Elizabeth Lombardo, PhD
June is PTSD awareness month, a time to bring attention to a disorder that threatens many veterans’ quality of life. By understanding the condition better, we aim to eliminate the stigma associated with PTSD and ensure those who suffer are able to find the help they need.
PTSD is an often-debilitating anxiety disorder that can negatively impact emotional wellbeing, physical health, relationships, the ability to work and the ability to participate in daily life. To meet criteria for PTSD, someone has to have experienced a traumatic event (directly or vicariously) and have specific symptoms for over a month.
People who have served in the military are often exposed to many different types of trauma. That experience can have negative effects on a veteran’s mental and physical health even after they’ve left the battlefield, turning into a chronic condition called posttraumatic stress disorder (PTSD). In fact, for veterans who served in the Vietnam War, 15 out of every 100 (or 15%) were diagnosed with PTSD according to a study in the 1980s. For Gulf War veterans, 12% have PTSD.
PTSD presents in four significant ways:
Intrusive thoughts: These present as involuntary re-experiencing of memories, nightmares and flashbacks. They can result in intense emotional and physical reactions including panic attacks, racing heart and shaking.
Avoidance of reminders: Avoiding people, places, situations, thoughts, or other stimuli (such as specific sounds or even smells) that remind the person of the trauma. This could include evading friends, family and everyday activities.
Changes in mood and cognitions: These are negative thoughts and feelings that started or worsened after the trauma. These can include negative thoughts and assumptions about oneself or the world, inability to recall important aspects of the trauma, guilt and shame, feeling isolated and an inability to experience positive emotions.
Increased arousal and reactivity: These can present as hypervigilance, heightened startle reaction, irritability or aggression, reckless behaviors, difficulty concentrating and problems with sleep.
What’s more, people with PTSD are at increased risk for other psychiatric issues. For example, vets with PTSD are 3-5 times more likely to also have major depressive disorder. Substance abuse and other anxiety disorders are also more common in those with PTSD.
When I was doing my internship for psychology, I had the honor of working at the Houston VA for a year. There, I worked with hundreds of veterans in individual and groups settings. Many of my clients struggled with PTSD. One very special vet helped me better understand how it can impact the lives of veterans for years and even decades after they experience a traumatic event.
We’ll call him Bob for the sake of anonymity. In 1967, at the age of 17 years, Bob enlisted in the Army and spent 366 days in Vietnam where he witnessed atrocities, suffering and death. He came back only a year older, but his life was forever changed. Coming back to a country where many opposed the war and its soldiers, Vietnam vets were often shamed and shunned. Bob was offered no psychological support, nor was he given any training on what to do after his military deployment. He was honorably discharged and left to figure things out himself.
For decades, Bob struggled with what we now know are classic signs of PTSD (flashbacks, intrusive thoughts, hypervigilance, angry outbursts, detachment). He could not hold down a job; he was volatile in relationships; he trusted no one and his sleep was consistently interrupted by horrendous nightmares.
But it wasn’t until decades later that Bob learned his reactions were not uncommon and that his behaviors were the result of his trauma. When we explained that we could treat his condition, Bob was floored. By then he had convinced himself he was a bad person, an unlovable individual, someone destined for unhappiness.
Bob and I worked together for a year before my training was over. I think of him often and wish he had gotten the help he needed sooner. One of the key variables to helping Bob was not only getting him the psychiatric treatment that he needed, but also to enlist the support of his family and friends. It is the people with whom a veteran spends most of their time who can make a significant positive impact on their life.
Perhaps you have a loved one who struggles with PTSD. If that is the case, my heart goes out to you. PTSD can be frightful, for the individual and their loved ones.
Here are five tips to help a loved one who has PTSD:
Learn about PTSD
As described above, PTSD is a complicated psychiatric anxiety disorder. It is helpful to really understand PTSD, as well as learn how it specifically presents in your loved one’s life.
People with PTSD can spend a lot of time in the emotional Red Zone. This is a state where, if distress runs on a continuum from 0 (none at all) to 10 (the most distressed they have ever been), the person is experiencing distress at a 7/10 or higher. It is in the Red Zone that the limbic system (fight, flight or freeze) takes over. In essence, rational thinking and behaving often go out the window.
Another important part of understanding PTSD is to not personalize the symptoms. If your loved one has an angry outburst, it is easy to interpret that as an attack on you. In reality, it may be the symptoms of PTSD. Understand that your loved one’s behaviors are not indicative of how they feel about you or how they want to act. Do your best to practice patience and understanding. Shame is a common experience for people with PTSD, and you don’t want your reaction to contribute to their shame if you can help it.
Optimize your communication
Good communication is key to any relationship and plays a big role in how you can best support a loved one with PTSD.
Express your commitment to the relationship. Let them know you care deeply about them and want to support them in the best way possible. Focus conversations not only on their struggles, but also on positive events. Make plans for the future to help instill hope and to give them something to look forward to. Highlight positive attributes about your loved one; practice gratitude for who they are and things they do.
Because volatility and angry outbursts are not uncommon for people with PTSD, it can be very helpful to problem solve with your loved one when they are in a calmer state what to do if/when these emotional explosions occur. This is best done when you and your loved one are outside of the Red Zone. Discuss signs that they are feeling angry, steps each one of you can agree on if things get out of hand and even a code word to indicate you or your loved one needs space.
In case matters get dangerous (such as your loved one being physically threatening) create a crisis plan together so that, if needed, you have the resources in place. And, because your loved one is part of that planning, executing the crisis plan will not feel like a blow to them.
Address potential triggers
Certain external events and internal experiences can provoke increased distress for your loved ones. External triggers may include situations where they feel stuck (such as being in traffic or waiting in a waiting room for a long time), media coverage of traumatic events, anniversaries of the original trauma, and people or places associated with the trauma. Sensory stimuli, such as smells, sounds and sights, can also serve as triggers. Internal triggers can be physical distress (such as hunger, overheating, sickness), strong emotions and feelings of distrust.
These external and internal experiences can instigate the symptoms of PTSD. As such, it is helpful to proactively identify potential triggers and take steps to help them avoid these events. For example, try to schedule appointments during less busy times and, if you have to drive somewhere, make attempts to do so during a non-rush hour time.
You may choose to help your loved one find a safe place where they feel comfortable and can decompress if their anxiety heightens. This could be a specific room or area within the home or someplace outdoors. This is a place where your loved one can have some solitude and peace to decrease their distress and feel better.
Nightmares can be a trigger for greater anxiety for many people with PTSD. If your partner experiences nightmares, work together to determine the best way to help them. It could mean getting a bigger bed so you are safe (nightmares can result in violent outbursts for some) and having a system to help support your loved one if a nightmare occurs (such as speaking calmly to them).
What’s more, it is not uncommon for people with PTSD to “self-medicate” with alcohol or drugs. Of course, these substances can also cause irrational thinking and behaving, which can lead to more problems. Encourage your loved one to engage in healthier behaviors (see below) to help decrease their distress and feel more empowered.
Get your loved one support
Your loved one will benefit from support, both professional and with everyday activities.
When it comes to professional support, please know that there is much that can be done to help treat PTSD. If your loved one is not already getting treatment from a Veterans Administration medical center, find one near you and enroll them for services. While there have been horror stories about VA hospitals, I can tell you that I have worked in a handful of them around the country and, each time, been extremely impressed with the quality of care provided. Alternatively, there are independent therapists who specialize in working with veterans. A resource such as Psychology Today allows you to search for therapists in your area. Support groups with other veterans who are dealing with PTSD can also be very powerful.
Supporting your loved one outside of professional help is also important. Encourage them to engage in positive, healthy activities. Spending time with friends and family who are a source of positivity for your loved one can be helpful. Exercise is a great habit to get into to decrease anxiety and stress, boost positive energy and help with sleep. Meditation or relaxation exercises can help people with PTSD; you can even do them together. For many with PTSD, volunteering for a cause about which they are passionate can help boost a sense of purpose and decrease anxiety.
Another way to support your loved one is to truly listen to them, without judgment or fear. If they feel comfortable with you, they may choose to share some of what happened or what they are currently experiencing with you. This could involve talking about the trauma, flashbacks, nightmares or overall anxiety. Learning how to listen openly in an empathetic, nonjudgmental way can take practice. It is also an incredible gift to give your loved one. Wait for them to initiate these conversations; you don’t want to force them but rather be open to them if your loved one is ready to talk.
Address your own self-care
Being with someone who has PTSD can be very stressful. If you really want to help your loved one, taking care of your own stress is vital. That means getting the sleep, exercise, relaxation, nutrition, fun and downtime that you need to be the best you possible. This may require that you ask for assistance from friends and family, such as watching your children while you go for a walk if you have young ones.
Burnout is not uncommon for those with loved ones who have PTSD. Make sure you take time to meet your physical and emotional needs. Have sources of support and meaning outside of your relationship to ensure that you have positive experiences. Don’t feel guilty for taking care of yourself; it is vital if you want to be the best “you” for yourself and your loved ones!
Take these steps to help you and your loved one deal with PTSD. And, remember, this can be challenging, so give yourself a break! You are doing a great job!
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Dr. Elizabeth Lombardo is a Licensed Practicing Psychologist with a Ph.D. in Psychology and a Master's degree in Physical Therapy, and the authority on how to crush your inner critic so that you can live a life of purpose, fulfillment and True Success™. She’s America’s most trusted celebrity psychologist with over 100 national media interviews. She writes for Chubb and Combined Insurance in an effort to help educate readers, but her medical opinions and advice are for informational purposes only and should not be considered a substitute for visiting your doctor.