Understanding Relationship PTSD And Its Link To Abusive Relationships

Post-traumatic stress disorder (PTSD) may be commonly associated with discrete traumatic events, such as being deployed in a war zone or experiencing a sexual assault. However, it is also possible to develop PTSD from ongoing traumatic events, such as being in an abusive relationship. PTSD that results from these situations may manifest in different ways than other trauma-related disorders, but treatment from a mental health professional may address and reduce these kinds of symptoms. 

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What is relationship PTSD?

While relationship trauma is generally understood to be a possible cause of PTSD, relationship PTSD and post-traumatic relationship syndrome are not currently listed as official mental health diagnoses. However, as more research is being conducted on the specific impacts of surviving an abusive relationship, more targeted treatments to assess symptoms associated with this kind of traumatic event are being deployed. 

Abuse in relationships can include sexual abuse, emotional abuse, physical abuse, verbal abuse, and financial abuse, or a combination of multiple different forms of abuse. While these kinds of abuse may be more common in a romantic or intimate relationship, an abusive romantic relationship is not the only kind of relationship that can lead to relationship PTSD symptoms.

A form of traumatic stress caused by abusive or unhealthy relationships

Any relationship can become abusive, including the following:

• A parent abusing a child
• A child abusing a parent (this situation can be more common in cases of adult children abusing aging parents, which can be a form of elder abuse)
• A friend abusing a friend
• A work supervisor abusing a subordinate

Overlapping PTSD and PTRS symptoms

PTRS and relationship PTSD can be seen as forms of PTSD, so someone experiencing relationship PTSD may display a number of traditional PTSD symptoms. However, there are some PTSD symptoms that may be more common or prevalent in a person whose trauma is linked to a close relationship. 

PTSD symptoms are typically classified into one of four symptom categories: intrusive symptoms, avoidance symptoms, mood- and cognition-related symptoms, and arousal and reactivity symptoms. 

Symptoms of relationship PTSD or post-traumatic stress disorder

A person who has developed relationship PTSD may be more likely to display intrusive symptoms, mood- and cognition-related symptoms, and arousal and reactivity symptoms, along with symptoms that may be unique to experiences with relationship trauma. Avoidance symptoms may not be as common in this form of post-traumatic stress disorder, although updated research may be needed.

Intrusive symptoms associated with relationship PTSD

• Recurring nightmares related to abusive experiences
• Flashbacks, in which a person may dissociate from the present moment and believe they are re-experiencing the relationship abuse
• Intrusive thoughts and memories related to abusive experiences
• Physical symptoms of anxiety when thinking about or being reminded of the relationship abuse, such as sweating, shaky hands, pounding heart, shallow breathing, overwhelming feelings of fear/panic, etc.
  

Mood- and cognition-related symptoms associated with relationship PTSD

• Disproportionate responses to emotional stressors
• Difficulty coping with the challenges of everyday life
• Having a hard time concentrating

Arousal and reactivity symptoms associated with relationship PTSD

• Irritability and being “on edge”
• Troubles with falling asleep, staying asleep, or sleeping restfully
• Being easily distracted
• Extreme or exaggerated startle response

Unique symptoms of relationship PTSD

• Attraction to unhealthy relationship dynamics that may mirror the abuse of the past relationship
• Quickly moving from relationship to relationship 
• Fear of being alone, or, conversely, a tendency to isolate oneself from other people and avoid meaningful connections entirely
• Having a hard time building trust with others
• Unwillingness to engage with or process emotions related to the past relationship
• Believing one does not “deserve” a healthy relationship
• Blaming oneself for past experiences of abuse
• Loss of sexual desire and interest

Treatments for relationship PTSD and PTRS

Many of the treatments for relationship PTSD and PTRS overlap with common treatments for PTSD that is not caused by relationship trauma. However, the treatment approaches for relationship PTSD may focus more on the relational aspects of symptoms and ways to build trust and meaningfully connect with other people again.

Eye movement desensitization and reprocessing (EMDR) therapy

EMDR therapy tends to be well-known in the trauma treatment community. It typically involves bilateral stimulation of the brain through activities like following a therapist’s finger as they pass it back and forth in front of your eyes or holding onto alternately vibrating buzzers in each of your hands. 

During bilateral stimulation, a person may be able to engage directly with traumatic memories without becoming re-traumatized in the process. For people with relationship PTSD, this process could involve recalling specific aspects of the abuse. Often, in this mental state, people can recognize that the traumatic relationship was not their fault and that they can be in control of their relationships moving forward.

Prolonged exposure (PE) therapy

Prolonged exposure therapy generally has the same goal as EMDR therapy, which is to bring a person to a point where they can process their trauma. However, it normally uses a different mechanism. While EMDR therapy can put a person in an altered brain state, prolonged exposure therapy may gradually expose the person to stimuli related to their trauma. The stimuli usually become progressively more intense, but less negatively impactful as a person builds up resilience to engaging with reminders of their traumatic experience.

For a person with relationship PTSD, the stimuli could be related to abuse that took place within the relationship. For example, if the dinner table was a frequent site for arguments that escalated into physical abuse, and as a result, the person is now hesitant to eat meals with a new partner, PE therapy could involve gradually engaging with aspects of the meal preparation and sharing process. 

Cognitive behavioral therapy (CBT) for mental health

Cognitive behavioral therapy can be seen as one of the most widely practiced treatments for a variety of mental health conditions, including PTSD. It normally focuses on the relationship between thoughts and behaviors, based on the premise that adjusting unhelpful thoughts could reduce the presence of unwanted behaviors. 

For PTSD, and relationship PTSD specifically, therapists often use a form of CBT known as trauma-informed CBT. In this therapeutic practice, a therapist and client may work together to target the negative beliefs and self-blame that can arise when a person has survived a traumatic event (or a series of traumatic events, as in an abusive relationship). For a person with relationship PTSD who blames themselves for the abuse, trauma-informed CBT could involve working through distorted beliefs about what happened and coming to a healthier understanding of the relationship.

Worried that past relationship trauma could be holding you back?

An online therapist can help you heal

Online therapy

Difficulty trusting other people, especially in new relationships, can be a hallmark of relationship PTSD. In some cases, this fear of meaningfully engaging with new people could extend to a person’s relationship with their therapist. It may be unlikely that a person will be able to make any progress in alleviating their symptoms if they do not feel comfortable being authentic and vulnerable with their therapist.

Benefits and efficacy of online therapy

In these situations, online therapy may be a beneficial alternative to traditional in-person therapy. Online therapy can put a bit of distance between a person and their therapist, which may help people with relationship PTSD feel more comfortable and open up more easily. 

Research has indicated that therapy for PTSD can be just as effective when delivered online as in an in-person format. Either option may be helpful for individuals who want to address relationship PTSD and other mental health concerns.