Several years ago I wrote a post called, 10 Tips for Understanding Someone With PTSD. The idea for the piece came from what I wish my family had known when I was struggling with symptoms of post-traumatic stress disorder. Since then I’ve received so many emails from survivors asking how to explain to friends and family what they need to know in order to participate in the life of a PTSD survivor. I’ve also received so many emails from caregivers asking for advice about how to support a loved one. The emails always start with, “I’m not suffering from PTSD but my [boyfriend/girlfriend/wife/husband] is and I don’t know how to handle this.”
Admittedly, there’s a big divide between PTSD sufferers and the people who love them. Partly this is due to the difference between surviving a trauma and dealing with the memories and emotional and physical transformations trauma causes versus watching from the sidelines. And partly, it’s due to the difference between wanting to help and not knowing how versus not necessarily wanting help but deep down knowing you need it. (For lots of info about caregiving visit our Caregivers section on this site.)
My own PTSD experience and recovery just about crushed my relationship with each person in my family. I was a horrible, awful, isolating, angry, resentful and rage-driven person toward anyone who tried to interfere (a/k/a help) with what I was doing. Primarily, this meant I really decimated my mother who, up until my trauma, had been the most cherished person in the world to me. After my trauma I couldn’t stand her attempts to soothe, support or lead me to things that might release me from the pain in which I lived.
Why did I act like that? Simple: Healing felt dangerous. Love felt dangerous. Happiness felt dangerous. Forgetting what had happened felt dangerous. Consumed by constant feelings of threat I was always in full protection mode, even when that meant destroying my relationship with my mom. Which put a real crimp in my relationship with my father and brother who tried to referee or speak on her behalf or show me her point of view. Lucky for me, my mom never gave up. In the end, it was her standing by ready to love and support me no matter what that caught me every time I collapsed and helped me regain my footing when I finally admitted I needed help and, more importantly, was ready to accept it.
Based on all I’ve learned since my recovery and the original 10 Things post—and in support of and respect for all the caregivers who reach out for advice, and the survivors who want to educate those around them—I’ve decided to write a sort of 10 Things, Part 2, to thank caregivers for what you do, recognize the burden you bear, and try to offer survivors more information to give those around them to try to bridge the gap between the survivor and caregiver experience.
If you want to know how to best support your PTSD loved one, start by understanding these Do’s and Don’ts, and incorporating them into how you relate to your survivor:
Do: Research how trauma causes brain and body changes down to the cellular level. These changes are instantaneous and deepen over time, plus lead to mood swings, sleep disturbances, inability to regulate emotions, and hypervigilance to name a few. (Check out the archives of my radio show for a quick education from leading experts.)
Don’t: Expect your loved one to be able to immediately control any of these things. With time, the proper professional guidance, and dedication many of these changes can be reversed. Until that is achieved refrain from blaming, shaming or belittling the behaviors these changes cause.
Do: Accept there is no simple or guaranteed solution to PTSD recovery. The neurophysiological and psychological impact of trauma deeply embeds in both the conscious and subconscious mind. Recovery is a unique path for every individual, which means it must be discovered in process. Your best action would be to help identify treatment options.
Don’t: Put pressure on the recovery process. Admittedly, you are going to bear the brunt of managing the live and your loved one’s mood swings while recovery happens. As much as you want the end result to occur immediately (as does your PTSDer) this will not happen. Healing post-traumatic stress must take time so that it happens in a way that is acceptable, manageable and long-lasting.
Do: Find ways to make your loved one feel loved. PTSD is very isolating, demeaning and demoralizing. It is hard to feel lovable in the middle of symptoms’ chaos. Even though it can be hard for you to separate your survivor from the behavior, try to—there’s still a human inside the PTSD distortion.
Don’t: Expect big (or even small) gestures of love in return. PTSD saps energy and makes connecting with others very difficult. Resist your normal and human desire to have an equal exchange of love and appreciation. Until things progress far enough in recovery that won’t happen (although you do, definitely, deserve it!).
Do: Find a balance in your helpful support. There are times to press for recovery actions and times to pull back. Survivors struggle with wanting to heal versus fear of doing the work, which means there will be times engagement in recovery can happen and times it can’t. Be flexible in your encouragement and find times just to treat your loved one like a normal person.
Don’t: Make demands about what should happen and when. Being overbearing increases survivor anxiety and further activates the fight/flight/freeze response, which means you can actually trigger threat response behavior. Resist the urge to constantly campaign for recovery. Instead, opt for days when you gently probe the topic mixed with days you remain quiet about it.
Do: Share your feelings. You are human. You will need to vent your frustration, disappointment and despair. It’s important and fair for your loved one to know how this situation is impacting you.
Don’t: Be disrespectful. When you offer your side of the experience resist the urge to condemn, accuse or fault your loved one. Instead, speak in terms of 1) When X happens…, 2) It makes me feel… 3) How can we do things differently? This encourages collaboration, which keeps you both on the same side.
Do: Accept the new boundaries in your relationship. For a (long) while your connection will change. There may be periods of silence, less discussion of intimate subjects and even an overall feeling of distance. Embrace this as a necessary stage and find ways to make small non-threatening or non-expectant connections.
Don’t: Smother your PTSD survivor. A normal response to a feeling of loss in a relationship might be to immediately try to reclaim the past. Resist the urge to constantly try to create what used to be or ask for a removal of the new boundaries. Survivors need space to rediscover themselves, the world and their place in it.
Do: Be patient. Right now you’re the one who has more control over your emotions, thoughts, behaviors, actions and feelings. As unfair and tough as it is accept it the job of tolerance belongs to you.
Don’t: Forget that you still matter too. Life with PTSD can make it seem like everyone and everything else is eclipsed. Remember that you still need outside activities, friends in whom you can confide, down time, days off and moments of fun and relaxation. You are entitled to these things. They are an important aspect of how to help you manage the stress of living with PTSD.
While PTSD living and recovery can seriously test relationships, and sadly, some will crumble, it is possible for loving connections to span the test of time and healing. My mom is, again, one of the most cherished people in my world. I’m so grateful that she was able to weather the storm of Hurricane Michele and still be standing when the calm of recovery finally appeared.
Have ideas for other tips people need to know about PTSD? Add your thoughts in the comments!