Emotional intimacy is typically a cornerstone of healthy relationships of all kinds, including romantic connections. Without this type of intimacy, it can be difficult for all parties in a relationship to feel safe and connected and for their relationship to grow. While there are many reasons why people in a romantic relationship might struggle with emotional intimacy, one of the potential causes is intimacy avoidance due to post-traumatic stress disorder (PTSD). This article aims to define intimacy avoidance in PTSD and to explore treatment options for this and other symptoms of the condition. 

What is PTSD?

PTSD is a mental health disorder that arises as the result of experiencing or witnessing a traumatic event. This mental health condition can develop at any age and can be caused by many different types of stressful and life-changing events.

Combat veterans and sexual trauma survivors are often at risk of developing PTSD. Those who have experienced abuse from family members, romantic partners, or peers at school or work may be at risk, as well. PTSD may also affect people who survive other types of life-threatening experiences, such as a violent assault, war, a natural disaster, or a serious car accident.

PTSD symptoms

The symptoms of PTSD can vary somewhat from person to person, but they typically fall into four categories:

1. Reexperiencing, such as having flashbacks to or nightmares about the traumatic event
2. Hyperarousal, such as being easily startled,  feeling constantly on edge, or experiencing severe anxiety Mood and cognition changes, such as mood swings, irritability, angry outbursts, feelings of shame or guilt, a lack of interest in previous activities, negative thought patterns, or social withdrawal
3. Avoidance behaviors, such as avoiding reminders of or conversations about the event, which may trigger painful memories

What causes intimacy avoidance in PTSD?

One of the most significant potential side effects of PTSD is intimacy avoidance. Intimacy avoidance can fall under the category of avoidance symptoms, sometimes referred to as the “avoidance cluster.” An individual may avoid intimacy—whether physical or emotional to keep traumatic memories from being at the forefront of their minds, often by avoiding PTSD triggers. They might try to emotionally “block” recollections of or emotions related to the experiences that traumatized them in an attempt to avoid panic attacks, psychosis, or other severe potential symptoms of PTSD. This pattern can take a variety of forms, such as: 

• Avoidance of physical closeness
• Emotional withdrawal in relationships
• Difficulty forming an emotional connection with others
• Difficulty communicating, even in a supportive relationship
• Difficulty setting healthy boundaries

Effects of repressing feelings

Repressing emotions can also lead to a variety of negative health effects in the long term, including increased pain levels, an elevated risk of cancer and cardiovascular problems, and an increased likelihood of depression and anxiety. 

How PTSD affects relationships over time

With all this in mind, how does PTSD affect relationships? In addition to mood swings, panic attacks, and other mental and physical symptoms, the emotional avoidance that can be common in PTSD may also pose significant challenges. If an individual isn’t in touch with their emotions, it can be difficult for them to be vulnerable, speak up for their needs, and feel deeply connected to another person—all of which can prevent them from forming new relationships or maintaining existing ones. Research suggests that social connections are critical for health and well-being, so seeking treatment for this and other PTSD symptoms can be paramount.

Complex PTSD and intimacy

Complex PTSD is a type of PTSD that may amplify these challenges further. In contrast to PTSD, which typically arises from a single event, complex PTSD tends to arise from chronic or repeated traumatic events. Individuals with complex PTSD may develop severe anxiety, long-standing challenges with trust, and a sense of profound disconnection from others. This may lead to more intense emotional withdrawal and difficulty managing PTSD triggers.    

Fear and avoidance of emotional intimacy due to PTSD

If you are experiencing PTSD or are the romantic partner of someone with this condition, you may be able to recognize some of the signs of emotional avoidance. These may include symptoms like:

• Emotional numbness, or emotions and reactions to experiences that seem dulled, delayed, or nonexistent
• Emotional distancing from friends, family, and/or romantic partners
• Lack of interest in previous sources of enjoyment, such as hobbies or physical intimacy

Additional symptoms of PTSD may exacerbate or coexist with signs of emotional avoidance as well, such as:

• Difficulty sleeping
• Irritability
• Chronic worry or stress
• Nervousness and anxiety
• Flashbacks to traumatic events
• Anger issues
• Poor impulse control
• Engaging in unhealthy coping mechanisms, such as substance misuse

Emotionally avoidant behaviors can cause individuals to lose interest in establishing or deepening emotional or physical intimacy with their romantic partners. They can also decrease or entirely eliminate a person’s sexual desire and capacity for emotional availability. Getting treatment for PTSD may help an individual manage these symptoms to improve their well-being and the health of their relationships.  

Strategies that support intimacy and emotional regulation

Several strategies may help individuals with PTSD improve their emotional regulation, manage physical closeness, and potentially promote greater intimacy in relationships. Some examples include:

• Practicing mindfulness to build an awareness of how emotions manifest in your body, especially during intimate moments
• Pausing to name the emotions you’re feeling in those moments without judging yourself
• Identifying situations that cause you distress and practicing healthy coping strategies, such as grounding exercises, to use when they arise 
• Setting clear boundaries with your partner and moving at your own pace
• Remembering to practice self-care activities, like getting exercise, eating a nutritious diet, and engaging in fulfilling hobbies 
• Acknowledging that the process of building a healthier relationship with intimacy can take time and remembering to be patient with yourself

Keep in mind that while these strategies may help supplement PTSD treatment, they are not a substitute for professional help. In the following section, we’ll explore professional treatment options that, when performed by a licensed therapist, may help individuals manage trauma and begin the healing process. 

Treatment options for PTSD-related intimacy avoidance

Treatment for PTSD typically consists of some form of therapy, sometimes in combination with medication. Talk therapy, in particular, may help those with PTSD regain their ability to become aware of and process their emotions. It may also support them in learning to manage other PTSD symptoms, develop healthy coping mechanisms, and improve their mental health and relationships overall. 

Cognitive behavioral therapy (CBT) is one type of talk therapy that’s commonly used for those with PTSD, and it can be an effective way to treat symptoms like intimacy avoidance. Its core aim is to help the individual learn to recognize and then shift distorted thoughts that may be contributing to negative feelings and other symptoms. Another type of therapy, known as acceptance and commitment therapy (ACT), may also be helpful, as it’s designed to directly address avoidant behaviors and help individuals experience their full range of emotions. This may aid in the healing process and help couples affected by PTSD strengthen their emotional connection. 

Several other therapy types are designed specifically for survivors of trauma. For example, prolonged exposure therapy (PE), a subtype of CBT, is designed to help survivors slowly confront traumatic memories, which can gradually reduce the effects of PTSD triggers. Similarly, eye movement desensitization and reprocessing (EMDR) is another type of therapy that uses guided eye movements to encourage the brain to reprocess memories of trauma. 

Getting support through BetterHelp

While therapy can be an important part of the healing process for those living with PTSD, it can also be a vulnerable experience. Some people may find it difficult to speak about their trauma or their symptoms with a therapist face-to-face—particularly if they’re experiencing signs of emotional avoidance or challenges with emotional regulation. 

In these situations, online therapy may represent a more comfortable alternative to traditional therapy. Platforms like BetterHelp allow individuals to meet with a licensed therapist remotely via voice call, video call, or in-app messaging from wherever they feel comfortable, as long as they have an internet connection. Research suggests that virtual CBT, in particular, can be as effective as in-person CBT for those with PTSD.