Misdiagnosing TBI as PTSD

PTSD as TBI
Introduction
Post traumatic stress disorder (PTSD) and traumatic brain injury (TBI) bear similar appearances in terms of symptoms. However, treating the two issues requires completely different methods and interventions and therefore it is important to be able to tell the two problems apart. However, as the symptoms are sometimes indistinguishable a thorough and complete understanding of both is necessary so that a health care provider can make an appropriate determination as to which is which.
Background
PTSD emerged in the 1980s as an explanation for behavioral problems that it was then believed stemmed from some kind of external experience that harmed the psychological makeup of the individual. It was used to diagnose soldiers, for instance, who returned home from wars abroad and found it difficult to cope with civilian life. They often turned to drinking or to drugs or gambling or some other form of self-destructive behavior. For their symptoms they were given treatment—a combination of drugs and therapy.
This is different from TBI, as that is a brain injury which is caused by some trauma to the head. It is a physical condition that requires usually a physical intervention. PTSD on the other hand has been described as a catchall diagnosis that is not really valid for all patients who receive this diagnosis.
Defining PTSD and TBI
PTSD has been defined as “a disabling condition, resulting from exposure to traumatic events. Symptoms include intrusive re-experiencing of the trauma, avoidance of trauma-related stimuli, and alterations in cognition, mood, arousal, and reactivity” (Christova et al. 2695). The symptoms of TBI can be similar but can also include speech impairments, fatigue, fainting, nausea, and difficulty concentrating. Likewise, the methods of treatment differ. This is because PTSD relates to an earlier trauma that was suffered by the individual which has caused the person to suppress feelings or thought so as to not have to deal directly with the trauma. In many cases, the individual tries to self-medicate by using drugs or alcohol to help stifle the impulses and feelings that emanate from the PTSD and the underlying trauma that has never been adequately addressed by a professional care provider.
TBI on the other hand stems from a brain injury that alters the physical condition of the brain in some way, which impedes the body’s natural ability to function according to acceptable normative patterns of behavior. In many cases TBI and PTSD are co-morbidities that occur in the patient together (Walter et al. 442). As the problem is a physical condition rather than a psychological, emotional or psychosocial condition, TBI treatment usually relies upon methods such as surgery, medication and therapy in order to address the issues that stem from the physical damage caused to the brain. In the case of TBI, the problem is a physical one that debilitates one’s ability to act, while PTSD is a psychological or emotional one that limits the individual’s ability to cope (Groves).
AIS Health and Stress states that PTSD actually stands for Poor Treatment from Slipshod Diagnoses (1). This tongue in cheek way of putting it comes from the fact that the AIS organization has found PTSD to be an easy way for doctors to diagnose a patient whom they don’t understand or have not taken the time to figure out: “Since the term first appeared in the American Psychiatric Association's 1980 DSMIII (Third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders) it is often assumed that PTSD is a new disorder. Its purpose was to describe a set of symptoms resulting from exposure to a traumatic event ‘considered to be outside the range of usual human experience’” (AIS Health and Stress 1). However, if doctors were eager to actually uncover the problems that the person has faced and has learned to probe to see whether other issues and variables might be impacting the patient (such as TBI for instance), the care giver would probably arrive at an alternate diagnosis—one that actually gets to the root o the problem and helps the patient to solve the issues that are plaguing him.
The Problem That Emerges
As AIS Health and Stress points out, the problem of too quickly labeling a disorder as a symptom of PTSD is that the patient may have a serious issue that is not getting treated because the patient is only receiving treatment for PTSD, which usually focuses on helping the patient to cope with some event or experience that has traumatized the person. This intervention can come by way of cognitive behavioral therapy (CBT) for instance or by way of cognitive processing therapy (CPT); however, as Groves shows, “no one treatment modality has been identified as being particularly effective in combat veterans presenting with PTSD” (735). The reason no one treatment modality has been identified as effective in treating PTSD could be because the patient is not actually suffering from what the DSM has called PTSD—it could be, on the contrary, that the patient is actually suffering from TBI, which would be a physical brain injury that most likely requires surgery to ease pressure that is being placed on the brain, as Walter et al. have suggested.
Any problem related to this issue is the fact that PTSD is far too commonly accepted as clearly defined problem when it is actually anything but: “There is a tendency to believe that just because something has a name, that it has been defined, or has a meaning that everyone agrees on,” AIS Health and Stress points out (2). This means that PTSD has won wide acceptance among the public when in reality it is undeserved, if one is to judge by actual medical measures. PTSD has not been clearly defined and explained in precise parameters and this causes it to be widely and loosely applied by physicians when they do not have an alternate diagnosis to give or an explanation that is readily at hand.
If PTSD is a disorder of the mind, it should not be viewed as a disease or as physical problem as TBI actually is. AIS Health and Stress explains that “disease means there is a structural or functional disturbance in the body that can be objectively diagnosed by laboratory tests, imaging studies and/or tissue pathology”—which is exactly what can help one lead to a diagnosis of TBI, because it presents physical evidence of harm to the brain, usually in the form of swelling or pressure or bleeding and so on (3). There is some physical sign of a problem occurring under the skull that can often be explained by something that happened to the individual—such as a fall, self-harm, or some other form of accident that led to the injury in the brain. However, if these tests are not conducted, then it can be impossible to actually diagnose TBI, and the patient may instead be diagnosed with PTSD, which is not really the problem, only an explanation of the behavioral symptoms that have been exhibited by the patient—an explanation that has been received by the medical community and by the public as sufficient in describing what the person is going through. The problem of course is that it is not always sufficient and can in fact be a harmful diagnosis that distracts from the real physical harm that has occurred to the patient’s brain as a result of the TBI. In other words, a real brain injury may be the reason the patient is behaving badly; it many not actually have anything to do with PTSD at all.
The solution would be to do more tests for TBI among PTSD patients. As PTSD patients may have some experiential trauma that they have suffered, this trauma is viewed by care providers as the source of the problems for the patient. However, it may not actually be the real source but only an imagined one. As Walter et al. have suggested, the real problem may be that TBI is the actual source of the patient’s behavioral issues because there is a real trauma physically occurring on the brain that is causing the patient to act erratically. Unless this real, physical trauma is addressed, no amount of therapy or drug intervention is going to help the patient to cope with the issues—especially not if the source is believed to be an imagined trauma that is not really responsible for any of the patient’s pain.
Conclusion
In conclusion, PTSD and TBI are two distinct problems that patients can suffer from. The former is still somewhat vague in terms of how it is defined and how it is applied, while the latter is much more definite and relies upon various tests, such as brain scans to determine that there is a physical problem with the brain from the result of an accident or injury to the head. Unfortunately, many patients who suffer from TBI may only be diagnosed as suffering from PTSD. The reality as researchers have shown is that for most PTSD patients, there is an occurrence of TBI that has happened and this helps to explain their symptoms more definitively and can point to an alternate way to treat the patients as opposed to simply relying on the pharmaceutical interventionist approach or the cognitive behavior or cognitive processing therapeutic approach that is often applied for PTSD patients.


Works Cited
AIS Health and Stress. “Why PTSD Stands for Poor Treatment from Slipshod
Diagnoses. AIS Health and Stress, Feb 2013, 1-3.
Christova, Peka, et al. "Diagnosis of posttraumatic stress disorder (PTSD) based on
correlations of prewhitened fMRI data: outcomes and areas involved." Experimental Brain Research 233.9 (2015): 2695-2705.
Groves, Carla. "Exploring issues related to PTSD versus personality disorder diagnoses
with military personnel." Journal of Human Behavior in the Social Environment 25.7 (2015): 731-745.
Walter, Kristen H., et al. "Comparing effectiveness of CPT to CPT?C among US veterans
in an interdisciplinary residential PTSD/TBI treatment program." Journal of Traumatic Stress 27.4 (2014): 438-445.