Brain Injury, PTSD, and Behavior

Symptoms of TBI and PTSD overlap; treating the whole person is crucial. Learn more from our interview with Dr. Harvey Jacobs, psychiatrist / behavior analyst.

[Dr. Harvey Jacobs] There's been a lot of emphasis on Post Traumatic Stress Disorder, PTSD, especially over the last years with increased military activity and wounded warriors. But PTSD has been around for a long time, and it's a series of symptoms—real symptoms—that are related to exposure to a very traumatic event, and your reaction later on. It's one of many factors that affect behavior and you really have to understand that. A lot of times I'll get a call that somebody's having a behavior problem, and the assumption is that some obvious issue is causing that, such as this person had a blast injury. They were in Iraq, or this person had a brain injury, and so the assumption is that all the behavioral challenges are related to that. But when we take a look at a person, we really have to take a look at the whole person. We have to take a look at the constellation of their experiences, their life history, their presumptions, understandings, to address this. So a lot of times these issues may be related to their exposure to a traumatic event as compared to their traumatic brain injury. So it's important to differentiate that. I worked with somebody a number of years ago who had a brain injury and he was coming out of early rehab, and it was his first day out of bed. And the physical therapist was getting him into his chair and he was very excited about that he was getting back on his feet. He sat in the chair and he was all smiles. She was all smiles, and she leaned over to put the seat belt on so he wouldn't fall out of the chair. And as soon as she did that, he punched her in the face and knocked her out. And the issue was, "Oh my goodness, why did this man do this? What in his brain injury caused him to do this?" Well, the facility hadn't done a lot of history on this gentleman, and it turned out that 20 years earlier, he was a prisoner of war in the Vietnam conflict, and he was kept in underground tunnels in North Vietnam for three years tied to a chair. So this had much less to do with his brain injury than this gentleman was having a flashback to a very traumatic event in his life. We have to understand that the issues of depression, the issues of anger, the issues of frustration and all those things can be a function of many factors, and so PTSD is one of those that we have to look at.
Posted on BrainLine November 12, 2010.

Produced by Vicky Youcha and Brian King, BrainLine