Defining Safe Sex

Last week I said safe sex means different things to different people. On a personal level, that means each of us needs to define safe sex for ourselves. Today we’re going to walk through defining safe sex. What is means to you, and how you can take steps to keep yourself safe while enjoying the sex life that suits you.

How Safe Do You Want to Be?

An Indie driver and a commuter both try to be safe when they drive–but what an Indie drive considers “safe” most commuters would consider suicidal. Race car drivers wear fire-proof undies for a reason.

Do you want to be completely protected from any risk of STIs? Are you comfortable with maybe getting herpes but want to be sure you are safe from HIV? Maybe you know your statistics and just want to get tested once in a while so you can get treated for anything early.

In addition to STIs, there is also pregnancy. Unlike STIs, how protected you want to be when it comes to pregnancy may vary from partner to partner.

As far as pregnancy goes you can opt entirely by never putting penis and vulva together. Or (slightly less extreme) never have PIV and except the infinitesimal risk that sometimes comes with getting semen on the outside of the vulva.

You can use various forms of birth control, which has more risk that not having PIV sex at all, but way less risk than going without birth control.

Or you can say fuck it, I don’t care about starting a pregnancy (or fuck it I WANT to start a pregnancy) and go for all the PIV sex with no birth control.

STIs are complicated–maybe there are some STIs you are willing to risk (Personally, I don’t give a fuck about herpes) but others you want to be protected from. What protects against some STIs won’t offer protection against others.

In general terms, you can choose not to have genital contact at all, and that will reduce your chance of getting STIs to almost nothing. (Sexually transmitted infections can be transmitted other ways–they aren’t exclusive to sex. For most STIs however, non-sexual transmission is rare.)

You can only have genital contact with people who get tested regularly and weren’t infected at the time they got tested. This offers significant protection, but not perfect protection. The more frequently you and your sex partners connect with new sex partners, the less protection it gives.

You can use barrier methods such as condoms and dental dams. This provides some protection against some STIs. It provides significant protection against HIV and Hep B, two of the STIs that are the most worrisome in terms of treatment and long-term impact.

You can combine STI tests and barrier method for more protection than either alone.

You and your partners can do visual checks of each other for outward signs of infection, which provides some protection against a few STIs.

You can not worry about protection for most STIs ahead of time. Truvada will protect you against HIV.

You can just get tested yourself regularly so you can catch and treat any infections early.

Which of these options sounds like “safe sex” to you?

Once you have a general idea of how you would define safe sex, it’s time to do some research. Learn about the different STIs and how they are transmitted. Learn about different birth control options. As you learn, you are further defining safe sex for yourself.

Maybe you started with wanting the protection that comes from only having sex with partners who test regularly and test STI negative. But as you learn more you decide that you really aren’t concerned about herpes and genital warts, so you’re comfortable being with a sexual partner who has either one of those STIs. Maybe you aren’t worried about barrier methods as protection from STIs, but as you learn about birth control options you decide that you definitely want to use condoms in addition to any hormonal birth control. That extra protection is reassuring.

Make sure you take the time to talk with your partner(s) about how they define safe sex. You don’t need to agree, you do need to respect each other’s definitions. Always remember that people need to be able to consent to risks. Don’t put your partner at risk in ways they don’t consent to, and if a partner puts you at risk without your consent, it’s time to get out of that relationship.

This post is part of the Safe SEx and Polyamory blog series.

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Everyone’s Safe Sex Definition is Different

A few weeks ago, I said that safe sex is like safe driving. You do your best to keep yourself safe and take reasonable precautions, but there are no guaranteeing. Sex is like driving in another way. Some people are comfortable driving in Le Mans and the Indie 500, some won’t go over 55 mph on the freeway, and some won’t drive at all. Safe driving for someone running the Indie is going to be a bit different from safe driving for someone on the freeway. And if no driving is safe enough for you, that’s why there are bicycles and trains.

The definition of “safe driving” depends on who you are talking with. Defining “safe sex” is the same.

Reid Mikhalo openly identifies as a slut. You might call him a race car driver in the world of safe sex. He’s comfortable with a much lower level of safety than many people, but it’s safe enough for him. Me? I’m comfortable on the freeway. I’m not overly worried about STIs, but I want to take reasonable precautions. You might catch me pushing 70 mph sometimes, but I try to keep it around 65*. My partner Michael has an extremely low comfort with risk. When it comes to sex, he’ll drive around town, but no way in hell is he getting on the highway.

Each of us has learned about safe sex, the risks involved in sex, and decide for ourselves how to define “safe sex.” All of us accept some risk in order to have the joy of sharing our bodies with our partners. All of us have different levels of risk we are comfortable with.

Of course, like safe driving, defining safe sex effects other people. A race car driver may go over 200 mph on the Indie, surrounded by other race car drivers. When they’re on the freeway, they usually keep the posted speed limit. They know that folks driving on the freeway aren’t prepared for racing style driving–among other things they don’t usually have Nomex underwear. In the same way, we need to think about not just the amount of safety we need to feel comfortable, but the amount of safety our partners need.

Michael’s low-risk level impacts my sex life. His boundaries are pretty clear, and if I pop on the sexual highway he will not be comfortable continuing our sexual relationship. That chafes at me.

Don’t get me wrong, there is some beautiful scenery on those back roads, and I love sharing it with him and other folks who are comfortable keeping it slow. But that highway is damn tempting. Sometimes I want to take Michael and shake him. “It’s just a highway!” I want to say, “People drive on it safely every day!”

But it is his choice and his right to set the safety level he is comfortable with. I can choose to keep to his speed, or I choose to strike out on my own. What I can’t do is bully, badger or shame him for his choice.

Which is why, should the opportunity arise, I will not be revving it up to 90 and jumping into bed with the very sexy Reid Mikhalo.

Obviously, it is easier to be in a relationship with people who have similar comfort levels to your own.

Sadly, it is also very easy to fall into the trap of shaming people for having different comfort levels. Attacking people as “promiscuous” or “prude” is a part of monogamous culture (at least in the US), that we really need to leave behind. People have reasons for the way they define “safe sex.” You don’t need to agree with their reasons. You don’t need to like their reasons. You don’t even need to know their reasons.

You only need to do three things:

  • Decide what your safe sex definition
  • Set your own boundaries based on that definition.
  • Respect the boundaries of other people.

Setting your safe sex definition is the first step. If you haven’t done it yet, now’s a pretty good time to start.

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This post is part of the Safe Sex and STIs blog series.

*The normal speed limit for freeways on the East Coast of the US.

Zika Virus: A New STI?

Over the past several months, new reports in the US have focused on a “new” threat: the zika virus. Until recently, zika was believed to be transmitted only by mosquitoes, but there is now new evidence for sexual transmission.

Some History

The zika virus has been around at least since the 1950s. It was originally found in rhesus monkeys in the equatorial regions of Africa and Asia. Very rarely it was spread to humans in the region. Sometime in the early 2000s it made the jump to humans as a preferred host and began spreading. Between 2007 and 2014 the virus spread through Micronesia and Oceania before appearing in the South America in 2014. From South America it spread north, and the first cases appeared in the US in 2015.

Symptoms

Zika fever, caused by the virus is usually very mild. Headache, rash and fever are common symptoms. It is estimated that 1 in 5 people infected with the zika virus develop zika fever.

Long Term Complications

Since the zika virus appeared in Brazil there has been spike in cases of microcephaly. Microcephaly is defined as a skull that is within less than 2 standard deviations of normal for size and age. In other words, a skull that is too small for the brain to develop properly. Children with microcephaly frequently suffer from neurological disorders and shorter lifespan.

We do not know if zika causes microcephaly. At this time, scientists have proven that it is possible for zika to be transmitted from mother to fetus. This means that zika may be the cause of these birth defects. Other possible causes have been proposed. It is notable that increases in microcephaly are not being reported in other areas with the zika virus. For the time being, governments in South American countries with zika infections are advising their people to avoid pregnancies until the epidemic is under control.

Zika fever also appears to be connected to the development of Guillain–Barré syndrome in adults.

TransmissionUpdate May 12, 2016

Scientists have recently determined how the zika virus causes birth defects. We can now say with certainty that zika causes birth defects, and is most damaging during the early stages of pregnancy.

HIV PrEP: Truvada

Of all the sexually transmitted infections out there, HIV is the biggest concern for most people. That’s why in the US the FDA’s approval of a drug to help prevent HIV infection was greeted with such relief. Several other countries have also approved Truvada to help prevent the spread of HIV.

Truvada is the first medication approved as a pre-exposure prophalyxis (PrEP) for HIV. That means taking Truvada before being exposed to HIV protects you against infection.

Truvada is actually a combination of medications. Tenofovir and emtricitabine are both anti-retroviral drugs which have been used to treat HIV/AIDS for years. They are most often used in combination with protase inhibitors, which use a different biochemical process to attack HIV.

For people who are not infected with HIV, but might be exposed, Truvada is believed to offer significant risk reduction. However it has some rare adverse effects that are extremely damaging. For this reason, the FDA recommends it only for people who are at high risk of infections:

  • Gay or bisexual men who have either have had anal sex without a condom or been diagnosed with an STD in the past 6 months
  • Heterosexual men or women who do not regularly use condoms during sex with partners of unknown HIV status who are substantial risk
  • Injection of illicit drugs in the last month with sharing of equipment
  • Discordant heterosexual and homosexual partners where one partner is HIV-positive and the other HIV-negative

Taking Truvada consistently can reduce your risks by up to 92%. However PrEP is like the birth control pill. Not taking it consistently leaves you unprotected. Benefits of taking Truvada take affect after 72 hours on the medication. It is necessary to continue taking Truvada for 30 days after a high risk exposure to be sure HIV transmission levels stay reduced.

Your doctor will not prescribe Truvada unless you have tested HIV negative in the past month. While on Truvada you will need to be tested regularly, and if you do become infected with HIV will need to stop taking Truvada immediately.

This is very important. Anyone taking Truvada during stage 1 of an HIV infection is putting themselves at risk of developing a drug resistant strain of HIV. This means during later stages, when you actually need the medications, they won’t work.

As I mentioned before, Truvada has some risks associated with it. If you look up side effects of Truvada you will get a long and scary list of potential side effects. It is important to realize that this list is a combination. It includes side effects of taking Truvada in combination with other drugs for treatment of HIV/AIDs and side effects of taking Truvada as PrEP. The most common reported side effects for taking Truvada as PrEP are headache, abdominal pain, and decreased weight. Truvada can in rare circumstances cause loss of renal function. People taking PrEP are advised to get their renal function tested every 3-6 months while on Truvada.

Whether or not Truvada is of benefit to someone in a polyamorous relationship will largely depend on your approach to safe sex. If you take a low risk approach–only having sex with people who are tested regularly for STIs, using condoms, etc, Truvada is probably not right for you. If you are comfortable with a high risk approach to safe sex–going bareback with multiple partners, getting tested infrequently or having sex with new partners often enough that testing is not effective for protection, than Truvada may be a good idea. As always, talk with your doctor, I am not an expert.

Standard Disclaimer

This post is part of the Safe Sex and STIs blog series.

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Safe Sex Vs Safer Sex

I don’t know about the rest of the world, but in the US over the past ten years or so, it has become common to speak of “safer sex” instead of “safe sex.” The idea, apparently, is that sex is never 100% safe, no matter how careful you are there is always the risk of getting an STI or someone getting pregnant, and, therefore, it is misleading to speak of “safe sex,” we should always and only speak of “safer sex.”

I’m calling bullshit.

When I was learning to drive I didn’t take a “safer driving” course, I took a safe driving course. The mandatory certificate for food handlers is called ServeSafe, not “ServeSafer.” Neither driving nor food handling can ever be made 100% safe. In the case of driving, because no matter how careful you are, some other idiot on the road can ram into you. In the case of food, because if the spinach came into your kitchen with e coli already on it, no matter how carefully you wash the leaves, someone might get sick from your salad.

In every similar context, American English is happy to use “safe” to mean “making the best effort to be safe.” But suddenly, when it comes to sex, “safe” can only be used to mean “100% without risk.”

Folks, show me anything 100% without risk and I will show you where you are wrong. Life doesn’t work that way. But in the rest of life, we are comfortable saying, “Yes, there is risk, I accept that and do my best to reduce the risk.” The push to use “safer sex” is coming from the same sex shaming viewpoint as the pamphlets at the local anti-abortion place that tell people you should never have sex outside of monogamous marriage or you might get an STI.

Like I said at the beginning, this may be just a US thing. God knows we have sex stigma to spare here. But it needs to stop. Which is why throughout this blog series I talk about safe sex. Not safer sex.

This post is part of the Safe Sex and STIs blog series.

Fluid Bonding and Safe Sex

Fluid bonding is a common term in polyamory safe sex discussions. Fluid bonding commonly means having sex without a condom or other barrier method. The idea being that your fluids are mingling and joining together.

In hierarchical poly relationships, fluid bonding it usually reserved for the primary couple or group. In egalitarian or solo poly fluid bonding is a sign of a highly entwined relationship and a great deal of trust. It is also a potential minefield.

Fluid Bonding and STIs

One of the more popular discussed reasons for fluid bonding is it reduces the risk of getting infected with an STI. By only having barrier-free sex with people you trust, you get some of the benefits of a closed relationship (barrier free sex, lack of worries about infection with the people you have sex with most often) while still being open. So far so good, right?

Here’s where the trouble comes in: barriers are not 100% effective in preventing STIs. For instance, the last time I checked the research, male condoms were believed to be 80% effective in reducing transmission of HIV. 80% risk reduction is damned good—but it is not risk-free. And barriers still only protect against some STIs. It is still possible for people in fluid bonded relationships to pick up an infection and spread it to their fluid bonded partners.

Whether or not you are fluid bonded, you still need to get tested, regularly.

Fluid Bonding and Pregnancy

Whether or not you prefer to practice fluid bonding, pregnancy throws a wrench in the works. Some people rely on fluid bonding to prevent pregnancy outside the “main” relationship. Some people prefer not to fluid bond, but want to have a baby. In both cases, it is vitally important to remember that there is no such thing as 100% effective birth control.

I’ve harped on this point until I’m blue in the face. The vast majority of people who think they are protected from unexpected pregnancy, aren’t.

This doesn’t mean you shouldn’t use fluid bonding as part of your birth control plan. It does mean you need to be honest with yourself about the risks of whatever approach to birth control you choose.

Fluid Bonding and Assumptions

Fluid bonding requires using barrier methods with everyone other than your fluid bonded partners. Simple, right?

Well, if your partner agreed to fluid bonding because they were worried about pregnancy, they may not see a need to use dental dams. You, in the meantime, are trying to reduce your STI exposure and assume barrier methods are being used with all genital contact. Can you say “Recipe for drama?”

Whatever your reason for fluid bonding, check your assumptions at the door. Make sure you and your partner(s) are on the same page about what you expect. Whether your relationship is built on agreements or boundaries, don’t let assumptions bite you on the ass.

What Do You Want to Learn About STIs and Safe Sex?

I’m going to pick up and finally finish my extremely drawn out blog series on safe sex and STIs. Last spring I finally finished a run down of various STIs and their symptoms, causes, treatments, etc. Now I want to go back to that series and talk a bit about options when you or someone in your polycule has an STI, communicating about safe sex with your partners and a few other things.

But before I get too deep into that, I’d love for you to tell me if there is anything you really want to know about STIs and safe sex in polyamorous relationships. I can’t promise to have an answer, but I’ll damn well try. Leave a comment below, or contact me privately!

Posts so far

(Updated February 8, 2016)

  1. STDs/STIs
  2. What are STD/STIs?
  3. STD/STIs Protection (Introduction)
  4. Protecting Against STD/STIs: Barrier Method
  5. Preventing STD/STIs: Testing Agreements
  6. Preventing STD/STIs: Be a Smart Slut – Open Relationships, Promiscuity and STD/STIs
  7. Protecting Against STD/STIs: Abstinence/Closed Relationships
  8. STD/STI Testing: Introduction
  9. Polyamory and STD/STIs: Getting Tested
  10. What Does STD/STI Testing Involve?
  11. STD/STIs: How often should I get tested?
  12. The Long List of STD/STIs
    1. Bacterial Vaginosis
    2. Chancroid
    3. Chlamydia
    4. Crab lice
    5. Cytomegalovirus (CMV)
    6. Genital Warts
    7. Granuloma Inguinale
    8. Gonorrhea
    9. Hepatitis (A, B & E)
    10. Herpes (1 & 2)
    11. HIV & AIDS
    12. Human Papillomavirus (HPV)
    13. Molluscum Contagiosum
    14. Pelvic Inflammatory Disease (PID)
    15. Pubic Lice (Crabs)
    16. Scabies
    17. Syphilis
    18. Trichomoniasis (Trich)
  13. Fluid Bonding and Safe Sex
  14. Safe Sex Vs Safer Sex

Polyamory and PTSD (and other trauma and stress related disorders) Part 2

Part 1

Ways to Manage Trauma and Stress Related Disorders in a Poly Relationship

Okay, I said this about anxiety and the same goes here:

If anxiety manifests in ways that look like jealousy or controlling behavior, do not follow standard poly advice for dealing with jealousy. Learn to tell the difference between anxiety-induced and jealousy-induced behavior. Treat jealousy like jealousy and anxiety like anxiety. Your partner has tools for managing anxiety for a reason. Use them! Treating anxiety like jealousy just compounds the problem.

Similarly, treating PTSD like abuse just compounds the problem.

When someone’s trauma causes them to act other unhealthy manners—including abusive manners—treating them like an abuser doesn’t help. That doesn’t mean their harmful behavior should be allowed to pass. But telling someone in the middle of a triggered response to past trauma that they are guilt tripping you and you won’t stand for it doesn’t help anyone.

Similarly, calling someone out for gaslighting and telling them that you aren’t going to put up with this shit, does no good when they honestly believe what they are saying.

This is also a good place to link to an old rant of mine. At some point in the healing process, people with trauma and stress related start to recognize that their thoughts and feelings are distorted. “I know what I’m feeling isn’t real, but I can’t stop feeling this way,” or any similar statement is not an invitation to tell your partner all the reasons why they are wrong to feel that way.

Managing trauma and stress related disorders starts with everyone involved learning to recognize what is the real person and what is the disorder. This can be as simple as not taking it personally if a partner needs to cancel a date because they can’t drive that night. It can also be as complicated as learning to recognize the unintentional gaslighting of a partner who honestly remembers things wrongly.

You can’t deal with the disorder until you can recognize when the disorder is fucking with things.

Next, focus on small steps. If the very idea of polyamory is triggering flashbacks of past betrayal, scheduling your first date next week will not work. In fact, this is one of the rare situations where I would actually encourage a couple to date together. Either both date the same partner or double dates with both their partners. Yes, this is completely against The Big Book of Poly. Explain the situation to potential partners, be VERY aware of the difference between a triangle and a T, and it can work.

Another option, if you are living with a partner and that partner going out on dates is triggering is for your partner to try having “date nights in.” I hope it goes without saying, but this absolutely needs to be your partner’s decision. Date nights in is something I’ve done a fair bit of in the last few years. Not because of mental health issues, but because my most entwined partner is disabled and we have a young child. Leaving my partner who sometimes couldn’t stand up w/o help alone with a young child (or worse, infant) he might or might not have been able to take care of was not something either of us were comfortable with. So poly partners and potential poly partners would come to our home, usually after the kid was asleep for the night. My live-in partner would put on his headphones and lose himself in a computer game or video. My visiting partner and I would have a “date night” on the living room couch, bed, or front porch.

Now, moving slowly doesn’t mean refusing to make changes. You can start out dating together or having date nights in to reduce the amount of triggering someone in your polycule is dealing with. Eventually you will want and need to move towards dating separately/having date nights out. Exposure is a big part of treatment for trauma and stress disorders for a reason—the only way to heal is to slowly push the boundaries of the disorder. Note, NOT your boundaries, but the boundaries imposed on you by the disorder. And ONLY at a pace you agree to. Note also, I didn’t say “a pace you are comfortable with.” When it comes to trauma there ain’t no such thing. Like doing physical therapy for damaged muscles, if you stick to what is comfortable you will not heal. But it needs to be your pace, and no one else’s. Poly partners can support, encourage, suggest, or set their own boundaries on what they are and are not willing to deal with. They can’t set the pace for you.

Once the effects of the disorder are recognized, everyone involved needs to be involved in setting ways to work around, with, and through these things. For something like not being able to drive, or needing to avoid dogs, this can be as simple as making alternate transportation available.

For problems directly triggered by polyamory it can be more difficult. I suggest having two levels of response for most trauma related problems. “This is triggering me but I can deal with it (maybe with a bit of support.” and “OMFG help!!!”

If a poly partner recognizes signs that someone’s reaction or action is due to a disorder, point it out. “Hey love, it sounds like this is triggering you. I get you are angry and scared. How do we deal with this?”

If there are things that can make it easier to deal with your partner leaving, ask for them. If there is nothing that will help, but now that you recognize being triggered you can deal with it, this is a good time to try to push through. There may be backlash later but you can probably manage until your partner gets back from their date—tell them that. They’ll go out, and you’ll deal as best you can until they come back, and when they come back you can ask for whatever aftercare you might need.

If you absolutely can not deal, tell your partner. DON’T assume that they know how badly you are doing. Have an “OMFG help!” response you’ve discussed and agreed to try ahead of time. Maybe your partner doesn’t go out when you are doing this badly. Maybe they call their partner and switch to a date night in. Maybe your partner doesn’t leave you alone, but helps you contact another partner, friend, relative, etc, to come over and be with you while they are out.

Trauma and stress related disorders that are severe enough to regularly impact dating and relationships—especially if dating and relationships are triggers—definitely need to be discussed upfront. And that doesn’t mean just the person with the disorder discussing their needs with potential partners. It means their partners discussing it with their potential partners. Everyone who might be impacted by the disorder needs to know what to expect. Otherwise they do not have the opportunity to give fully informed consent.

Okay, But What If I’m Just Starting to Date Someone with a Trauma and Stress Related Disorder?

The above discussion is mostly directed at people with trauma and stress related disorders and their long term partners. If you are just starting to date someone with a trauma and stress related disorder—or if you are starting to date someone whose entwined partner has a trauma or stress related disorder—you are in a very different boat.

But it starts out the same. Learn as much as you can about their disorder, how it affects their behavior and how it affects you.

There is a line from the musical Rent that is very relevant here, “I’m looking for baggage that goes with mine.” As I’ve said before we all have baggage. Mild trauma and stress related disorders, especially when they are largely under control, can go with most people’s baggage, as long as you are willing and able to work with them a bit. Severe trauma are stress related disorders are a very difficult type of baggage to match. If your baggage doesn’t “go” with he baggage of someone who has a trauma or stress related disorder that’s okay. But if you find them attractive, interesting, and generally someone you’d like to be in a relationship with, and they tell you some of their baggage is labeled “PTSD” or “Acute Stress Disorder,” don’t give up on them just based on the label. Get to know them and their baggage enough to see if maybe their needs and challenges can actually fit with yours.

Be prepared for an adjustment period. Dealing with something like severe PTSD has a steep learning curve, and like I’ve said before flashbacks can be horrible to watch. In general, the longer its been since the trauma that caused the disorder the better a grasp your potential partner will have on it and the better they will be able to tell you what they need and how it affects things. But that is only “in general” because everyone, and every trauma, is different. My experience has been that trauma from a single incident (bad car accident) causes a smaller range of problems than trauma over a long period of time. That isn’t to say that trauma from a single incident is easier to deal with—but trauma related to a bad car accident will usually only have triggers related to cars. Trauma related to single incident of rape will have triggers associated with that single incident (where it took place, what was done, sex in general). Trauma from a long term abusive relationship can be triggered by a wider variety of things. The trauma isn’t just associated with being in the car—it’s associated with being in bed, and sitting down to dinner, and saying something foolish in public, and the smell of burnt bread, and the scent of the abusive partner’s shampoo, and broken dishes, and, and, and, and…

So depending on what caused the trauma (and how severe it is), a potential partner may not be able to tel you everything about how the trauma affects them. They may not realize that the smell of burning bread triggers them until you get distracted in a make out session one day and they forget dinner is cooking.

What they can and need to tell you is a general idea of how severe the problem is, what areas of life it affects, what they need from you if they are triggered while you are together (or triggered when you are supposed to get together), and as much as they can of their major and common triggers.

Once you now what you are dealing with, it’s a matter of patience, flexibility, and awareness.

When Disorders Become Abusive

I said before that treating a partner with PTSD like an abuser when the disorder causes them to say things that are gaslighting or otherwise abusive doesn’t work. But what does work? How do you respond in a healthy manner when negative thoughts start to sound like a guilt trip?

First off, you need to be able to recognize what is happening. If you can’t recognize 1) what my partner is saying right now sounds like gaslighting and 2) they are saying this not to manipulate me, but because they really believe it, you will not be able to deal with it. And dealing with this is, at least initially very much on the ill person’s partners. Why? Because you can’t even begin to fix something you don’t realize is happening. And from the perspective of a person with a trauma or stress related disorder, all they are doing is expressing ho they feel. Polyamory is supposed to be about communication, right? So why do people keep getting angry when they try to communicate how they are feeling or the way they perceive things?

Once you recognize what is happening, you need to NOT address it right away. Instead you need to address what is under it. Let’s say a partner with PTSD says that obviously they aren’t important, they don’t matter, they might as well just die for all anyone cares about them.

You recognize it as a potential guilt trip. But you also recognize that your partner is genuinely hurting and is really attacking themselves, not trying to get a reaction out of you. What do you do?

In my experience the best way is to address it head on. “I’m sorry you feel that way. I love you very much, and I love having you in my life—even when (you drive me crazy/things don’t work out/we have a fight). I’m sorry I can’t (give you what you need right now/make this right/etc).” If you can do something for/with them, “How about we do X for a while, I think that might cheer both of us up.” If you need to take care of yourself or need to get out the door, “I really need to do this right now, but maybe when I get back we can do X.”

Reassure, offer support, and don’t let their negative thoughts/outbursts/etc keep you from doing what you need to do.

Later, when they are in a better place mentally and you are calm, is the time to bring up. “When you get upset and say things like that, it comes across as a guilt trip/manipulative/emotional abuse. I know you don’t mean to or want to do that. I need you to be aware of the way you say things.”

It will take TIME to make a change. Because they are not fully in control of themselves, because their thoughts and perceptions are distorted, and because they are dealing with psychological arousal, they won’t be able to “stop and think before you speak.” But if they aware of the problem, they will work to be aware of how they communicate and get better. It will probably start with their saying something about it after they calm down, “Hey, I shouldn’t have said that before, I’m sorry.”

I have had PTSD, I have had a long term partner with PTSD, and I have had a metamour with PTSD. Of all the mental illnesses I have dealt with, PTSD is the most difficult in a polyamorous relationship (or, I believe, any relationship). The flashbacks, dreams and memories are horrifying, but at the end of the day they are just a thing. You get through them. The psychological arousal combined with negative thoughts are destructive. Both destructive to the person with the disorder and destructive to the people who care for them.

Mild trauma and stress related disorders aren’t easy to deal with. But most people I have known who are willing and able to do the work involved in polyamory have also been full capable of doing the work involved in maintaining a health relationship while dealing with the disorder. Severe trauma and stress related disorders demand a huge amount of time, energy, and compassion. Polyamory can work with severe trauma and stress related disorders—in fact, a healthy polycule can make the disorder easier for everyone involved and help the person with the disorder heal. But it is definitely not a relationship that is right for everyone.

 

This post is part of the Polyamory and Mental Illness blog series.



Polyamory and PTSD (and other Trauma and Stress Related Disorders)

This post and others discussing specific mental disorders will reference the Diagnostic and Statistical Manuel of Psychiatry and Psychology, Edition Five (DSM-5). Apologies to my international readers, I’m just not familiar enough with the ICD to use it as a reference.

Trauma and Stress Related Disorders

  1. Post Traumatic Stress Disorder (PTSD)
  2. Acute Stress disorder
  3. Reactive Attachment Disorder
  4. Disinhibited Social Engagement Disorder
  5. Adjustment Disorder

PTSD is the best known of the trauma and stress related disorders. In the US it is widely associated with military personnel and the psychological damage of military service. However Trauma and Stress Related Disorders, including PTSD, can be caused by any type of trauma. Car accidents, abuse, natural disasters, and high-stress jobs such as working in an ER or fire department are only a few of the possible causes of trauma and stress related disorders.

PTSD and Acute Stress Disorder are can be caused by trauma that has happened in the past or long term ongoing traumas.

Reactive Attachment Disorder and Disinhibited Social Engagement Disorder are childhood disorders. From what I can find they result from trauma related to loss of caregivers or damage to a child’s ability to connect with their caregivers. While these disorders develop in childhood, they don’t magically disappear when people become adults. Residual effects can cause difficulty with social interaction or forming attachments to loved ones.

Adjustment Disorder is a (relative) mild disorder caused by ongoing life stress. These stresses don’t need to reach the level of trauma. Anything from a family illness, to job instability, to loss of a relationship, can cause adjustment disorder. An important facet of adjustment disorder is that it is not an ongoing psychological condition. As soon as the stressor causing adjustment disorder is removed, the disorder will go away on its own.

Symptoms of Trauma and Stress Related Disorders

Symptoms vary a great deal, and everyone’s experience of trauma and stress related disorders will be different. However most symptoms fall into a few general categories:

  1. Re-experiencing the event—flashbacks are the best known form of this. Literally reliving the event or events that caused the trauma. However it can also take the form of dreams, obsessive thoughts, or disturbing memories popping up out of no where. One note about flashbacks: most people assume flashbacks are either visual (seeing the event again) or full-sensory (experiencing it with all your senses). However flashbacks can take other forms. A person may suddenly feel their abusers hands on them, reliving the physical feeling of the abuse. Of hear screaming or other sounds associated with the trauma.
  2. Heightened arousal—Arousal in the psychological sense is not the sexual arousal we usually associate with the word. In fact, arousal in psychology is a lot closer to what laypeople call the “fight-flight-freeze” response. In a state of arousal, everything is more intense. Arousal can lead to everything from aggressiveness to impulsiveness. It often causes hyper-vigilance and sleep disorders.
  3. Avoidance—someone with a trauma or stress related disorder will often go out of their way to avoid anything that reminds them of or is associated with the trauma or stress.
  4. Negative thoughts, mood, or feelings—this can take a lot of forms, from negative thoughts about yourself, to negative thoughts about the whole world. At base it is a distorted perception caused by the trauma or stress. Someone with adjustment disorder related to job loss might think that there is no point in trying to find a job. Obviously they just aren’t worth hiring. An abuse survivor will often expert other people to act like their abuser did. Etc. Memory loss from the trauma is also associated with this symptom.

Treatments for Trauma and Stress Related Disorders

Medication

There are no medications specifically for trauma and stress related disorders. Unlike many mental illnesses, with these disorders there is a very clear, non-biological cause. Effective treatment needs to address the experience and associated feelings.

That said, medication is sometimes used in association with other treatment. Anti-depressants, anti-anxiety meds, and sleeping medications are sometimes used to treat the symptoms, especially with PTSD. These medications can help a person with a trauma or stress related disorder to continue with as close to normal life as possible while they heal.

Therapy

Cognitive behavioral therapy (CBT) is often cited as the most effective treatment for trauma and stress related disorders. Exposure therapy—gradually exposing yourself to the trauma and things that remind you of the trauma in a safe place—is often used and can be very effective. Even more than other forms of therapy, exposure therapy requires the right therapist. You NEED to feel safe and secure in order for exposure therapy to work. Support groups for survivors of various traumas often include unofficial exposure therapy, as people discuss their own experiences with others who they know will understand.

Eye movement desensitization and reprocessing (EMDR) is a relatively new approach to trauma therapy. Ever notice it’s easier to talk about hard stuff if you have something to distract you? A lot of people like to have “something in their hands” when discussing emotionally difficult topics. This is because having something benign to focus on helps distance our emotional reaction. EMDR uses this tendency to help trauma survivors face and deal with their trauma without the extremes of emotional reaction. There is still a lot of speculation about how and why it works. It does seem to allow trauma survivors to better cope with their trauma, reducing symptoms and speeding healing.

Alternative Treatments

I don’t know of any alternative treatments that I would trust which are specifically for trauma and stress related disorders. That said, herbal calmatives may help reduce arousal symptoms, meditation can also be helpful in dealing with negative thoughts and gaining space from strong emotions, and I personally have found that Massage Therapy can be a huge help in healing from trauma associated with sexual abuse.

When Trauma and Stress Related Disorders and Polyamory Collide

Some problems that come with trauma and stress related disorders are obvious. I’ve had flashbacks, and I’ve held loved ones while they relived the worst experiences of their life. I honestly can’t tell you which is worse.

Other problems are both more subtle, and more frustrating.

Someone whose trauma or stress was related to betrayal, abuse within a relationship, abandonment, and similar issues will find themselves triggered by many things that are a normal part of polyamorous relationships. And constantly waiting for your current partners to abuse you/betray you/abandon you like the people who caused your trauma never does good things for a relationship. In a poly relationship, your poly partners spending time with someone else—or even just the expectation of them spending time with someone else—can definitely be triggers.

Worse, the combination of psychological arousal and negative thoughts can come across as anything from a jealous rage to a guilt trip to gaslighting. (Remember—distorted perspective. Someone with a trauma or stress related disorder literally doesn’t see the world the way it really is.) And while the person lost in their trauma doesn’t intend or even realize that this is how they are acting, the people around them can still be hurt by it.

Let me note that this level of problem is not universal with trauma and stress related disorders. Please do not assume everyone with a trauma or stress related disorder will be affected this way. This is the most damaging effect trauma and stress related disorders can have on relationships—that does NOT make it the most common.

Other types of trauma can cause other types of problems. Trauma from a car accident may make riding in a car difficult to impossible—which interferes with going on dates, poly meet ups, or just picking a visiting partner up from the hospital.

For partners who don’t understand the impact trauma and stress related disorders can cause, refusing to do something that seems simple to them can cause other problems. “Why do I always need to come visit you. It’s just a short drive!”

Because of my specific trauma, I used to get flashbacks eating certain foods. The consistency and texture of food is a big meal to me, which many people have never understood or accepted. Being invited over to dinner was a mine field. I would struggle to navigate trying to be polite, trying to avoid conversation ending-explanations, and trying not to trigger myself. So as awesome as it might sound for a poly partner to offer to put together a picnic for us…

And of course, having a panic attack, flash back, or other trauma related freak-out as your partner is walking out the door to go on a date—no matter what the trigger or cause—is not only disruptive to your own relationship, but to your partner’s relationships as well.

Part II on ways to manage PTSD and other Trauma and Stress Related disorders.

This post is part of the Polyamory and Mental Illness blog series.