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Child Psychiatrist /Adult Psychiatrist

Boundary Problems Associated with PTSD and Substance Abuse

Updated: Sep 14, 2023

Note: Some people become upset when reading the list below. Only read it if you feel safe to do so, and stop if it is too upsetting.

 A person's feet are chained to a bomb with the word PTSD.


People with PTSD and 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 (i.e., feeling excited when it is really fear). it 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 (e.g., 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.

Ideas for a Commitment

Commit to one action that will move your life forward! It can be anything you feel will help you, or you can try one of the ideas below. Keeping your commitment is a way of respecting, honoring, and caring for yourself.

Option 1: In a real-life situation this week, try setting a boundary with either yourself or someone else.

Option 2: Memorize your top three ways to say "no" to substances.

Option 3: Pick a role play and write out how you would handle it.

Option 4: Fill out the Safe Coping Sheet. (See below for an example applied to this topic.)


Old Way

New Way Situation

My mother keeps critizing me

My mother keeps critizing my decisions

* Your Coping *

  • Consequence get overwhelmed and resentful. I just let her talk at me until she's done. Sometimes I go out afterwards and smoke crack so I can get a "holiday" from her.

  • I feel walked over. I know the crack is destroying my body and my bank account.

  • I set a boundary by asking her to stop criticizing meit is hurting my recovery, and I cannot listen to it right now and will leave the room if necessary.

  • I feel better, like I've taken control. She seemed surprised and didn't like hearing it, but it was okay.

How safe is your old way of coping?

How safe is your new way of coping?

Rate from 0 (not at all safe) to 10 (totally safe)

Source: Seeking Safety

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