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Mild traumatic brain injury VS. Post traumatic stress disorder

Brie Stark's picture


Should there be a distinction between mild traumatic brain injury & post traumatic stress disorder?


Evidence of Similarity by Confusion

An Excerpt from:

Concerns grow about war veterans' misdiagnoses
Brain injuries can defy easy detection

A wounded soldier was transferred to a military hospital in Iraq. Medical professionals worry that troops may not get the proper care for traumatic brain injury when they return home. (THOMAS WAGNER/ASSOCIATED PRESS)

By Laura M. Colarusso, Globe Correspondent  |  June 10, 2007

As the medical community learns more about the brain impairments afflicting troops fighting in Iraq and Afghanistan, concern is growing back home that these battle-weary soldiers may be facing yet another obstacle: misdiagnosis.

Traumatic brain injury has become a high-profile condition, thrust into the national spotlight now that thousands of troops who have left the war zone continue to struggle with the consequences of combat. Better known as TBI, the ailment is a physical wound caused by the head-rattling shockwaves associated with bomb explosions that tear brain cells apart.

But TBI shares many of the same symptoms with a common battlefield psychological condition known as post-traumatic stress disorder. Both are often marked by depression, mood swings, irritability, problems concentrating, and memory dysfunction. The similarities can cause healthcare professionals to overlook mild traumatic brain injuries, especially when a patient lacks visible wounds, according to doctors and veterans advocates familiar with the issue.

"Mild brain injuries are really difficult to evaluate because there are a lot of overlapping symptoms with post-traumatic stress disorders," said Jordan Grafman, a neuroscientist who studies the effects of TBI on Vietnam veterans at the National Institutes of Health. "Doctors are likely to default to psychological diagnoses especially when they see a lot of PTSD."

Officials at the Pentagon and the Department of Veterans Affairs say that misdiagnosing mild TBI as PTSD is especially problematic because the two conditions are treated differently. Stress disorders are usually treated with counseling and anti anxiety or anti depression medications, while brain injuries typically require some combination of occupational, physical, and cognitive therapy.

The Full Article


When PSTD & TBI Manifest Together

An Excerpt from:

PTSD, TBI Or Both?

May 15, 2007

One challenge that military healthcare providers are facing with soldiers returning from Iraq, is the challenge of differentiating between PTSD and Mild Traumatic Brain Injury. Both can have similar symptoms, so at times, it can make distinguishing between the two very difficult. Both are signature problems that are seen coming out of Iraq and Afghanistan. In the past, it was thought that one could not suffer from both PTSD and TBI. While that is normally true in the general population, however with the types of situations our troops are faced with and the injuries that they are succeptible to, it is a common to see both together in military personnel returning from the warzone.

PTSD is an emotional injury in response to a traumatic event. Many of the symptoms are emotional in nature. However, there are a variety of cognitive problems as well. Problems such as forgetfulness, inattention, a sense of being overwhelmed with even very simple tasks and clouded thinking. These symptoms can also been seen in patients who experienced a Mild Traumatic Brain Injury. MTBI results from a relatively mild blow to the head that causes just enough of a physical injury that normal brain functions of memory, attention, mental organization and logical thinking can be compromised. Thus making it difficult at times for the healthcare provider to be able to distinguish the difference. Especially when the person may in fact be suffering from PTSD, but has also suffered from a blow to the head.

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An Excerpt from Jonathan Shay's Introduction to his new book, "Odysseus in America"

The American Psychiatric Association has saddled us with the jargon "Post-Traumatic Stress Disorder" (PTSD) -- which sounds like an ailment -- even though it is evident from the definition that what we are dealing with is an injury: "The person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others." We do not refer to a veteran who has had an arm blown off by a grenade as suffering from "Missing Arm Disorder." But I am not going to fight it. "PTSD" it is, even though I much prefer "psychological injury." Combat PTSD is a war injury. Veterans with combat PTSD are war wounded, carrying the burdens of sacrifice for the rest of us as surely as the amputees, the burned, the blind, and the paralyzed carry them.

Full Introduction



Where Does This Bring Us?

An Interesting Point:… if we are to regard PTSD as an emotional manifestation of a TBI --> a purple heart is awarded for TBI, but not PTSD.

(More information about purple hearts for TBIs)

The Black Heart

The New York Times:

THE Pentagon’s recent decision not to award the Purple Heart to veterans and soldiers suffering from post-traumatic stress has caused great controversy. Historically, the medal has gone only to those who have been physically wounded on the battlefield as a result of enemy action. But with approximately one-third of veterans dealing with symptoms of combat stress or major depression, many Americans are disappointed with the Pentagon’s decision; many more are downright appalled. As a former Marine infantry officer and Iraq war veteran, I would urge the Pentagon to consider a different solution altogether.

First, let me say that both sides of the Purple Heart debate have expressed some reasonable concerns. Those who believe that the Purple Heart should be reserved strictly for the physically wounded hold a more traditional sense of the battlefield in which wounds are bloody and undeniable. The gashes of war carry an irrevocable purity that tends to make the issue concrete and uncomplicated.

And yet there have been complications. During the 2004 presidential election, John Kerry’s Purple Hearts, awarded for his service in Vietnam, were labeled by his opponents “purple owies” because the wounds he suffered were not considered dire enough. It was a petty episode, to be sure, but it demonstrated the disparate views of this medal. In the interests of guarding the nobility of the Purple Heart, many service members, including me, have suggested that not every last physical wound merits a decoration.

When I was in Iraq, the most common wound behind the many Purple Hearts we awarded was the “perforated eardrum,” an eardrum punctured by the concussion of a nearby explosion. In the vast majority of cases, no blood was ever shed. Seldom did these marines ever miss a day of full duty. And yet they were all awarded the coveted medal.

Admittedly, I was dubious about the “recognition” of these and other lesser wounds; I felt that in a way they subverted the obvious intent of the Purple Heart — honoring soldiers who have been seriously hurt. But where to draw the line? Perhaps it should be awarded only to those who required admittance into a combat support hospital. “The Purple Heart deserves at least one night out of action,” I argued at the time. But my own commander stood fast by the rules, affirming: “A combat wound is a combat wound, no matter how small. So they get the medal.”

A year later, back at Camp Lejeune, N.C., I was making calls to the families of wounded marines — a difficult duty even when the wounds were minor. But I noticed during that time that I never once made a call to a family about a marine’s psychological wounds. I never got a casualty report for post-traumatic stress, despite the rising number of veteran suicides. Never once.

Why, I asked myself, if a combat wound is a combat wound no matter how small, shouldn’t those people suffering from the “invisible wounds” of post-traumatic stress also receive the Purple Heart? Difficulty of diagnosis is one of the central justifications the Pentagon has given, citing the concern that fakers will tarnish the medal’s image. Spilt blood cannot be faked.

But this seems an unconvincing argument not to honor those who actually do suffer from post-traumatic stress. For example, the possibility of fakers has not prevented the Department of Veterans Affairs from awarding disability payments to service members who have received a diagnosis. Why should the military itself be different?

The distinction, I suspect, lies in the deep-seated attitude toward psychological wounds. It is still difficult for many members of the military to truly believe that post-traumatic stress is, in fact, an injury and not the result of a weak or dysfunctional brain. The same culture that demands tough-mindedness also encourages skepticism toward the suggestion that the violence of war can hurt the healthiest of minds.

Still, almost all service members agree that veterans suffering from confirmed cases of post-traumatic stress should be cared for. The reality of psychological wounds is becoming harder and harder to deny. That post-traumatic stress can lead to suicide is no longer in question. That far too many of those returning from combat experience deep and long-lasting devastation is irrefutable.

So why not recognize the struggles of these many individuals with a medal? Why, for instance, if a veteran has been given a diagnosis of post-traumatic stress and awarded benefits, should he not also be awarded a Purple Heart? Sadly, as long as our military culture bears at least a quiet contempt for the psychological wounds of war, it is unlikely those veterans will ever see a Purple Heart. That is too bad, I think, because they do deserve all the honor the physically wounded receive.

But there may be another solution — perhaps a new decoration, a new medal, could be established specifically for those suffering from post-traumatic stress. It would be awarded to those whose minds and souls have been sundered by war.

I urge General Eric Shinseki, the new head of Veterans Affairs and former Army Chief of Staff, to work hand in hand with the Defense Department to bring about some form of official recognition for these wounded veterans. The current stigma of post-traumatic stress would likely prevent many soldiers from wearing the medal initially, but its mere existence would help crystallize in the American — and the American military — consciousness one of the more obscure human costs of war.

I suggest we call this medal the Black Heart. Certainly the hearts of these soldiers are black, with the terrible things they saw and did on the battlefield. Certainly the country should see these Black Hearts pinned on their chests.

Tyler E. Boudreau, a former Marine captain, is the author of “Packing Inferno: The Unmaking of a Marine.”

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