Could PTSD caregivers be inflicting secondary wounds?

Could PTSD caregivers be inflicting secondary wounds?

May 6, 2011 ~ Secondary Wounding occurs during the “healing process”.  Some of the treatments currently available for PTSD are doing more harm than good.  There are still a lot of unknowns when it comes to understanding PTSD, therefore we must be carefully consider treatment options. Improper treatment can lead to further problems with devastating results.

When nothing seems to be going right, treatments, programs, and health care providers may be the first place we will point our fingers of blame, but we need to realize that if we don’t have a good understanding of PTSD, we ourselves, the family members and caregivers, could be inflicting the secondary wounds onto our PTSD survivor. It is crucial that you gain an understanding of Secondary Wounding. It could make the difference between having a relationship with your traumatized veteran.

Because PTSD is considered an “invisible wound”, it is often impossible for others to recognize one is struggling with this condition.  Cruelty and harm can often begin right in the family.  Even friends and trained professionals can create a bigger problem for the affected individual.  Instead of providing support, a typical response from those of us around the trauma survivor may be one that causes shame.  Negative reactions to behaviors characteristic of PTSD are common and most of us will react in a way that is hurting rather than helping with recovery.

Our combat veterans are expected to be strong, invincible, macho, and without fear.  For this reason, it takes an incredible amount of courage for the veteran to tell someone else that they are experiencing difficulties.  Often trauma survivors will go for long periods of time suffering alone for fear that they will be judged unfairly. It may start with their commanding officers who may  dismiss the complaint and respond with an attitude that leaves the soldier feeling inadequate.  “Get over it and get back to work.”

Don’t be surprised if you don’t see your name written next to one of these descriptions.  If you do, don’t beat yourself up.  Just be grateful you now understand that you need to make a few changes.  I can honestly say that it has been very difficult for me to change my behavior, my attitude, and my perspective, but it has made a difference in the relationship I am rebuilding with my combat veteran.

Author Aphrodite Matsakis, Ph.D. has written I Can’t Get Over It – A Handbook for Trauma Survivors. In her book, she explains Secondary Wounding.  I have used some excerpts from her book to help you to understand the significance of Secondary Wounding.

Helping A Loved One Through PTSD

Secondary wounding occurs when the people, the institutions, caregivers, and others to whom the survivor turns for emotional, legal, financial, medical, or other assistance respond in one of the following ways:


Commonly, people will deny or disbelieve the trauma survivor’s account of the trauma. Or they will minimize or discount the magnitude of the event(s), its meaning to the victim, its impact on the victim s life.

Blaming the Victim:

On some level, people may blame the victim for the traumatic event, thereby increasing the victim’s sense of self-blame and low self-esteem.


Stigmatization occurs when others judge the victim negatively for normal reactions to the traumatic event or for any long-term symptoms he or she may suffer. These judgments can take the following forms:

Ridicule of, or condescension toward, the survivor

Misinterpretation of the survivor’s psychological distress, as a sign of deep psychological problems or moral or mental deficiency or otherwise giving the survivor’s PTSD symptoms negative labels.

An implication or outright statement that the survivor’s symptoms reflect his or her desire for financial gain, attention, or unwarranted sympathy.

Punishment of the victim, rather than the offender, or in other ways depriving the victim of justice.

Denial of Assistance:

Trauma survivors are sometimes denied promised or unexpected services on the basis that they do not need or are not entitled to such services or compensation.

Beliefs of others can inflict Secondary Wounding

In essence, secondary wounding occurs because people who have never been hurt or traumatized have difficulty understanding and being patient with people who have been hurt. Secondary wounding also occurs because people who have never been confronted human tragedy are sometimes unable to comprehend the lives of those in occupations that involve dealing with human suffering or mass casualties on a daily basis.

In addition, some people simply are not strong enough to accept the negatives in life. They prefer to ignore the fact that sadness, injustice and loss are just as much a part of life as joy and goodness. When such individuals confront a trauma survivor, they may reject, depreciate or ridicule the survivor because that individual represents the parts of life they have chosen to deny.

On the other hand, it also happens that trauma survivors are rejected or disparaged by other survivors those who have chosen to deny or repress their own trauma and have not yet dealt with their loses or anger. When trauma survivors who are not dealing with their traumatic pasts see someone who is obviously suffering emotionally or physically, they may need to block out that person in order to leave their own denial system intact.

The following sections give a brief run-down of some of the common causes of secondary wounding.


Some secondary wounding stems from sheer ignorance. Especially in the past, there were few, if any, courses on PTSD available to medical, legal, and mental health professionals. Today such courses are available in many locations; however, they are not a required part of the training in any of those fields.


Another cause of secondary wounding is that many helping professionals are themselves suffering from some form of PTSD or burnout. As a result of having worked for years with survivors, they (like those survivors) are emotionally depleted. They may also, like many survivors, feel unappreciated and unrecognized by the general public and by those in their workplace.

“Just World” Philosophy:

Another hurdle victims face is the prevalence and persistence of the “just world” philosophy. According to this philosophy, people get what they deserve and deserve what they get. The basic assumption of the “just world” philosophy is that if you are sufficiently careful, intelligent, moral, or competent, you can avoid misfortune. Thus people who suffer trauma are somehow to blame for their misfortune. Even if the victims aren’t directly blamed, they are seen as causing their own victimization by being inherently weak or ineffectual.

The Influence of Culture:

Our nation was founded by individuals who overcame massive obstacles by means of hard work, self-sacrifice, and physical and emotional endurance. As a nation today, as in the past, we pride ourselves on the can-do spirit and our American ingenuity we are certain we can overcome almost any hardship. The American dream tells us that our country is so bountiful and so full of opportunities that anyone who wants the good life can have it; all they have to do is pull themselves up by their own bootstraps.

Abraham Lincoln is quoted as saying, “People can be happy as they make up their minds to be,” implying that in the personal realm, man can be master of his own fate. If only he were right.

Source: Excerpts from I Can’t Get Over It – A Handbook for Trauma Survivors

Author: Aphrodite Matsakis, Ph.D.

Originally published by the author at


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