Vicarious trauma and secondary PTSD

February 20, 2009 By Claire
Posted in Spouse and Family

This is something I am hoping to address more in the future. Secondary PTSD is not unheard of. I know that there are many military families who experience vicarious or “shadow” type symptoms of PTSD. I was shocked to recognize some of the behaviors in me when my son was in Iraq (hyper-vigilance, sleep disturbances, replaying pictures or sounds of war scenes I have watched on shows, etc.) I could not shut some of this stuff out. No matter how hard I tried, and when I got news that he had taken shrapnel, or with each announcement of a fallen friend, the symptoms increased.

A friend posted the following on a board I frequent. It’s a good intro and primer. Secondary PTSD is not officially recognized in the Diagnostic and Statistical Manual DSM (insert most recent, but soon to be revised again, and again, and again edition here). There has been, however, a lot of research done regarding this in the field of social work and working with abused children or other populations where intense trauma and stress causes a PTSD type of a syndrome. When I revisit this topic I will also touch on something called “shadow” syndromes. It was something we explored a lot when I worked in mental health.

Walking on Eggshells
By Mary Tendall and Jan Fishler

Exceprt

LINK

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!”

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