How Does PTSD Affect Family Life? Especially For Families With Children

A person with PTSD will have symptoms that will affect the whole family. The ability of the affected person to function as a parent, partner, employee and community member is undermined by these symptoms. Changes in their functioning can lead to unmet family needs and increased levels of stress for the family.

You and other family members may find it difficult to adjust to these changes and to communicate or discuss family problems together. You may feel frustrated, hurt, angry, rejected, and become distant toward each other which could lead to feelings of guilt and self-blame. As a result, relationships within the immediate and extended family can be seriously strained and involvement in work, social and community activities will likely become restricted. Here are some real life examples of how an affected person's role in the family can change:

"The younger children just don't understand why their father doesn't like to play with them anymore. For example, when they had a lot of their toys and belongings lying around, (he) used to make a game of it and help them clean up. Now he is short with them and orders them around. They come to me for help and comfort. Sometimes I feel like I have an extra kid around the house that I need to look after."

"I had to encourage him to interact with our seven-month-old son, who was only two weeks old when he left. I noticed a difference, our families noticed a difference and our friends noticed a difference."

Affected families also report a variety of other impacts on their lives as a result of the symptoms of the affected person. You may recognize some of these impacts happening in your situation. Take note of the things that apply to you and think about how you could put into practice the suggested actions.

1. Intrusive symptoms such as vivid memories or strong beliefs that the trauma is recurring can cause families to feel worried about the sufferer or perplexed by the behaviour. Others may feel embarrassed (if it occurs in a social situation) or uncertain of how to respond and begin to withdraw from your life.

Action: Learn about the symptoms yourself; talk to others about them; and have information that friends and family members can read to help reduce the discomfort and maintain important connections.

2. There is a need in all of us to confide in others about the stresses and difficulties we are having. However, because of particular attitudes or beliefs, some people have difficulty understanding and accepting psychological problems. It is important to choose people who do not judge others and can keep a confidence.

Action: Use discretion when confiding in others. Think in advance about who in your circle of family and friends can provide this support in a respectful manner.

3. The discomfort of others combined with the avoidance behaviours of the affected person tend to isolate the family socially. Some families find that their social and recreational activities are significantly reduced.  

Action: Gradually re-introduce spouse/partner and family, social and recreational activities as symptoms improve.

4. Persons with PTSD often report being unable to feel emotions. Family members may feel rebuffed by a sufferer who is unable to show appropriate involvement, emotion and affection. This can be particularly hard on children. 

Action: Understand that this is part of the emotional response to the disorder and not a true reflection of how the person feels about their family and friends. Talk openly with your family and friends about this and reassure them that you do care.

5.  anxiety experienced by the person with PTSD may lead to overprotective behaviour that creates conflict in the family.  

Action: Separate the feelings from the facts by "reality testing"; talk about what risks the overprotective behaviour is trying to prevent and whether they fit with the current situation.

6.  Inappropriate expression of anger and irritability can begin to harm family relationships and cause anxiety and upset within your children.

Action: Acknowledge and take responsibility for your anger. Learn about and use anger management techniques. Let family members know they are not to blame.

7. Sometimes anger is expressed in abusive behaviour toward a spouse or a child. This is a signal that attempts at coping have broken down. Verbal or physical abuse of family members is never acceptable.  

Action: If abuse occurs in your family take immediate steps to ensure that it is stopped and not repeated. Seek outside help and follow through on the treatment recommended. It takes courage to take this step but it is the most important gift you can give to your family.

8.  Sufferers may abuse alcohol or other drugs in a attempt to blunt memory or relieve symptoms of anxiety or depression. Family members may respond with embarrassment, anger, and/or fear for the health and safety of the affected person. This can be very difficult for families to cope with.  

Action: Understand that abuse of alcohol and drugs is not a solution to symptom management. Seek addictions treatment and practice alternate ways of managing your symptoms.

How May Your Children Be Affected?

As a result of the symptoms of the affected parent and the increased parental stress of coping with them, your ability as parents to meet your child's needs may also be impacted. What follows is a way of thinking of your child's basic needs in a structured fashion. As you read through each one, ask yourself if there are examples in your family of when the child's needs are being affected. Make a list of these examples and talk about them with your partner. Evaluate if action is needed by noting how often similar things happen and how your child reacts. If action is needed, make a plan to change the situation. Check the ideas that follow in the "What Can You Do?" section to help you in making a plan.

Physical Needs

Some disruptions of household routines that address the child's physical needs may include:

• meal schedules and school lunches;
• opportunities for physical activity; and
• regular sleep routines.

Psychological/Emotional Needs

Some psychological/emotional needs affected by changes in your situation may include:

• expressing closeness/affection;
• open communication;
• structure and routines in the home;
• trust/safety; and
• fun/leisure/relaxation.

Social Development Needs

Ways in which family traditions and community involvement are affected may include:

• having the child's friends over to play, watch movies, etc.;
• family social activities like birthdays, outings, holiday rituals; and
• community participation like scouts/guides, choir, youth clubs.

Intellectual Development Needs

Some opportunities for intellectual support and stimulation that may be affected include:

• attendance at kindergarten and school;
• reading to children;
• help with homework;
• board games and hobbies; and
• visits to the library, museums.

Spiritual Needs

Important family values that may be sidelined include:

• sharing, cooperation, fairness, in the family;
• participation in Sunday school and religious services; and
• helping others in need.

No family is perfect. Celebrate the things you have been able to achieve despite the stress and disruption in your family life. Also, remember that children can be quite resilient and adaptable to change and that they feel most secure when it is clear to them that Mom and Dad are "in charge," that you talk and work together to solve daily problems.

What Can You Do?

Parents play the lead role in meeting their child's needs and helping children manage stress in their lives by providing a supportive physical and emotional environment. First, here are some ideas for creating a supportive environment.

• Give your children regular undivided attention and time even if this time cannot be for a very long period. Play with them, read to them, go for walks or do other enjoyable activities together. Ask how things are going for them.
• Seek out support of family and friends. Address some of your child's needs by "sharing the care" through using the positive relations the child has with relatives, family, friends and neighbours.
• Maintain a calm atmosphere in the home when your children are present to enhance their feelings of security.
• Provide a comfortable and familiar environment by keeping to daily routines as much as possible.
• To the extent possible, try to restore family traditions that existed before the events that led to PTSD (i.e. before becoming ill, did he/she routinely make a special pancake breakfast on Sunday; read bedtime stories, help with homework, etc.).
• Encourage kids to focus on things they enjoy and get involved in extra-curricular and community activities.
• As parents, talk together to identify how your children may innocently trigger intrusive memories (i.e. slamming doors, shouting, etc.). Discuss ways to reduce these events. Try different approaches, talk about them and make changes if necessary.
• Take care of yourself. Practice positive thinking and self-talk, learn muscle relaxation and breathing exercises, and other techniques that can help you cope. Lower your expectations. Find sources of support, take breaks, exercise, eat a healthy diet and maintain good general health. Keep up medical check-ups. Contact your local public health or mental health office to find out more about reducing stress. By taking care of yourself you will be better able to support your children.

Seek professional help if you have concerns or feel that you are unable to manage your child's reactions and behaviours, or if you are experiencing intense emotions such as fear, anger, depression, problems at work, intimacy, or substance abuse problems. Remember, regardless of what has happened, it is never too late to seek help for yourself and for your children.

Understanding and Meeting Your Child's Psychological/Emotional Needs

We will now focus on the psychological/emotional needs of your children because in families under stress this is the area where children may experience the most immediate impact. It is also the area where families are most likely to be asking for information and assistance. We try to look at things from the child's point of view and encourage you to take this perspective when considering how to help your child.

When a parent has been diagnosed with PTSD and things at home have been changing, children feel the impacts. Children always know when something serious happens in a family. They are quick to notice physical and emotional changes in their parents and they will attempt to come up with an explanation for why this is happening and what to do about it. At the same time, depending on age, they may lack the information, thinking skills and language in order to come up with an accurate understanding of what is happening and why. It is not surprising then that they will often come to wrong conclusions like: "I'm bad - punish me."

Critical Events

From time to time your child will be unintentionally exposed to PTSD symptoms of the affected parent. Families report a variety of circumstances in which their child may be affected. For example:

• The affected parent has had a disturbing nightmare and the child has been awakened and frightened by yelling or the crash of furniture.
• The affected parent has a flashback and tries to protect the child from a danger which the child cannot see or understand.
• The child approaches the affected parent from behind and touches them to ask for some help. This results in a startle response and an angry outburst directed at the child.

There will of course be other examples that you can identify in your particular circumstances but in each instance the general pattern of response to support your child(ren) is the same. Where possible talk about these possibilities in advance and agree that the non-affected parent or other adult in the home can assume a leadership role in these situations. Here are suggested steps for the non-affected parent to follow.

• Protect your child from further distress by removing him/her from the situation and helping to stop the reaction that is taking place. Help the affected parent to re-establish their orientation to reality and their sense of safety.
• Reassure your child that he/she is safe and the affected parent is going to be fine. Talk calmly to your child about what just happened and help them express their feelings about the event.
• Talk to your child about how and why this happened to help give an explanation to the events that they can understand.
• Where the child was the trigger/target of the event, let them know that it was not their fault and that the reaction was not appropriate. As soon as possible, have the affected parent talk to the child and take responsibility for the event, apologize for the upset and reinforce the message that it was not their fault. If the affected parent is still too upset to do this, speak on his or her behalf and try to have the conversation later when things are more settled.
• When things are settled down, set a time for the family to talk about what to do if this kind of thing happens again. In particular, give the child permission to say stop, move away from the situation and call for your help.

How Do You Know if Your Child is Under Too Much Stress?

Everyone experiences stress, including your children. It is a very important and natural part of life. It is important to remember that some stress is good because it helps us learn to cope with the tasks of everyday life. Stress becomes harmful to the physical and emotional health of your child when it is constant, unrelieved and overwhelming.

There is a broad range of physical and behavioural symptoms that you may notice in a child experiencing too much stress. The younger the child is, the less likely he or she is able to tell you about what is bothering them. Signs of stress are more likely to show up in a child's actions, such as in play or interactions with others. The key is to look for long term changes in your child's normal behaviours.

The following is a list of potential symptoms that may be exhibited by children under too much stress.

• frequent crying;
• fear of being alone;
• drop in school performance;
• inappropriate attention-seeking behaviour, temper tantrums;
• headaches, body aches, pains;
• regression to behaviour of younger child, e.g., wetting the bed;
• worry and concern for others;
• speech problems;
• inability to concentrate;
• fear of strangers;
• nightmares or other sleep disturbances; and
• increased aggressive behaviours, angry outbursts.

If your child is exhibiting one of these symptoms, it does not necessarily mean they are under too much stress. However, if they are exhibiting several of these symptoms, and they continue over a long period of time; or they are exhibiting extremes of one or more symptoms, they are likely having difficulty coping with stress. If so, seek professional help to assess the situation and decide what to do.

Source: Veterans Affairs Canada