Help your relationship recover from PTSD, TBI, and other invisible injuries for military wellness

Brain injury and trauma can occur without warning, and the path to recovery isn’t always clear, which can strain your romantic relationship. Chances are you might be recovering from physical and emotional wounds too. However, by learning more about the injury and accepting the different ways your relationship might have to adapt, you can both weather the storm together.

Invisible wounds are those injuries that affect not just the physical body, but ones that also impact your emotional and mental health. Post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and moral injury are all examples of injuries that Service Members might experience during their careers. And while a specific event (or series of events) might cause these types of injuries (along with possibly causing bodily harm), the path to healing emotional wounds isn’t always clear or straightforward. On top of that, these types of emotional wounds can make it very hard to interact with others or build close, satisfying relationships.

How invisible wounds impact relationships

Each injury is different and affects everyone differently too. While it can be tough to form many close relationships because of the symptoms associated with a TBI, PTSD, or moral injury (MI), it’s often the partner or spouse who feels it the most, especially those who were in a relationship prior to the injury or diagnosis.

  • New role as caretaker. An uninjured partner is likely to shift into a caregiving role. This can be fulfilling and frustrating for both of you. It’s likely neither of you expected one would have to intensely depend on the other as sometimes happens after a traumatic injury. However, it’s also an opportunity to show commitment and gratitude towards each other on a regular basis.
  • Grief. You might feel a sense of loss or grief about your couple relationship, which can be similar to the grief felt after the death of a loved one. You also might grieve future plans that now have to be canceled or adjusted. And you might mourn for the couple you once were. Your view of future goals and dreams probably needs to be modified or abandoned, and that’s hard. These feelings are normal, and talking about them with your partner, others you trust, or a professional therapist can help.
  • Emotional disconnect. After suffering a trauma, it can be difficult to have deep or meaningful emotions. This might be because the injured person is avoiding those types of feelings completely, or because a physical injury to the brain makes it harder to access those emotions. In either case, this can make partnerships and marriages difficult because healthy relationships rely on emotional connection.

PTSD and relationship recovery

PTSD Symptoms: •Nightmares or night terrors •Flashbacks •Distress •Avoidance •Memory loss •Negative beliefs •Fear, anger, guilt, or shame •Detachment from others •Reckless behavior •Hyperalert •Easily startled or scared •Lack of focusPost-traumatic stress disorder is a mental health condition that occurs after someone experiences or witnesses a traumatic event or has been exposed to a traumatic situation for an extended period of time. Though any event can potentially be experienced as traumatic, painful events such as childhood abuse, sexual assault, a car accident, or a life-threatening situation during military service might cause post-traumatic stress symptoms.

PTSD is linked with relationship difficulty, and relationship stress can make things worse. So it can be very easy to find yourself in a negative cycle in both your relationship and your recovery. PTSD is linked with more verbal aggression, poor communication, difficulty with intimacy, sleep disturbance, and sexual problems as well. All of these symptoms can make it difficult to keep your relationships on track. Meanwhile, partners of those with PTSD might struggle with the role of caretaker and sometimes feel like they’re walking on eggshells trying to avoid triggering their partner. You might both notice you’re focused so much on the PTSD and its symptoms that other parts of your life or relationships drift away. Consider some strategies to support your relationship health.

  • Seek treatment…together. Eye movement desensitization and reprocessing (EMDR) and other treatments can help those with PTSD. Family and partner involvement in treatment also has a big impact on reducing symptoms and preventing the onset of related issues such as substance abuse. You also have a chance to work on the couple aspects of your relationship that might otherwise get lost in individual treatment. Seeking treatment together also helps you get in the mindset that you’re tackling the PTSD together, so you don’t feel alone.
  • Lean on others. While social support is always an important aspect of general social fitness, it’s particularly important to couples dealing with PTSD. For one thing, when deployment ends, social support tends to decline for those who don’t have that connection to their teammates day in, day out. If an injury was a part of a deployment, then the disconnection of coming home can make recovery extra difficult. Some research suggests that a strong support network might be the most important factor in avoiding PTSD after trauma.
  • Open up in a safe environment. It’s common for someone with PTSD to disconnect from their emotions to help cope and shake off those strong and traumatic feelings from the initial event. And that involves avoiding thinking about or sharing details of the trauma. That can make it hard for you to emotionally connect, and your partner might not even know what happened or what could potentially trigger a traumatic memory. Having safe conversations about the event with your partner can help on the path to recovery and help them support you better. Consider having these conversations with a professional present to help you focus on avoiding blame, giving advice, or trying to distract your partner from their pain. Instead, try to listen and validate your partner’s experience.

How moral injury affects loved ones

Moral injury symptoms: •Self-destructive impulses •Loss of religiousness, faith, or hope •Guilt or shame •Feelings of betrayal •Loss of trust •Lack of purpose •Self-blame •Anxiety or depression •	Sleep problems •	Substance abuseA moral injury is an emotional and spiritual injury that can result when you feel like you have witnessed, done, or failed to prevent something that violates your own morals or moral code. Moral injuries can also occur when you’ve witnessed or been a part of something that goes against your values or religious beliefs. It’s often accompanied by a PTSD diagnosis because it can often result from a traumatic event. And like PTSD, someone struggling with moral injury might find it hard to connect to others or even find meaning in their relationships. Those dealing with MI might also experience strong feelings of guilt and shame, which like PTSD, can be difficult to share with others—even those closest to them. And, if the details of the cause of the MI have been shared with a spouse or partner, some partners actually experience secondary trauma as a result. All of this can make it difficult to maintain a happy and healthy relationship in the long run. Still, there are things you can do to tackle moral injury together.

  • Focus on trust. Often people struggling with moral injury feel a sense of betrayal. In military contexts, it might be a betrayal from the institution or from command for being put in a situation that challenges one’s morals. But this feeling of betrayal can make it difficult to trust others in the military and even those closest to you. From a team perspective, it’s important to focus on building trust at work, and it’s crucial to do the same in your personal relationships as well.
  • Find forgiveness through mental flexibility. It can take time to recover from MI, and recovery requires support. A mental health professional or even a supportive partner can help reframe and “re-story” the event(s) that caused the MI. Use your mental flexibility skills to challenge your assumptions about what led you to compromise your moral values. Often, you might be only telling yourself part of the truth, and a supportive listener can help expand the narrative. With that, you can start to forgive yourself and come out of the negative cycles of guilt or shame.
  • Reconnect to your purpose, and share it. Often with MI, you might feel like you don’t know what to believe anymore because the values you once lived by no longer feel authentic or realistic. It’s OK to take some time to explore who you are now, what you believe in, and how you identify spiritually. The important thing to remember is that your partner is part of that journey too. Make sure you’re both talking about the values you hold, and what might be changing, so that you can continue to grow together.

TBI symptoms can impact your relationship

TBI Symptoms: •Cognitive decline •Trouble focusing •Challenges with planning & executive function •Impacts to learning and memory, language, or motor skills •Limited social skills •Headaches •Sensitivity to sound or noiseTraumatic brain injuries range in severity, but generally impact mental capabilities, affect behavior, and sometimes cause physical impairments. TBI is linked with relationship dissatisfaction because of the changes it can cause to emotional and mental health. In fact, couples coping with TBI have higher rates of relationship strain (almost three times more) than those who struggle with orthopedic injuries. Those diagnosed with TBI might also struggle with sexual functioning, which can also be a challenge in romantic relationships. And finally, many people who experience a TBI often go through a period of healing and physical rehabilitation which—in the military—can mean long separations and time apart from family. Check out some ways to get through a TBI together.

  • Address all symptoms. TBIs affect many areas of brain health, and so while (on the outside) it might seem like your injured Service Member is upset or quick to anger, consider the many sensory issues they might be trying to manage along with managing social interactions. It can be a lot to juggle at once, and can lead to what seems like a short fuse. Consider making simple adjustments to your home environment to support your Warfighter’s needs. Also, take some time to learn more about the symptoms of TBI so that as a unit, you understand the changes you might be seeing rather than taking them personally or blaming each other. Your TBI survivor also might not be able to handle detailed, more tedious jobs such as paying bills or balancing your family budget. Get creative about how you can reassign roles, so you’re both still involved and feel engaged in your partnership.
  • Focus on supporting each other. Since a TBI can fundamentally change the brain, it’s important that you and your partner maintain open communication about the symptoms and struggles you’re having. A lot of recovery from TBI is about physical recovery, and there’s a lot of research that emphasizes how important support from loved ones is during healing. Work towards establishing a new understanding of what it means to be a couple in your current circumstances. Strive to answer, “Who are we now?” together. Build new rituals as a team, find new ways to manage frustrations, and divvy up responsibilities at home.
  • Call for backup. It’s important for you both to maintain support outside of your relationship. Caregivers need a break to take care of themselves every so often. Encouragement from other family members and friends can help as you recover from your loved one’s TBI together. You both can’t make it through this process alone or by only depending on each other. Reap the benefits of getting comfortable asking others for help because it could bring some relief.

Invisible wounds are challenging to understand and to overcome. Often when someone experiences a TBI or struggles with PTSD or MI, it can be difficult to maintain close relationships. But recovery to your mental health, brain health, and relationships can be achieved through support and understanding. Remember, you’re on this journey together and can come through it stronger with effort.

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