Is it time to accept that my (29F) boyfriend (28M) isn’t capable of being a healthy partner?

TLDR: My boyfriend (a survivor of significant trauma) has been neglectful and careless as I’ve been navigating a health issue. Does he deserve continued patience and forgiveness or do I need to accept that he doesn’t have the capacity to be a healthy partner?

My (29F) boyfriend (28M) has been diagnosed with PTSD and is seeking an Autism diagnosis. He survived a severely abusive childhood, ran away from home at age 15, and spent the rest of his teens and early twenties in constant danger and instability. He struggles with his mood and self worth, but at his core he is an incredible man. For the entirety of our relationship he has been working hard to heal and grow through therapy and lifestyle changes, and with that in mind I’ve done my best to meet him with patience and forgiveness in the challenging moments.

All that said, I’m wondering if my patience is crossing the line into self-betrayal. For example:

I went for a run last week and sustained some chafing on my vulva. I didn’t think it was a big deal until a couple days later when my labia had swelled to about three times its size and I started experiencing fever, chills, and body aches. Turns out the abraded area had gotten infected and the infection had entered my bloodstream. I’m on the mend now thanks to some intense antibiotics, but it’s been a miserable few days. My whole body has been inflamed and achy, I’ve been exhausted and weak, I’m stressed about missing work at a critical time, I can’t sit or walk comfortably. And I’m feeling really disappointed and heartbroken by how my boyfriend has been behaving towards me.

When I first started to decline, I asked if he would take on the responsibility of making dinners while I was unwell. He agreed, then showed up after work missing a couple of key ingredients for the recipe he’d chosen. He said he had already eaten some pizza on the way and was too tired to go back to the store (which, for the record, is five minutes down the road). I was bummed but I brushed it off and scrounged up a meal out of what I could find in the fridge. The next night rolls around and the same thing happens with a different recipe. This time I was truly upset. I’ll admit that my reaction was pretty scathing. I told him it seemed more like weaponized incompetence than a mistake; it didn’t make sense to me that a grown man couldn’t handle planning and making a meal. I called him selfish and inconsiderate. He had a huge reaction, said I was belittling him, accused me of verbal abuse, and told me he didn’t want to be with someone who couldn’t appreciate his efforts. After cooling off I realized I’d probably taken it too far, so I approached him warmly and apologized for my inappropriate tone. Eventually he accepted my apology. At that point I was way too exhausted to go shopping, so I suggested some meal ideas based on the available ingredients and eventually he relented and cooked something up. The next day he texted me “I’m going to make dinner, you just rest” but I knew better, so I dragged myself into the kitchen and made a big batch of food. Sure enough, when he got home that night he’d forgotten to get anything for dinner. He did stop at a general store to pick up my favorite chocolate and a few specific things I’d asked for, though. I told him I was really grateful for that but decided to let the dinner issue go.

Now, bear in mind that through all of this he was generally uninterested in other forms of caretaking. No “hey, how are you feeling today?”. No “can I get you anything?”. I’d ask him for a glass of water, for an ice pack, for help making the bed. He’d say “of course, baby”, turn back to his youtube video, and then I’d have to ask again before he maybe followed through. On top of all of that, there were several moments when he tried to tickle me or roughhouse and I felt like I was talking to a toddler, repeating “please be gentle, I’m in a lot of pain” before finally getting snapping at him to stop and/or getting up and moving to another room.

Last night I broke down in front of him. I explained how unloved and exhausted I was feeling, how much I was yearning for some care and nurturing. I told him it didn’t really seem like he cared about how I was doing. At first he rolled his eyes and got defensive, but eventually he softened and thanked me for sharing my feelings. He told me he’d been feeling really emotionally overwhelmed after an intense therapy session and admitted that he’d essentially been tuning me out for a while. He looked me in the eyes and told me how much he loved and appreciated me. He showered me with kisses, turned on one of my favorite shows, and gave me a little foot massage. It felt really, really nice and I made a point of telling him that.

Then, this morning, he woke me up trying to roughhouse. I still wasn’t feeling great so I calmly told him that I wanted to get more rest and went back to sleep. He woke me up again a short while later to ask for a backrub and I totally lost my patience. I started crying angrily. I said I couldn’t understand why he was continuing to behave with so little regard for my wellbeing. Remembering the look of sheer disdain on his face makes my stomach drop. He rolled his eyes, told me that it was unfair for me to be angry, said he couldn’t believe I was having such a big reaction to being woken up. Then he said he didn’t have the energy to keep having these conversations with me. A little while later I re-approached him, feeling heavy but calm, and told him that the last few days had been really damaging. I implored him to consider how seriously his behavior was impacting me and suggested that we talk about whether or not we should continue the relationship. He got really angry again and left for the gym as I begged for him to please just talk to me.

I feel so spun up and confused. I have moments of thinking that my feelings are totally justified, that I deserve better, and that I need to come to terms with his lack of capacity and break up with him. There’s a part of me that feels manipulated, mistreated, and self-protective. Then I have moments when I think maybe he’s right, maybe I’m being way too critical and high maintenance, maybe I’m the one being cruel. And then, on top of everything, I think about how brutal his life has been and I feel deep grief and guilt at the thought of leaving him. I think I know what most of you are going to say . . . and maybe I just need that external affirmation.

Thank you for reading this far, and thank you for any and all advice.

Edited for formatting.