With millions of American soldiers deployed to Afghanistan, Iraq and other regions of conflict, military spouses must too frequently adjust to the repercussions of combat-related trauma. Spouses report feeling like collateral damage; too often feeling alone in managing the effect of PTSD on their marriage and the person they love. With an estimated minimum of 20% of Iraq and Afghanistan veterans suffering from PTSD, the ripple effect on marriages is extraordinary. Spouses are forced to take on two roles, acting both as a partner and a caregiver, as they confront issues including addiction, depression, intimacy issues and overall marital stress.
Military spouses anticipate challenges when they marry a soldier. Spouses accept that frequent moves, tours, and training that requires separation, will be part of the union. They accept that there will be things that their partner must keep confidential. However, when PTSD becomes an additional factor, solid marriages can become at risk. Spouses can expect to feel overwhelmed by their partner’s mental health and associated behaviors that can spiral marriages into crisis.
Here are some evidence-based points for couples coping with PTSD within the marriage:
1. Reach out for help immediately
While you may have been a couple that dealt with challenges independent of outside support, coping with combat-related PTSD is different. Both you and your spouse require information and treatment to sustain a healthy relationship. Spouses and veterans benefit from education about the effects of trauma and strategies to respond to triggers and symptoms. Too often, couples wait to access help and the symptoms escalate to a point of crisis.
2. Make safety a priority
Combat-related trauma can bring on flashbacks, nightmares, and disruptions in the ability to self-regulate. If the veteran or the spouse is noting the difficulty in managing anger and aggression, seek support prior to a crisis occurring. Recognize that suicide risk increases with combat-related PTSD. Make safety a priority for the veteran and the family unit by involving medical and mental health support.
3. Recognize the risk of isolation and avoidance
One of the symptoms associated with PTSD is avoidance of feelings. To cope with overwhelming symptoms, people may find that they isolate themselves from family and friends. Other avoidance strategies may also increase, including substance abuse, gambling or other forms of self-destructive behavior. Spouses may find that they pull away from friends and family to avoid explaining the family situation. Instead, increase involvement through individual or group support. Increasingly, Military Family Resource Centers, Veterans Affairs, and community organizations are offering spousal support groups and professional therapy.
4. Understand the how
When things change drastically, as they do when a spouse suffers PTSD, it is helpful for both the veteran and the spouse to increase understanding of what is happening. Psychoeducation through therapy can assist in normalizing what you and your spouse are experiencing. People in combat, no matter how well-trained and effective they are, are placed in abnormal situations. Trauma is a normal reaction to an abnormal situation. While some people do not develop PTSD or an Operational Stress Injury (OSI), for those who do, the brain is constantly working in a heightened state of anxiety.
5. PTSD takes up a lot of space
People in loving marriages, reasonably accept that both individuals have needs to be met. When one person in the marriage suffers from PTSD, the inability to emotionally self-regulate, and the behaviors that go with it, are overwhelming and spouses can be left feeling like there is no room for their needs. One spouse of a soldier who suffers from PTSD explains, “It’s like my day is never my own. I wake up and I wait. If I make plans they change based on his needs and it doesn’t matter what I want.” Understand that, until symptoms are treated, the person suffering from PTSD is trying to manage complex feelings, including high anxiety and sometimes auditory, visual and thought intrusions, that can be all-consuming for both people in the marriage.
6. Intimacy issues are likely
Couples who once had healthy intimate relationships may find themselves feeling disconnected. PTSD can cause night sweats, nightmares, and physical aggression during sleep which results in spouses sleeping separately. Some medications also alter sexual performance which lends further to the sexual disconnect. Be conscious of the need for physical intimacy but understand that the lack of may be symptomatic of the trauma. It is not the fault of either spouse.
It is challenging for spouses to relate to a partner who returns from deployment with PTSD. Clinical support for veterans, and spouses, is essential to ensure once stable marriages are not collateral damage of the combat experience.