Posttraumatic stress disorder (PTSD) has a PR problem. On the one hand, the media almost exclusively represents PTSD as a problem solely related to the experience of combat in military service (in fact, causes of PTSD range from natural disasters to child abuse, sexual assault, life-threatening illnesses, car accidents and domestic violence with military sexual trauma as the bigger PTSD precursor for veterans).

On the other hand, this very normal reaction to an abnormal experience (20% of the 70% of US adults who experience trauma will end up with PTSD—that’s over 24 million people) is illustrated in films, books and television shows by characters who often behave in violent, crazy manners. For survivors who cope with symptoms and the loss of inner peace the multi-layered truth of the PTSD experience stems more from the internal struggle against involuntary symptoms than external behaviors. In between cause and result is the human being who wrestles with a loss of self-connection, safety and control.

Observing the extreme behaviors PTSD creates can make anyone hypercritical and full of the opinion that a survivor in the throes of symptoms has simply gone crazy. However, erratic mood swings, frequent rage, sleep-deprivation, catastrophizing, concentration challenges and a reduced capability for decision-making derive from the very same origins of trauma-initiated psychological and neurophysiological alterations.

Trauma can be summed up as 1) any moment that’s less than nurturing, 2) being overwhelmed beyond the ability to cope, and 3) any experience that changes one’s sense of place in the world. These psychological shifts substantially uproot an individual’s sense of two core elements for which every human strives: safety and control. Lacking these essential aspects can catapult a personality into the full spin of a compass whose dial no longer calibrates north.

Compounding the psychological shift are embedded neurophysiological changes that impede full mental functioning and whole-body rhythms. When the survival part of the brain (that oldest, most reptilian part at the back of the head) takes over to ensure survival it literally overwhelms the mid- and outer parts of the brain, those newer, more highly evolved elements related to proper emotional and executive-thinking function. The dysfunction of sophisticated brain structures interferes with sleep, memory formation and access, emotional regulation, speech, interpersonal interaction and even the threat detection process which, in PTSD, becomes stuck in the “on” position.

It would be a challenge for anyone to live with a constant fear of impending danger, stuck in a feeling of powerlessness, helplessness and lack of control, battling the exhaustion of insomnia while trying to anticipate emotional or physical meltdowns. For the PTSD survivor this can all be complicated by the unpredictable resurgence of unwanted memories and trauma-related intrusive thoughts. Cycling through anxiety and the distortion of an always activated trauma loop leads survivors to create a fear-driven lifestyle moderated by the need to feel safe and in control of themselves and the rest of the world. The exhausting and unending battle for a sense of self-efficacy disconnects survivors from themselves and others for enormous and lonely periods of time.

Watching a survivor struggle—and enduring the toll that effects on relationships—can severely strain the bonds of family and friends. Averting irreparable relationship damage and maintaining attachments benefits from creating an environment that fosters connection, communication and collaboration. Some ideas for achieving this include:

Connection: Feeling linked to anyone or anything poses a challenge for PTSD survivors. Rather than forcing consistent contact offer your own consistent presence whenever and however it’s desired.

Communication: In a very real sense trauma can (temporarily) leave survivors with an inability to express thoughts and feelings. Keep communication flowing by chunking down topics to small, manageable pieces and employing alternative methods of communication (i.e. letters, email, text messages) that allow a slower paced dialogue.

Collaboration: PTSD necessitates that survivors and those around them find new ways of working together that respect the intrusion of symptoms. Collectively identifying lifestyle methods that work—and maintaining them—while eschewing those that don’t makes symptoms’ management easier to bear.

As the more functional person in the PTSD relationship friends and family members, unfortunately, bear the brunt of absorbing (although not in a way that threatens their own well-being) the dysfunction of the PTSD survivor. This is particularly true during the recovery process when symptoms can become increasingly exacerbated as therapeutic processes challenge the status quo. The best way to approach maintaining a relationship despite PTSD is to make the effort to go into the world of the PTSD survivor (learn about PTSD, try to see things from that perspective) rather than ask him to fully function in yours.

Click here to see Rose’s tips for healthy and happy relationships

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