Living with someone who has PTSD
PTSD can take a heavy toll on relationships. It can be hard to understand your loved one’s behavior—why they are less affectionate and more volatile. You may feel like you’re walking on eggshells or living with a stranger. You may have to take on a bigger share of household tasks, deal with the frustration of a loved one who won’t open up, or even deal with anger or disturbing behavior. The symptoms of PTSD can also lead to job loss, substance abuse, and other problems that affect the whole family.
It’s hard not to take the symptoms of PTSD personally, but it’s important to remember that a person with PTSD may not always have control over their behavior. Your loved one’s nervous system is “stuck” in a state of constant alert, making them continually feel vulnerable and unsafe. This can lead to anger, irritability, depression, mistrust, and other PTSD symptoms that your loved one can’t simply choose to turn off. With the right support from friends and family, though, your loved one’s nervous system can become "unstuck" and they can finally move on from the traumatic event.
Helping someone with PTSD
tip 1: Provide social support
It’s common for people with PTSD to withdraw from friends and family. While it’s important to respect your loved one’s boundaries, your comfort and support can help the person with PTSD overcome feelings of helplessness, grief, and despair. In fact, trauma experts believe that face-to-face support from others is the most important factor in PTSD recovery.
Knowing how to best demonstrate your love and support for someone with PTSD isn’t always easy. You can’t force your loved one to get better, but you can play a major role in the healing process by simply spending time together.
Don’t pressure your loved one into talking. It can be very difficult for people with PTSD to talk about their traumatic experiences. For some, it can even make things worse. Instead, let them know you’re willing to listen when they want to talk, or just hang out when they don’t. Comfort for someone with PTSD comes from feeling engaged and accepted by you, not necessarily from talking.
Do “normal” things with your loved one, things that have nothing to do with PTSD or the traumatic experience. Encourage your loved one to participate in rhythmic exercise, seek out friends, and pursue hobbies that bring pleasure. Take a fitness class together, go dancing, or set a regular lunch date with friends and family.
Let your loved one take the lead, rather than telling him or her what to do. Everyone with PTSD is different but most people instinctively know what makes them feel calm and safe. Take cues from your loved one as to how you can best provide support and companionship.
Manage your own stress. The more calm, relaxed, and focused you are, the better you’ll be able to help your loved one.
Be patient. Recovery is a process that takes time and often involves setbacks. The important thing is to stay positive and maintain support for your loved one.
Educate yourself about PTSD. The more you know about the symptoms, effects, and treatment options, the better equipped you'll be to help your loved one, understand what they are going through, and keep things in perspective.
Accept (and expect) mixed feelings. As you go through the emotional wringer, be prepared for a complicated mix of feelings—some of which you’ll never want to admit. Just remember, having negative feelings toward your family member doesn’t mean you don’t love them.
Tip 2: Be a good listener
While you shouldn’t push a person with PTSD to talk, if they do choose to share, try to listen without expectations or judgments. Make it clear that you’re interested and that you care, but don’t worry about giving advice. It’s the act of listening attentively that is helpful to your loved one, not what you say.
A person with PTSD may need to talk about the traumatic event over and over again. This is part of the healing process, so avoid the temptation to tell your loved one to stop rehashing the past and move on.
Some of the things your loved one tells you might be very hard to listen to, but it’s important to respect their feelings and reactions. If you come across as disapproving or judgmental, they are unlikely to open up to you again.
Communication pitfalls to avoid
Give easy answers or blithely tell your loved one everything is going to be okay
Stop your loved one from talking about their feelings or fears
Offer unsolicited advice or tell your loved one what they "should" do
Blame all of your relationship or family problems on your loved one's PTSD
Invalidate, minimize, or deny your loved one's traumatic experience
Give ultimatums or make threats or demands
Make your loved one feel weak because they aren't coping as well as others
Tell your loved one they were lucky it wasn't worse
Take over with your own personal experiences or feelings
Tip 3: Rebuild trust and safety
Trauma alters the way a person sees the world, making it seem like a perpetually dangerous and frightening place. It also damages people’s ability to trust others and themselves. Anything you can do to rebuild your loved one’s sense of security will contribute to their recovery.
Express your commitment to the relationship. Let your loved one know you’re here for the long haul so they feel loved and supported.
Create routines. Structure and predictable schedules can restore a sense of stability and security to people with PTSD, both adults and children. Creating routines could mean getting your loved one to help with groceries or housework, for example, maintaining regular times for meals, or simply “being there” for the person.
Minimize stress at home. Try to make sure your loved one has space and time for rest and relaxation.
Speak of the future and make plans. This can help counteract the common feeling among people with PTSD that their future is limited.
Keep your promises. Help rebuild trust by being trustworthy. Be consistent and follow through on the things you say you’re going to do.
Emphasize your loved one’s strengths. Tell your loved one you believe they’re capable of recovery and point out all their positive qualities and successes.
Encourage your loved one to join a support group. Getting involved with others who have gone through similar traumatic experiences can help some people with PTSD feel less damaged and alone.
Tip 4: Anticipate and manage triggers
A trigger is anything—a person, place, thing, or situation—that reminds your loved one of the trauma and sets off a PTSD symptom, such as a flashback. Sometimes, triggers are obvious. For example, a military veteran might be triggered by seeing his combat buddies or by the loud noises that sound like gunfire. Others may take some time to identify and understand, such as hearing a song that was playing when the traumatic event happened, for example, so now that song or even others in the same musical genre are triggers. Similarly, triggers don’t have to be external. Internal feelings and sensations can also trigger PTSD symptoms.
Common external PTSD triggers
Sights, sounds, or smells associated with the trauma
People, locations, or things that recall the trauma
Significant dates or times, such as anniversaries or a specific time of day
Nature (certain types of weather, seasons, etc.)
Conversations or media coverage about trauma or negative news events
Situations that feel confining (stuck in traffic, at the doctor's office, in a crowd)
Relationship, family, school, work, or money pressures or arguments
Funerals, hospitals, or medical treatment
Common internal PTSD triggers
Physical discomfort, such as hunger, thirst, fatigue, sickness, and sexual frustration
Any bodily sensation that recalls the trauma, including pain, old wounds and scars, or a similar injury
Strong emotions, especially feeling helpless, out of control, or trapped
Feelings toward family members, including mixed feelings of love, vulnerability, and resentment
Talking to your loved one about PTSD triggers
Ask your loved one about things they may have done to cope with triggers in the past in response to a trigger that seemed to help (as well as those that didn’t). Then you can come up with a joint game plan for how you will respond in future.
Decide with your loved one what you should do when they have a nightmare, flashback, or panic attack. Having a plan in place will make the situation less scary for both of you. You’ll also be in a much better position to help your loved one calm down.
How to help someone having a flashback or panic attack
During a flashback, people often feel a sense of disassociation, as if they’re detached from their own body. Anything you can do to “ground” them will help.
Tell your loved one they’re having a flashback and that even though it feels real, it’s not actually happening again
Help remind them of their surroundings (for example, ask them to look around the room and describe out loud what they see)
Encourage them to take deep, slow breaths (hyperventilating will increase feelings of panic)
Avoid sudden movements or anything that might startle them
Ask before you touch them. Touching or putting your arms around the person might make them feel trapped, which can lead to greater agitation and even violence
Tip 5: Deal with volatility and anger
Anger Management: Tips and Techniques
PTSD can lead to difficulties managing emotions and impulses. In your loved one, this may manifest as extreme irritability, moodiness, or explosions of rage.
People suffering from PTSD live in a constant state of physical and emotional stress. Since they usually have trouble sleeping, it means they’re constantly exhausted, on edge, and physically strung out—increasing the likelihood that they’ll overreact to day-to-day stressors. For many people with PTSD, anger can also be a cover for other feelings such as grief, helplessness, or guilt. Anger makes them feel powerful, instead of weak and vulnerable. For others, they try to suppress their anger until it erupts when you least expect it.
Watch for signs that your loved one is angry such as clenching jaw or fists, talking louder, or getting agitated. Take steps to defuse the situation as soon as you see the initial warning signs.
Try to remain calm. During an emotional outburst, do your best to stay calm. This will communicate to your loved one that you are “safe” and prevent the situation from escalating.
Give the person space. Avoid crowding or grabbing the person. This can make a traumatized person feel threatened.
Ask how you can help. For example: “What can I do to help you right now?” You can also suggest a time out or change of scenery.
Put safety first. If the person gets more upset despite your attempts to calm him or her down, leave the house or lock yourself in a room. Call 911 if you fear that your loved one may hurt himself or others.
Help your loved one manage their anger. Anger is a normal, healthy emotion, but when chronic, explosive anger spirals out of control, it can have serious consequences on a person’s relationships, health, and state of mind. Your loved one can get anger under control by exploring the root issues and learning healthier ways to express their feelings.
Tip 6: Take care of yourself
Letting your family member’s PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout and may even lead to secondary traumatization. You can develop your own trauma symptoms from listening to trauma stories or being exposed to disturbing symptoms like flashbacks. The more depleted and overwhelmed you feel, the greater the risk that you may become traumatized.
In order to have the strength to be there for your loved one over the long haul and lower your risk for secondary traumatization, you have to nurture and care for yourself.
Take care of your physical needs: get enough sleep, exercise regularly, eat properly, and look after any medical issues.
Cultivate your own support system. Lean on other family members, trusted friends, your own therapist or support group, or your faith community. Talking about your feelings and what you’re going through can be very cathartic.
Make time for your own life. Don’t give up friends, hobbies, or activities that make you happy. It’s important to have things in your life that you look forward to.
Spread the responsibility. Ask other family members and friends for assistance so you can take a break. You may also want to seek out respite services in your community.
Set boundaries. Be realistic about what you’re capable of giving. Know your limits, communicate them to your family member and others involved, and stick to them.
Support for people taking care of veterans
If the person you’re caring for is a military veteran, financial and caregiving support may be available. In the U.S., visit VA Caregiver Support to explore your options, or call Coaching into Care at (888) 823-7458. For families of military veterans in other countries, see the Resources section below for helplines.