The experience of being a sibling of a person with PTSD

Post-Traumatic Stress Disorder (PTSD) is the most common disorder following a traumatic event. The disorder includes four main symptoms: intrusiveness, avoidance, negative changes in emotion and cognition and hyperarousal. Therefore, this disorder greatly affects those who deal with it. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013), the different symptoms of PTSD can be expressed in a variety of ways. For example, re-experiencing the traumatic event can be reflected in recurring and intrusive memories of the event, traumatic nightmares, various dissociative reactions that may even lead to a complete loss of consciousness and clear physiological reactions following exposure to stimuli related to the traumatic event. In addition, there may be ongoing avoidance of stimuli reminiscent of the trauma and a dulling of the person’s general reactivity. This can be expressed by attempts to avoid thoughts, feelings or conversations that relate to the trauma, as well as attempts to avoid people or places that evoke memories of said trauma. Moreover, there may be negative changes in cognition and mood that began or worsened after the traumatic event.

Naturally, this disorder has considerable ramifications on the individual's immediate environment. These ramifications entail, among other things, readjustment and adaptation to the changes that occur within the individual coping with PTSD, as well as changes that take place within the family system and each of its members. Amid the different ramifications that may affect relatives of those coping with PTSD, one is especially significant – secondary traumatic stress (Figley, 1983). Secondary traumatic stress relates to the trauma experience indirectly and is experienced by people who are in close contact with those who have experienced a traumatic event.

The objectives of this study were to examine the experience of siblings of people with PTSD, the appearance of secondary traumatic stress symptoms among them, and the disorder’s effect on the siblings’ relationship.

The current study is a qualitative study conducted via semi-structured in-depth interviews. The study population consists of 14 adult siblings of people who cope with PTSD following various life events, most of them security incidents. About half of the traumatic events experienced by their siblings occurred when the interviewees were minors, and another half when they were adults.

The analysis of the findings consisted of content analysis and categorical data analysis. It raised three main themes that reflect three different types of implications for the siblings: responsibility and involvement, a sense of helplessness and growth. Within each theme, both the personal level and the family level are discussed and referred to. In the theme of responsibility and involvement, one may notice that the extent ranges from total involvement, to the point of constant care of the sibling and living with him or her, to minimal involvement, to the point of severing ties with the sibling. Additionally, one may discern the shift that occurred among respondents over the years in regard to the degree of involvement and sense of responsibility toward their siblings.

In the theme of helplessness, it appears that the sense of helplessness accompanies family members of those dealing with PTSD in different ways and in varying degrees. The sense of helplessness usually began to appear when it was understood that the sibling was changing, and the disorder was diagnosed. It continued due to the challenges of personal and familial coping with the symptoms of the sibling dealing with PTSD. In addition, it was found that siblings who had very close relationships and even lived with their sibling coping with PTSD, experienced symptoms of secondary traumatic stress.

In the theme of growth, it seems that the experience of growth rarely exists among the interviewees. However, some felt that their sibling’s coping with PTSD led them to be more sensitive to their environment.

The findings indicate that siblings of those who deal with PTSD are affected in different ways by their sibling’s coping, and that the degree to which they are affected is related to how close of a relationship they have. Additionally, it appears that over the years, a change occurs in the level of closeness and degree of responsibility, or alternatively, an inner discussion occurs within the siblings regarding the closeness and responsibility toward their siblings and the family. Moreover, the study shows the effect on the entire family system, which usually undergoes a significant change following the sibling’s injury.

This study is unprecedented in its examination of the effect of PTSD on the population of siblings, as it appears that the symptoms of post-traumatic distress have an impact on the environment of those coping with it (Dekel & Monson, 2010), however no studies about the effect of PTSD on siblings was found so far. The findings of this study are consistent with previous studies that discuss the coping of family members of people dealing with PTSD and the coping of siblings of people with special needs, disabilities, and physical and mental illnesses. According to Feigley and Feigley (2009), trauma is interpersonal by nature and therefore a systemic entity. As a result of the various symptoms experienced following a traumatic event, the immediate environment, usually family and friends, is also affected by the experiences and the interaction with the person who experienced the traumatic event. Thus, when an individual in the family copes with difficulty and various symptoms associated with this difficulty, the rest of the family members are affected, as is the family system as a whole. This study was developed in order to open the gates for additional research on the subject, and its importance stems from its raising awareness about siblings’ coping in particular, and the families’ coping in general, when a family member is dealing with PTSD. In addition, this study is significant in that it raises the need for support systems for siblings and other family members, that include counseling and the provision of information about coping with post-trauma at the time of diagnosis, and individual and family counseling over the years.