May 29, 2012

PTSD and Sex

by Dr. Kat in Sex No Comments

With the issues of returning veterans from Iraq being highlighted in the news, the effects of their war experiences on their personal lives cannot be ignored. We have soldiers returning to their partners who have forever been psychologically affected by combat. Returning to the safety and security of one’s home and loved one is a fallacy to many of these men and women. The concept of “invisible war wounds” has been touched upon in the media. We hear the term PTSD bandied about on a regular basis but what does that truly mean? How does it manifest in the relationships and sex lives of these post-war experience civilians?

PTSD (post traumatic stress disorder) involves a triad of disabling responses, all caused by an event that terrifies, horrifies or renders one helpless. These include:
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* recurring intrusive recollections;
* emotional numbing and constriction of life activity; and
* a physiological shift in the fear threshold, affecting sleep, concentration, and sense of security.

By definition in DSM IV (the 1994 edition of the Diagnostic and Statistical Manual, which is the official lexicon of psychiatric diagnoses, written and published by the American Psychiatric Association), this syndrome must last at least a month before PTSD can be diagnosed (see Appendix A. page 19).

Furthermore, a severe trauma must be evident and causally related to the cluster of symptoms. There are people who are fearful, withdrawn and plagued by episodes of vague, troubling sensations, but they cannot identify a specific traumatic precipitant. In these instances diagnosis of PTSD would not be appropriate.

According to Dr. Petra Zebroff , “PTSD may include flashbacks and hallucinations, but neither is necessary for the diagnosis. When prolonged flashbacks and prolonged hallucinations, particularly auditory hallucinations that command violent activity, occur, other diagnoses may be involved, such as Dissociative Disorder and Brief Psychotic Disorder. These may co-exist with PTSD and require additional treatment.”

In order to avoid these symptoms, the ability to numb one’s self and to avoid certain situations initially serves as a coping mechanism. However, eventually when day-to-day activities and relationships are affected the response becomes maladaptive.

The concept of “false alarms” becomes common. Any number of sights, sounds or smells may trigger a PTSD episode. This can lead to lack of concentration and interrupted sleep. Life and certainly relationships are stifled as partners often feel pushed away and emotionality avoided. Very often sex ceases in these relationships, as it becomes a time of vulnerability to emotional upheaval versus a time of enjoyment, connection and healing. Many relationships falter in these times, as there may be reluctance on the part of the sufferer to seek diagnosis and treatment. Also, many partners of those affected feel disempowered and lack information as to how they can provide support to their loved one while soothing their own issues that may become triggered by the lack of support they are experiencing.

The importance of strong communication on behalf of both partners cannot be underscored enough. This can lead to the support needed for the sufferer to get proper diagnosis and treatment, while enhancing the prospect of not only maintaining but growing the relationship in response to these adverse circumstances. There is hope.