TBI and PTSD: Navigating the Perfect Storm

Marilyn Lash, MSW, Brain Injury Journey magazine
TBI and PTSD: Navigating the Perfect Storm

So often people talk about the effects of traumatic brain injury or the consequences of post-traumatic stress disorder as separate conditions — which they are. But for the person who is living with the dual diagnosis of TBI and PTSD, it can be hard to separate them.

Just as meteorologists predict “the perfect storm” when unusual and unprecedented conditions move in to create catastrophic atmospheric events, so can the combination of PTSD and TBI be overpowering and destructive for all in its path. The person with TBI and PTSD is living in a state unlike anything previously experienced. For the family, home is no longer the safe haven but an unfamiliar front with unpredictable and sometimes frightening currents and events.

While awareness of PTSD has greatly increased with recently returning service members and veterans, it is not new and nor limited to combat. Anyone — children, adolescents, adults, elderly — who is exposed to a life-threatening trauma can develop PTSD. Car crashes, shootings, floods, fires, assaults, or kidnapping can happen to anyone anywhere. But the rate of PTSD after brain injury is much higher in veterans than civilians due to their multiple and prolonged exposure to combat. According to O’Connor and Drebing, it is estimated that up to 35% of returning veterans with mild brain injury also have PTSD.

What’s unique about PTSD?

Symptoms of PTSD include:

  • Unwanted and repeated memories of the life-threatening event
  • Flashbacks where the event is relived and person temporarily loses touch with reality
  • Avoidance of people, places, sights, or sounds that are reminders
  • Feelings of detachment from people, even family, and emotional numbness
  • Shame about what happened and was done
  • Survivor guilt with loss of friends or comrades
  • Hypervigilance or constant alertness for threats.

Individuals with PTSD are at increased risk for depression, physical injuries, substance abuse, and sleep problems, which in turn can affect thoughts and actions. These risk factors also occur with brain injury.

PTSD is a mental disorder, but the associated stress can cause physical damage. TBI is a neurological disorder caused by trauma to the brain. It can cause a wide range of impairments and changes in physical abilities, thinking and learning, vision, hearing, smell, taste, social skills, behaviors, and communication. The brain is so complex, the possible effects of a traumatic injury are extensive and different for each person.

When PTSD and TBI coexist, it’s often difficult to sort out what’s going on. Changes in cognition such as memory and concentration, depression, anxiety, insomnia, and fatigue are common with both diagnoses. One basically feeds and reinforces the other, so it’s a complicated mix — it’s the perfect storm. It may help to consider and compare changes commonly seen with TBI and PTSD.

Memory

TBI: A period of amnesia for what went on just before (retrograde amnesia) or after (anterograde amnesia) the injury occurred is common. The length of time (minutes, hours, days, or weeks) of amnesia is an indicator of the severity of the brain injury. For example, the person may have no memory of what happened just before or after the car crash or IED explosion.

PTSD: In contrast, the person with PTSD is plagued and often haunted by unwanted and continuing intrusive thoughts and memories of what happened. The memories keep coming at any time of day or night in such excruciating detail that the person relives the trauma over and over again.

Sleep

TBI: Sleep disorders are very common after brain injury. Whether it is trouble falling asleep, staying asleep, or waking early, normal sleep patterns are disrupted, making it hard to get the restorative rest of sleep so badly needed.

PTSD: The mental state of hypervigilance interferes with slowing the body and mind down for sleep. Nightmares are so common with PTSD that many individuals dread going to bed and spend long nights watching TV or lying on the couch to avoid the night’s terrors. Waking up with night sweats so drenching that sheets and clothing are soaked. Flashbacks so powerful that bed partners have been struck or strangled while sleep battles waged.

Isolation

TBI: Many survivors of TBI recall the early support and visits of friends, relatives, and coworkers who gradually visited or called less often over time. Loss of friends and coworkers leads to social isolation, one of the most common long-term consequences of TBI.

PTSD: The isolation with PTSD is different as it is self-imposed. For many it is simply too hard to interact with people. The feeling of exposure outside the safe confines of the house is simply too great. The person may avoid leaving the house as a way of containing stimuli and limiting exposure to possible triggers of memories. As a result, the individual’s world becomes smaller and smaller.

Emotions

TBI: When the areas of the brain that control emotions are damaged, the survivor of a TBI may have what is called “emotional lability.” This means that emotions are unpredictable and swing from one extreme to the other. The person may unexpectedly burst into tears or laughter for no apparent reason. This can give the mistaken impression that the person is mentally ill or unstable.

PTSD: Emotional numbness and deadened feelings are a major symptom of PTSD. It’s hard for the person to feel emotions or to find any joy in life. This emotional shutdown creates distance and conflicts with spouses, partners and children. It is a major cause of loss of intimacy with spouses.

Fatigue

TBI: Cognitive fatigue is a hallmark of brain injury. Thinking and learning are simply harder. This cognitive fatigue feels “like hitting the wall,” and everything becomes more challenging. Building rest periods or naps into a daily routine helps prevent cognitive fatigue and restore alertness.

PTSD: The cascading effects of PTSD symptoms make it so difficult to get a decent night’s sleep that fatigue often becomes a constant companion spilling over into many areas. The fatigue is physical, cognitive, and emotional. Feeling wrung out, tempers shorten, frustration mounts, concentration lessens, and behaviors escalate.

Depression

TBI: Depression is the most common psychiatric diagnosis after brain injury; the rate is close to 50%. Depression can affect every aspect of life. While people with more severe brain injuries have higher rates of depression, those with mild brain injuries have higher rates of depression than persons without brain injuries.

PTSD: Depression is the second most common diagnosis after PTSD in OEF and OIF veterans. It is very treatable with mental health therapy and/or medication, but veterans in particular often avoid or delay treatment due to the stigma of mental health care.

Anxiety

TBI: Rather than appearing anxious, the person acts as if nothing matters. Passive behavior can look like laziness or “doing nothing all day,” but in fact it is an initiation problem, not an attitude. Brain injury can affect the ability to initiate or start an activity; the person needs cues, prompts, and structure to get started.

PTSD: Anxiety can rise to such levels that the person cannot contain it and becomes overwhelmed by feelings of panic and stress. It may be prompted by a specific event, such as being left alone, or it can occur for no apparent reason, but the enveloping wave of anxiety makes it difficult to think, reason or act clearly.

Talking about the Trauma

TBI: The person may retell an experience repetitively in excruciating detail to anyone who will listen. Such repetition may be symptomatic of a cognitive communication disorder, but it may also be due to a memory impairment. Events and stories are repeated endlessly to the frustration and exasperation of caregivers, friends, and families who have heard it all before.

PTSD: Avoidance and reluctance to talk about the trauma of what was seen and done is a classic symptom of PTSD, especially among combat veterans.

Anger

TBI: Damage to the frontal lobes of the brain can cause more volatile behavior. The person may be more irritable and anger more easily, especially when overloaded or frustrated. Arguments can escalate quickly, and attempts to reason or calm the person are often not effective.

PTSD: Domestic violence is a pattern of controlling abusive behavior. PTSD does not cause domestic violence, but it can increase physical aggression against partners. Weapons or guns in the home increase the risks for family members. Any spouse or partner who feels fearful or threatened should have an emergency safety plan for protection.

Substance Abuse

TBI: The effects of alcohol are magnified after a brain injury. Drinking alcohol increases the risks of seizures, slows reactions, affects cognition, alters judgment, interacts with medications, and increases the risk for another brain injury. The only safe amount of alcohol after a brain injury is none.

PTSD: Using alcohol and drugs to self-medicate is dangerous. Military veterans drink more heavily and binge drink more often than civilian peers. Alcohol and drugs are being used often by veterans to cope with and dull symptoms of PTSD and depression, but in fact create further problems with memory, thinking, and behavior.

Suicide

TBI: Suicide is unusual in civilians with TBI.

PTSD: Rates of suicide have risen among veterans of OEF and OIF. Contributing factors include difficult and dangerous nature of operations; long deployments and multiple redeployments; combat exposure; and diagnoses of traumatic brain injury, chronic pain, post-traumatic stress disorder, and depression; poor continuity of mental health care; and strain on marital and family relationships. Veterans use guns to commit suicide more frequently than civilians.

Summary

There is no easy “either/or” when it comes to describing the impact of TBI and PTSD. While each diagnosis has distinguishing characteristics, there is an enormous overlap and interplay among the symptoms. Navigating this “perfect storm” is challenging for the survivors, the family, the caregivers, and the treatment team. By pursuing the quest for effective treatment by experienced clinicians, gathering accurate information, and enlisting the support of peers and family, it is possible to chart a course through the troubled waters to a safe haven.

References:

O’Connor, M. & Drebing, C. (2011). Veterans and Brain Injury. In Living Life Fully after Brain Injury: A workbook for survivors, families and caregivers, Eds. Fraser, Johnson & Bell. Youngsville, NC: Lash & Associates Publishing/Training, Inc.

Ehde, D. & Fann, J. (2011). Managing Depression, Anxiety, and Emotional Challenges. In Living Life Fully after Brain Injury: A workbook for survivors, families and caregivers, Eds. Fraser, Johnson & Bell. Youngsville, NC: Lash & Associates Publishing/Training, Inc.

Posted on BrainLine March 7, 2013. Reviewed July 26, 2018.

Marilyn Lash, MSW has more than 35 years experience working with individuals with disabilities and their families in medical, rehabilitation, educational, and vocational settings. Her primary focus is supporting families and developing community programs along with user-friendly publications for families, educators, and clinicians. She is a founding partner of Lash & Associates. Marilyn recently joined a team of specialists who facilitate retreats for wives of wounded warriors, which take place near military bases around the country. She is a former chair of the Board for the Brain Injury Association of North Carolina and former chair of the Brain Injury Advisory Council for North Carolina. She continues to share her insights as a keynote speaker at many brain injury conferences.


Used with permission from Brain Injury Journey magazine, issue #1, Lash & Associates Publishing/Training, Inc.

Comments (61)

I have what they are refering to now as complex ptsd mixed with that ive had over 20 concussions in my lifetime. I am a civilian and am 32 y/o. No one ever explained to me what a concussion was or what it felt like until i was 29. The perfect storm is correct. The intertwining of these two diagnoses makes it difficult if not impossible to prove whether it is a correlation or causation of the symptoms that i have. And bc of the lack of medical care we dont know what came first the PTSD or the PCS. My most recent concussion has turned my life upside down and rideside up all at the same time. For me my PTSD already had a dissociative aspect as far as we know so the memory loss and forgetting days conversations and names has all mingled. My hypervigilance is so bad i can scream simply by a word i often slap or hit punch 3x when scared and my speech has been effected as well. The other day i screamed at my own hair out of the corner of my eye. I think humor is important and thats what gets me through. The other day i was reading aspartame off a soda bottle to check ingredients guess what part my mind got stuck on and repeated. Some days are drastically better than others and i pray some day there will be more research done. Ive found research itself is easy its funding and bureaucracy that makes it difficult. I wish luck to all those looking to find answers and thank you for your time.

Jgirl86
I feel so alone.

:(

Interested to read all of your stories and don't feel so alone now. My situation is still something of a mystery to me. I am still unsure whether to believe the specialist as to my diagnosis. It doesn't make any sense to me. In 1997 I was diagnosed as an adult with amnesia about a serious incident that apparently occurred in my home as a child. I have no memory whatsoever of any such incident. I was in disbelief and so shocked to be told this that I developed both PTSD and TBI as a result. Just like that. The therapist tried to press me to remember to 'work through it' but I would get so stressed in the sessions that my mind would just shut down and I would 'fall asleep' right in the session. I have never recovered, 22 years later. I used to be a high achiever with a geat family but I lost all that. I have never been able to get my mind to function enough since to be able to work at any kind of a job. I get angry that my life has been wasted over something I don't even remember

My husband returned from Iraq 10 years ago and was so angry and vulgar that I didn’t quite recognize him. The years passed and his anger was all that I was subjected to. He verbally abused me every chance that he had, and I am not a quiet or meek person. I told him he needed help repeatedly for years, to no avail. As it turns out, he was addicted to porn and was cheating on me for 5 years with multiple women. One in particular for 5 years. After I figured out what he had been doing I was ready to walk. Surprisingly on the same day he wanted to talk and began telling me about his time in Iraq. Everything came out and it has been almost a year. I truly don’t understand how this can be so as he excelled at his job and was always helpful and courteous to everyone around him except for me. No one believes that he could be so verbally abusive. Everything that I read says people don’t function with ptsd, but he did. The other weird thing is that the since the day everything came out, he has felt no anger, pain, or need to even watch porn, and continually tries to make it all up to me. I have read nowhere that someone with ptsd can just come out of it like that. I am trying to figure out my future, but the confusion of it all has me spinning.

I wrote before
I was a special operation soldier
I fought hard to keep my country safe I love my country
Now my mind and body is fighting me I found out my brain is having my body relieve all the injuries in the military
My injuries are
Falling 700 feet with a total parachute failure unconscious for 13 hrs, seeing 17 comrades killed around me , holding the hand of a soldier dying after being cut in half from machine gun fire, a woman having her head blown off from a sniper.
I had over 15 surgeries and 3 months at walter Reed hospital.
People tell me I am lucky to be alive . Now I tell them no I wished I had died. The pain is intense it bends me over , I fall down alot. I scream in silent so my wife can't hear me and this is with my 4 oxycodone a day my zoloft 1 aday. I chose this low dose 10 years ago I only wanted as little I could stand .
A doctor told me to take responsibility for my pain because I chose special operations.
Now the USA has an epidemic on pain meds.
I am tired I keep going but no pain meds i will not.
I love my country why won't my country love me back.

Yes, my head "almost" went through a windshield. That is, it created a bubble in the windshield in the shape of my head. Police and ambulance there, not one person asked whose head did that! I walked home, two miles from the accident. Parents yelled at me for being late. Told them, they didn't think to take me to the hospital. Had headaches for years, every time I bent down, head would throb. Have serious memory problems, feel stupid all the time. Married a psycho woman who treated me like dirt and I thought I was doing something wrong so I kept trying to change to appease her. Now realize I always think I'm the problem, attract narcs have serious trust issues, paranoia and hypervigiliance, always thinking someone is plotting against me (like my Ex) or someone has a problem with me. Over-react, under-react, react in the wrong way, not sure what to do when. Got divorced, now I hate the government, don't trust lawyers. Broke, think of ending it every day.

Dear J.M.,

I'm so sorry that you're going through this and that you don't feel understood. You may think no one has ever experienced what you’re going through and that no one can help you. I'm here to say that you can get through this.

Have you expressed what you’re struggling with to your family or to a friend? If you’re not comfortable talking with them or feel they're unable to understand, please consider reaching out to one of these confidential resources:

National Suicide Crisis Line (24/7)
1-800-273-8255

When you call you will hear a message that you’ve reached the crisis line, there will be brief hold music while you’re connected. Then a skilled, trained crisis worker who works at the Lifeline network crisis center will answer the phone. This person will listen to you, understand how your problem is affecting you, provide support, and share any resources that may be helpful.

Crisis Text Line (NAMI)
Text HOME to 741-741
to connect with a trained crisis counselor to talk via text message.

When you text HOME to 741-741 the first two responses are automated. They tell you that you're being connected with a Crisis Counselor, and invite you to share a bit more. It usually takes less than five minutes to connect you with a Crisis Counselor. When you’ve reached a Crisis Counselor, they’ll introduce themselves, reflect on what you’ve said, and invite you to share at your own pace. You’ll then text back and forth with the Crisis Counselor. You never have to share anything you don’t want to.

Hi my name is Connie. I am on my second bout of PTSD. And have had multiple concussions. The first @ 18yrs old a car crash where my head was caught between the roll cage and concrete I was drug 50ft before expelled from the vehicle. It scapled me. A year of surgeries I looked normal on the out side. Not one dr then told me I had TBI or PTSD. My whole family was called in to say goodbye. I made it navigating on my own with family to help. I never really remembered the car wreak even years later. 10yrs I suffered. Then in between I had many more concussions. I always was rough on my self. Then my brother shot and killed my dad and tried to kill my mom. I was a thousand miles away. My husband is in the military. I have never felt so helpless my whole life. Now im three years into battling my second round of PTSD. All I feel is empty or like im drowning at the same time. I feel guilty about everything. And Rage but control is what is killing me slowly. I agree with all said above. I am all that and more. My saving grace has come from a stellate ganglion block. I am at war with my self internally at all times. The block helps there need to be more people discussing this block it helps like nothing else. There is hope.

I was diagnosed with Complex-PTSD and had severe closed head injuries due to a motor cycle accident. Is there any specialists in or near Indianapolis, IN

Wow. I thought I was a special kind, then I read that is common for those who isolate with PTSD. So, I decided to let that go. Then I read the first few sentences in this article. I am a special kind of hopeless. Like, should have been gone hopeless.

U have suffered 10-12 serious traumas equivalent to one that caused be on of my TBIs. Someone tried to murder me with a baseball bat (according to doc). My brain became bloody applesauce. Four weeks afterwards, in the hospital, I had the first cognitive thought since the assault "I am still alive". 11 months later a serious car accident delivers another serious tbi and offers up extended, if not permanent eye focus problems. Shit, the shattered skull severed my hearing nerves, now I am losing eye sight? Yep. Truth is there. In these words there is horrific truth. I never want to see you suffer. I suffer so alone. It is the only safe place I have. In bed. Alone. On my back. Nothing behind me but a bed.

My daughter was beaten to near death by an ex-boyfriend Dec. 30, 2015. This informative article has answered most of the questions I had about TBI & PTSD, she has symptoms of both minus the violence. We had to relocate her due to the constant threat of the abuser, away from her family and support system, because law enforcement would not revoke his probation and put him in jail. Through your website I was able to find a facility that treats both of these and the whole person. Thank you so much.

Hello.
When I was 17; I was beaten, tortured and dumped south of town. It left me with PTSD and TBI. I haven't been able to find help beyond pills that don't work. There is a place that offers help near me. But it's too expensive. My doctor keeps offering me meds but I am tired of them not working. I have. A good diet and exercise that is very important to living this way.

I really don’t like how this is written. If family and friends of the person who has PTSD keep reading about how it makes the person violent and add in domestic violence they will assume this is the case. When I’m facg most of the research has been done with sufferers of PTSD from violence related to war. So for these sufferers they may be violent if they feel threatened as this is how they protect themselves in war. If the trauma did not come from this type of violence the sufferer may not be violent. I’m tired of seeing this about people with PTSD being violent and the research being mainly from veterans. It leaves family and friends thinking everyone with PTSD is violent. This of course is not true.

I too agree with this my ptsd came from traumatic bereavement and no not violent but complete opposite infact...

I understand where you are coming from with this concern.

PTSD goes hand in hand with feeling SAFE. There should be more empathy and understanding. People who care about those who suffer from PTSD should always work to make their loved one feel SAFE. It is something PTSD sufferers deal with every day. We react so seriously because we perceive a threat which puts us in fight or flight mode.

You must understand this about PTSD survivors. As a veteran once said: a bag of trash is just a bag of trash to everyone else, but to someone who has served and seen soldiers blown apart, it’s not just a bag of trash. Have some empathy here - it’s a reality for I have PTSD from several traumatic events one of which was a home invasion. I am so suspicious of anyone coming to my home uninvited. I had some people who came to my front door right after my mom had come in. They were pretending to be needing oil for their car. I overheard my mom talking to this person. When I came into the living room to intervene I threatened them and ran them off. I chewed my mother out for standing there with door open talking to these people. I pulled photos from my critter cam and called police. Another guy in their group was at their car while the officer talked to me. I told the officer I was nearly taken from my home and take threats like this very seriously. I then turned to the other guy and told him that if they ever stepped foot in my house I’d be ready. I do have a permit to carry, but I prefer to avoid problems as best I can instead. I call police if I have a suspicion.

Trying to be aware of your daughter's deficits and how she can learn to identify them can help. For example, I know I tend to chat and get too personal with strangers not realizing they may not be safe. I’ve run into situations as a result, so I now try to have a “circle of trust” of guy friends and non-emergency law enforcement to help.

These comments and the body of evidence that has grown to help us understand the complexities of issues each PTSD/TBI sufferer faces gives me HOPE! Through my own challenges and discoveries, I hope my experience one day can be a beacon for veterans as civilians like me.

I was not given assistance or rehab. As a typical severe TBI victim, I lived for 30 years never realizing my injury and subsequent injuries affected my life. I constantly struggled and still do. I had tutors in school and used academic support services to graduate with a Doctoral degree finally.

I am finally seeking accommodations at work because I am so afraid of losing my job that I have started looking at my needs seriously. I always knew something was wrong since the gruesome accident, but I had poor self-awareness. My family is military, so there was no support for an injury like severe TBI that had no visible signs after the initial swelling and unconsciousness. My head was swollen like a pumpkin, but luckily the CT scan showed I was ok back in 1987. S

Rather than be angry that I’ve suffered, I try so hard every day to believe that my experience, my life is not for naught. Sometimes I feel that nothing would be for meaningful to me, more healing for my soul than to help others because I have some insight. I understand how important it is to preserve the DIGNITY and autonomy of PTSD/TBI victims.

Every case is complex, but there is overlap that can help support many related conditions -autism, anxiety, victims of abuse and neglect. I hope nothing here is offensive to anyone. My intentions are to share in our struggle, believe and hope for a life of safety, compassion and healing.

I have PTSD and C-PTSD from severe domestic violence.
I agree TOTALLY with you. I am NOT violent, in fact I am the very opposite. Too dang nice all the time! Most domestic violence victims are Empaths, which is why the abusers are attracted to them to begin with.
There needs to be WAY MORE awareness about PTSD from being physically beaten and emotionally abused.
So, so, so many CHILDREN are getting PTSD from school shootings and horrible abusive parenting.
There are way too many people now a days that should NEVER EVER have children !!!!

YES, I said it!

Well said. I suffer with ptsd it does make me quick to temper but not lash out

I agree with your statement about the assumption of violence with PTSD. There needs to be more research done on civilians with PTSD to separate the violence from the scenarios.

Hi, my name is Steven (Steve for short). I'm 45 years old. I've suffered TBI from 13 to 15 concussions playing sports or just hitting my head at work etc. I also have PTSD. Raped as a kid, car accidents, divorce, my sister and Grandma dying within months of each other, then a major car accident where my wife drove off a cliff, we survived 80 ft down. I have burns and almost lost a foot. She was trapped. I helped free up her legs, climbed out ripping a gash in my leg 4 inches long. I blacked out, woke up 20' below my truck, wife yelling "don't die don't die." I couldn't do anything. I screamed & screamed. I can still smell, hear the sounds. I have chronic migraine syndrome.

I need help. I'm losing my memory. I feel like I going nuts. My family is falling apart. Substance helps pain, thoughts, memory, ideas, yet makes temper worse. please help. steveamore12@gmail.com

Hang in there. You’ve had enough. keep the ones who understand you close. They do care about you. Spend time with old friends doing something relaxing or creative. Painting like Jackson Pollack is fun or fly fishing.

I too suffer from a TBI/PTSD associated with a tragic violent event. It has been almost 8 years now since mine. I can tell you reach out for brain injury support. Or PTSD support.... i attend a group called Point Man it is a support group for PTSD sufferers. For the first couple years after my injury i was basically a shut-in. But i sought after rehabilitation....
My advice is SEEK OUT support and help through the welfare office, dept of aging, mental health office, health insurance company, a good bible based church.... anyone that can provide much needed healing.
I suffer from symptoms even 8 years later.... but I have come along LONG WAY. I hope this is encouraging to you and that you choose to HANG IN THERE.

Interesting read

I have TBI and PTSD from a car accident. The doctor told me I'm going to have seizures when I get older (but) in 2000 I was shot plus my son was killed. I have a hard time remember which was first and the dates? I'm homeless and my HISS social worker is prejudices and/or discriminative which amount to gross negligent. An administration appeal judge has ordered the county to reevaluate my case and my social worker denied benefits and closed my case so I reappeared. This new administration judge is making me prove my disability now. I was given SSI benefits for PTSD in 2000 well that when I applied. So when my epilepsy seizure started I told SSI and IHSS about my new disorder, now this is 2018 I have to prove my PTSD to the administration appeal judge and social worker, my TBI and PTSD disorders, Chronic kidney disease and TB is the perfect storm, now my special needs are being denied I need compensation for court orders denials, mental abuse and physical abuse, I'm in Los Angeles Ca. 90013, Crocker St. Skid row my case now is in Rancho Dominguez office 75 case number 0661533, I think my memory cognitive abilities are gone, I've stressed out to the maximum no families support couple with I fine it hard to trusts anyone. Please help with any ear.

I read this with such a heavy heart.."Navigating the Perfect Storm, a more perfect title does not exist..Our lives have been destroyed..I often get the question, "Why don't you just leave, why do you stay?"...I always say because I love him and I want to know that I did everything that I could possibly do to help him...Sometimes we have to learn to let go and let them make that decision of help on their own..I often cry knowing that our youngest child has never known what an awesome, loving and caring father he once had but those memories have long faded away for him..I often wonder if it would be easier for me to let go if I had never known that kind, caring, wonderful, full of love person that was so great...

I want to say it just breaks my heart reading of all the suffering people are enduring. My youngest son, a Veteran, suffers from PTSD/TBI & it has been a difficult road for him, however, there has been improvement over the years. I'd like to offer one bit of info. I've been a volunteer with therapy horseback riding centers for several years and my horse is a therapy horse at this time.  I have seen such dramatic improvements in Military people who have tried this, and some have never  touched a horse ever in their lives. Find a PATH center in your area and just give it a try. Military are NEVER charged for a session. Negative, even suicidal people have come out with a whole new outlook.  Not a guarantee, just some possible hope.  

This is a great read and information, thank you very much. The "wave-tops" are definitely hit on this read, and answers many targeted questions for many that can relate. It gives a great foundation for those who can connect these pieces to branch outward in getting the rightful assistance, treatment and help.

You have got to educate VA mental health! Thanks so much for opening my eyes!!!! The VA in Illinois has had me flying blind! Well everyone! It's a sad damn day when I can look at this article and read it, and learn more about my dual diagnosis of TBI / PTSD in a few moments, than any mental health or medical professional at the VA has ever tried to explain to me in my 8 years in the system! Explains why the CPT therapy was a failure and why I am having these problems/symptoms that some of the VA so-called professionals keep trying to downplay! Like it's an issue of attitude or something I have the ability to control. Sorry but after reading this, Yes, I am here to rant about the VA! They are either horribly under-educated or just want to push meds! They downplay everything so when it's time for a re-evaluation they can try to get your rating reduced! Seems like everyone who is good and understands is fired or let go! Replaced with someone that tries to convince you that there's an ordinary explanation for every individual symptom you have other then being real with you about your condition! Like trying to cover up the fact that military service, blasts, and fighting in Iraq had everything to do with it! I was always told horror stories about the VA but I never would have dreamed that I would be experiencing it firsthand! I thought these people were here to help us! I guess in Illinois they are setting us up for failure! Sorry for the long vent!

I have a TBI and PTSD. Something that the VA and many other people do around those of us that suffer from this is insane. They treat us like we’re defective. They talk about us and at us. And like our opinion isn’t valid. Which is crap.

Its all VA's and dr's are set to follow a strict guide line to not help and not to document the TBI and ptsd and mdd completely to the T. Any who do help are fired, quit, or move. Many would be va dr's are at the bottom of the latter for med school with fake degrees

I have experienced the same thing. They keep denying my tbi which is in my records. They finally approved me for ptsd after years of denials and me being pretty much homeless and broke and lost. Bad enough dealing with ptsd after a 15 months deployment where you left the wire daily, but then we have TBi which they downplay and are trying to blame a mood disorder like bipolar which i never had before. My cognitive functions have been getting worse and worse over the years after multiple blasts and concussions to the head. My head even swells up. They also employ trainees it seems or people who can't get jobs in other hospitals so they come to the VA i believe and take the lower pay. Something really needs to be done about our VA healthcare. They frustrate the veteran to a point where they feel hopeless and just give up altogether. I can imagine what the ww2 and nam vets went through. ptsd/tbi is not something new but finally recognized by the medical community. Keep your head up brother and stay strong. US army combat veteran. 10+ years.

I totally agree if with what this man is saying.

In 2006 I was denied treatment. Evidently, the hospital was not prepared to handle The National Guard and reserve coming home from tours from Iraq and Afghanistan. Their automatic reply in the ER when they found out you are National Guard or reserves was "sorry we can't treat you, you are a reservist." They could not comprehend nor can they until today that reservist and National Guard are the majority of troops to deploy overseas in these 2 wars. And it is my opinion today that the general lay personnel and nurse practitioners primary have the training to do what is needed for these dual diagnosis. Plus the other physical ailments (compressed spine, TBI, dislocated shoulders). VA will say only one diagnosis for every 6 months which has been my case. I received my wounds in 2005 and I'm still just starting to get treated for some of them. But the TBI and PTSD have made me homeless, isolated, and embarrassed to show my face to anybody that I once cared for including my children and family. I do have the fake world of Facebook though.

I do understand all these symptoms. I am a very "to myself" person. I was treated terrible in service with an attack. I have always suppressed this and it took 23 years before I was even aware of the help I might seek from the V.A. I was diagnosed rather quickly with PTSD and started council. The first psychological council seemed to help but she retired and I was left with another that seemed to not understand. The next was group therapy. This only onset more of my depression.One-on-one worked a little better but she has been out due to her life threatening challenges. I'm back to myself with no help with council. I do not feel suicidal and try real hard to stay positive but looking at medical records the headaches that are debilitating for few days at a time. The headaches have increase with physical and or mental stress so I just do what I can to stay calm and try not to push. I do not and cannot work but I could use a more steady councilor that is more in tune with head trauma and PTSD. I also have a neck injury that leaves me with plenty of reasons not to do too much. After 6 years with the VA no one has helped me understand this. Thanks for your article. Have a nice day. The VA could use more councilors trained in this area.

My Daughter is post severe TBI (3 months coma) From auto accident 9 years ago. She has developed possible p.t.s.d. From the voids in her life she wants badly. Her delusions seem to be caused from her desires and scary night terrors.( A year ago she had a Neuro sych / (insurance co. Said we had to do this or they stop paying) that was more like an interrogation..she dropped 17 lbs in a month) I was told even though I am her legal guardian, I could not be with my daughter during the testing/ I regret not walking out with her. She was happy and easier for 7 years and now personalty changing to depression seclusion and combative. Meds? Anxiety? PTSD? Difficult to trust anyone (docs) anymore. Support? Recommendations? We've come so far and to just let go is not an option, I don't want her to get hurt or hurt anyone. Reply if you have advice or support, thanks! .

Just curious, been dealing with a TBI going on 9 years now age 48.. how do you ignore it ?  Get so fed up with it sometimes constant  hissing  noise, post trauma vision syndrome

My wife suffers from both.

I have PTSD and TBI I don't see my life getting any better. I am in a wheel chair I can't take it anymore. The drugs the VA put me on for PTSD aren't helping, the TBI and PTSD wore me me down. I'm not sure why I'm commenting here but I'm sorry to bother anyone just wanted to say I'm not unbalanced just lost in the VA system

I have been diagnosed with PTSD a moderate TBI with bleeding and contusion in the grey matter, Depression and anxiety. And you are right you have to earn the right to hear about my PTSD and my TBI I'm going to tell you every time. Depression is death when and how. The only thing keeping me alive are my heavy medications. There is too much to say about all of this and it's hard finding people that understand the extent of these injuries.

Hi my is Joe I have TBI and PTSD as a child I was abused woke out of bed and yeld at for nothing . I felt so ashamed and so alone at tines . I couldnt do enough to make my moms boy friends happy enough .I was hit by a speeding car when I was 5yrs of age beat with a 22 cal pistol when I was 20 . and from the time I was I was labled unstable from the stat of California. I've attempted suicide I've atenpted in 2012 and thank God the chamber had locked up. Thoughts of depression and suicide run thorough mind everyday uncomfortable feeling . I don't like it . December 7 2012 scares me . I wish there were support groups for those who struggle with this same thing I do .

I am a 52 year old male.. I found out i have lived with ptsd and tbi for 27 years . i just fond out in 2013 . Thank god i went too er was having hallucinations unrelated to tbi but was found then. I was an explosion in 1987 in  lav.. with 2 marines lav  battalion in 1987 at Fort Benning, Ga.  To my knowledge now was first time used in our unit. I was a test dummy so too speak . i was dummy in side who lived .I was medic at time . Treating others and unknowing my self.. Im lucky im alive and back in Va care. It helps me every day make a difference in a positive way.

PTSD is recognized by the World Health Organisation as a comparison of a physical injury such as quadriplegic. I have suffered since 2007, had 5 hospital admissions & my 6th tomorrow. I am a person who was assaulted. After the assault I was a functioning alcoholic. I have now been clean for 6 years & 11 months. How easy it would be just to pick that bottle up again, to feel safe & happy! I know too well that would be catastrophic! I am on loads of medication, have had years of therapy & sometimes I just want to be dead! I never asked for this life, however I have two options 1. Keep fighting or 2. Give up! I was a high achiever that lived a very successful fulfilling life! Lately hence my admission I fail to eat, shower, isolate & hate my life! One thing though the choice is mine to keep fighting or give up! I truly understand the battles each any everyone of you face! I have joined a number of support groups on Facebook which have validated my illness! I am building the 'guts' up to so a 12 week program at one of the most successful programs in Australia. I accept I will never have what I had but I need at least half of my old life back! Keep self soothing fellow warriors & remember there are people that do understand!

The man I love was recently given a PTSD & TBI diagnosis. I'm not surprised as I picked up on some cognitive issues, mood swings and withdrawal. His injuries were sustain while serving. He called to tell me and he is now pushing away from me. Telling me to move on with my life. He is fearful he will harm me unintentionally, or be a burden. My position is I love him...good or bad. Advice?? Should I give him his space to sort out the implications if the diagnosis. I can't imagine being with any other man; I love him deeply. Am I being foolish??

When you love someone so much, you have to listen to your inner voice. He is pushing you away because he doesn't see himself as the man he once was, but he still needs to be loved regardless of his ability to live you back the same. It is up to you whether or not you can live with his partial love, the balance will always be off. As for me, I had already loved my husband for 15 years when he got a TBi with PTSD and I have learned to accept this new personality that looks like my husband as I vowed in sickness & in health I could never leave, that would be torturous to him. We've been to support groups & that was the common denominator among tbi survivors is that no one understand & they just leave them. It's certainly not marital bliss but when you exchange vows you know it's for better or worse. I'm just glad that I can still love him & he is still with me in this world. I do miss the old personality but if he wasn't here for me to love, my life would be so lonely

The man I love has Pstd & TBI. I can't begin to imagine what he is experiencing. I just know that he needs me to be there. Sometimes you can read articles like this one in an attempt to understand what she or he is living, sometimes are you trying to convince yourself that you can love them enough. I think it's a testament of strength and loyalty to have the back of your beloved vet. Given the sacrifice and the emotional and physical that may constitute the new version of your amazing person. Don't take it to heart, be proud them and yourself. He tells me to go away and leave him alone..... Like that's going to happen.... Love him to much.

I was diagnosed w TBI and PTSD 19yrs ago. I've been a serious opiate addict from '99 on! I left hosp.,after 6 mnths, ama, w 2 grocery carts a month,of every type of morphine u can think of, that's correct,2! Last xmas the woman i've lived w died. I found my best friend August 8, after 2days and it wasn't pretty! I think about suicide practically every day! I don't take chemicals (pharmaceutical) anymore,...i smoke weed n it helps keep my mind in check!

Vet Centers are the best things about the VA. I am a female veteran with PTSD and TBI. No big surprise I'm single. Those who have significant others... do what you can to love and appreciate them. They know you have problems but they love you away. That's a blessing. Don't jump on them for not understanding... be thankful they'll listen. We all the PTSD and TBI combination sucks but that doesn't mean life has to. I know finding enjoyment in life can be like trying to find a needle in a hay stack but keep digging. It's there. The process will keep you alive and the findings will keep you grateful for life. That's my spill. Keep fighting the good fight friends and comrads. And when you can't fight take a nap and when you can't take a nap tell someone you who loves you and knows you that you need a hug. I don't know yall but I love you all and you're not alone. Take care.

I've been out since 2008. I've been dealing with (what I believe to be Both, TBI and PTSD) on my own, since 2003. I just cannot get myself to go to the VA. I hate that place so much. I hate everything about them. I get one to two migraines a week from an injury sustained in Iraq. When I was in the Army, I never had an issue getting my meds, they were always on time, and as I grew immune, they would change it up. When I ETS'ed out of the Army, and the VA took over, I was without meds for 3 months. They messed everything up and what really bothered me the most, was their apathy for the whole situation. I finally walked out and never went back. I've been struggling out here on my own with migraines, anxiety so bad that I throw up in the morning if I know I have to leave my house that day. My memory, and thinking are shot and I am just burnt out. I am afraid to tell the VA about my condition in fear that they will use it against me and treat me like I am some kind of liability. I am not a violent person. After the war I had to unplug from anything violent--I can’t even hunt anymore. I would never harm another person or animal. I just don't trust them and I don't know how much longer I can keep doing this on my own. Civilians could care less about my injuries, and its hard to keep a job, and keep an employer happy with 1 to 2 migraines a week. I get nervous, and at times I have to be alone so I can calm down and steady my nerves. I am sick of apologizing for my condition and working through the pain day after day. I won an award for the last company I worked for. I was one of only a couple of reps in the nation (this is a Forbes company) to achieve this goal. I couldn't even go to the dinner with the top leadership because I was afraid I would not be able to handle it and look like an ass in front of them. After all that effort and working through all that pain, they still made it very clear that my migraines were "interfering with scheduling" and I could be fired for missing days. I even asked if I could use my personal days for migraine days (instead of vacation days like everyone else uses them for) and my manager said no. "We would have to make that exception for everyone if we did that". I was new to the company so I had to wait one year before I was eligible for FMLA. How am I supposed to live like this? I have no choice but to return to the VA and everything inside of me cringes at the idea of that. I am no longer near Detroit though, so perhaps a different location will be better. Sorry for the babble… just need to vent sometimes.

I feel as if you are wrong in part. I have both PTSD and a TBI I spent 2.5 months in a coma. I have been a fish out of water since. I have spent over half my life this way. I am very intelligent, and find most of this life a bore. I listen to everyone, but find most to be myopic. People who are supposed to help are to busy trying to label you, for then they don't need to spend time thinking about me, or more often they want to give you more medicine so you lose free thought. They want to manage you as if you are a pet that can learn tricks, and point to as a success. I want more, and in fact need more. This life is becoming a waste of time.

To all are hurting. It is not you , It is those who do not want to help you. 

Selfishness and Greed. That is the way of Human nature ! It has nothing to do with suffering  TBI and PTSD. They use it as an excuse to not help you!

Please understand what I'm about to explain. We  might suffer from TBI and PTSD.  I ;myself; did undertake  "Journeys for Answers" and came up with all different reasons that don't even have nothing to do with this conditions. It is simply the attitude of some people towards folks like us.This has always occurred in the past and present for all war vets and regular folks with no combat time. It is a phenomenon called "Selfishness and Greed!" The people who work for the different levels of our government such as city,state and federal :WHO! do not have not one minute of Armed Forces Service and who control key positions where a job can be given to a veteran and yet they hold those positions from being filled because THE GOV gives them a bonus for doing the most work with the least employees. This the main cause. People Factor is the Key.NOT YOUR CONDITION,CORRUPT GOV> There is a lot of bad people out there wheeling and dealing with vet benefits! So to all my fellow sufferers It is not you ,it is the attitude of the people above you that just don't to give what you need; just out of greed and selfishness. Eventually it will catch up with them. I have met them all. IT IS NOT US IT IS THEM> YOU GOT NOTHING TO SUFFER FOR NEEDLESSLY. IT S NOT YOUR FAULT,IT IS NOT OUR FAULT! They are the perpetrators! From all nationalities and races. Corrupt to the max!Nobody monitors them!

The only thing that helped me was antipsychotics at first....and only one out of seven helped but it stripped me of my sense of connection and spirituality...it literally caused me to stop believing in God due to a chemical change in my brain which subsided when I discontinued taking it....was the strangest most empty feeling I've ever had...weird to say the least. Anyway...I suffer mostly from night terrors and major night sweats...avoidance and flashbacks...one thing helped....prazosin. It is a blood pressure medicine that makes it hard for your brain receive signals from adrenaline that increase with nightmares and flash backs...night sweats stopped for the most part and so did night terrors and flashbacks were decreased... Thought this might help you... Getting decent sleep is the corner stone to combating this illness and Prazosin has had a tremendous positive effect for many suffering like us... Ask your doctor about it if you haven't already been offered this as an option. Regards, Holly

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