Can you develop PTSD from emotional abuse?

Post-Traumatic Stress Disorder (PTSD) is a condition traditionally associated with veterans of war. However, people can also develop PTSD when they experience emotional abuse. The term post-traumatic stress disorder (PTSD) conjures up the image of a person in distress, perhaps coming home from war, and struggling to re-acclimate to civilian life. Many of our nation’s veterans have experienced severe physical and emotional trauma, but PTSD stemming from emotional abuse can be just as valid and challenging to live with.

While this image of a military person may be accurate, it is a narrow view of PTSD and fails to account for the innumerable circumstances that can cause PTSD. It can occur in those who are emotionally abused, as well. The human body was not designed to withstand an extended period of abuse, intense stress, or intense fear—this includes reactions to verbal abuse and other types of emotional trauma as well as physical harm. Thus, it’s possible to develop the physical, mental, and emotional symptoms of PTSD in response to any one of these situations. 

What is post-traumatic stress disorder?

Post-Traumatic Stress Disorder is an anxiety disorder that occurs when someone has witnessed or experienced a traumatic event. Physical abuse may or may not have been involved. This can include war, an accident, a natural disaster, rape, sexual assault, abuse, a car accident, physical trauma, or any other traumatic experience either witnessed as a bystander or experienced as a survivor.

PTSD creates something of a wound in the minds of its survivors, as the stress of the event is far too much for the mind to fully comprehend and reconcile. Instead, PTSD throws up a mental file of sorts that slots the event away to be deconstructed and understood later. This is sometimes described as going into fight or flight mode, and when that happens, a person’s brain releases stress hormones to help the physical body deal with the trauma. Although fight or flight is an effective coping mechanism, it can also cause distress. This is because the brain may develop triggers, which cause the individual to recall the event down the road. When this happens, the fear and distress brought about by the trauma are re-lived and can have significant consequences on one’s mental health.

Since triggers can be anywhere and episodes may be violent or marked by extreme terror, people can have intense episodes while out and about, in the middle of school, or even while alone at home. Thus, the condition is often exacerbated by the fear of experiencing an episode in an unsafe place or experiencing the judgment of people nearby when an episode occurs. Some people with PTSD may go on to develop agoraphobia for this reason and may struggle to perform day-to-day tasks without assistance. This can also cause social withdrawal, difficulty in interpersonal relationships, isolation, dissociation, self-blame, or even physical health problems. Other mental health conditions can develop as a result.

In both mild and severe cases of PTSD, it’s important to seek professional medical advice and treatment. A licensed therapist can help a person move past their troubling memories, address negative feelings, and develop skills to help them cope as a part of their treatment plan. 

Can you develop post-traumatic stress disorder from emotional abuse?

Yes, it’s possible to develop PTSD after experiencing emotional abuse. This is true regardless of someone’s gender, age, socioeconomic background, or any other identifier. It's possible to experience both PTSD and C PTSD or complex PTSD after emotional abuse. However, emotional abuse PTSD does not typically follow the standard cycle. The form of PTSD commonly associated with emotional abuse is called "complex" or "compounding" because it displays symptoms related to a series of traumatic events, rather than a single, stark event. Therefore, C PTSD results from ongoing trauma, such as experiencing emotional abuse long term, or prolonged exposure to traumatic experiences. 

Emotional abuse and complex post-traumatic stress disorder

Complex PTSD (C PTSD) can manifest in unpredictable ways. For instance, someone with PTSD following a car accident might avoid cars altogether or drive as quickly and recklessly as possible. As its name implies, C PTSD can be particularly challenging. After all, healing from a single traumatic event is difficult enough. People with C PTSD have often experienced abuse, neglect, and other forms of trauma repeatedly, and this can have a significant effect on someone’s mental health. 

Narcissism and emotional manipulation

Emotional abuse appears to go hand-in-hand with narcissism, whether the person with Narcissistic Personality Disorder is the perpetrator in the emotionally abusive relationship or the person experiencing the abuse. It has been suggested that NPD is a direct result of some form of abuse or suffering ongoing trauma. The condition is not known to exist from infancy, nor is it known to develop without the presence of some type of abuse in one's past, whether that came from a parent or other family members, a caregiver, or an abusive relationship with a loved one.

PTSD stemming from emotional abuse, emotional trauma, anxiety, and depression are often intertwined, leading to a rather extensive diagnosis for some individuals. Even so, understanding that all these disorders can be linked helps mental health professionals create a specific, targeted treatment plan. Such a plan can ease the symptoms of these related disorders and potentially halt a cycle of abuse and mental distress.

Narcissistic abuse and PTSD: What's the correlation?

PTSD can be difficult to navigate when dealing with narcissistic abuse, particularly if your abuser is a partner in a romantic relationship or someone close to you. You may lack support from your family or friends when embarking upon your healing journey, and the toll narcissistic abuse takes on its survivors is substantial. Emotional abuse from narcissism often requires you to cut off contact entirely with your abuser to begin healing, and the resulting PTSD symptoms can take time to overcome.

Narcissistic abuse often involves something called "gaslighting," which essentially is a tool to convince a narcissist's subject that they are crazy or unworthy and that all perceived abuse is either imagined or deserved. Recovering from emotional abusers that use narcissistic abuse tactics is sometimes more complicated than processing a single traumatic event. In some cases, it may require a complete overhaul of the way an individual has come to think about themselves, the world around them, and their abuser.

Symptoms of PTSD from emotional abuse

According to the latest diagnostic and statistical manual (DSM-5), the symptoms of PTSD are far-reaching and can look different based on the cause of the trauma in question.

It is important to note, though, that a person with PTSD may also have other emotional symptoms (such as difficulty with emotional regulation) and even physical symptoms. According to the criteria of the diagnostical and statistical manual, without these four symptoms present for at least four weeks, a PTSD diagnosis is not usually relevant. Moreover, if these symptoms are present but daily life is not affected, then post-traumatic stress disorder (PTSD) is not usually diagnosed.

Intrusive thoughts

Intrusive thoughts are unwanted and often have different themes. They might be thoughts about harming oneself or others, irrational fears, feelings of paranoia, or even flashbacks from the event itself. They may come during the day or in the form of chronic nightmares. These thoughts are often difficult to push away and affect daily living and mental health.

Avoidant behavior

Avoidant behavior is usually engaged to avoid triggering the symptoms of post-traumatic stress disorder (PTSD). You might avoid certain places around town, not listen to or watch certain songs or movies, or keep your distance from specific people to keep the symptoms of PTSD at bay. Avoidant behavior can eventually wreak havoc on your life, as you cannot always avoid the triggers of PTSD. For example, it may not be practical to simply stop going to work, school, or the grocery store altogether.

Persistent negative thoughts/feelings

Negative thoughts, actions, and emotions in PTSD are not fleeting moments of sadness, anger, or frustration, but are instead persistent, ongoing thoughts that negatively impact your ability to live your life. If you are experiencing PTSD, you may feel that no one can be trusted, that you are bad or evil, that you are unworthy of love, that everyone is out to get you, or other negative thoughts. Negative thoughts in PTSD can eventually lead to other problematic thinking patterns. This type of thinking can be common for those living with PTSD from emotional abuse.

Arousal/reactive symptoms

Arousal and reactive symptoms are best described as feelings or impulses that seem out of your control. Constantly having angry outbursts followed by feelings of remorse is one example. Being easily startled or frightened is another reactive behavior, as is reckless behavior, such as engaging in deliberately dangerous stunts. These symptoms can function as a means of avoiding your experience, or they can be an unconscious re-creation of fear and adrenaline. 

Treatment options for PTSD

There are several treatments available for PTSD. However, when people experience PTSD from emotional abuse, more extensive treatment is often required because the affected individual is typically not working to recover from a single event, but from a cycle of abuse. Compounding trauma is not impossible to recover from, but it may demand a lot of introspection, rewiring, and healing.

How counseling can help

Counseling is one of the most common treatments for PTSD, and a variety of support groups or talk therapy sessions can be an effective course of action for healing. One type of therapy that can be used to heal from PTSD is eye movement desensitization and reprocessing therapy (EMDR), but there can be many other options as well. Peer-reviewed studies demonstrate that these forms of therapy can help defuse and redirect intense emotions, build self-esteem, teach coping skills and strategies to increase positive emotions, and help those who have undergone psychological abuse learn to nurture healthy relationships with others. 

In some severe cases, a physician may prescribe medication such as selective serotonin reuptake inhibitors (SSRIs) to help manage symptoms.

Online therapy with BetterHelp

Sometimes, people with PTSD from emotional abuse have trouble attending in-person counseling sessions. This is often because of the shame associated with the condition as well as reactive symptoms that can cause embarrassment in public. Online therapy is sometimes a feasible alternative because you can attend sessions from home. BetterHelp is one internet-based resource that offers professional treatment, daily tips, and high-quality sources of information about PTSD.  

The effectiveness of online therapy

For those concerned about the effectiveness of online therapy for treating PTSD, researchers have found some encouraging results. Some treatments for this condition such as cognitive behavioral therapy (CBT) are now recommended in the form of online counseling. More studies are being conducted to evaluate the effectiveness of other therapeutic interventions delivered online such as Eye Movement Desensitization and Reprocessing (EMDR). Researchers have found that EMDR delivered online can be a successful way of treating post-traumatic stress disorder as well as other mental disorders. It may be a viable option for your situation as well.