TBI and PTSD Together

Challenges of Traumatic Brain Injury with Post Traumatic Stress Disorder

Individuals who suffer from both Post Traumatic Stress Disorder (PTSD) and a Traumatic Brain Injury (TBI) have to cope with complex physical and psychological symptoms.

Post-Traumatic Stress Disorder is considered a psychological disorder secondary to a traumatic event. There does not have to be physical damage to the brain, or any history of head trauma, to suffer from PTSD.

Traumatic Brain Injury is a physical injury in which nerve cells and other soft tissues in the brain have been injured.

The damage that occurs from head trauma and traumatic brain injury has physical, emotional and psychological effects. However, the underlying cause of these effects can be traced back to nerve cell and chemical changes within the brain.

Individuals who suffer from TBI may also develop PTSD due to the stress of the injury or circumstances surrounding the injury. This is a very common occurrence in military veterans.

While there is some overlap in the symptoms of both TBI and PTSD, other symptoms of each condition are unique. At times, it may feel as though these symptoms are in conflict.

For example, the physical symptoms of a structural brain injury can trigger PTSD reactions such as fear, anxiety or depression. This can make PTSD and TBI challenging for both the patient and the clinician to manage.

PTSD and TBI Interactions

PTSD has been described as causing an overall feeling of "numbness".

Finding enjoyment is more difficult, and spontaneous feelings of joy or hopefulness occur less frequently. There is an overall sense of muted or deadened reactions to the environment, and that feeling remains most of the time. However, there are also times when specific triggers cause a sudden outburst, or over-expression of emotion.

In TBI, emotions may be unpredictable, intense and not necessarily associated with the events at hand. When there is brain injury, the nerve cells responsible for sending chemical messages and responding appropriately to a variety of situations may be damaged. This can lead to mood swings, behaviors and emotional reactions that are not appropriate to the circumstances.

TBI related symptoms can sometimes trigger PTSD responses. For example, changes in respiratory rate can trigger a sudden and overwhelming fear of suffocating. Difficulty moving a limb due to the brain injury may cause fear that some process is leading to immanent death. These are long term effects that require focused treatment.

Treating Both PTSD and TBI

Much PTSD treatment includes exposure therapy, where the original trauma is relived in a variety of ways until the negative response to the event is lessened. In other words, when the negative event is pictured in the mind, or similar events are watched on video but nothing bad happens, the mind learns that the memories are not threatening.

“This treatment is based on extinction learning, which occurs when a conditioned stimulus is repeatedly presented in the absence of an aversive outcome, thereby facilitating new learning that the stimulus is no longer signaling threat.”

The challenge with extinction learning in the presence of a moderate to severe traumatic brain injury, is that the actual events around the traumatic event may not be remembered. This means it’s more difficult to create treatment scenarios that accurately recreate the traumatic event. 

Despite the absence of clear memories of the trauma, certain situations, dreams or images can still cause PTSD like reactions. Reconstructing those images and working with them in a therapeutic manner can help transform both the physical response to TBI, and the psychological effects of PTSD. This is now an active area of research.

Understanding why a symptom is experienced, and then treating that symptom appropriately requires care from a specialist who understands both TBI and PTSD. There are medications, therapies and support groups available for those who suffer from both conditions.


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