Trauma, or PTSD, is usually viewed as something that only affects the person who experienced the trauma. This is simply not true. Trauma can not only affect the client, but their current family, their family of origin, even their friends. How?
Let us create an imaginary client. I will call him "John". John just came back from Iraq and is suffering the symptoms of PTSD or war-related trauma. Where before John was a bright, generally happy, outgoing, loving son and husband he is now moody, withdrawn, extremely irritable, sometimes explosive, often depressed and always hypervigilant (heightened startle responses and flashbacks). Often, a person suffering from trauma symptoms will begin to abuse drugs or alcohol in order to numb them. This creates problems of its own. It seems obvious how this will affect his own family. His wife and children become "shell shocked" by his violent outbursts, mood changes, irritability and overreactions to minor events. They are often hurt by his withdrawal, not understanding why he pulls away from them, why he isolates himself from them, why he refuses to talk to them. His wife may blame herself for not being able to reach him or be there for him. When he withdraws she and the children may blame themselves for not being able to help. "If only I were a better wife he would not get mad or he would open up to me or he would trust me and tell me what is going on". "If only I were a better son/daughter I would not irritate him and make him mad." The marriage will have problems not only because of his behavior, but because his wife has lost the man she originally married. She will have to learn to live with this new, traumatized John and she may not be willing or able to make this adjustment. But his direct family are not the only ones who are affected.
John's parents and siblings may blame themselves as well. His father may feel guilty for encouraging him to join the military or serve his country. His mother, like his wife, may feel it her fault he cannot open up to her or confide in her. "If only I were a better mother he would trust me and talk to me." His siblings may harbor the same concerns.
People will also start to avoid John as he withdraws from them. Not knowing how to comfort him or reach him, not knowing how to deal with the trauma, they retreat themselves and attempt solely not to "set him off". They start to walk on eggshells with John and tiptoe around him. They may pity him. They may resent his behavior and the fact that they cannot get past it. They may blame him for not being able to "get over it". They may resent the way the trauma has changed their relationship with John forever. They may fear not knowing when or where or why he will blow up next. They may avoid him to avoid the behavior.
Not only family members are affected by John's symptoms. His work is often seriously impaired. He is irritable and emotionally unpredictable at work. If he withdraws and cannot report to work he may be fired. If he gets explosive at work he may be fired. If his drug or alcohol use starts to impair his attendance or work performance he may be fired. Trauma symptoms often result in sporadic, unreliable employment or prevent employment all together.
Now John has another obstacle. He is no longer the breadwinner in his family. His wife may have to go to work while he stays home or hold a job while he tries to work. The family's finances may suffer terribly, they may even become homeless in this economy. Family and friends may be called upon for daycare or financial assistance. This puts a burden on them and John will feel guilty and humiliated about this. All of this puts tremendous burdens on the marriage. It may not survive.
Worst of all, this all puts increased pressure on John, who is already struggling to maintain. This may result in serious depression - even to the point of suicide. If John is driven to the point of suicide, his children lose a father, his wife loses a husband, his parents lose a son, his siblings lose a brother. And most of them will blame themselves. "I should have called that day." I should have seen this coming." "I should have known how badly he was feeling." "I should have invited him over that day."
It is important when treating trauma to treat everyone in the traumatized person's life. This is true whether the trauma results from war, rape, childhood abuse or incest, natural disaster or an accidental injury.
The history of PTSD, the symptoms and the course of recovery are described concisely and eloquently in terms both client and clinician can appreciate by Dr. Judith Herman in her book, "Trauma and Recovery".