This document discusses post-traumatic stress disorder (PTSD) and its secondary effects on families. It defines PTSD as an anxiety disorder that develops after a traumatic event. It also defines secondary PTSD as indirect exposure to trauma through accounts from a person with PTSD, which can cause similar symptoms. The document notes that secondary PTSD is not officially recognized but family members of those with PTSD can experience PTSD-like symptoms. It concludes that secondary PTSD needs to be recognized and treated similarly to PTSD to help families.
1. Post Traumatic Stress Disorder~Secondary Effects on the Family Course Code: PSY492 Submitted by: Marcanne Smith Date: April 12, 2010
2. What is Post Traumatic Stress Disorder (PTSD)? Anxiety disorder developed after experiencing a traumatic or life-threatening event Disintegration of the human psyche’s natural protection mechanism of fear – “fight or flight” Associated with persistent, frightening thoughts and memories, or flashbacks, of the ordeal Persons with PTSD often feel chronically, emotionally numb
3. What is secondary PTSD? Indirect exposure to trauma through a firsthand account or narrative of a traumatic event Act of mirroring side effects of PTSD Altering of behaviors for fear of verbal and/or physical abuse from PTSD patient
4. Who is effected by secondary PTSD? Family members Co-workers Friends Acquaintances
5. Understanding Secondary PTSD PTSD / Secondary PTSD is not prejudiced Co-workers can be indirectly affected Friends can be lost Acquaintances can become unwilling victims of rage associated with both PTSD and Secondary PTSD Family members adopt trauma as their “own”
6. Is Secondary PTSD real? Continuous indirect exposure (retelling of events) to traumatic events can transfer PTSD-like symptoms Negative behaviors of PTSD person can result in traumatic events Currently, the Diagnostic and Statistical Manual of Mental Disorders (4th Edition) does not recognize secondary PTSD as a valid disorder; consequently treatment options are extremely limited for family members.
7. Treating PTSD patient Intensive couples therapy Retelling of events to family member in a non-threatening, neutral environment Personal recounting without projecting Film footage Treating Secondary PTSD
8. Defining “victim” Secondary PTSD needs to be declared valid psychoses Secondary PTSD can be as damaging as PTSD Secondary PTSD is as treatable as PTSD Joint effort between therapist and patient Conclusion
9. References Black, T. G. (2004). Psychotherapy and Outcome Research in Ptsd: Understanding the Challenges and Complexities in the Literature. Canadian Journal of Counselling, 38(4), 277+. Post Traumatic Stress Disorder. (2010). Retrieved on April 17, 2010 from http://www.ptsd.ne.gov/what-is-ptsd.html Solomon, Z., Dekel, R., Zerach, G., & Horesh, D. (2009). Differentiation of the Self and Posttraumatic Symptomatology among Ex-pows and Their Wives. Journal of Marital and Family Therapy, 35(1), 60+ Taylor, S. (Ed.). (2004). Advances in the Treatment of Posttraumatic Stress Disorder: Cognitive Behavioral Perspectives. New York: Springer Williams-Keeler, L., McCarrey, M., Baranowsky, A. B., Young, M., & Johnson-Douglas, S. (1998). Ptsd Transmission: a Review of Secondary Traumatization in Holocaust Survivor Families. Canadian Psychology, 39(4), 247+. Williams, M. B. & Sommer, J. F. (Eds.). (1994). Handbook of Post-Traumatic Therapy. Westport, CT: Greenwood Press
Hinweis der Redaktion
People with PTSD experience three different kinds of symptoms. The first set of symptoms involves reliving the trauma in some way such as becoming upset when confronted with a traumatic reminder or thinking about the trauma when you are trying to do something else. The second set of symptoms involves either staying away from places or people that remind you of the trauma, isolating from other people, or feeling numb. The third set of symptoms includes things such as feeling on guard, irritable, or startling easily (Post, 2010).An estimated 7.8 percent of Americans will experience PTSD at some point in their lives, with women (10.4%) twice as likely as men (5%) to develop PTSD. About 3.6 percent of U.S. adults aged 18 to 54 (5.2 million people) have PTSD during the course of a given year (Post, 2010).
PTSD is marked by clear biological changes as well as psychological symptoms. PTSD is complicated by the fact that people with PTSD often may develop additional disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person’s ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting. These symptoms often transfer to family members of the PTSD person as they experience second-hand the traumatic events. Secondary PTSD is a relatively new psychological diagnosis that is still undergoing research in an effort to find effective therapies (Taylor, 2004).
Further research of secondary PTSD reveals that family members often feel helpless at not being able to provide aid and support to the PTSD patient, resulting in feelings of despair or inadequacies (symptoms akin to that of PTSD). Often times the family members feel somehow responsible or to blame for the after-effects of the trauma experienced (Williams, Sommer, 1994). This disparity often leads to their own feelings of inadequacies as they attempt to alleviate the PTSD patients suffering. The family member undergoes a classic denial mentality in an attempt to protect their own sense of psychological stress.Partners of PTSD veterans are survivors. Throughout their lives they have overcome many traumas and obstacles. Many of these people (particularly military families) come from dysfunctional families of origin, some of which are characterized by abusive behaviors and substance abuse. The PTSD partner frequently assumes caretaking, over-responsible roles in their families of origin, and, as a result, they continue in similar roles as adults. As partners of PTSD veterans, they face many situations that add to their resiliency and stamina. They have learned, often from a very young age, to fight for survival, which contributes to the endurance they have in coping with the veterans' PTSD (Taylor, 2004).
A study published in 2007 on the wives of veterans of the Croatian War revealed that of had no symptoms of secondary PTSD, 21 had up to 5 symptoms, 19 had greater than 6 symptoms, and 13 women had more than 11 symptoms of secondary PTSD. Although they knew about their spouse’s trauma and subsequent onset of PTSD symptoms, 22 of the women met the diagnostic standard for PTSD themselves. Of the 56 women studied 70% reported emotional disturbance, 63% reported avoidance of thoughts and feelings, 56% reported periods of rage and annoyance. The study revealed that two-thirds (about 37) of these women felt they needed professional psychological help; only four out of the 37 sought help (Williams-Keeler, et al, 1998).Victims of traumatic events can be severely affected by PTSD, but individuals who are close to the victims also are influenced by behavior changes, adjustment problems, and other PTSD symptomology that affect victims. This indirect influence of traumatic events on persons other than the primary victims of trauma has been referred to as secondary traumatization. . PTSD spouses tend to be less happy, less satisfied, and experience greater distress than spouses of those without a diagnosis of PTSD. In addition to the symptoms that occur when one member of a household experiences PTSD, a number of interpersonal problems are likely. The households of PTSD veterans are often characterized by confusion and uncertainty for family members as they wonder what behavior will trigger the veteran's PTSD symptoms.
The DSM-IV (APA, 1994) states that trauma may result when a "person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self and others [and] the person's response involved intense fear, helplessness, or horror". According to the APA definition of trauma, the secondary PTSD would be a valid diagnosis. In the retelling of traumatic events people thus experience their own version of the traumatic events. Often times these events can be multiplied in intensity due to their own self imaging and comprehension of the events, resulting in an onslaught of PTSD symptoms. It is argued that family members cannot experience PTSD symptoms because they have not directly experienced the traumatic event(s); however, a study conducted with Holocaust survivor family members indicated the presence of trauma transmission (Williams-Keeler, et al, 1998). Through communications of the trauma, family members “adopt” the trauma as their own and began to develop their own PTSD symptoms as a result of the constant retelling of events.
Research indicates that bringing a spouse into the PTSD treatments (particularly with military wives) is an effective method to reduce secondary PTSD. This allows the retelling of traumatic events to be done so in a neutral environment, mediated by a counselor to ensure the absence of anger or fear. Further research also shows that by showing film footage of what the soldier experienced during war time wives gained a stronger, deeper empathy for the trauma their husbands experienced which enable a greater understanding of the symptoms presented in the marriage (Black, 2004).Extensive therapy for secondary PTSD patients would focus on four main areas; 1) coping with veteran PTSD symptoms, 2) unmet needs, 3) violence, and 4) emotional abuse. Secondary PTSD patients most often are attempting to cope with their partner's alcohol or substance abuse, physical abuse, fear of the veteran's PTSD symptoms, and possible ending of the relationship. To the extent of the intensity of stress associated with each of these issues these women tend to be ineffective in their coping strategies causing more difficulties in the emotional interaction between both people (Taylor, 2004).
The majority of research on stress disorders uses a narrow definition of victim and, therefore, has focused only on individuals who have most immediately experienced extreme stressors. Previous empirical studies have not found conclusive evidence for PTSD symptoms in veterans' partners. Nevertheless it seems important to assess the characteristics, predisposing factors, and problems of female partners that may be related to their PTSD-like symptoms. Problems associated with physical and emotional abuse, personal traumatic events, family-of-origin experiences, and personal attributes all may play a role in secondary PTSD patient symptomology. This suggests the use of a broader definition of the term “victim” (Black 2004). Given the extent of the problems faced by female partners and the limited research focus in this area, there is a dire need for professionals to gain a better understanding of veterans' female partners' PTSD. This is a population that has been virtually disregarded but that deserves to be noticed. Some of the specific symptoms and problems experienced by victims of traumatic events are known, and professionals are becoming more aware of possible systemic effects of PTSD. Having experienced secondary PTSD, I support its existence as a psychological theory. It is difficult to feel indifference when a loved one is displaying obvious symptoms (i.e. dark, uncontrollable rages, deep state of depression, etc.). According to the APA definition of PTSD the myriad of symptoms associated with this disorder can classify as a traumatic event. Thus, secondary PTSD develops and presents the same symptoms. Secondary PTSD symptoms are not limited to spouses of combat veterans. In work with families who have relatives currently at risk, deployed in the Middle East it has been observed 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” (Solomon, et al, 2009).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.
