kinds of guilt. One being guilt over what they had to do in combat to survive. The other is what’s referred to as “Survivor’s Guilt” which is feeling guilty because they survived whereas their friends or co-workers did not.
Avoidance/Lack of Emotion
This Veteran seems to be shutting down. They avoid any situation that could cause a symptom to arise or emotion to “bubble up”. They may stop responding to emotional situations altogether and withdraw into themselves during emotional times rather than communicate with a loved one or trusted friend.
This is a “hallmark” symptom of post-traumatic stress disorder based on Hollywood’s version and is your stereotypical “flashback”. Real “flashbacks” can be just thinking about the situation to actually believing you are reliving the event. The situations the Veteran
experienced can creep into their thoughts without them trying to bring them to the surface.
This can be a “flashback” of reliving an event or seeing and/or hearing other things that are not there. These can be very traumatizing and challenging for a Veteran to deal with
and are often one of the most frightening portions of PTSD.
Behavioral Symptoms of PTSD
The Veteran is experiencing huge amounts of anger over “minor” things that would never have bothered them in the past. “Little” things are suddenly a HUGE trigger for gigantic screaming matches over what is, in reality, nothing.
The Veteran is going from being relaxed or only mildly irritated to “Extreme Rage” as above in a matter of seconds. This can be described as a “blowing up” in some families. It's like lighting a match to a tank of gasoline and it just explodes.
The Veteran is pulling away from everyone. He or she is no longer able to share thoughts, feeling, or emotions with those he or she loves. They also may not want to be physically close to anyone and begin to sleep in a different portion of the house, work extended
hours, and find other ways to just not be there.
Alcohol or Drug Abuse / Dependence
The Veteran is using alcohol or drugs (illegal or non-prescribed prescription) to mask their symptoms and cover up issues they do not want to face. This is commonly “jokingly” called “self-medicating”.
Always Being on Guard (Hypervigilance)
The PTSD Veteran is constantly scanning crowds, traffic, and other areas for potential threats. A bag sitting in the middle of the street is seen as a potential bomb. A person in an airport is “suspicious”.
The Veteran is not feeling emotions normally. They feel very little emotion if any at all toward the people and activities around them. They often seem vacant and like a hollow shell.
The Veteran is struggling to remember things. Things are constantly being lost, conversations are forgotten, and little details like their phone number are difficult to remember. This may lead to aggression and frustration because of the lack of ability to recall information the Veteran knows should be available to him or her.
Lack of Concentration
The Veteran is unable to concentrate in one or more areas. They may be struggling at work and having poor performance, struggling in school, or not be able to concentrate on their favorite hobbies to completion.
The Veteran may be experiencing extremely disturbing dreams. These may or may not be directly associated with combat. They can be combined with other symptoms. The nightmares can include sleepwalking and physical aggression in their sleep.
Unable to Fall Asleep or Stay Asleep (Insomnia)
The Veteran is having difficulty falling asleep in the evening. It may feel like their brain “just won’t shut off”. They lie awake for hours despite being utterly exhausted. Veterans may also get up while still awake or from being asleep to check that doors and windows
are locked, family members are all present and accounted for, and other “odd” but logical nighttime “concerns”.
Being Easily Startled / Increased Startle Response
The Veteran is easily “spooked” reacting in a large way to loud noises that sound similar to explosions, gun fire or other “combat sounds”. Some common “everyday” noises that cause this are a car backfiring, a balloon popping, fireworks and even bubble wrap.
The Veteran feels they are not worth anything to society anymore. They may feel the loss of their job in military service or be concerned about their abilities being compromised due to disabilities. They may feel very “low” or “down in the dumps”.
Feeling Hopeless About the Future
The Veteran feels that nothing positive lies before them any longer, as if there is no good in the world nor any good things to come. They become lost in a sea of nothing.
Not wanting to see/hear anything that reminds you of your deployment. The Veteran avoids the news, movies, and other things that would remind them of their deployment. They may avoid memorabilia in the house, friends who were deployed with them, and
become agitated when confronted with these items. They may also try to avoid people who remind them of those who were in the location where they were deployed.
Lack of Appetite
The Veteran may barely be eating enough to stay alive. Their emotions have left them not desiring food or even, at times, repulsed by the thought of having to eat.
Overeating / Gorging
The Veteran may be “self-medicating” with food drowning their pain by endlessly eating. Sometimes this is combined or alternates with lack of appetite.
Physical Symptoms of PTSD
The Veteran may experience anything from a minor headache to migraines that last for days. The headaches may be connected with other symptoms or appear and disappear on their own.
Rapid Heart Rate or Sweating
The Veteran may experience profuse sweating and or “feel” or “hear” their heartbeat when they are reminded of their trauma or while they are experiencing other symptoms. Some Veterans report that they experience this symptom without it being connected to the traumatic event and will break out in a sweat and begin to hyperventilate (feel short of breath) even when they are not remembering the event. This can be incredibly distressing to them because it “has no reason.”
Here are some things to consider when your loved one returns from war:
Don't be anxious to get back to everyday life
Allow for re-adjustment
Become acquainted again
Respect the different person he or she may have become
Don't try to make up for lost time
Accept that things may be different
Don't have unrealistic expectations
Talk to each other openly and listen with empathy
Don't be surprised if your sex life is uneasy at first
If you have children be open and reassuring
Spend quality time with your partner and as a family
Don't be controlling or manipulative
Learn to make decisions together again
Keep the faith; you need each other more than ever.
Relationships and PTSD
How does trauma affect relationships?
Trauma survivors with PTSD may have trouble with their close family relationships or friendships. The symptoms of PTSD can cause problems with trust, closeness, communication, and problem solving. These problems may affect the way the survivor acts with others. In turn, the way a loved one responds to him or her affects the trauma survivor. A circular pattern can develop that may sometimes harm relationships.
How might trauma survivors react?
In the first weeks and months following a trauma, survivors may feel angry, detached, tense or worried in their relationships. In time, most are able to resume their prior level of closeness in relationships. Yet the 5% to 10% of survivors who develop PTSD may have lasting relationship problems.
Survivors with PTSD may feel distant from others and feel numb. They may have less interest in social or sexual activities. Because survivors feel irritable, on guard, jumpy, worried, or nervous, they may not be able to relax or be intimate. They may also feel an increased need to protect their loved ones. They may come across as tense or demanding.
The trauma survivor may often have trauma memories or flashbacks. He or she might go to great lengths to avoid such memories. Survivors may avoid any activity that could trigger a memory. If the survivor has trouble sleeping or has nightmares, both the survivor and partner may not be able to get enough rest. This may make sleeping together harder.
Survivors often struggle with intense anger and impulses. In order to suppress angry feelings and actions, they may avoid closeness. They may push away or find fault with loved ones and friends. Also, drinking and drug problems, which can be an attempt to cope with PTSD, can destroy intimacy and friendships. Verbal or physical violence can occur.
In other cases, survivors may depend too much on their partners, family members, and friends. This could also include support persons such as health care providers or therapists.
Dealing with these symptoms can take up a lot of the survivor's attention. He or she may not be able to focus on the partner. It may be hard to listen carefully and make decisions together with someone else. Partners may come to feel that talking together and working as a team are not possible.
How might loved ones react?
Partners, friends, or family members may feel hurt, cut off, or down because the survivor has not been able to get over the trauma. Loved ones may become angry or distant toward the survivor. They may feel pressured, tense, and controlled. The survivor's symptoms can make a loved one feel like he or she is living in a war zone or in constant threat of danger. Living with someone who has PTSD can sometimes lead the partner to have some of the same feelings of having been through trauma.
In sum, a person who goes through a trauma may have certain common reactions. These reactions affect the people around the survivor. Family, friends, and others then react to how the survivor is behaving. This in turn comes back to affect the person who went through the trauma.
Trauma types and relationships
Certain types of "man-made" traumas can have a more severe effect on relationships. These traumas include:
Childhood sexual and physical abuse
Prisoner of war
Survivors of man-made traumas often feel a lasting sense of terror, horror, endangerment, and betrayal. These feelings affect how they relate to others. They may feel like they are letting down their guard if they get close to someone else and trust them. This is not to say a survivor never feels a strong bond of love or friendship. However, a close relationship can also feel scary or dangerous to a trauma survivor.
Do all trauma survivors have relationship problems?
Many trauma survivors do not develop PTSD. Also, many people with PTSD do not have relationship problems. People with PTSD can create and maintain good relationships by:
• Building a personal support network to help cope with PTSD while working on family and friend relationships
• Sharing feelings honestly and openly, with respect and compassion
• Building skills at problem solving and connecting with others
• Including ways to play, be creative, relax, and enjoy others
What can be done to help someone who has PTSD?
Relations with others are very important for trauma survivors. Social support is one of the best things to protect against getting PTSD. Relationships can offset feelings of being alone. Relationships may also help the survivor's self-esteem. This may help reduce depression and guilt. A relationship can also give the survivor a way to help someone else. Helping others can reduce feelings of failure or feeling cut off from others. Lastly, relationships are a source of support when coping with stress.
If you need to seek professional help, try to find a therapist who has skills in treating PTSD as well as working with couples or families.
Many treatment approaches may be helpful for dealing with relationship issues. Options include:
• One-to-one and group therapy
• Anger and stress management
• Assertiveness training
• Couples counseling
• Family education classes and Family therapy
What are the most common relationship problems for people with PTSD?
PTSD can affect how couples get along with each other. It can also affect the mental health of partners. In general, PTSD can have a negative effect on the whole family.
Male Veterans with PTSD are more likely to report the following problems than Veterans without PTSD:
Marriage or relationship problems
Poor family functioning
Most of the research on PTSD in families has been done with female partners of male Veterans. The same problems can occur, though, when the person with PTSD is female.
Effects on marriage
Compared to Veterans without PTSD, Veterans with PTSD have more marital troubles. They share less of their thoughts and feelings with their partners. They and their spouses also report more worry around intimacy issues. Sexual problems tend to be higher in combat Veterans with PTSD. Lower sexual interest may lead to lower satisfaction within the relationship.
The National Vietnam Veterans Readjustment Study (NVVRS) compared Veterans with PTSD to those without PTSD. The findings showed that Vietnam Veterans with PTSD:
• Got divorced twice as much
• Were three times more likely to divorce two or more times
• Tended to have shorter relationships
Families of Veterans with PTSD experience more physical and verbal aggression. Such families also have more instances of family violence. Violence is committed not just by the males in the family. One research study looked at male Vietnam Veterans and their female partners. The study compared partners of Veterans with PTSD to partners of those without PTSD. Female partners of Veterans with PTSD:
• Committed more family violence than the other female partners
• Committed more family violence than their male Veteran partners with PTSD
Mental health of partners
PTSD can affect the mental health and life satisfaction of a Veteran's partner. The same research studies on Vietnam Veterans compared partners of Veterans with and without PTSD. The partners of the Vietnam Veterans with PTSD reported:
• Lower levels of happiness
• Less satisfaction in their lives
• More demoralization (discouragement)
• About half have felt "on the verge of a nervous breakdown"
These effects were not limited to females. Male partners of female Veterans with PTSD reported lower well-being and more social isolation.
Partners often say they have a hard time coping with their partner's PTSD symptoms. Partners feel stress because their own needs are not being met. They also go through physical and emotional violence. One explanation of partners' problems is secondary traumatization. This refers to the indirect impact of trauma on those close to the survivor. Another explanation is that the partner has gone through trauma just from living with a Veteran who has PTSD. For example, the risk of violence is higher in such families.
Partners have a number of challenges when living with a Veteran who has PTSD. Wives of PTSD-diagnosed Veterans tend to take on a bigger share of household tasks such as paying bills or housework. They also do more taking care of children and the extended family. Partners feel that they must take care of the Veteran and attend closely to the Veteran's problems. Partners are keenly aware of what can trigger symptoms of PTSD. They try hard to lessen the effects of those triggers.
Caregiver burden is one idea used to describe how hard it is caring for someone with an illness such as PTSD. Caregiver burden includes practical problems such as strain on the family finances. Caregiver burden also includes the emotional strain of caring for someone who is ill. In general, the worse the Veteran's PTSD symptoms, the more severe is the caregiver burden.
Why are these problems so common?
The exact connection between PTSD symptoms and relationship problems is not clearly known. Some symptoms, like anger and negative changes in beliefs and feelings, may lead directly to problems in a marriage.
For example, a Veteran who cannot feel love or happiness may have trouble acting in a loving way towards a spouse. Expression of emotions is part of being close to someone else. Not being able to feel your emotions can lead to problems making and keeping close relationships. Numbing can get in the way of intimacy.
Help for partners of Veterans with PTSD
The first step for partners of Veterans with PTSD is to gather information. This helps give you a better understanding of PTSD and its impact on families. Resources on the National Center for PTSD website may be useful.
Some effective strategies for treatment include:
• Education for the whole family about the effects of trauma on survivors and their families
• Support groups for both partners and Veterans
• Individual therapy for both partners and Veterans
• Couples or family counseling
Daniel Applegate is a Licensed Professional Counselor at Compass Counseling and Consulting who is passionate about his work with Veterans and other sufferers of Post Traumatic Stress. Contact our office by phone, at, 217-693-4918, or via email, at, [email protected], to set up an appointment with Daniel or one of our therapists on staff.