Family and Friends

If you are family or a friend of someone with PTSD, you need to understand that you are on the journey as well. PTSD is a very difficult and lifelong condition. I have seen people with PTSD end up isolated without family or friends. People think that it is difficult to deal with someone who has PTSD. Imagine how hard it is to have PTSD, if you think that dealing with someone with it is hard, let me tell you, having it is many times harder. People who suffer PTSD are many time more likely than the average to commit suicide. Of those with PTSD who commit suicide nearly all are isolated and unable to reach out for help. Remember that being there is not the same as "being there". You need to be more than just physically there, you need to be emotionally there as well. 

I can tell you that there have been many times that the simple act of my wife grabbing my hand has saved me. The key for anyone dealing with someone with PTSD is communication. This one is on you as the loved one. Just like with any negative thing, people with PTSD are trying to distance themselves from the negative. That is a very hard thing to do when you relive it. So often times we don't want to talk about our trauma or about our symptoms. This is very much the first brick wall that needs to be destroyed. This is one of the big ones that many people get wrong, they either allow the person to distance and it slowly eats the person alive, or they will be too aggressive. The key is to get the person to talk just a little. Let them know you are a safe person to talk to. Trust is critical at this point. Once they begin to open up some of the stress is going to lift. Remember the S stands for stress. This stress is both emotional and physical. 

Here is a huge thing to understand, once the person trusts you and begins to open up, they are going to go through something that is often termed "decompression". This is a period when the stress begins to decompress and come out. This may even make their symptoms worse for a short time, this person hasn't just been repressing the stress from trauma but, their everyday stress. Often times people with PTSD are the person that is call, cool, and collected in hard situations. In fact many "seem" to thrive under stress. This is because people with PTSD are masters of repression. So be ready when they reach this stage, they are going to act differently. They may even withdraw a bit. Don't let that deter you, be there for them. 

The severity and course of the decompression is going to depend on the time of repression. Don't think of time as days, weeks, or years. Think about it as emotional time, someone who had a trauma in childhood and went on to live an emotionally normal life is not equal to a police officer who has spent 25 years seeing suffering and death. Each person has a natural amount of stress and trauma they can deal with, that is going to play a role. 

Once the person has made it out of this stage, then and only then can you really begin to start to deal with the more practical issues with PTSD, if you have made it to that point, they may open up about the trauma, they may open up about reliving episodes, night terrors, and nightmares. PTSD at its heart is a loop in the brain that continues to re-engage the fight or flight instinct. So obviously this is where most PTSD treatment also takes place. There is the emotional side which is often treated with SSRIs. This makes the body increase serotonin levels. This helps with moods, and helps to reduce the number of times the body go into fight or flight. So it does help the physical side. The thing is we also have to deal with the physical side, think about how much damage is done by having your body be in this mode so much. People with PTSD are more likely to have heart conditions, diabetes, ulcers, and even cancer. Needless to say this can reduce lifespan greatly. In most cases lifestyle choices need to be made. 

Then under all of this we need to get to practical aspects. For instance my wife and I needed a bigger bed because when I have night terrors, I kick. You have to understand this, sometimes you may have to make sacrifices. It maybe a matter of comfort for you but, a need for them. Reliving is a realistic flashback, a nightmare is just a reliving that happens when you are in REM sleep, and a night terror is the same thing, just in a different stage of sleep. When awake obviously we can often pull ourselves out of that moment however, in both nightmare and night terror the person has no control, so often they relive the entire trauma. So it is with no surprise that the number one issue people PTSD deal with is sleep. Subconsciously we begin to avoid sleep altogether. People with PTSD often become frustrated with our own brains over sleep, just like everyone else we want a good night sleep. But night after night lay awake, and once asleep, sleep is terrible. There is one drug that treats this Prazosin. Big but here, it only lessens the night issues and only works for about 50 percent of people. So back around to the practical aspects, sleep is the biggest area you need to understand. This area is the one that I have seen break up couples the most. Just imagine what the other person goes through every time they sleep, then think how precious would you consider sleep. 

There are several comorbids with PTSD, Depression, General Anxiety Disorder, and Social Anxiety Disorder are the big three. All three are exacerbated by lack of sleep, and the symptoms of PTSD. So again we have a point where lifestyle choices have to be made. Don't expect a person with PTSD to want to go clubbing at two in the morning. For me even going shopping can be a difficult thing. So stop and think about what is likely to be a trigger and what is likely to just be a major problem for that person. 

When all is said and done, it is very easy to just take the steps to understand what your loved one with PTSD need, and how to keep things on track. All it really takes is just a bit of kindness and understanding on your part. Don't blow up your relationship with anyone just because they are dealing with PTSD, just treat them kindly.