Because the symptoms of PTSD and other trauma reactions change
how a trauma survivor feels and acts, traumatic experiences that
happen to one member of a family can affect everyone else in the
family. When trauma reactions are severe and go on for some time
without treatment, they can cause major problems in a family. This
fact sheet will describe family members' reactions to the traumatic
event and to the survivor's symptoms and behaviors.
It's no wonder that family members react to the fact that their
loved one has gone through a trauma. It's upsetting when someone
you care about goes through a terrible ordeal. And it's no wonder
that people react to the way a traumatized family member feels and
acts. Trauma symptoms can make a family member hard to get along
with or cause him or her to withdraw from the rest of the family.
It can be very difficult for everyone when these changes occur.
Just as people have different reactions to traumatic experiences,
families also react differently when a loved one is traumatized. In
the section below, many different types of reactions are described.
A family may experience many of these reactions, or only a few. All
of the reactions described, however, are common in families who
have had to deal with trauma.
Sympathy
One of the first reactions many family members have is sympathy
for their loved one. People feel very sorry that someone they care
about has had to suffer through a terrifying experience. And they
feel sorry when the person continues to suffer from symptoms of
PTSD and other trauma responses. It can be helpful for the person
who has experienced the trauma to know that his or her family
members sympathize with him or her, especially just after the
traumatic event occurs.
Sympathy from family members can have a negative effect, though.
When family members' sympathy leads them to "baby" a trauma
survivor and have low expectations of him or her, it may send a
message that the family doesn't believe the trauma survivor is
strong enough to overcome the ordeal. For example, if a wife has so
much sympathy for her husband that she doesn't expect him to work
after a traumatic experience, the husband may think that she
doesn't have any confidence in his ability to recover and go back
to work.
Depression
One source of depression for family members can be the traumatic
event itself. All traumas involve events where people suddenly find
themselves in danger. When this happens in a situation or place
where people are used to feeling safe, just knowing the event
happened could cause a person to lose faith in the safety and
predictability of life. For example, if a woman gets mugged in the
parking lot of a neighborhood shopping center, her family may find
they feel depressed by the idea that they are not really as safe as
they thought they were, even in their own neighborhood.
It can also be very depressing when a traumatic event threatens
a person's ideals about the world. For instance, if a man gets
traumatized in combat by seeing someone tortured, it can be very
depressing to know that people are capable of doing such cruel
things to each other. Before the man was faced with that event, he
may have been able to believe that people are basically good and
kind.
Depression is also common among family members when the
traumatized person acts in a way that causes feelings of pain or
loss. There may be changes in family life when a member has PTSD or
other symptoms after trauma. The traumatized person may feel too
anxious to go out on family outings as he or she did in the past.
The traumatized person may not be able to work because of PTSD
symptoms. As a result, the family income may decrease and the
family may be unable to buy things and do things the way they did
before the traumatic event. A husband may feel unloved or abandoned
when-because of her depression-his traumatized wife withdraws
emotionally and avoids being intimate or sexual. Children whose
father can't be in crowds because of combat trauma may feel hurt
that their father won't come to see them play sports. When PTSD
lasts for a long time, family members can begin to lose hope that
their loved one or their family will ever get "back to normal."
Fear and Worry
Knowing that something terrible can happen "out of the blue" can
make people very fearful. This is especially true when a family
member feels unsafe and often reminds others about possible
dangers. Very often, trauma survivors feel "on edge" and become
preoccupied with trying to stay safe. They may want to get a guard
dog, or put up security lights, or have weapons in the house in
order to protect themselves and their family members. When one
person in a family is very worried about safety, it can make
everyone else feel unsafe too. However, something that helps one
person feel safe-like a loaded weapon under the bed-may make
another person feel unsafe.
Family members can also experience fear when the trauma survivor
is angry or aggressive. As described above, trauma survivors can
become angry and aggressive automatically if they feel they are in
danger. Trauma survivors may also become angry and aggressive
because they are frustrated that they have trauma symptoms, or
because they learned to be aggressive as a way to protect
themselves in the trauma situation. No matter what the reason for
the anger and aggression, it naturally makes family members
fearful.
Many trauma symptoms can cause family members to worry. A wife
might worry that her traumatized husband who becomes angry and
violent at the least provocation will be injured in a fight or get
in trouble with the police. A daughter may worry that her mother
will make herself ill by drinking heavily as a result of a
traumatic event. A man's inability to keep a job because of
trauma-related problems may cause his family to worry constantly
about money and the future.
Avoidance
Just as trauma survivors are often afraid to address what
happened to them, family members are frequently fearful of
examining the traumatic event as well. Family members may want to
avoid talking about the trauma or trauma-related problems, even
with friends. People who have experienced trauma hope that if they
don't talk about the problem, it will go away. People also don't
wish to talk about the trauma with others because they are afraid
that others won't understand or will judge them. Sometimes, if the
traumatic event is one associated with shame, such as rape, family
members may avoid talking about the event and its effects because
of social "rules" that tell us it is inappropriate to talk about
such things. Family members may also not discuss the trauma with
others because they fear it will bring their loved one more
shame.
Family members may avoid the things that the trauma survivor
avoids because they want to spare the survivor further pain, or
because they are afraid of his or her reaction. For example, the
wife of a combat veteran who is anxious about going out in public
may not make plans for family outings or vacations because she is
afraid to upset her husband. Though she doesn't know what she can
do to "fix" the problem, she does know that if the family goes to a
public event, the husband will be anxious and irritable the whole
time.
Guilt and Shame
Family members can feel guilt or shame after a traumatic event
for a number of reasons. A family member may experience these
feelings if he or she feels responsible for the trauma. For
instance, a husband whose wife is assaulted may feel guilt or shame
because he was unable to protect her from the attack. A wife may
feel responsible for her husband's car accident if she thinks she
could have prevented it if she had gotten the car's brakes fixed. A
family member may feel guilt and shame if he or she feels
responsible for the trauma survivor's happiness or general
well-being, but sees no improvement no matter how hard he or she
tries to help. Sometimes, after years of trauma-related problems in
a family, a family member may learn about posttraumatic stress
disorder and realize that this is the source of their family
problems. The family member may then feel guilty that he or she was
unsupportive during the years.
Anger
Anger is a very common problem in families that have survived a
trauma. Family members may feel angry about the trauma and its
effect on their lives. They may be angry at whomever they believe
is responsible for the traumatic event (this includes being angry
at God). They can also feel anger toward the trauma survivor.
Family members may feel that the survivor should just "forget about
it" and get on with life. They may be angry when their loved one
continues to "dwell" on the trauma. A wife may be mad because her
husband can't keep a job or because he drinks too much or won't go
with her to social events or avoids being intimate with her or
doesn't take care of the kids. Family members may also feel angry
and irritable in response to the anger and irritability the trauma
survivor directs at them.
Negative Feelings
Sometimes family members have surprisingly negative feelings
about the traumatized family member. They may believe the trauma
survivor no longer exhibits the qualities that they loved and
admired. A person who was outgoing before a trauma may become
withdrawn. A person who was fun loving and easy-going before a
trauma may become ill tempered. It may be hard to feel good toward
a person who seems to have changed in many ways. Family members may
also respond negatively to behaviors that develop following a
trauma. For instance, family members may be disgusted by a woman's
over-drinking in response to a trauma.
Family members may also have negative feelings about the
survivor that are directly related to the traumatic event. For
example, a wife may no longer respect her husband if she feels he
didn't behave bravely during a traumatic event. A husband whose
wife was raped may feel disgusted about what happened and wonder if
she could have done something to prevent the assault. A son may
feel ashamed that his father didn't fight back when he was beaten
during a robbery. Sometimes people have these negative feelings
even when they know that their assessment of the situation is
unfair.
Drug and Alcohol Abuse
Drug and alcohol abuse can become a problem for the families of
trauma survivors. Family members may try to escape from bad
feelings by using drugs or drinking. A child or spouse may spend
time drinking with friends to avoid having to go home and face an
angry parent or spouse. On the other hand, spouses sometimes abuse
drugs or alcohol to keep their loved ones "company" when they're
drinking or using drugs to avoid trauma-related feelings.
Sleep Problems
Sleep can become a problem for family members, especially when
it is a problem for the trauma survivor. When the trauma survivor
stays up late to avoid going to sleep, can't get to sleep, tosses
and turns in his or her sleep, or has nightmares, it is difficult
for family members to sleep well. Often family members are also
unable to sleep well because they are depressed and/or they are
worried about the survivor.
Health Problems
Family members of trauma survivors can develop health problems
for a number of reasons. Bad habits, such as drinking, smoking, and
not exercising may worsen as a result of coping with a loved one's
trauma responses. In addition, many illnesses can be caused by
trauma-related stress if it goes on for an extended period of time.
When family members constantly feel anxious, worried, angry, or
depressed, they are more likely to develop stomach problems, bowel
problems, headaches, muscle pain, and other health problems.
What can families do to care for themselves and the
survivor?
Trauma survivors and their families often don't know what to do
to care for themselves. First, it is important to continue to learn
more about trauma and its effects. Some books are listed below that
may be helpful. For veterans, educational classes may be available
through a local VA Medical Center or VA Readjustment Counseling
Service Vet Center (see below).
Treatment for PTSD is available in most communities through
psychologists and social workers in private practice. Insurance may
help pay for this treatment. Community mental-health centers and
private mental-health clinics (such as those run by charitable or
church organizations) may also provide treatment, sometimes at low
or reduced fees. To find phone numbers for mental-health
professionals, you can look in the yellow pages of your local phone
book under "Mental Health Services" and "Therapists."
Veterans can receive treatment at a
local VA Medical Center or VA
Readjustment Counseling Service
Vet Center 1-800-905-4675.
Insurance may help pay for treatment at a VA center, and treatment
for some veterans is provided at no cost (when their PTSD is
determined to be service-related). To find phone numbers for local
VA Medical Center or VA Readjustment Counseling Service Vet
Centers, you can look in the "Government Pages" of your local phone
book under "Veterans Affairs". In that section, look under "Medical
Care" for a VA Medical Center phone number and under "Vet Center"
for the Readjustment Counseling Service Vet Center phone
number.
Family members of a traumatized person should find out as much
as they can about PTSD and get help for themselves, even if their
loved one doesn't seek treatment. Family members can encourage the
survivor to inquire about education and counseling, but they should
not pressure or try to force their loved one to get help. Classes
or treatment may also be useful for stress and anger management,
addiction, couples communication, or parenting.
While in the process of getting help, if family members feel
comfortable, they should let their loved one know that they are
willing to listen if the survivor would like to talk about his or
her trauma. But the family should stop if anyone gets too upset or
overwhelmed. If everyone is able, it is also important to talk
about how the trauma is affecting the family and what can be done
about it.
Suggested Readings
Allen, J. G. (1995).
Coping with Trauma: A Guide to Self-Understanding.
Washington, DC: American Psychiatric Press.
Mason, P. (1990).
Recovering from the War: A Woman's Guide to Helping Your Vietnam
Vet, Your Family, and Yourself
Matsakis, A. (1996).
Vietnam Wives: Facing the Challenges of Life with Veterans
Suffering Post Traumatic Stress (Sidran Press, 1996, ISBN
1-886968-00-4)