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While it’s no easy feat, getting out of a toxic or abusive relationship is an important step to take for your mental health and physical safety (with the help of professionals, of course, as leaving is a dangerous time for survivors).
But for some, leaving these relationships doesn’t bring the instant relief you might imagine. Those upsetting, traumatic experiences can haunt you afterwards, causing low self-esteem, flinching easily, having flashbacks, or similar effects. And for some survivors, the aftermath could mean having post-traumatic relationship syndrome (PTRS).
What is post-traumatic relationship syndrome?
“PTRS [is a] newly proposed subcategory of PTSD [post-traumatic stress disorder] that can occur as a result of experiencing trauma in an intimate relationship,” says Caroline Nichols, LICSW, CEDS, the director of family and support services at Lightfully Behavioral Health in Los Angeles. She adds you may have heard it referred to as “relationship PTSD.”
While PTRS is not an official diagnosis in the DSM-5 (the diagnostic guide used by mental health professionals in the U.S.), researchers have discussed the potential of PTRS as its own condition, separate from PTSD, since at least 2003.
An abusive relationship is the main cause of PTRS. “That abuse could be overt, like physical violence, or more subversive, like financial abuse,” says Bonnie Scott, LPC, therapist and founder of Mindful Kindness Counseling. “The idea is that the person does not feel safe in their romantic relationship, and that can cause trauma because it’s intimate…When the relationship ends and the person tries to move on, they may find their symptoms get in the way of forming new relationships or feeling safe in relationships at all.” Said symptoms include flashbacks, anxiety or panic, and negative changes in thought and mood that disrupt daily life and functioning, she says.
Some risk factors for PTRS are previous trauma or abuse, a history of substance abuse, a family history of PTSD or other mental health disorders, poor coping skills, a lack of social support, and ongoing stress, Nichols adds. However, not everyone who experiences an abusive relationship will have PTRS, just like not everyone who endures trauma gets PTSD.
It’s important to note that while other traumatic things besides abuse can happen in a relationship, PTRS is specific to having lived through an abusive intimate partnership. “It may be more common to find that those who experience trauma within the relationship (i.e., death, serious disease, accident) develop symptoms related to PTSD,” Nichols clarifies. Struggling to process a particularly awful breakup, for example, doesn’t necessarily mean you have PTRS. However, “it’s feasible that once someone recovers from the breakup, they may become more aware of abusive aspects of a relationship, therefore resulting in symptoms related to PTRS,” says Nichols.
Since PTRS isn’t an official DSM diagnosis, some therapists just use the PTSD diagnosis. “For my clients, I use the PTSD diagnosis, particularly because the current DSM has broadened the definition and diagnostic criteria to include ‘repeated exposures’ instead of the previous ‘single exposure to [a] traumatic event,’” Scott says (which is relevant to an abusive relationship where you were constantly exposed to trauma). “I’ve always used the PTSD diagnosis because trauma is trauma when it comes to my therapy style and theory.”
Regardless of how you label it, your pain is valid. No matter what the relationship or breakup looked like, breakups are awful. It’s understandable that they may affect you deeply.
So how is PTRS different from PTSD?
If PTRS is so similar to PTSD, why does it need its own subcategory? Well, there is a difference between the two.
“Those with PTRS experience relational symptoms instead of the hallmark avoidance symptoms associated with a PTSD or CPTSD diagnosis,” Nichols explains. To break that down a little bit, people with PTSD or CPTSD (which stands for complex PTSD) tend to avoid things that are related to or remind them of their trauma, like places, events, or even thoughts and feelings. That’s not necessarily the case for people with PTRS, research suggests.
Instead, people with PTRS experience a different set of symptoms that specifically have to do with their relationships with others. These include difficulty trusting others, loneliness or isolation, jumping into new relationships, shame, guilt, self-blame, and believing the world is unsafe. This is likely a result of how you were hurt in the relationship.
That said, there is some overlap between other PTRS and PTSD symptoms. Both conditions involve re-experiencing symptoms (like having flashbacks or recurring memories or dreams of their trauma) and what’s known as arousal and reactivity symptoms (like feeling easily startled or tense, or feeling irritable or having angry outbursts). It’s also possible that someone could have both conditions, Nichols adds.
However, Scott says individuals shouldn’t focus so much on getting the label right before seeking help because trauma is complex, and symptoms and experiences differ from person to person. “My clinical experience of treating trauma is there’s no quick fix no matter what causes the injury,” she says. “The common trauma responses of avoidance, intrusive thoughts and memories, increased nervous system activation, and negative changes in mood will look different for every client and every trigger.”
Instead, Scott says people should focus primarily on getting the help they need. “Generally, I would say trauma and grief can show up as a lot of overlapping symptoms, so it’s worth it if it’s affecting someone’s day-to-day life to talk to a pro about it.”
What can help you cope with PTRS
Unfortunately, these symptoms can last a while—especially without treatment—and there’s no set timeline. “It can be mostly resolved, where it doesn’t affect your day-to-day life, but the triggers remain and can be pressed at any time,” Scott says. “Typically, people are most reactive between one to six months post-trauma, but activation waxes and wanes throughout life and can be cyclical.”
So how can you handle it? First off, Nichols recommends finding a trauma-informed therapist to get diagnosed and, most importantly, receive proper care. She says to look for a therapist who has training in prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), cognitive processing therapy (CPT) or trauma-focused cognitive behavioral therapy (TF-CBT), as these forms of therapy are shown to help people process and cope with traumatic events. Scott practices somatic-based trauma work and brainspotting, and says EMDR, narrative therapy, therapeutic yoga, and group therapy are also popular options. (These types of therapy are often listed on a therapist’s Psychology Today page, which you can find through this database.)
To figure out which type is best for you, talk it through with a therapist before your first appointment. It’s possible that multiple types of therapy could help, so don’t put too much pressure on yourself to find the exact right one the first time.
Don’t forget that the relationship you have with your therapist is paramount. “As in all therapy relationships, the important thing is that the client feels safe and supported, and there’s good rapport,” Scott says. It may take you time to find the right fit, and that’s okay.
Nichols also advises building a solid support system you trust, engaging in self-care, establishing boundaries, and trying to make your space feel as comfortable as possible.
Scott adds the importance of taking medication if needed and learning grounding skills. An example of a grounding technique is the 5-4-3-2-1 method, where you list five things you can see, four things you can hear, three things you can feel, two things you can smell, and one thing you can taste (or are grateful for).
Healing from an abusive relationship sucks—there’s no eloquent way to put it. You shouldn’t have had to go through what you did, both with your partner and after your breakup. Try to be compassionate with yourself. Your feelings are valid and you deserve support.
If you are currently experiencing or have previously experienced abuse, contact The National Domestic Violence Hotline by calling 1-800-799-SAFE (7233), texting START to 88788, or chatting with them online.