Understanding Intimacy Avoidance in PTSD

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When we hear the words "PTSD" or "trauma," we may assume that a person was sexually victimized, and because of a traumatic event, has emotionally shut down. While this is a very real situation for many sexual abuse survivors, equally important to consider are other forms of trauma that can lead to avoidance of intimacy in relationships.

Post-traumatic stress disorder (PTSD) is identified by the current Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as having the potential to develop after experiencing or witnessing a traumatic event (i.e. active shooter; sexual assault) or chronic, recurring traumatic events (i.e. child abuse/neglect; captivity; or domestic abuse) and includes four key features: intrusive symptoms; avoidance behaviors; self-destructive behavior/hyperarousal; and changes in mood/cognition.

Common experiences with intimacy avoidance may include feeling engulfed or enmeshed with a partner or within a significant relationship such as family or close friend. This may behaviorally look similar to the “push-pull” seen in some dynamics, where one person pushes away or runs, while the other pulls close or chases. What can differentiate between the two are individual differences, personal history, and function(s) of the avoidant behavior. However, it is much more complex than behaviorally walking away or avoiding relationships altogether.

Some commonly report that they feel emotionally numb or disconnected, which may include fear of abandonment, feeling rejected, socially isolated, emotionally engulfed, or having a constant need for approval from others/validation. Because these feelings and experiences can cause more stress, avoiding situations or people who “trigger” vulnerable emotions — from love, to anger, to fear or shame — is commonly reported. Essentially, avoiding feelings that cause distress can “trigger” avoidant behavior, which can keep a person suffering from PTSD caught in a self-defeating cycle of: disconnection –> emotional trigger –> avoidant behavior.

Emotional numbing, or avoidant behavior, can affect the quality of a person’s life; they may lose interest in activities they once enjoyed, there may be increases in interpersonal/relationship problems, and/or a detachment or inability to remain emotionally close to others. Similarly, fight/flight behavior and self-sabotaging behavior (self-medicating, “distracted” behavior, eating disorders, cycling through relationships, promiscuity, or other risky behavior) are reported, which can exacerbate avoidance of intimacy.

For example, if a child grew up in an invalidating or abusive environment where they were not allowed a voice, went unheard, or were physically abused, this can stay with them through childhood and into adulthood which can then impact the quality of their adult relationships. If the child developed an insecure or avoidant attachment style from prolonged or recurrent neglect or abuse, they may feel emotionally engulfed or fear abandonment in their intimate relationships, which may “trigger” avoidant behavior (“running” from relationships, preferring isolation, or developing a cycle of leaving an intimate relationship when feeling engulfed and then replacing the partner to prevent a fear of abandonment).

Working through emotional “triggers,” distracted behavior, and intimacy avoidance can be challenging because the avoidant behavior is in place to help numb a person from feeling overwhelmed or emotionally vulnerable. The downside of this pattern is that, over time, more drastic, chronic, or habitual avoidant behaviors are often used to continue pushing away emotions and feelings that “trigger” vulnerability or emotional engulfment. By pushing emotions away or minimizing them, this ultimately can make symptoms of PTSD more intense or of a longer duration. Similarly, with emotional avoidance or disconnection, a person may become more out of touch with their own emotions and the emotions of others, which can lead to loss of important relationships.

Creating a safe space for a person experiencing emotional engulfment, disconnection, or avoidant behavior or other symptoms of PTSD is important in helping empower them. Family members and intimate partners may look for ways to lessen avoidant reactions, such as being sensitive to the person’s sense of autonomy, using positive reinforcement, unconditional positive regard, focusing on positive qualities, and use of humor to de-escalate a stressful situation, which may help buffer against avoidant behavior. Similarly, the person may benefit from tracking their own reactions to environmental stimuli that “trigger” avoidant behavior in order to redirect and calm them and to empower them in better understanding their emotions and fostering awareness.