As a Psychologist, Do You Treat TBI and PTSD Together or Separately?
As a psychologist, do you treat TBI and PTSD together or separately?
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[Lt. Col. Jeffrey Yarvis] PTSD and TBI share a a lot of common symptoms. There is a very faint nosological or diagnostic boundary between the two. And often they are treated separately, and so they can be confounding and create confusion in the person with them. And I guess the first thing I would say is that these wounds in general because they are difficult to decipher and they are invisible are different than a physical injury. When somebody has a physical injury with a TBI and there is intracranial involvement, I say this carefully, it's obvious, and so their very appearance sort of rallys support to them. So if they have an amputation—not that I would trade places with that individual—but they are viewed as somebody who has probably also sustained a TBI and probably has some kind of post-traumatic stress response. And they are given a lot of social, emotional, and medical support rightfully so, but when these wounds are invisible and—if you will— your gray cells get mushed together and your marbles get rolled around, it is very hard to describe, and it is very hard to know what is going on. And you may not even know what is happening to you. And so warriors know now that these are signature injuries of the war that we have done a lot to reduce stigma, but what we have done at Fort Belvoir is we have tried to integrate the services together to address them simultaneously. And that way the warrior does not feel confused about, "Why didn't they address my TBI or PTSD." And because they share symptoms what we typically like to do is rule out the psychological symptoms first. And part of that is also because sometimes when you wait with TBI the symptoms abate a little bit, and so we also want to educate them about those symptoms. So some of the shared symptoms are the emotional dysregulation that might manifest itself as anger or outbursts or impulsivity. There is a certain degree of anxiety that comes with these changes and behaviors. So PTSD is really an anxiety disorder—you know—with some other unique features to it, but when you have a change in functioning it is also anxiety producing on top of what might have actually caused the initial injury. And so those two things become confusing. And then with those symptoms there is a certain degree of masking your previous performance levels. And so often there is an assumption that there is a traumatic brain injury because my cognitive functioning or my ability to concentrate, for example, is not quite the same. And then as a result of that anxiety or that hypervigilance that they both share there is often also sleeplessness which makes those symptoms worse as well. And so we try to figure out whether it is organic or whether it is psychological. Now if we know there has been a physical injury then we often will—you know—target right away the neurological symptoms associated with TBI, but if there hasn't been some kind of documented or pretty credible report that that has happened then we may target the psychological symptoms first.
Posted on BrainLine May 14, 2013.
Produced by Victoria Tilney McDonough and Erica Queen, BrainLine.
Lt. Col. Jeffrey Yarvis, PhD is the first integrated service chief of the Fort Belvoir Community Hospital. He is an assistant professor of Family Medicine and director of Social Work at the Uniformed Services University of the Health Sciences.