Boundary Problems Associated with Substance Abuse & PTSD

The following list comes from one of the treatment manuals we use when working with Substance Abuse & PTSD titled: Seeking Safety by Lisa M. Najavits and can be used as a helpful tool to further understand the boundary problems you may be experiencing due to Substance Abuse or PTSD. 

People with PTSD and/or substance abuse may be prone to boundary problems, such as the following: 

  • Extremes: trusting too much or too little; isolation or enmeshment. 
  • Relationships that are brittle (easily damaged, fragile). 
  • Tolerating others’ flaws too much; doing anything to preserve the relationship. 
  • Use of substances as an attempt to connect with others. 
  • Avoiding relationships because they are too painful. 
  • Overcompliance at times; too much resistance at other times. 
  • Always being the one to give. 
  • Spending time with unsafe people. 
  • Not seeing the hostility in others’ words or actions. 
  • Being overly angry, with a hair-trigger temper; often ready to “blow up.”
  • Difficulty expressing feelings; expressing them in actions rather than words (acting out). 
  • May respect men for being “strong” and disrespect women for being “weak.”
  • Feeling that one can never get over a loss; not knowing how to mourn; fear of abandonment. 
  • Difficulty getting out of bad relationships. 
  • Confusion between fear and attraction (ie: feeling excited when it is really fear)
  • Relationships with people who use substances. 
  • Living for someone else rather than yourself. 
  • Manipulation: guilt, threats, or lying. 
  • Reenactments: getting involved in repeated destructive relationship patterns (ie: recreating the trauma roles of abuser, bystander, victim, rescuer, or accomplice)
  • “Stockholm Syndrome”: feeling attachment and love for the abuser
  • Wanting to be rescued; wanting others to take responsibility for the relationship.
  • Confusion about what is appropriate in relationships: What can one rightly expect of others? When should a relationship end? How much should one give in a relationship? Is it okay to say “no” to others? 
  • “Identification with the aggressor”: believing the abuser is right.

Make a note of which ones you notice for yourself to process with either your therapist or another safe person you can talk with. 

Written by: Betty Gebhardt