TBI and PTSD – Is there a difference?
May 1, 2012
TBI and PTSD – Is there a difference?
We hear so often that, “TBI and PTSD are the signature wounds of the wars in Iraq and Afghanistan.” It’s on the news, in the papers, and featured in stories all over the media. We hear it so often, yet I still believe that the general public does not really know what it means. The wounded warriors and their families who are living with this dual diagnosis know all too well that simply getting through each day can be a constant struggle. The combination of traumatic brain injury and post-traumatic stress disorder results in a cascade of symptoms that affect not only the wounded warrior but everyone in the family as well.
What’s TBI and what’s PTSD?
“How do you tell the difference?” That’s the question most often asked by the wives of wounded warriors whom I have met at retreats over the past 6 months. I wish there were a simple answer. Even the most skilled clinicians find it hard to answer this question.
PTSD has some distinguishing symptoms – the flashbacks, nightmares, hypervigilance, and increased startled response are classic. What most service members, veterans, families and caregivers find most confusing and frustrating is the overlapping symptoms of PTSD and TBI. Take a look at the following list of shared symptoms: cognitive changes, depression, anxiety, insomnia, and fatigue. Cognitive changes can include a wide array ranging from difficulty with memory to slower processing, and lower attention.
Dangers on the Road – and the Roadside
One scenario that the wives have shared repeatedly is riding in the car with their husband driving when he “lost it” or “had a meltdown” and they literally feared for their lives. Erratic driving has been increasingly reported among returning service members and veterans. Let’s take a look at how the combined effects of PTSD and TBI can lead to real dangers in the car. The wounded warrior may already be in a state of high alertness when driving as the roads in the war zones held constant dangers for roadside bombs and IEDs. Even when back home and driving in a familiar neighborhood, the sight of a blowing trash bag at the curb may heighten the warrior’s anxiety and even trigger flashbacks. If the warrior has not slept well the night before – common with both both TBI and PTSD – then he may already be on edge. Leaving the isolation and safety of the house may further increase the anxiety and sense of vulnerability for the wounded warrior.
But some consequences of brain injury can also affect driving safety. The wounded warrior may have some changes in vision that affect the ability to see clearly, particularly areas that fall within peripheral (side view) vision. Or it may be that a hearing loss from a blast injury means that the wounded warrior driver does not hear an approaching car until it is right next to his vehicle. The persistent headaches, so common with mild brain injuries, can affect the driver’s concentration and alertness. Sensitivity to noise after a brain injury can make it hard for the driver to deal with honking horns or radios. The noise of children arguing or playing in the back seat may increase irritability and lead to distractions. The traffic helicopter overhead may be a trigger of combat memories or even flashbacks. Sensitivity to light may make it hard to adjust to sunlight or shadows on the road. The quick temper that often accompanies a brain injury may shorten the warrior’s fuse and contribute to road rage. The increased distractibility from a brain injury can lower alertness for other vehicles. It is no wonder that so many women report they were trapped in their car with their wounded warrior driving and literally feared for their lives.
Living with both
This example illustrates that it’s not always a clear “either or” situation. Both PTSD and TBI are complex diagnoses with many overlapping effects. Being aware of their combined effects can help everyone living with the wounded warrior be alert to possible interactions. It’s not as simple as, “he’s a jerk” or “doesn’t care” or “won’t listen.” Discussing these combined effects with treating clinicians or counselors can help shed light on this.