Natalie* experienced panic attacks, nightmares, severe anxiety and avoidance after the break-up of a relationship, but it was years before she finally got answers. “In the first year of my 30s, I had a job that I loved and a rosy-coloured view of the world. I was excited about life, despite having suffered a number of losses in my 20s, both in my relationships and health. But two significant things happened that year that ultimately changed me. I was still processing the grief of suddenly losing a loved one months earlier when, against my better judgement, I become involved with a guy at work. About five months into a toxic on-off casual relationship with him, I started seeing a counsellor to help me cut ties and rebuild my self-worth.
“It soon became clear that I had fallen for someone who didn’t respect or care for me with any inch of his being. Though it pained me, I stopped replying to his emails and Facebook messages, the only avenues of communication he deemed worthy of me. A month later, when I discovered he was in a serious relationship with someone in the same company, my whole world came crashing down. It was an unexpected blow. Their love affair was very public, but for me, even more so. I couldn’t escape it. I spiralled out of control. But it wasn’t until a few years later that I finally discovered what I was experiencing was anxiety disorder.
“Looking back now, it seems crazy. Working in the same office, I lived in constant fear, experiencing panic attacks, nightmares and crying episodes in the carpark. Most mornings I would wake up in a state of shock, fearful and gasping for air. From the moment I woke until my eyes shut at night, I obsessively replayed the whole saga over again in my head, trying to find answers. How did I not see it coming? I felt deeply ashamed, guilty and humiliated. I fell into a dark depression and dropped 6kg within a matter of weeks.
“My days obsessively began to revolve around how I could avoid encounters with them as a couple. I started using the fire stairs to access other floors in the building, for fear of another unbearable elevator ride. When they turned up at the same café for lunch, I began to shake uncontrollably. I started strategically timing my bathroom visits and trips to the water cooler. I cried in my car as I drove to and from work, and would time my arrival early each morning so as not to bump into them. I also withdrew from work functions and social gatherings with our colleagues.
“Outside of work, my self-destructive behaviour was beginning to affect my friends and family, so with their help, I sought intensive treatment. It gave me some tools to help me cope on a day-to-day basis, but living through it for more than a year was one of the hardest things I’ve ever had to do. It took more than two years for me to finally be diagnosed with anxiety, but I’ve since been able to manage it and move on. And I’m a stronger person for it.”
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder, typically seen in those who have experienced life-threatening violence or trauma. But, what’s less known, is that symptoms can also occur following the break-up of a relationship. Despite the stigma surrounding mental health and, particularly, emotional disorders, Natalie’s experience of heartbreak is not unique.
Dr Tara Wyne, a clinical psychologist at The LightHouse Arabia in Dubai, says it’s normal for most people to experience some type of anxiety or PTSD-related trauma following a break-up. But when the symptoms persist for several months or more, that might indicate a bigger problem.
“PTSD is a psychological disorder that is triggered by a traumatic life event, typically life-threatening, but it can occur any time there is an acute or prolonged trauma. A traumatic break-up can cause PTSD, and this would fall under the category of attachment trauma,” she says. For those involved, this anxiety disorder manifests itself in debilitating ways.
“A diagnosis of PTSD causes symptoms that include reliving and re-experiencing the traumatic event in the form of flashbacks and nightmares, anxiety, being hyper-alert and avoiding reminders of the trauma, difficulty sleeping and being emotionally numb, as well as an extreme distrust of others. A diagnosis requires that the symptoms persist beyond a month and interfere with daily life and functioning,” Dr Tara says.
She adds that a patient’s life experiences and losses up until that point may make them more susceptible to break-up related PTSD. “Some people are more likely to develop PTSD because they have some vulnerability from either early life difficulties in relationships, difficult family circumstances or stressful life events as an adult. Previous relevant difficult experiences can also add up over time and increase your chances of suffering from this disorder in the future,” she says.
Acrimonious, bitter divorces, in particular, or the sudden demise of a committed, trusting relationship are common triggers. “PTSD symptoms are more likely to occur if your break-up was sudden, very unexpected and your partner was someone you deeply trusted,” says Dr Tara. If you feel abandoned and betrayed and did not see it coming, and you cannot make any sense of what just happened to you, you are unlikely to be able to integrate this event and move on,” she says. That being said, just because you’re experiencing relationship-related emotional trauma doesn’t necessarily mean it’s PTSD. “In my experience, full-blown diagnosable break-up-induced PTSD is relatively rare, what is far more common is having significant symptoms and features of trauma after a bad break-up,” says Dr Tara. “The pain and distress is still significant and people may truly suffer, but mainly there is reliving and re-experiencing, rather than the multiple dimensions of symptoms required to meet the full diagnosis of PTSD.”
Dr Mona Moussa, a personal development trainer at Lifeworks Counselling in Dubai, takes a different view. She says PTSD can only be diagnosed following the break-up of a relationship when violence or abuse has occurred. “More recent research has coined the term ‘post-traumatic relationship syndrome’ to refer to the traumatic experience following physical or emotional abuse in an intimate relationship. The diagnosis of PTSD requires that the event experienced involve the threat of death, violence, or serious injury,” she adds. “[A break-up] is very stressful, definitely. It can lead to intense feelings of sadness, loneliness and grief, result in feelings of depression and anxiety and lead to significant impairment in a person’s day-to-day functioning at home and at work,” says Dr Mona.
“It can lead to disturbances in sleep and eating, result in the person withdrawing from others and feeling isolated, and it can result in the person losing their sense of meaning and no longer being able to enjoy activities that they used to enjoy,” she says. However, she adds these symptoms alone don’t warrant a clinical diagnosis of PTSD.
“A person may be more vulnerable to the negative effects of a break-up if they are already under a lot of compounded stress, have suffered a number of losses in the past and if they tend to use unhelpful coping patterns – for example, avoiding and ignoring the problem and denying its existence, self-blaming and continuous rumination on the negative. That being said, PTSD and “healthy, non-abusive” relationship break-ups are still treated in the same way.
“Treatment involves validating the person’s grief following their break-up: acknowledging their loss and pain, providing them with a non-judgemental and safe place to express and explore their pain, helping them to connect with their inner self and tap into their inner strength, and rebuilding their views of the world and others in a more adaptive way,” says Dr Mona. Acknowledgment, it appears, is key. Dr Tara says that often even the notion that our feelings are irrational can further add to the trauma. “A great many of us feel ashamed, we’re almost embarrassed to be struggling with a break-up this way. However, we all cope differently, we may attribute a certain meaning to the break-up that makes it more traumatic than it would be to another person,” she says.
“Every person’s experience and perception is unique,” adds Dr Mona. We should never be afraid to seek help for a problem that’s bigger than us.
*Name has been changed
What you can do to alleviate symptoms
The symptoms of PTSD, anxiety and trauma can be overwhelming. But here are some things you can do to help you through it…
- Keep a sense of routine in your day to give you a sense of predictability and comfort
- Consider cognitive behavioural therapy, eye movement desensitisation and reprocessing therapy and mindfulness-based therapies, such as Acceptance and Commitment therapy
- Do yoga and meditation to help calm and reset the sympathetic nervous system
- If you’re a friend, provide practical support. Offer to run errands or buy groceries rather than just saying you’re “there for them”