Wounded Families in the Aftermath of PTSD: The Invisible Emotional Wounds by Marilyn Lash, M.S.W.

Sex is not the Same as Intimacy

rose“Be sure to ask your doctor if your heart is healthy enough to have sex.”  That’s the closing line to a commercial for medication for erectile dysfunction. You’ve probably seen the ad on TV. Attractive couples soulfully gaze at each other and gently sip wine as the sun sets. Despite the long list of possible dire side effects, the message is clear: A pill will fix everything and restore not only sex, but intimacy for these couples. If only it were that easy. For so many returning service members and veterans dealing with post-traumatic stress disorder (PTSD), the question may be, “Are your emotions ready for intimacy?”  Sex and intimacy are very different. While sex is a physical act, intimacy is an emotional connection. As Matt and Cassi Brown have shared so openly in their article, the emotional numbness that is symptomatic of PTSD is directly connected to loss of intimacy. Yet it is the elephant in the room that too often is not discussed with family, friends, physicians, or counselors.  When the connection between loss of intimacy and PTSD is not understood, too many partners “take it personally” and feel unloved, unworthy, unattractive, and rejected. Whether the demands for sex are constant or sex is avoided for long periods, loss of intimacy can undermine the very core of a couple’s relationship.

What is PTS?

Recently renamed Post Traumatic Stress, it stems from exposure to a traumatic event involving actual or threatened death or serious injury to oneself or others with feelings of fear, helplessness, or horror.  While PTS or PTSD is not limited to combat exposure or the military, a survey by the Wounded Warrior Project reveals the extent of trauma exposure among our returning service members. When asked about their combat experiences in the War on Terror, the survey found that:

  • 83% had a friend who was seriously wounded or killed
  • 78% witnessed an accident resulting in serious injury or death
  • 77% saw dead or seriously injured civilians, and
  • 63% saw these types of traumatic events six or more times.

The good news is that not every service member with this exposure will develop PTSD.  The bad news is that long multiple deployments, shorter times between deployments, and multiple threat exposures—the very factors that characterized service in Iraq (Operation Iraqi Freedom or OIF) and Afghanistan (Operation Enduring Freedom or OEF)—have contributed to the development of PTSD.  The estimates of the numbers and percentages of service members and veterans diagnosed with PTSD are constantly changing as more attention and resources have been directed to earlier screening and treatment. But there is no “getting home free” for many combat veterans as PTSD does not always have an immediate onset. Some estimate that between 10-30% of OEF and OIF service members will develop PTSD symptoms within a year of leaving combat as they struggle to make the transition from military to civilian life.

I have often heard veterans comment that “Life was easier in combat.” The rules were clear, the orders were given, the chain of command was followed. For many, dealing with a spouse and children with constantly changing dynamics of communication, expectations, and responsibilities is like “negotiating a minefield” every day with no clear path in sight.

The Invisible Wounds of  PTSD

Amputated limbs, disfiguring burns, wheelchairs, prosthetics, ventilators—these are the visible evidence of severe injuries. It is the less visible emotional wounds of PTSD that are harder to manage and can damage relationships:

  • Anger so consuming and intense that it pushes away friends and family
  • Avoidance of sights, sounds, or situations that can trigger memories and flashbacks leading to extreme self-isolation
  • Feeling “dead inside” and finding no joy in life any more
  • Nightmares, flashbacks, and night sweats that turn nights into a siege of horror
  • Insomnia resulting in such physical and mental exhaustion that nothing seems possible
  • Drinking and self-medicating to “dull the pain” and “calm my nerves”  and “try to sleep”
  • Unpredictable mood swings from minor impatience to catastrophic melt downs
  • Verbally or physically assaulting or abusing spouses and children.

Treating the wounds of war, including PTSD, means treating the veteran’s mind, spirit, and relationships as well as the body. The damage among family relationships is clear when research compares veterans with and without chronic PTSD. Veterans with chronic PTSD have:

  • More numerous and severe relationship problems
  • Poorer family adjustment
  • Higher divorce rates
  • Less self-disclosure and emotional expression
  • Greater anxiety related to intimacy.

PTSD Affects Parenting

As Matt and Cassi so clearly show in their story, everyone in the family is affected by PTSD, including the children. As children witness a parent’s withdrawal and mood swings, as they hear the arguments and shouting, as they no longer bring friends home, PTSD becomes another entity in the home. It’s hard for a child to understand why daddy can’t go to the movies because he can’t sit in a darkened room or why he won’t sit down at the restaurant or why he never gets up before noon. The natural questions of “Why won’t he…? “ and “Why does he…?” too often become internalized and the child believes that “It’s my fault” and “My daddy doesn’t love me anymore.” ptsd child

The world shifted for the children in the family while a parent was deployed, and it shifted again with a parent’s return. The happy homecoming reunion of parent and child can go into a downward spiral as the effects of PTSD or injuries become apparent.

Dr. Jennifer Price has identified three patterns in how children respond to a parent’s PTSD symptoms. She describes the “over-identified” child who mimics the feelings and behaviors of the parent with PTSD in an effort to connect or feel closer. For example, if the parent yells a lot, the child yells more; if the parent complains of headaches, so does the child. The “rescuer” child takes on adult roles to fill in for the parent with PTSD. This child can be readily identified because he simply acts too grown-up for his or her age. This is the child who now parents the parent, manages the household, or takes on too much responsibility, often avoiding friends and peer activities. The emotionally uninvolved child gets little emotional support from the parent with PTSD and disconnects. This can lead to problems at school, depression, anxiety, worries, fears, and relationship problems later in life.

If you see any of the patterns in your children, it’s important to reach out and support them and consider professional guidance or counseling. Some researchers have characterized the impact of a parent’s PTSD symptoms as secondary traumatization for the child. Getting help is not something only for the veteran. PTSD is a family affair. It affects everyone in the family. All share a need for information, support, and guidance.

 About the Author

Marilyn Lash, MSW is President of Lash and Associates Publishing/Training with a special interest in the impact of trauma on families. She is participates in retreats for women caring  for wounded warriors led by Hope for the Homefront. This article is based on the experiences of women in a new battle on the homefront.


Special Collection on Brain Injury Journey

Special Collection on Brain Injury Journey

 This article is posted with permission from Brain Injury Journey – Hope, Help, Healing, Vol 1, 2014.


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