PTSD and TBI: Navigating the Diagnosis

June is Post-Traumatic Stress Disorder (PTSD) Awareness Month, a time intended to raise public awareness about issues related to PTSD, reduce the stigma associated with PTSD, and ensure that suffering from the invisible wounds of war receive proper treatment. This month, at the Steven A. Cohen Military Family Clinic, we want to bring attention to this disorder that is estimated to affect as many as 30% of our veterans and servicemembers, and its relationship with Traumatic Brain Injury (TBI).

What is the difference between PTSD and TBI?

Many often talk about the effects of TBI or the consequences of PTSD as separate conditions - which they are. But for those living with the dual diagnosis, it can be difficult to separate them.

PTSD is a trauma-related disorder that can occur as a result of witnessing or experiencing a life-threatening event, severe injury, or death. There are four major clusters of symptoms associated with PTSD:

Reexperiencing: having intrusive thoughts of the traumatic event, nightmares, flashbacks, etc.

Avoidance: trying to avoid reminders, triggers, or memories of the traumatic event

Mood Symptoms/Negative Cognitions: depression, loss of positive enjoyment, emotional numbness, and pessimism about the future, self, and others

Hyperarousal: on-edge, hyperalert, easily startled, “head on a swivel”

TBI occurs from a bump, sudden blow, or jolt to the head, or from a penetrating head injury. Explosive blasts can also cause TBIs, which is why this injury is concerning among those who serve in the military. They can be mild, moderate, or severe, and symptoms at the time of injury include loss of consciousness, confusion, dizziness, “seeing stars,” or other signs of concussion. TBI affects the function of the brain, and can include impaired memory, trouble with learning, concentration, attention, as well as emotional and behavioral regulation. The degree of impairment and the recovery process depend on the severity of the injury. In many cases, particularly with mild or moderate TBI, there may be no physical changes seen on imaging (such as a CT or MRI).

Research into PTSD and TBI has found that 1/3 of veterans with TBI also have PTSD. According to the VA, 60-80% of service members with blast injuries also have TBI, suggesting that the two co-occur for a significant number of veterans.

How are PTSD and TBI diagnosed?

It is important for veterans and active-duty servicemembers to screen for both PTSD and TBI as part of routine medical care as the symptoms of even a mild TBI can persist for years. There is some overlap between the symptoms of PTSD and TBI, so it is important to consult with a skilled clinician as part of any workup.

The Steven A. Cohen Military Family Clinic screens for both TBI and PTSD as part of the initial workup for all new clients, and can provide a more comprehensive assessment and referrals as needed. TBI assessments will often include referrals to neurology, neuropsychological testing, or for imaging studies to further assess physical changes in the brain. If you have had persisting symptoms from a head injury or concussion, it is important to talk to your health care provider about additional evaluation and treatment.

What effective treatments are there for individuals with both PTSD and TBI?

TBI is often treated with cognitive rehabilitation which helps the individual relearn skills or strategies that help with processing information. For instance, someone with memory problems will learn techniques to help remember information, such as using a daily planner, as well as completing tasks that allow the brain to recover memory abilities that were disrupted by the TBI. Research has shown that people with TBI and PTSD can benefit from PTSD treatment as well, such as Cognitive-Processing Therapy (CPT) and Prolonged Exposure Therapy (PE) for treatment of their PTSD symptoms. By reducing PTSD symptoms, particularly those that overlap with TBI symptoms, individuals can benefit from improved functioning. Because the presence of both TBI and PTSD can make recovery from each more difficult, it is ideal to engage in treatment to simultaneously address both issues.

To learn more about PTSD and TBI, as well as how to manage it, please view these resources from Cohen Veterans Bioscience and the VA or contact our office at 240-847-7500.

Stay healthy, Stay safe!

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Amma Owusu-Donkor, LCSW-C

We’re thrilled to introduce Amma Owusu-Donkor as the Cohen Clinic’s newest social worker. She is a licensed clinical social worker-clinical (LCSW-C) who previously served as a clinical supervisor at a male prison. She has experience treating mental health disorders as well as substance abuse. Now at the Cohen Clinic, Amma is providing therapy to individual veterans and their families. Welcome aboard, Amma!

Ta Shawn Couser

The Cohen Clinic joyfully welcomes Ta Shawn Couser as its new Office Manager. Ta Shawn has managed medical practices in the fields of OB/GYN, family practice, internal medicine, and psychiatry since 2004. She is also the proud daughter of a Vietnam War veteran. We are very excited to have her as part of our team!