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Post Traumatic Stress Disorder (PTSD) is best understood as a traumatic stress injury. It involves reactions to extreme stress and trauma that can affect your thinking, emotions, physical sensations, and behaviour. These are natural responses that usually subside when the stressful event passes.
But with PTSD they get “locked on”. Just like physical injuries, we as humans can be more or less resilient to stress injuries depending on a number of factors. But none of us are immune, and just like elite sports people who can be injured at the peak of their fitness, even the toughest of first responders can incur a traumatic stress injury if a particular thing hits at a particular time.
For further information refer to Understanding PTSD in the Fortem Resource Library
If there is one thing that people with PTSD wish for from those around them, it is understanding. They can often feel isolated in their own private hell, with no way to explain what is going on in their bodies and minds. There are many ways in which you can support them.
PTSD can occupy the majority of a person’s mental, emotional and physical resources, consuming them with danger, injustice, pain and/or loss. This is why they may be distant, withdrawn, shutdown or irritable. Remembering this will help you to understand that the person with PTSD is operating at minimum capacity, and help you to be open to negotiating tasks and commitments.
But it is not static: some days are relatively good, some can be quite bad. It’s hard to predict how the person is going to be at any given time. This is why it is hard for people with PTSD to commit to future social gatherings, and why they
might withdraw at the last minute.
Remember that their reactions and behaviour come from something that happened, not who they are.
It is important to build some knowledge and skills around how to provide support for your loved one or colleague, and for yourself.
Try to avoid telling them what they “should” do. Try to get in the habit of asking what it is that they need. This in turn can encourage them to volunteer information that will help you understand what is happening and how you can help.
Believe us: if they could, they would! The person’s nervous system is locked in a state of constant alert, and this is not fun for them.
Many people with PTSD feel like the memories and knowledge they carry is toxic, and will cause harm to their loved ones if they share it. They try to protect their loved ones by withdrawing.
Assume that there is a very powerful reason for their being so sensitive, reactive, irritable, or avoidant. Let them know that you want to understand their triggers (but that this does not need to involve retelling details of the trauma). Plan ways of managing common triggers together, so that it feels like a team approach rather than something to be ashamed of and to hide from you.
Flashbacks are when someone with PTSD is triggered back to a traumatic event. They can lose touch with their current environment and respond as though they are back in the trauma. There are some simple things you can do to help ground them:
There are lots of ups and downs with PTSD, and recovery can be a slow process. It can be extremely hard when someone you care about is struggling. When they are distressed, often the most supportive thing to do is just be quietly present and caring. You could say, “You’re having a rough time today. I’m here. Let me know if you need anything.”
Creating structure and routine can restore a sense of stability and predictability. Try to negotiate how to do things in a way that is manageable. Negotiate space for time out, and discuss family activities that allow connection without feeling too overwhelming. Fortem can help with these through our free Wellbeing Activities.
You will need to be understanding and flexible, but wherever possible, try to keep up activities that are fun and help your loved one stay connected to the good things in their lives. Social connection is a powerful support for recovery
It is hard to watch someone you care about behaving differently. Know they are doing the best they can, and avoid judgement and blame. People with PTSD often withdraw from family and friends because they feel ashamed, don’t want to be a burden, or believe that others won’t understand. Being understanding and accepting is a huge comfort.
Try to see the good in them even if it’s not visible every day. Highlight their strengths, and remind them of the qualities you love – they will have a hard time seeing these parts of themselves.
Although it’s often not obvious, most people with PTSD are very upset about the impact of their struggles on the family. Try to balance understanding with clear boundaries about your own needs and expectations. PTSD is no excuse for bad behaviour – you have the right to stay clear about what is okay and what is not.
Try to maintain both acceptance and boundaries. For example, you might say, “I understand you are doing it tough today. I don’t want to be spoken to in that way. What do you need right now?
Developing a simple, non-threatening way of checking in with each other can be very useful. Many people find SUDS (Subjective Units of Distress Scale) a good way of doing this – it’s really just a fancy way of saying, “How stressed or distressed are you feeling right now?” Each of you can rate your own feelings.
Print out the image below and put it somewhere that you will see it regularly – you might like to stick it on the fridge to help remind you to do a regular check-in.
There may be moments when your loved one or colleague is angry. Try to remember that anger may be communicating distress or vulnerability. Try to stay calm, give them space, ask what they need and encourage them to express this. It can be helpful to set up ways of responding to anger in advance (when they are calm). Remember, you don’t need to compromise your own boundaries about how you want to be treated.
It is absolutely possible to recover from PTSD. There are a number of PTSD specific treatments, and psychologists that specialise in trauma, and you will find a list of these in the following section.
It can be difficult living with someone who has PTSD. You will need to look after yourself and get your own support. You will have lots of mixed feelings about the situation and it can be helpful to have someone understanding who you can vent your feelings with. You may also need to fill the gap that could be left by your loved one’s emotional withdrawal and lack of warmth.
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