VietNow National Magazine

Although it's not "contagious," PTSD can affect everyone around a person who has PTSD. This "Secondary PTSD" can become a vicious cycle for all concerned.

Walking on Eggshells

By Mary Tendall and Jan Fishler

Secondary Post Traumatic Stress Disorder, PTSD: (Not a defined mental disorder within the DSM-IV) occurs when a person has an indirect exposure to risk or trauma, resulting in many of the same symptoms as a full-blown diagnosis of PTSD.

Based on the many letters we have received, we know our readers can relate to the issues that post traumatic stress disorder, PTSD, raises among veterans and their families. While it is clear that combat veterans who have witnessed or experienced severe trauma are the primary recipients of this disorder, family members can also be affected by this condition. Although PTSD is not contagious like a bad cold or the flu, it can also affect the mental health and life satisfaction of partners. Over time, without intervention, it can become a vicious cycle. Here is an example of how this cycle might occur.

Although he knows it agitates him, Gary,* a combat veteran, watches the news every night at 6 o’clock. The news about the war in Iraq is upsetting, and by the time the program is over, Gary is angry and agitated. His wife, who has been in the kitchen making dinner, has no idea what her husband has just witnessed. She knows only that he is detached and uninterested in talking to her during their meal. When she asks if something is wrong, Gary accuses her of nagging him, leaves the table, and spends the rest of the evening in his shop, where he continues to have intrusive thoughts about the war. His wife, on the other hand, is upset by behavior she does not understand. If this situation continues, several things might occur: Gary’s wife could become depressed, alienated, and betrayed by her husband’s lack of communication; she could start drinking before dinner to numb her feelings of despair; or she might constantly be on the lookout for various cues and triggers that bring on her husband’s reactivity. Eventually, her behavior – especially her hyper vigilance – could become a stressor to Gary. The result is a dysfunctional and unhappy couple.

For the past 29 years, Darlene* has lived with Bob,* a Vietnam veteran diagnosed with PTSD. She describes this time as “walking on eggshells, never knowing when he’ll blow.” Over the years, to deal with her husband’s reactivity, Darlene has increased her own vigilance. She says that when her children were little, she often sided with them against Bob – especially when he had unrealistic expectations of them. Many times she had to leave public gatherings due to her husband’s confrontations. As their marriage progressed, Darlene’s continual vigilance took its toll, leaving her with many of the same symptoms as her husband. Her anticipation of “a blowup at any moment” created distance in her relationships – not only with family members, but also with friends. She complains that she has had no social life.

Because this aspect of trauma is not commonly addressed, Darlene and Bob were unable to take the necessary steps to communicate safely and act in ways that could have created a healthy family dynamic. Instead, they focused on blaming each other, and their marriage and their children suffered.

As one wife of a combat veteran who has attended several support groups over the years explained, “A few months ago, my husband told me he felt like he was ‘walking on eggshells,’ and I had to laugh. Apparently, my secondary PTSD had affected him.”

Secondary PTSD is not a defined mental disorder within the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV), published by the American Psychiatric Association and serving as the main diagnostic reference used by mental health professionals in the United States. However, the condition does occur when a person has an indirect exposure to risk or trauma, resulting in many of the same symptoms as a full-blown diagnosis of PTSD. These symptoms can include depression, suicidal thoughts and feelings, substance abuse, feelings of alienation and isolation, feelings of mistrust and betrayal, anger and irritability, or severe impairment in daily functioning.

Many Vietnam veterans grew up in households with fathers who had served in combat. Consequently, some veterans entered combat already having PTSD symptoms. After treatment, these veterans often acquire a new awareness about their parents, and it is not uncommon to hear statements such as, “Now I understand why my dad was so demanding. He was a workaholic and had no friends. I am like that, too!”

Secondary PTSD symptoms are not limited to spouses of combat veterans. In work with families who have relatives currently deployed in the Middle East, it has been observed that the mere thought of a distant, at-risk loved one generates fear that repeatedly sets family members on edge. Television coverage offers images that fuel the existing fears. The fear of a catastrophic event, coupled with the fear of losing a loved one, tricks the primitive part of the brain into believing that it has already happened. As a result, family members exhibit many of the symptoms of PTSD – increased irritability, increased self-medication with alcohol or drugs, sleeplessness and nightmares, social isolation (“I don’t want people asking about my son/daughter.”), poor concentration, and relationship issues. As one mother of an American soldier in Iraq shared, “I haven’t relaxed since Sharon was deployed.”

The mind has the power to create states that affect the body in both negative and positive ways. If negative thoughts and fears can cause irritability, angry outbursts, loss of interest, and hyper-vigilance, just imagine what positive thoughts might do. While it is common to blame a spouse or to become a victim, it is much more productive to take an honest look at issues and learn how to create a healthy environment. Rather than get fixated on the reactivity of the person identified with PTSD, it is more productive to view PTSD as a family matter – one that can be resolved if everyone takes time to work on his or her own issues.

At this point, you might be wondering if you or your family members have secondary PTSD. If you are close to someone who suffers from an untreated trauma, or fear for someone’s well-being who is at a sustained risk, it is important to do some self-assessment. Ask yourself: Is my sleep worse? Am I more on edge or irritable much of the time? Do I avoid social engagements more often? Am I self-medicating with alcohol or drugs? Have I developed unhealthy, distracting activities? Do I eat a less-healthy diet and exercise less? If many of the above are true, it is important to take the necessary healthy steps to calm the nervous system and create a more accurate perspective.
• Take a warm bath or shower an hour before sleep, and go to bed at the same time each night.
• Take long, deep breaths when you find yourself feeling irritable or depressed. This will give your nervous system the message that you are okay.
• Force yourself into healthy social events with good friends. Isolation adds to depression when it is based on avoidance. Socialization will bring smiles and necessary connection with others.
• Assess your use of alcohol and/or drugs. Very moderate use of alcohol is the only way to indulge. Eliminate drugs as a means of escape, unless used as prescribed.
• Create activities that are safe and that bring satisfaction. If you don’t know of any, check the newspaper for ongoing activities in your area. Taking a walk routinely with a friend is a very healthy and safe activity, and your friends will enjoy it, too.
• Eat a healthy diet and make time to exercise. Just do it! You will feel better and have more energy in a matter of days. Make it a new habit.

Another variable to consider in healing PTSD and secondary PTSD is communication. In times of combat, communication is one of the essential tools for survival, but in a non-combat environment, the rules for communication change. Where ordering, advising, lecturing, interrogating, and silence can be life-saving behaviors in a combat zone, they are roadblocks to healthy communications among friends and family members.
Positive thinking and positive self-talk are also important components of healthy communication. Because
the brain responds to constructive thoughts, thinking pleasant thoughts and making beneficial statements can go a long way to improve the atmosphere in the home. Instead of criticizing yourself or blaming yourself or others, tell yourself that you are doing the best you can.

Taking a communication class together or reading the same book about communication can be extremely helpful in lowering the anxiety level between couples. One combat veteran and his wife did both. They signed up for a weekend communication class and also bought a book on the same topic. As a result, the couple reached a new level of understanding and intimacy because they had the tools to communicate in a way that was non-threatening and non-defensive.

Whether you have PTSD or secondary PTSD, it might be comforting to know that you are not alone and that there is help. While therapy and medication are often used to heal trauma that results from extreme stressors, there are things you can do to help yourself. Join a support group where you can talk about problems in a safe environment and learn more about the disorder. Avoid alcohol or illicit drugs, and learn everything you can about the condition. Remember – PTSD and secondary PTSD are treatable. In recent years as a result of improved information, a solid support system and additional help when necessary, many families have reported improved communication and relief from symptoms.

*Names and some situations in this article have been changed.

Mary Tendall has worked for almost 14 years with combat veterans as a licensed marriage and family counselor, specializing in PTSD.

Jan Fishler is a freelance writer, trainer, and video producer who is married to a Vietnam veteran.

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