Items filtered by date: June 2016

What are the most common relationship problems for people with PTSD?

PTSD can affect how couples get along with each other. It can also affect the mental health of partners. In general, PTSD can have a negative effect on the whole family.

Male Veterans with PTSD are more likely to report the following problems than Veterans without PTSD:

• ·         Marriage or relationship problems
• ·         Parenting problems
• ·         Poor family functioning

Most of the research on PTSD in families has been done with female partners of male Veterans. The same problems can occur, though, when the person with PTSD is female.

Effects on marriage

Compared to Veterans without PTSD, Veterans with PTSD have more marital troubles. They share less of their thoughts and feelings with their partners. They and their spouses also report more worry around intimacy issues. Sexual problems tend to be higher in combat Veterans with PTSD. Lower sexual interest may lead to lower satisfaction within the relationship.

The National Vietnam Veterans Readjustment Study (NVVRS) compared Veterans with PTSD to those without PTSD. The findings showed that Vietnam Veterans with PTSD:

• ·         Got divorced twice as much
• ·         Were three times more likely to divorce two or more times
• ·         Tended to have shorter relationships

Family violence

Families of Veterans with PTSD experience more physical and verbal aggression. Such families also have more instances of family violence. Violence is committed not just by the males in the family. One research study looked at male Vietnam Veterans and their female partners. The study compared partners of Veterans with PTSD to partners of those without PTSD. Female partners of Veterans with PTSD:

·         Committed more family violence than the other female partners

·         Committed more family violence than their male Veteran partners with PTSD

Mental health of partners

PTSD can affect the mental health and life satisfaction of a Veteran's partner. The same research studies on Vietnam Veterans compared partners of Veterans with and without PTSD. The partners of the Vietnam Veterans with PTSD reported:

• ·         Lower levels of happiness
• ·         Less satisfaction in their lives
• ·         More demoralization (discouragement)
• ·         About half have felt "on the verge of a nervous breakdown"

These effects were not limited to females. Male partners of female Veterans with PTSD reported lower well-being and more social isolation.

Partners often say they have a hard time coping with their partner's PTSD symptoms. Partners feel stress because their own needs are not being met. They also go through physical and emotional violence. One explanation of partners' problems is secondary traumatization. This refers to the indirect impact of trauma on those close to the survivor. Another explanation is that the partner has gone through trauma just from living with a Veteran who has PTSD. For example, the risk of violence is higher in such families.

Caregiver burden

Partners have a number of challenges when living with a Veteran who has PTSD. Wives of PTSD-diagnosed Veterans tend to take on a bigger share of household tasks such as paying bills or housework. They also do more taking care of children and the extended family. Partners feel that they must take care of the Veteran and attend closely to the Veteran's problems. Partners are keenly aware of what can trigger symptoms of PTSD. They try hard to lessen the effects of those triggers.

Caregiver burden is one idea used to describe how hard it is caring for someone with an illness such as PTSD. Caregiver burden includes practical problems such as strain on the family finances. Caregiver burden also includes the emotional strain of caring for someone who is ill. In general, the worse the Veteran's PTSD symptoms, the more severe is the caregiver burden.

Why are these problems so common?

The exact connection between PTSD symptoms and relationship problems is not clearly known. Some symptoms, like anger and negative changes in beliefs and feelings, may lead directly to problems in a marriage. For example, a Veteran who cannot feel love or happiness may have trouble acting in a loving way towards a spouse. Expression of emotions is part of being close to someone else. Not being able to feel your emotions can lead to problems making and keeping close relationships. Numbing can get in the way of intimacy.

Help for partners of Veterans with PTSD

The first step for partners of Veterans with PTSD is to gather information. This helps give you a better understanding of PTSD and its impact on families. Resources on the National Center for PTSD website may be useful.

Some effective strategies for treatment include:

• ·         Education for the whole family about the effects of trauma on survivors and their families
• ·         Support groups for both partners and Veterans
• ·         Individual therapy for both partners and Veterans
• ·         Couples or family counseling

VA has taken note of the research showing the negative impact of PTSD on families. PTSD programs and Vet Centers have begun to offer group, couples, and individual counseling for family members of Veterans.

Overall, the message for partners is that problems are common when living with a Veteran who has been through trauma. The treatment options listed above may be useful to partners as they search for better family relationships and mental health.

Resources

Matsakis, A. (2007). (Sidran Press, paperback, ISBN 1886968187). Back from the Front: Combat Trauma, Love, and the Family. Aphrodite Matsakis is a psychotherapist with a special interest in PTSD. Her book aims to help partners and Veterans understand the effects of combat trauma on relationships and family life. It also includes resources to help every member of the family.

Slone, L.B. & Friedman, M.J. (2008) (Da Capo Press, paperback, ISBN 1600940544). After the War Zone: A Practical Guide for Returning Troops and Their Families. Laurie Slone and Matt Friedman are in the leadership of the National Center for PTSD. Their book is a guide to homecoming for returning Veterans and their families. The book suggests ways families can cope with the effects of trauma.

Sources

Kulka, R.A., Schlenger, W.E., Fairbank, J.A., Hough, R.L., Jordan, B.K., Marmar, C.R., Weiss, D.S., and Grady, D.A. (1990). Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.

Jordan, B.K., Marmar, C.R., Fairbank, J.A., Schlenger, W.E., Kulka, R.A., Hough, R.L., and Weiss, D.S. (1992). Problems in families of male Vietnam veterans with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 60, 916-926.

American Article

How does trauma affect relationships?

Trauma survivors with PTSD may have trouble with their close family relationships or friendships. The symptoms of PTSD can cause problems with trust, closeness, communication, and problem solving. These problems may affect the way the survivor acts with others. In turn, the way a loved one responds to him or her affects the trauma survivor. A circular pattern can develop that may sometimes harm relationships.

How might trauma survivors react?

In the first weeks and months following a trauma, survivors may feel angry, detached, tense or worried in their relationships. In time, most are able to resume their prior level of closeness in relationships. Yet the 5% to 10% of survivors who develop PTSD may have lasting relationship problems.

Survivors with PTSD may feel distant from others and feel numb. They may have less interest in social or sexual activities. Because survivors feel irritable, on guard, jumpy, worried, or nervous, they may not be able to relax or be intimate. They may also feel an increased need to protect their loved ones. They may come across as tense or demanding.

The trauma survivor may often have trauma memories or flashbacks. He or she might go to great lengths to avoid such memories. Survivors may avoid any activity that could trigger a memory. If the survivor has trouble sleeping or has nightmares, both the survivor and partner may not be able to get enough rest. This may make sleeping together harder.

Survivors often struggle with intense anger and impulses. In order to suppress angry feelings and actions, they may avoid closeness. They may push away or find fault with loved ones and friends. Also, drinking and drug problems, which can be an attempt to cope with PTSD, can destroy intimacy and friendships. Verbal or physical violence can occur.

In other cases, survivors may depend too much on their partners, family members, and friends. This could also include support persons such as health care providers or therapists.

Dealing with these symptoms can take up a lot of the survivor's attention. He or she may not be able to focus on the partner. It may be hard to listen carefully and make decisions together with someone else. Partners may come to feel that talking together and working as a team are not possible.

How might loved ones react?

Partners, friends, or family members may feel hurt, cut off, or down because the survivor has not been able to get over the trauma. Loved ones may become angry or distant toward the survivor. They may feel pressured, tense, and controlled. The survivor's symptoms can make a loved one feel like he or she is living in a war zone or in constant threat of danger. Living with someone who has PTSD can sometimes lead the partner to have some of the same feelings of having been through trauma.

In sum, a person who goes through a trauma may have certain common reactions. These reactions affect the people around the survivor. Family, friends, and others then react to how the survivor is behaving. This in turn comes back to affect the person who went through the trauma.

Trauma types and relationships

Certain types of "man-made" traumas can have a more severe effect on relationships. These traumas include:

• Childhood sexual and physical abuse
• Rape
• Domestic violence
• Combat
• Terrorism
• Genocide
• Torture
• Kidnapping
• Prisoner of war

Survivors of man-made traumas often feel a lasting sense of terror, horror, endangerment, and betrayal. These feelings affect how they relate to others. They may feel like they are letting down their guard if they get close to someone else and trust them. This is not to say a survivor never feels a strong bond of love or friendship. However, a close relationship can also feel scary or dangerous to a trauma survivor.

Do all trauma survivors have relationship problems?

Many trauma survivors do not develop PTSD. Also, many people with PTSD do not have relationship problems. People with PTSD can create and maintain good relationships by:

• Building a personal support network to help cope with PTSD while working on family and friend relationships
• Sharing feelings honestly and openly, with respect and compassion
• Building skills at problem solving and connecting with others
• Including ways to play, be creative, relax, and enjoy others

What can be done to help someone who has PTSD?

Relations with others are very important for trauma survivors. Social support is one of the best things to protect against getting PTSD. Relationships can offset feelings of being alone. Relationships may also help the survivor's self-esteem. This may help reduce depression and guilt. A relationship can also give the survivor a way to help someone else. Helping others can reduce feelings of failure or feeling cut off from others. Lastly, relationships are a source of support when coping with stress.

If you need to seek professional help, try to find a therapist who has skills in treating PTSD as well as working with couples or families.

Many treatment approaches may be helpful for dealing with relationship issues. Options include:

• One-to-one and group therapy
• Anger and stress management
• Assertiveness training
• Couples counseling
• Family education classes
• Family therapy

American Article

Depression: What Is It?

It's natural to feel down sometimes, but if that low mood lingers day after day, it could signal depression. Major depression is an episode of sadness or apathy along with other symptoms that lasts at least two consecutive weeks and is severe enough to interrupt daily activities. Depression is not a sign of weakness or a negative personality. It is a major public health problem and a treatable medical condition.

Shown here are PET scans of the brain showing different activity levels in a person with depression, compared to a person without depression.

 Depression Symptoms: Emotional

The primary symptoms of depression are a sad mood and/or loss of interest in life. Activities that were once pleasurable lose their appeal. Patients may also be haunted by a sense of guilt or worthlessness, lack of hope, and recurring thoughts of death or suicide.

Depression Symptoms: Physical

Depression is sometimes linked to physical symptoms. These include:

• Fatigue and decreased energy
• Insomnia, especially early-morning waking
• Excessive sleep
• Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment

Depression can make other health problems feel worse, particularly chronic pain. Key brain chemicals influence both mood and pain. Treating depression has been shown to improve co-existing illnesses

Depression Symptom: Appetite

Changes in appetite or weight are another hallmark of depression. Some patients develop increased appetite, while others lose their appetite altogether. Depressed people may experience serious weight loss or weight gain.

Impact on Daily Life

Without treatment, the physical and emotional turmoil brought on by depression can derail careers, hobbies, and relationships. People with depression often find it difficult to concentrate and make decisions. They turn away from previously enjoyable activities, including sex. In severe cases, depression can become life-threatening.

Suicide Warning Signs

People who are depressed are more likely to attempt suicide. Warning signs include talking about death or suicide, threatening to hurt people, or engaging in aggressive or risky behavior. Anyone who appears suicidal should be taken very seriously. If you have a plan to commit suicide, go to the emergency room for immediate treatment.

Depression: Who's at Risk?

Anyone can become depressed, but many experts believe genetics play a role. Having a parent or sibling with depression increases your risk of developing the disorder. Women are twice as likely as men to become depressed.

Causes of Depression

Doctors aren't sure what causes depression, but a prominent theory is altered brain structure and chemical function. Brain circuits that regulate mood may work less efficiently during depression. Drugs that treat depression are believed to improve communication between nerve cells, making them run more normally. Experts also think that while stress -- such as losing a loved one -- can trigger depression, one must first be biologically prone to develop the disorder. Other triggers could include certain medications, alcohol or substance abuse, hormonal changes, or even the season.

Illustrated here are neurons (nerve cells) in the brain communicating via neurotransmitters.

Seasonal Depression

If your mood matches the season -- sunny in the summer, gloomy in the winter -- you may have a form of depression called seasonal affective disorder (SAD). The onset of SAD usually occurs in the late fall and early winter, as the daylight hours grow shorter. Experts say SAD affects from 3% to 20% of all people, depending upon where they live.

Postpartum Depression

The "baby blues" strikes as many as three out of four new mothers. But nearly 12% develop a more intense dark mood that lingers even as their baby thrives. This is known as postpartum depression, and the symptoms are the same as those of major depression. An important difference is that the baby's well-being is also at stake. A depressed mother may have trouble enjoying and bonding with her infant.

Depression in Children

In the United States, depression affects 2% of grade school kids and about one in 10 teenagers. It interferes with the ability to play, make friends, and complete schoolwork. Symptoms are similar to depression in adults, but some children may appear angry or engage in risky behavior, called "acting out." Depression can be difficult to diagnose in children.

Diagnosing Depression

As of yet, there is no lab test for depression. To make an accurate diagnosis, doctors rely on a patient's description of the symptoms. You'll be asked about your medical history and medication use since these may contribute to symptoms of depression. Discussing moods, behaviors, and daily activities can help reveal the severity and type of depression. This is a critical step in determining the most effective treatment.

Talk Therapy for Depression

Studies suggest different types of talk therapy can fight mild to moderate depression.Cognitive behavioral therapyaims to change thoughts and behaviors that contribute to depression.Interpersonal therapyidentifies how your relationships impact your mood.Psychodynamic psychotherapyhelps people understand how their behavior and mood are affected by unresolved issues and unconscious feelings. Some patients find a few months of therapy are all they need, while others continue long term.

Medications for Depression

Antidepressants affect the levels of brain chemicals, such as serotonin and norepinephrine. There are many options. Give antidepressants a few weeks of use to take effect. Good follow-up with your doctor is important to evaluate their effectiveness and make dosage adjustments. If the first medication tried doesn't help, there's a good chance another will. The combination of talk therapy and medication appears particularly effective.

Exercise for Depression

Research suggests exercise is a potent weapon against mild to moderate depression. Physical activity releases endorphins that can help boost mood. Regular exercise is also linked to higher self-esteem, better sleep, less stress, and more energy. Any type of moderate activity, from swimming to housework, can help. Choose something you enjoy and aim for 20 to 30 minutes four or five times a week.

Light Therapy (Phototherapy)

Light therapy has shown promise as an effective treatment not only for SAD but for some other types of depression as well. It involves sitting in front of a specially designed light box that provides either a bright or dim light for a prescribed amount of time each day. Light therapy may be used in conjunction with other treatments. Talk to your doctor about getting a light box and the recommended length of time for its use.

St. John's Wort for Depression

St. John's wort is an herbal supplement that has been the subject of extensive debate. There is some evidence that it can fight mild depression, but two large studies have shown it is ineffective against moderately severe major depression. St. John's wort can interact with other medications you may be taking for medical conditions or birth control. Talk to your doctor before taking this or any other supplement.  

Pets for Depression

A playful puppy or wise-mouthed parrot is no substitute for medication or talk therapy. But researchers say pets can ease the symptoms of mild to moderate depression in many people. Pets provide unconditional love, relieve loneliness, and give patients a sense of purpose. Studies have found pet owners have less trouble sleeping and better overall health.

The Role of Social Support

Because loneliness goes hand-in-hand with depression, developing a social support network can be an important part of treatment. This may include joining a support group, finding an online support community, or making a genuine effort to see friends and family more often. Even joining a book club or taking classes at your gym can help you connect with people on a regular basis.

Vagus Nerve Stimulation (VNS)

Vagus nerve stimulation (VNS) can help patients with treatment-resistant depression that does not improve with medication. VNS is like a pacemaker for the brain. The surgically implanted device sends electrical pulses to the brain through the vagus nerve in the neck. These pulses are believed to ease depression by affecting mood areas of the brain.

Electroconvulsive Therapy (ECT)

Another option for patients with treatment-resistant or severe melancholic depression is electroconvulsive therapy (ECT). This treatment uses electric charges to create a controlled seizure. Patients are not conscious for the procedure. ECT helps 80% to 90% of patients who receive it, giving new hope to those who don't improve with medication.

Transcranial Magnetic Stimulation

A newer option for people with stubborn depression is repetitive transcranial magnetic stimulation (rTMS). This treatment aims electromagnetic pulses at the skull. It stimulates a tiny electrical current in a part of the brain linked to depression. rTMS does not cause a seizure and appears to have few side effects. But doctors are still fine-tuning this treatment.

Good Outlook

In the midst of major depression, you may feel hopeless and helpless. But the fact is, this condition is highly treatable. More than 80% of people get better with medication, talk therapy, or a combination of the two. Even when these therapies fail to help, there are cutting-edge treatments that pick up the slack.

Taken from WebMD