Thursday, July 5, 2012

The letter T

TBI. PTSD. These acronyms have more in common than just the letter T.

The event that caused the brain injury might have been traumatic, causing fear to be stored. And TBI actually messes with the limbic system in your brain. That's the area responsible for all the squishy high-value stuff: emotions and mood, regulation of emotions, motivation, pleasure, hormones. Can't easily be controlled in quote-unquote normal folks. Frequently haywire in TBI folks. Also one of the hallmarks of PTSD.

One set of people, Camp A, believes they are mutually exclusive. Meaning you either have one, or the other. Both are kind of invisible injuries. So Camp A folks could just parse a person's symptoms to tell whether they have PTSD or TBI. Right?

Actually the list of symptoms for both is remarkably similar (slide 10). So good luck with that.

Another set of people, Camp B, believes they can coexist. Meaning they interact with each other, making each other worse, better, different - depending on the context. This is a much more complicated scenario.

For example, if a TBI survivor seems irritable or tearful, someone in Camp A would deny mild TBI because they would deny the interplay of cognitive and emotional symptoms in TBI. To them, only purely cognitive symptoms can indicate TBI. Emotional symptoms contaminate the diagnosis and can mean only one thing: PTSD.

Someone in Camp B could also deny TBI because of the overlap in symptoms. They could adopt the point of view that emotional symptoms must be subtracted in order to understand and treat TBI. They could even deny TBI altogether because mild TBI is said to eventually resolve itself in something like 95% of cases. (If you have the exact statistic, comments welcome...)

In my case sometimes I wish I could deny something! My TBI symptoms are clearly both cognitive AND emotional. Whatever is not TBI is related to caffeine. And cognitive issues, like not being able to track or remember what still needs to happen for Super Tour, bring post-traumatic symptoms to the surface. Recovery from the brain injury drives both types of healing for me. This puts me in Camp B.

Forensic psychologists and the military folks who treat returning soldiers are intensely interested in this topic. In Camp B you will also find the author of the linked presentation, Douglas C. Johnson, PhD of the Naval Medicine Center in San Diego. For him, PTSD and TBI are two sides of the same coin. They interact in unpredictable ways.

Dr Johnson's conclusion seems to be that the two disorders are so related that diagnosis has to be collaborative. If PTSD is suspected, a psychologist needs to evaluate that. The thing he says distinguishes PTSD from TBI symptoms is Criterion C (slide 28).

Criterion C: Avoidance & Emotional Numbing C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma)
  • Efforts to avoid thoughts, feelings or conversations
  • Efforts to avoid activities, places, or people
  • Inability to recall important aspect of trauma
  • Markedly diminished interest or participation in activities
  • Feeling of detachment or estrangement from others 
  • Restricted range of affect
  • Sense of foreshortened future
PTSD is a diagnosis that only a psychologist who specializes in PTSD is qualified to make. WiTh loTs of daTa poinTs. 

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