Visual argument: distinguishing TBI from PTSD in clinical diagnosis

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Visual Argument: Misdiagnosis of TBI Two of the most frequently confused illnesses in medicine today are that of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Both conditions produce similar symptoms in patients and often occur in similar populations (individuals who have undergone trauma in wartime or in other traumatic circumstances, such as a natural disaster). But they are very different conditions and require different courses of treatment. It should also be noted that they can are manifested in the same individual at the same or different times, as a result of the same experience, but are still different medical conditions. My visual argument depicts a physician showing a patient an X-ray, saying that the patient’s broken rib was fixed with Photoshop. This humorous photo suggests a deeper truth, however, that simply fixing the appearance of something does not treat the deeper condition. Giving someone inappropriate treatment for a physical illness such as TBI for a psychological illness like PTSD does not fix the problem. PTSD is characterized by symptoms such as an initial stressor, intrusive recollection (the inability to forget what occurred and experiencing flashbacks to the event), intense distress, numbing, avoidance of stimuli that cause the individual to remember the trauma, and hyperarousal (Figueroa et al. 60-61). But the initial trigger is still psychological, even if the stressor is physically experienced. TBI, in contrast, has somatic complaints such as dizziness, nausea, headaches, poor concentration, and low tolerance for frustration, as a result of a physical injury or trigger to the brain (Figueroa et al. 62). Psychopharmacology must thus be used with caution, given that treating a TBI as if it were PTSD can have severe consequences. “Unless diagnosed properly, psychoactive medications for depression, anxiety, sleep, pain, and panic attacks can worsen these symptoms by further destabilizing the neuronal networks that regulate hormonal balance” (Figueroa et al. 63). Again, this statement does not ignore the fact that a TBI and PTSD can be present in the same patient. But even if this is the case, the clinician must be aware of this fact and balance the treatment suggested for one condition to be counterbalanced with awareness that the other is present. Certain medications that might be prescribed to mitigate the symptoms of PTSD may not be appropriate for TBI. Unfortunately, to further complicate matters of treatment, there is no clear test that can absolutely and conclusively distinguish the two ailments. According to one prominent neuropathologist, “We’ve been diagnosing PTSD based on clinical symptoms, but we have not systematically characterized the pathology underlying this disorder” (Thompson 42). Again, because the clinical symptoms of the ailment are often confused with TBI, this approach can be problematic and imprecise at best. At worst, it can actually result in harm to the patient. The solution is not clear-cut. However, this does not mean that there is no hope for sufferers. What the evidence does indicate is that an individualized treatment plan is necessary for every patient suspected of having PTSD, TBI, or both. Components of such as plan may include physical rehabilitation, neurological rehabilitation, psychological and drug and alcohol counseling, vocational training, HBOT, EMDR, infrared therapy, and other noninvasive techniques (Figueroa et al. 64). Such an approach also allows for additional illnesses or social conditions which may not be mistaken for either PTSD or TBI but which frequently are comorbid with such illnesses, such as substance abuse and difficulties finding work after the individual has been in the service. There is no one-size-fits-all diagnosis or treatment for either PTSD or TBI. And certainly no Photoshop!