Perspectives from Veterans and Survivors of Domestic Violence

Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (CPTSD) are deeply distressing mental health conditions that develop in response to traumatic events. PTSD typically results from exposure to a singular trauma, such as combat or a violent assault, while CPTSD is linked to prolonged, repeated trauma, often involving interpersonal harm, such as chronic domestic abuse or childhood neglect. Both conditions are characterized by core symptoms such as hypervigilance, avoidance, intrusive memories, emotional dysregulation, and an altered sense of safety and trust. These symptoms frequently give rise to maladaptive behaviors—self-protective but counterproductive patterns of response—that impair individuals’ daily lives, relationships, and overall well-being.

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5) classifies PTSD and CPTSD under trauma- and stressor-related disorders, noting that CPTSD includes additional challenges such as difficulties with emotional regulation and interpersonal relationships (American Psychiatric Association [APA], 2013). These maladaptive behaviors are often particularly severe among individuals who have experienced certain forms of trauma, such as military combat or sexual violence. This article explores the maladaptive behaviors commonly seen in PTSD and CPTSD, with a focus on the specific experiences of veterans and survivors of domestic violence, including those who have experienced sexual assault.

1. Hypervigilance-Driven Behaviors

Hypervigilance is a common symptom in individuals with PTSD and CPTSD. It refers to a heightened state of alertness, where the individual feels constantly on guard, anticipating potential danger. This symptom is prevalent among veterans and survivors of domestic violence, whose trauma often involved sudden, life-threatening situations.

• Startling Easily: Veterans often report an exaggerated startle response to loud noises, sudden movements, or unexpected physical contact. For those who have experienced combat, these stimuli can resemble explosions, gunfire, or other battlefield conditions (Friedman et al., 2011). Similarly, survivors of domestic violence, particularly those who experienced physical abuse, may react strongly to loud voices or slamming doors, which can trigger memories of violent episodes.
• Discomfort with People Walking Behind: Veterans, especially those who served in hostile environments, often express discomfort when people walk behind them. This is a behavior rooted in the need to monitor their surroundings for potential threats, a survival skill honed during military service (Lanius et al., 2015). Similarly, survivors of rape or domestic violence, particularly those who were attacked from behind, may also exhibit this behavior. The inability to see who is approaching can trigger feelings of vulnerability and fear.
• Fear of Darkness: Many survivors of rape and domestic violence develop a fear of the dark, especially if their trauma occurred at night. In these cases, darkness may symbolize the lack of control or helplessness they felt during the assault (APA, 2013). Veterans with combat-related PTSD may also avoid darkness, associating it with night raids or ambushes that occurred in low-light conditions.
• Constant Environmental Scanning: Veterans and survivors alike may compulsively scan their surroundings for potential threats. Veterans, particularly those who served in war zones, might exhibit this behavior in crowded places, constantly surveying people and exits (Litz et al., 2009). Survivors of domestic violence, particularly those who lived with unpredictable or violent partners, may also engage in hypervigilant scanning, always anticipating the next outburst of aggression.

2. Avoidance Behaviors

Avoidance is a core symptom of PTSD and CPTSD. It involves consciously or unconsciously steering clear of situations, people, or emotions that might trigger painful memories of the trauma. Veterans and survivors of sexual assault or domestic violence frequently engage in avoidance behaviors as a way of managing the intense distress associated with their experiences.

• Avoiding Triggers: Veterans often avoid situations that remind them of combat, such as fireworks displays, large crowds, or even driving, especially if roadside bombs were a threat during their deployment (Friedman et al., 2011). Similarly, survivors of sexual violence may avoid locations or circumstances reminiscent of their assault, such as certain neighborhoods, bars, or even intimate settings with a partner. Survivors of domestic violence may avoid loud arguments or heated confrontations, fearing a return to the violence they endured.
• Substance Abuse: Alcohol and drugs are frequently used by veterans and survivors of sexual violence as a maladaptive coping mechanism. For many veterans, substance abuse provides temporary relief from intrusive memories or feelings of isolation after returning from war (Jacobsen et al., 2001). Survivors of rape or domestic abuse often use substances to numb the overwhelming emotions—guilt, shame, and fear—that accompany their trauma. However, this behavior can lead to addiction, further isolating individuals and worsening their symptoms.
• Emotionally Numbing: Emotional numbing, or the inability to experience positive emotions, is another form of avoidance. Veterans may find themselves feeling detached from their families and friends, unable to connect emotionally after returning from deployment (Friedman et al., 2011). Survivors of rape or domestic violence may suppress their emotions to avoid feeling vulnerable again. This behavior can impair their ability to experience joy, love, or satisfaction in relationships.
• Social Isolation: Many trauma survivors, including veterans and victims of sexual violence, withdraw from social interactions. For veterans, the transition from a structured, high-stress combat environment to civilian life can feel overwhelming, leading them to avoid gatherings or group activities (Litz et al., 2009). Survivors of sexual or domestic violence may isolate themselves to avoid questions, judgment, or the risk of encountering people who remind them of their trauma.

3. Intrusive Memories and Flashbacks

Intrusive memories, flashbacks, and nightmares are hallmark symptoms of PTSD and CPTSD. For veterans, these may involve vivid, uncontrollable recollections of combat experiences, while for survivors of rape or domestic violence, they may relive the assault or violent incidents in their minds.

• Aggressive Outbursts: Flashbacks can cause veterans to react aggressively, particularly if they are triggered by stimuli that resemble combat situations, such as loud noises or sudden physical contact. These outbursts may be an attempt to regain control in situations that feel dangerously out of control (Friedman et al., 2011). Survivors of domestic violence or sexual assault may also have aggressive reactions during flashbacks, especially if they feel physically threatened or trapped, reminding them of their lack of power during the trauma.
• Night Terrors: Veterans often experience night terrors related to combat, such as reliving firefights, explosions, or witnessing the death of a fellow soldier. These sleep disturbances can lead to chronic sleep deprivation, avoidance of sleep, or the use of substances to induce rest (APA, 2013). Survivors of sexual assault may experience nightmares that replay the attack or evoke similar feelings of helplessness and terror, contributing to the development of maladaptive sleep behaviors, such as sleeping with the lights on or avoiding sleep altogether.
• Self-Harm: Some survivors of sexual violence, particularly rape, may engage in self-harming behaviors, such as cutting or burning themselves. These actions often serve as a maladaptive way to regain control over their bodies or to punish themselves for feelings of guilt or shame (Ford & Courtois, 2013). Veterans may also engage in self-harm, particularly if they struggle with survivor’s guilt or feel disconnected from their civilian lives after returning from combat.

4. Emotional Dysregulation

Emotional dysregulation is especially prominent in CPTSD, where individuals have difficulty managing their emotions. Survivors of prolonged domestic violence or sexual assault often struggle with intense emotions, including anger, shame, guilt, and sadness. Veterans, too, may have difficulty controlling their emotions, particularly if they suppress feelings related to their trauma.

• Sudden Emotional Outbursts: Veterans with PTSD may have sudden emotional outbursts, particularly of anger, often without understanding the cause. These outbursts can be triggered by stress, frustration, or reminders of their trauma (Cloitre et al., 2014). Survivors of rape or domestic violence may also have emotional outbursts, particularly in situations where they feel threatened or powerless. This can make it difficult for them to maintain healthy relationships, as their emotional reactions may seem disproportionate to others.
• Perfectionism: Survivors of sexual violence or domestic abuse may develop perfectionistic tendencies as a way to regain control over their lives (van der Kolk, 2014). By maintaining strict order or routines, they attempt to create a sense of safety and predictability. However, this behavior can become maladaptive if they set unrealistic standards for themselves or punish themselves for failing to meet these standards.
• Chronic Guilt and Shame: Many survivors of rape or domestic violence experience pervasive feelings of guilt or shame, often blaming themselves for the abuse they endured. This chronic guilt can lead to self-sabotaging behaviors, such as engaging in risky relationships or sabotaging their own success (Herman, 1992). Veterans may also experience guilt, particularly if they feel responsible for the deaths of comrades or civilians during their service. This guilt can lead to self-isolation, depression, or reckless behavior.

5. Interpersonal Difficulties

PTSD and CPTSD can significantly impair relationships, leading to a range of maladaptive behaviors. Veterans and survivors of sexual violence or domestic abuse often struggle to trust others, maintain healthy boundaries, or engage in close relationships.

• Difficulty Trusting Others: Veterans with combat-related PTSD often struggle to trust others, particularly civilians, whom they may perceive as being unable to understand their experiences (Litz et al., 2009). Similarly, survivors of domestic violence or rape often struggle with trust, particularly in intimate relationships. They may fear being hurt or betrayed again, leading to emotional withdrawal or the avoidance of relationships altogether.
• Pushing Others Away: Survivors of sexual violence or domestic abuse may push others away, fearing that intimacy or closeness will result in more pain. This can manifest as emotional distance or sabotaging relationships, often as a means of self-protection (Ford & Courtois, 2013). Veterans may also push loved ones away, struggling to communicate their experiences and emotions, which can lead to misunderstandings or emotional disconnection.
• Fear of Intimacy: Sexual assault survivors often struggle with physical intimacy, particularly if their trauma involved sexual violation. They may avoid sexual relationships altogether or engage in sexual activity that lacks emotional connection, using it as a means of control rather than connection (Herman, 1992). Veterans with combat-related PTSD may also struggle with intimacy, feeling emotionally numb or detached from their partners.

Conclusion

The maladaptive behaviors seen in individuals with PTSD and CPTSD, whether they stem from combat trauma or sexual violence, represent attempts to cope with overwhelming emotions, distorted perceptions, and deep psychological wounds. While these behaviors may offer temporary relief or protection, they often reinforce the cycle of trauma, contributing to further emotional distress, isolation, and interpersonal difficulties. Recognizing and addressing these behaviors in a therapeutic setting, such as through cognitive-behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), or trauma-focused therapy, is essential for helping survivors of combat and sexual violence heal and regain control over their lives.

References

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Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2014). Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. European Journal of Psychotraumatology, 5(1), 25097. https://doi.org/10.3402/ejpt.v5.25097

Friedman, M. J., Keane, T. M., & Resick, P. A. (Eds.). (2011). Handbook of PTSD: Science and practice. Guilford Press.

Ford, J. D., & Courtois, C. A. (Eds.). (2013). Treating complex traumatic stress disorders in adults: Scientific foundations and therapeutic models. Guilford Press.

Herman, J. L. (1992). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. Basic Books.

Jacobsen, L. K., Southwick, S. M., & Kosten, T. R. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. The American Journal of Psychiatry, 158(8), 1184-1190. https://doi.org/10.1176/appi.ajp.158.8.1184

Lanius, R. A., Vermetten, E., & Pain, C. (2015). The impact of early life trauma on health and disease: The hidden epidemic. Cambridge University Press.

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695-706. https://doi.org/10.1016/j.cpr.2009.07.003

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.