What relationship issues are associated with Complex Post-Traumatic Stress Disorder (C-PTSD)?

Relationship Issues Associated with Complex PTSD

Individuals with Complex PTSD (C-PTSD) experience significant disturbances in relational capacities that profoundly impact their intimate relationships, characterized by difficulties with trust, emotional intimacy, and interpersonal regulation. 1

Core Relationship Difficulties in C-PTSD

Disturbances in Relational Capacities

C-PTSD is defined by the occurrence of core PTSD symptoms (reexperiencing, avoidance, hyperarousal) along with additional self-regulation problems, with "disturbances in relational capacities" being one of the five key domains 1. These relational disturbances manifest in several ways:

• Fear of relationships: Individuals with C-PTSD often experience significant fear and anxiety around intimate relationships 2
• Relationship preoccupation: Excessive worry and rumination about relationship status and security 2
• Relationship anxiety and depression: Persistent negative emotions specifically related to intimate connections 2
• Withdrawal responses: Tendency to withdraw from partners when experiencing shame 2

Emotional Regulation and Intimacy

The emotional dysregulation characteristic of C-PTSD directly impacts intimate relationships in paradoxical ways:

• Receipt of intimacy triggers negative emotions: When partners show caring, understanding, and validation, individuals with elevated PTSD symptoms often experience increased negative emotions, particularly fear 3
• Provision of intimacy reduces negative emotions: Interestingly, when individuals with PTSD symptoms provide caring behaviors to their partners, they experience decreased anger, guilt, and sadness 3

Gender Differences in Intimacy Behaviors

Research has identified important gender differences in how C-PTSD affects relationship behaviors:

• Men with higher PTSD severity provide less support: Husbands with greater PTSD symptom severity show reduced expressions of understanding, validation, and caring during discussions of relationship problems 4
• Women show resilience in providing intimacy: Women appear better able to maintain intimacy behaviors despite PTSD symptoms 4
• Male partners disclose more with traumatized wives: When wives have higher PTSD symptom severity, husbands engage in more self-disclosure during negative discussions 4

Psychological Mechanisms Behind Relationship Difficulties

Shame and Guilt

Shame and guilt play central roles in relationship difficulties for those with C-PTSD:

• Shame predicts complex PTSD severity: Both state and trait shame are significant predictors of C-PTSD symptom severity 2
• Shame avoidance predicts fear of relationships: Avoidance behaviors in response to shame specifically predict fear of forming intimate relationships 2

Dissociation

Dissociation has a profound organizing effect on relationship difficulties:

• Clinical dissociators show greater relationship problems: Those with clinical levels of dissociation experience significantly higher relationship preoccupation 2
• Independent contribution to relationship difficulties: Dissociation makes a distinct contribution to relationship problems beyond other C-PTSD symptoms 2
• Organizing effect on symptoms: Dissociation appears to have an organizing effect on the overall constellation of C-PTSD symptoms 2

Treatment Implications

Phase-Based Approach

The International Society of Traumatic Stress Studies (ISTSS) guidelines recommend a phase-based approach for treating C-PTSD, which has implications for addressing relationship difficulties 1:

• Phase I (Stabilization): Focus on safety, emotional regulation, and improving social and psychological competencies
• Phase II (Trauma Processing): Address trauma memories directly
• Phase III (Reintegration): Consolidate gains and help adapt to current life circumstances, including relationships

Relationship-Focused Interventions

When treating relationship issues in C-PTSD:

• Consider emotional context of intimacy: Treatments should address the emotional context of both providing and receiving intimacy 3
• Address dissociation: Given its organizing effect on symptoms and independent contribution to relationship difficulties, dissociation requires specific attention 2
• Target shame responses: Interventions should focus on shame and maladaptive responses to shame 2

Clinical Pitfalls and Considerations

Common Pitfalls

• Overlooking gender differences: Failing to recognize that men and women may show different patterns of relationship impairment with C-PTSD 4
• Missing the intimacy paradox: Not recognizing that receiving intimacy may increase distress while providing it may decrease distress 3
• Focusing only on trauma processing: Neglecting relationship skills and emotional regulation that are foundational to relationship functioning 1

Special Considerations

• Developmental impacts: When C-PTSD stems from childhood trauma, it can disrupt attachment with caregivers, development, and sense of self, creating deeper relationship challenges 1
• Complex psychological phenomena: C-PTSD often involves complicated psychological issues like identification with aggressors, various forms of dissociation, and self-destructive behaviors that complicate relationships 5
• Multilayered treatment needs: The treatment of relationship issues in C-PTSD requires addressing multiple layers of psychological functioning 5, 6

By understanding these specific relationship difficulties and their underlying mechanisms, clinicians can better address the profound interpersonal challenges faced by individuals with Complex PTSD.