Post-traumatic Relationship Syndrome



Karen Rodman, Director and Founder of FAAAS Inc has proposed that when the affected person is still in the relationship then this Syndrome should be called Ongoing Traumatic Relationship Syndrome. (OTRS)



Adapted from: Social Behaviour and Personality, 2003 by Vandervoort, Debra, Rokach, Ami. This is a description of a trauma-based syndrome called Posttraumatic Relationship Syndrome (PTRS) which may afflict individuals who have been traumatized by physical, sexual, and/or severe emotional abuse within an intimate relationship. In PTSD, there is overutilization of avoidant coping, but PTRS involves the overuse of emotion-focused coping.





"History, despite its wrenching pain cannot be unlived,

but, if faced with courage, need not be lived again."

People are social animals who cannot survive alone. From birth to death we are in the company of, and depend upon, significant others for survival. The relationships we partake in, may be life sustaining and nurturing and may promote personal growth and health, or may be abusive, destructive and traumatic. In this day and age we are surrounded by abuse and violence. Domestic violence and abuse is one of the most frequent crimes in our nation as well as one of the most underreported. Research has amply documented there are short- and long-term mental and physical health benefits when the relationships we partake in throughout life are positive, whereas abusive, restricting and non-nurturing relationships have been found to impair mental and physical health



Sexual, physical or severe emotional abuse (e.g., abandonment, betrayal, malevolent intent, or repeated victimization) often has devastating effects on the recipient. These effects can be long-lasting and broad ranging. Untreated trauma not only has dire effects on the individual (e.g., intense psychological distress, lost productivity, permanent disability, and increased industrial accidents), but also has broader ranging effects (e.g., social and community disorganization).





Why Post-Traumatic Relationship Syndrome?

The original impetus for the development of Posttraumatic Relationship Syndrome (PTRS) was clinical experience with clients whose symptoms were distinct from those with Posttraumatic Stress Disorder (PTSD) and to whom the traditional approaches to treatment of PTSD were inappropriate in a number of ways. Most notably, a major focus on getting in touch with the repressed traumatic memories is contraindicated in PTRS. The numbing of emotional responsiveness is not present in PTRS and with an overuse of emotion-focused coping, the client chronically approaches the traumatic memories too eagerly, leading to a harmful reliving of the trauma. In PTSD, there is a tendency to err on the side of too much constriction; in PTRS there is a tendency to err on the side of too much intrusion.



Another reason for the development of PTRS is adherence to the concept of a spectrum of posttraumatic disorders. Posttraumatic Stress Disorder has so dominated our concept of post-traumatic illness that it is often "perceived, albeit incorrectly, as a generic term for posttraumatic illness... [However], not all posttraumatic illness is posttraumatic stress disorder". The definition of posttraumatic illness in which the full criteria of PTSD are not met is the case in PTRS.



Interpersonal traumatic Stressors are particularly likely to create severe and long-term trauma responses. Even in the DSM-III-R's discussion of PTSD, it is noted that PTSD is likely to be "more severe and longer lasting when the Stressor is of human design". Further, research has shown that one of the biological functions of attachment is the regulation of physiological arousal. This may explain, in part, why people are more vulnerable in intimate versus non-intimate relationships and why traumatic Stressors in the intimate type of relationship are often harder to bear than those in the non-intimate and also harder to bear than traumatic Stressors attributable to nature or accidents.



Despite the devastating effects trauma in relationships can have, there is no diagnostic category specific to these effects. The fact the American Psychiatric Association (APA) is considering the possibility of proposing a relationship induced disorder ("Relationship Disorder", 2002) suggesting there is interest in and a need to develop such a concept. In light of the above, the present paper describes the symptoms of a relationship-induced posttraumatic illness entitled Posttraumatic Relationship Syndrome. Posttraumatic Relationship Syndrome can be defined as an anxiety disorder that occurs subsequent to the experience of physical, sexual or severe emotional abuse in the context of an emotionally intimate relationship. It involves a state of psychological crisis that exceeds the capacity of the individual's psychic structure to handle. It is a process that occurs over time and has debilitating effects on the individual.



The following symptoms characterize PTRS:



Initial response : The person's response involves intense fear/terror or horror and rage at the perpetrator.



Intrusive symptoms : (which were not present before the trauma):



(1) Persistent re-experiencing of the event(s) in images, thoughts, recollections, daydreams, nightmares, and/or night terrors;

(2) Extreme psychological distress (which may be accompanied by physiological reactivity) in the presence of the perpetrator or symbolic reminders

of the perpetrator (e.g., uncontrollable shaking).



Arousal symptoms : (which were not present before the trauma):



(1) Hyper vigilance (which may be the result of not feeling safe in the world)

(2) Sleep disturbances (insomnia)

(3) Persistent feelings of rage at the perpetrator

(4) Restlessness

(5) Difficulty concentrating

(6) Weight loss



Relational symptoms :



(1) Not feeling safe in the world

(2) Mistrust and fear of intimate relationships (or a particular type of intimate relationship)

(3) Sexual dysfunction, especially for those who have been sexually abused

(4) Disruption in the victim's social support network, isolation



Thus, PTRS applies to individuals who have suffered physical, sexual, or severe emotional abuse in the context of an intimate relationship, and who consequently display the above symptoms. As the person's basic personality structure remains intact, it does not include the development of a character disorder and rather than being akin to a personality disorder, PTRS is a syndrome - the ultimate cause of which is outside the self. Hence it falls into the category of a posttraumatic illness, since it develops along with the experience of trauma and would not have occurred if the person had not experienced the traumatic stressor(s). It is clearly a less severe syndrome than complex PTSD as it does not include the array of symptoms which characterize complex PTSD (e.g., dissociation, pathological changes in identity).



Posttraumatic Relationship Syndrome stressors:



(1) In PTRS, the traumatic Stressor may be physical, sexual, or emotional (whether or not there is an actual threat to one's physical integrity),

(2) PTRS requires direct involvement with the abuser and actually experiencing the abuse; and

(3) In PTRS, the Stressor must be in the context of an emotionally intimate relationship.



Response to the Stressor:

Rage at the perpetrator and anger is a possibility. Such symptoms are normal for victims of interpersonal trauma.



Coping with the trauma:

There is a more conscious experience of the trauma. There is, a state of psychological crisis, as the subjective experience of trauma shatters the psyche's ability to maintain equilibrium. The person remains too acutely aware of being in a traumatized state, so for counsellors, an overuse of emotion-focused coping can lead to unnecessary re-traumatization of the individual. In PTRS, the client needs to be taught to use desensitization techniques to make the processing of the trauma more manageable.



Clients with PTRS appear to be overly courageous in taking on more than they can handle with a concomitant failure to engage in adequate psychological self-protection.

Traumatic Stressors and the Nature of Psychological Trauma

The experience of extreme terror during traumatic events creates images of the events that are inscribed in memory. Because of the vividness of the memories, the memory frequently returns to consciousness and evokes the same emotions as the original experience. This creates the classic intrusion and arousal symptoms characteristic of the state of psychological crisis caused by the original trauma, signifying that the experience has not yet been able to be integrated into the self because it cannot be assimilated into one's current beliefs about the self and/or world.



Although an individual may become traumatized by a single act (e.g., one's spouse kidnapping one's children; getting AIDS from one's spouse), often there are multiple traumatic acts. According to Khan (1977), a traumatic intimate relationship does not have to include behaviours which are consistently traumatic. However, they acquire traumatic qualities when a series of intermittent traumatic experiences accumulate within one's interactions which may finally lead to a state of crisis or psychological breakdown. That changes the emphasis from "trauma" to a "traumatic situation", and converts it into a process - a process whereby the interactional framework, becomes a source of trauma for the victim.



Abusive behaviour may be overt or covert. Not only is behaviour that is motivated by an attitude of malevolent intent extremely traumatic, but such behaviour done covertly is likely to be even more traumatic. This is due to the fact that it renders one helpless to protect oneself until one discovers the behaviour that is being hidden or denied by the perpetrator. Thus, issues central to the experience of trauma, namely helplessness, powerlessness, sense of control and predictability of the world, as well as the ability to protect one's life and/or psychic integrity are even more important. Although one can leave the relationship upon discovery of the abuse, one may not be able to escape the ensuing psychological crisis such knowledge yields.



There are a myriad of bio-psychosocial factors that determine whether an individual will be traumatized by a given event(s). The physiological literature indicates that the biology of stress is different from the biology of trauma and posttraumatic disorders. Just as this literature is based on the assessment of symptoms in the client, so must the assessment of PTRS be. That is, the critical point in determining whether the individual has succumbed to PTRS is whether the symptoms developed subsequent to the experience of an identifiable traumatic event(s) in the context of an intimate relationship. If the patient's functioning before the trauma is drastically different from their post-morbid functioning, the logical conclusion is that it is a posttraumatic illness.





Psychosocial Effects of Post-Traumatic Relationship Syndrome

Traumatic Stressors challenge one's knowledge of the self and/or world. Maimed or shattered beliefs create a state of psychological crisis until new paradigms can be adopted, for these are the basis of our psychological stability. Trauma can destroy our functional illusions of individual invulnerability.



There are four core assumptions fundamental to our belief in such invulnerability:

(1) The world is benevolent or at least benign; (2) Life is meaningful; (3) We have control over our lives; and (4) Positive self-worth.