Post Traumatic Stress Disorder, like any other psychiatric illness affects not only the
identified patient but also the relationship with the family or significant other.
Symptoms of PTSD
The experience of a life threatening event as a direct participant or an observer, or even the perception of that event as a life threatening one could shatter somebody’ s sense of self sometimes forever. In most situations, the immediate effects of the disastrous experience, the anxiety, the insomnia, the numbness, the hyper vigilance tend to go away on their on within the first four weeks after the event. That would describe the ‘Acute Post Traumatic Stress Disorder’ that’s almost an expected reaction. Surviving a natural disaster, an act of terrorism, an motor vehicle accident can live a person wandering about and question his safety.
The age of exposure has its own play in the equation of how symptoms develop in accordance to the psychological issues that each age encounters. In the mind of survivors there will always be this question, sometimes unconscious, ‘ am I going to be safe next time I cross the street’ with different variations on the safety theme. Sometimes dreams about the event follow the person in their sleep, making him or her fearing the bedtime, avoiding the reliving of the trauma even in the imaginary land.
Sometimes the fear is extended to anything in the patient’s life that used to be known as stable before the traumatic event, even things or situations that have no apparent relation to it. I remember one of my patients saying “doc, as I’m sitting here talking to you, I wonder if your book stand will crumble on top of me before the end of the session”. This man used to successfully mind his life, family and business till the day a tragedy struck him.
Veterans with PTSD
After four weeks, most symptoms are gone, but for at least thirty percent of people witnessing the traumatic assault on their life or others, the symptoms can linger for years. Sometimes, patients suffer from an extreme avoidance, emotional and physical, of situations that even remotely remind him of the trauma. That can significantly impair their ability to function socially or in their family. Veterans avoid war movies, can’t live by airports, can’t stand crowds, for example. A former marine, while studying in law school told me that he always had to stay on the last row of the amphitheater, so his back wouldn’t be exposed. I knew that from other veterans, of the Vietnam, Persian Gulf and now Iraq or Afghanistan. Years after returning home they still ‘ have to watch their back’. A profuse sense of mistrust and watching for danger changed their personality.
How does all of that impact the ‘others’ in their patient lives? When I used to run a Vietnam PTSD group at VA, I was surprised at the number of failed marriages and the relationships that these men went thru. The patients suffering with PTSD are mostly consumed with the after trauma effects, the anxiety and the ‘ be on guard ‘ feeling. The level of mistrust and ‘ waiting for the other shoe to fall’ or the bookcase to crumble affect dramatically the relationship with the significant other. Patients start withdrawing from the intimacy of the relationship, withholding and not trusting. Sometimes patients have to make life changes that affect their family. My patient who on the way home ran over somebody who decided to end his life by jumping in front of the freeway traffic, never recovered from that. He had to move to a different part of town, sell the car and start all over. Sometimes the life partners can’t adjust to these changes.
Some of the PTSD symptoms are very often overlapping with those of Major Depressive Disorder. Irritability, loss of appetite, interest and libido, indecisiveness, passive or active thoughts of suicide, impaired concentration and insomnia affect patients ability to function, to be the partner they used to be. Unless they get professional attention, sometimes combined psychopharmacology and individual and couple therapy, their relationship can’t survive.
The ability to develop the emotional bonding the interpersonal interactiveness necessary for a healthy relationship is altered. We also have to keep in mind that more often then not patients who have a previous history of personality disorder are more prone to develop PTSD, due to most likely poor coping skills.
Treatment of PTSD
The best way to determine the appropriate treatment is to consult a psychiatrist or therapist earlier in the process. A variety of treatments are available besides medications, such as TMS (Transcranial Magnetic Stimulation), EMDR (eye movement desensitization and reprocessing) or CBT (cognitive behavioral therapy) involving prolonged exposure (PE) to trauma related stimuli.
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