Question: My husband is an Afghan war vet and he is now dealing with PTSD as well as lingering physical trauma injuries. He gets PTSD counseling with the VA but after about a year of therapy he doesn’t seem that much improved to me. I feel really terrible to be thinking this, but I am not sure how much longer I can endure. The problem is his anger. We will be having a nice day as a family and then some little thing will set him off and he’ll go into a blind rage, even smashing furniture and whatever else gets in his way. I understand that this is a part of his condition and I (try) not to take it personally and I try to be supportive, but it is really draining to always be waiting for the shoe to drop and for the explosion to come. We also have 2 small children. They are too young to understand why daddy gets so mad, but they can feel it. He is never physically abusive to any of us. I was prepared to stand by him and I think that this is the right thing to do and I know that his anger is not his fault. But since things don’t seem to be getting any better after a year of therapy, I honestly don’t know if I can stand this emotional roller coaster for the rest of my life. If he is not better after a year is likely to get better ever?

Ed Schmookler Says...:

Hello.

Your situation is quite serious, and I take it very seriously.

I think your questions are very appropriate. I will answer the best I can, but I will also have questions for you.

Post Traumatic Stress Disorder can go on, but it can also be treated. The effectiveness of the treatment depends on what is actually being done.  The VA can be good or not so good, in my experience. If his rages are continuing unabated, then he may need additional or different therapy.  Maybe the VA offers other options, maybe he will have to go outside of the VA to get help.  He may also benefit from anger management, which is not therapy but may be very important for him in learning how to deal with his rage.  

He should not just continue with this therapy without having a clear understanding from his therapist(s) that his rage is being dealt with. 

Is he just in group therapy?  Is he just getting meds?  Does he have an individual therapist?  Does the therapist know about his rage?

It may also be important to consider doing couples' therapy.  Have you told your husband what you feel about his raging?  Do you feel safe in bringing this up with him?  If not, then you might need to do it in the context of couples therapy. 

Have you spoken with the therapist(s) at the VA about what is going on?  They may be unaware of his rage and therefore not dealing with it at all.

Is he drinking or doing drugs, and is that part of the conditions of his raging?  If so, it would be imperative that he get treatment for that.

I would like to make sure that you get the best help possible here, because a lot of lives are involved (your husband, you, and your children).  Rage is serious and divorce is serious.  

If you are willing to talk with me further, you can either comment here or you can email me at edschmookler@sbcglobal.net.

Question: My fiancée grew up in a terrible and very violent household. Her father beat her mother regularly and would also beat and humiliate my fiancé and her sister pretty regularly. Her father died when she was 23. She is now 28. She has told me some of what growing up was life but it’s not something she likes to talk about very much. She hates her father and I know she doesn’t want our life to be anything like the family life she grew up in. I am concerned, however, that she has a violent and out of control side. She is normally a very sweet and kind person, but there have been a few times when we have had very big fights that she has become somewhat violent with me. She is always very apologetic afterward, but I can see that during the ‘heat of the moment’ she loses control. I suspect that she has learned this kind of violence growing up and it is what she resorts to as a last resort in very difficult situations. My main concern is that we plan on having a family together and I am worried that she may lose her temper with our children someday in the future and become violent. I know she would never want to do this. Will some sort of therapy help her overcome her deeply buried violent tendencies? Or is this something she is stuck with for life. I love her dearly, but if she is going to always be a violent person then I may have to rethink whether I can or should get married to her.

Ed Schmookler Says...:

Hello, anonymous,

Your concern seems very valid to me, and so is your understanding.  Yes, people do learn tendencies from other people.  In addition, being treated abusively can create a lot of unexpressed and (at the time) inexpressible rage.  So it may well be that when you are arguing, she gets triggered into re-experiencing the past, and her rage comes up and gets addressed to the one she's with (you), who may at that moment remind her of her father.

Therapy can definitely help with this, if a person is willing to work through the rage they carry, and if the therapist is experienced at dealing with trauma and abuse.

I think your concerns that family life might echo her childhood could well be valid, unless she gets some help in working through her past.  

Question: I have been in and out of numerous treatments for an eating disorder over the past few years. I knew of one reoccurring traumatic event that happened when i was from the ages of 7-12. However, upon going into a treatment that focused both on Trauma AND the Eating Disorder and used a method that I've grown to really find helpful with my system is IFS. However, as they unfolded a few more traumatic events that I did not even remember happening (except brief short memories I always thought I was "gross" for making up, "daddy would never do that"sort of thing). My therapist at treatment and I made a timeline of events that certain parts remembered, based on my father's abuse, and we believe it happened from, perhaps as young as 2 until the last that I almost remember it, but I was watching, not there, on my 18th birthday. and i've had body memories for years; i just never knew what they were. I have so many blanks in my life, especially in my childhood, so being told that things happened freaks me out. Even when I talk to my mother and she asks if ai remember this or that and I don't. I've known my system for a while; maybe about 5 years that the original two parts came, and then onward from there - especially as they started coming out, expressing real personalities and overtaking me infront of staff and peers after a few months, I've noticed that many only come out when I feel generally safe. I was diagnosed with DD-NOS, and the diagnosis, even that, embarrasses me. I feel like a crazy person when parts come out and buy things I don't remember buying, rearranging things, etc etc. It's too much! However, the founder of IFS, Dick Schwartz, is a good friend of my therapist's, and he was going to give the unbiased diagnosis of whether or not I truly have DID. I hope you believe me when I say that I don't even want a dissociative disorder, I don't want dissociation, PTSD, let alone DID.. But he was scheduled to come on a Friday and I left due to insurance on a Wednesday. My team decided that I either most likely had mild-DID or a factitious disorder because "some of my stories of my life were too factual, or too broken up and not connecting" but the reason they don't connect is that I honestly don't remember. I want to go back to this tx facility when I go back into residential tx for trauma, but should I face them again because maybe they're right and I don't even know it, or should I go somewhere else for alternate opinion? I know you don't know me, but I looked up factitious disorder and I don't believe that such a disorder fits me. I don't want the trauma I have and I'd gladly say I made it up if I had. I wish i'd made it up.. but I didn't, you know? What should I do? and does it really sound like I maybe have a Factitious Disorder? Is it common for therapists to debate between both?

Ed Schmookler Says...:

Hello, firstpersonplural,

Let's start by me saying I am not in a position to diagnose you.  I would have to see you, interview you, and perhaps even get to know you over a period of time  So anything I say must be understood within that context.

Let's next talk about Fictitious Disorder.  I don't know who is saying this.  To answer your last question first, no it is not common for therapists to debate between both, as far as I know.  In fact, I had to look up the criteria for Fictitious Disorder, since I've never heard anyone use the concept before. The criteria listed are:

  "DSM-IV-TR specifies three criteria for factitious disorder:

Question: My husband is a civil engineer who works on contracts rebuilding Afghanistan. He works 3 months overseas and then comes back for a month off. He has been doing this for a couple of years now and the money is really very good. He has been back now for a little over a couple of weeks this time and I hardly recognize the man. In the past, there has sometimes been a day or two of readjustment, as we all get used to one another again after an absence, but this time it feels like he is a completely changed person and not for the better. He is usually a pretty good natured guy but now he is tense and jumpy and irritable all the time. He seems to have nightmares and doesn’t sleep well, which is also very out of character. I think that it is pretty obvious that he is having trouble dealing with something that he went through over there, but when I ask him what’s wrong and what happened he just shuts me out. He won’t admit that anything unusual happened and he won’t admit that he has changed. I think he has PTSD but I cannot be sure. I really don’t know what to do. And he is scheduled to leave again in just over a week. I am worried that he is no shape to go back into a warzone right now but he gets so angry when I say anything about it. I could talk to his managers here about what I am seeing and I am pretty sure that if I go on record with them with my concerns they will postpone or even cancel his trip overseas. But If I do that and I am wrong about it all then I may cost him a very good opportunity and our family a needed paycheck. If he does have PTSD, how serious is it for him to be heading back over to Afghanistan without dealing with it before hand?

Ed Schmookler Says...:

Hello,

Well, the scenario you are describing is the scenario familiar to me from the Vietnam war and from this one. War is full of horror, and it can have very detrimental effects on people, including the development of PTSD.  

Of course, I cannot diagnose your husband without seeing him or talking to him.  But the way you describe his state is consistent with PTSD.  It could be other things he doesn't want to share with you, but, given the circumstances, PTSD is a reasonable guess as a starting point.

I am not an expert on warfare, and so I don't know whether he would be in more danger as a result of PTSD or not. PTSD can result in a high level of vigilance, so that can even help.  But with nightmares and with emotional shutdown, it is possible he would be tired and insufficiently responsive. I don't know.

But his managers would know a lot better than you or I would.

Your husband's refusal to acknowledge the change in him may be denial, it may be something else, but anger and denial are familiar in this situation.  

Perhaps you could talk frankly to him about your fears and let him know that unless he is willing to either see a therapist or to be more open with you, you will feel compelled to let his managers know about your concerns.  This gives him an opportunity to deal with this before involving his managers.  

If you do confront him like this, you will probably have to deal with more anger.  But his safety is paramount, and you may be more aware of what is going on with him than he is.

Please feel free to email me further at edschmookler@sbcglobal.net

Question: I experienced a violent home invasion about 4 months ago. I came home to find a robbery in progress and was beaten very badly before the intruders fled. I couldn’t remember much of anything useful to identify them, and so they have not been caught. I have been having a very hard time getting over the event. I moved out and found a new place across town. I just didn’t feel safe anymore at home and there was too much that was reminding me of the attack. I thought moving into a new place would help, but I am still very messed up and still have nightmares more days of the week than not. My friend, who is a nurse, has recommended keeping a daily journal or diary to write about my feelings and my memories of the attack and of the nightmares that I am having. She says that this is a therapeutic tool that is helpful for victims of trauma. I have been trying this for a week or so, but I find the experience kind of unpleasant, like reliving it unnecessarily, and it’s not making me feel any better. Is writing in a diary a good way to get past a traumatic experience? What else can I do to get on with my life?

Ed Schmookler Says...:

Hello, Linda,

First of all, I am very sorry that you were subject to this violent attack.  It is a real shame.

Getting over something like this is hard, and nightmares are a common response to trauma.  It is one of the symptoms of Post Traumatic Stress Disorder.  You might want to read about that online, in case you are someone who benefits from information.

For some people, writing a journal can help; for others, like yourself, it might do the opposite, just re-triggering the memories with no particular benefit. Maybe for you it is just re-traumatizing.  So maybe something else would be better for you.

I think sometimes the first order of business is to find safety, and you have done a big thing to help with that:  you moved.  One relevant question might be: is there anything else you can do to help you feel safe?  Are there people you know whom you can be with that can help with that sometimes?

Another aspect of this is that your body wants to deal with what happened.  When something like this happens, it comes out of the blue, and it is hard to integrate with the rest of your life.  Sometimes, talking to someone like a therapist can help. Maybe going over the event or your feelings now with someone who can support you will help you process through this in a relatively safe environment, rather than writing about it alone.

But I do want to say, there are no easy answers.  We are designed to remember what shocks and hurts us, so that we can watch out for any further similar danger.  

So it does take time to slowly get to where it bothers you less and less. 

Sometimes that can happen quicker with a therapist's support.  If you do see a therapist, make sure they have experience dealing with trauma.

Please feel free to discuss this further with me.  I will email you my address.

Hope this helps

Question: A decade ago, I survived a car crash that killed my wife. It wasn't our fault. But to this day I have memories of my wife crying out for me as she lay dying. I simply cannot get over it. I have remarried now for 6 years. My new wife is suggesting I should see a professional therapist. It is very unlike me and I'd like to think there are alternatives... What do you suggest, what are the benefits of seeking treatment? I am not rich, and a long therapy would put a big financial strain on my family...

Ed Schmookler Says...:

Hello, Tobin.

I am very sorry for the loss of your wife. I don't think we "get over" such huge losses. But we do move on, and it is good to see that you have done so, with a new person in your life.

The question about whether you should see a therapist is a good one. You are not just dealing with loss; you are dealing with a traumatic memory. Why does your wife think you "should" see a therapist? Does she feel this trauma stands in the way of your having a full life? Does she see you in what she thinks is unnecessary, chronic pain?

A good therapist can help you move through and past the traumatic memory that may be keeping part of you frozen in the past.  It can be a painful process, but afterward, the pain can subside, and you can have more freedom in your life, more chance for living in the present, and more potential for joy.

You certainly don't want to put a financial strain on your family, so it would be good to go to therapy only as long as is needed to resolve this better.

I think it is great to handle your own problems. But would you do that with your physical health too and avoid seeing a doctor? Ultimately, you will be handling the problems yourself; the only question is, could you benefit also from the help of another person?

As men, we don't like stopping and asking for directions, but sometimes it can shorten the trip.

It is your choice and only you know what is best for you.

Sincerely,

Ed