PTSD Versus TBI Diagnostic Difficulties Research Paper

Traumatic Brain Injury (TBI) and Post-Traumatic Stress Disorder (PTSD):

Different, Yet Commonly Confused Disorders

It is important that providers are mindful of the fact that very different mental illnesses can present similar features in a clinical setting. According to Theodore A. Henderson’s article, “TBI and PTSD Appear Similar but Treatments Must Differ,” confusion between traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) is particularly common among providers treating military personnel and veterans. This is exacerbated by the fact that the Clinician-Administered PTSD Scale contains many symptoms which exhibit features of PTSD, making diagnosis for providers which rely upon such instruments very challenging. An estimated 73% of veterans with TBI also have PTSD. Yet even civilians may receive inappropriate diagnoses, as the anxiety and trauma reported after a car accident may be diagnosed as PTSD even though it is actually caused by a TBI.

There are significant risks in confused diagnosis for both disorders. It is not simply that correct diagnosis can delay treatment. In fact, the classes of drugs used for PTSD such as serotonin reuptake inhibitors and benzodiazepines may be inappropriate for TBI, particularly benzodiazepines which may exacerbate the TBI patient’s symptoms. There are indications that brain scans may be useful in differentiating the two disorders, but psychiatrists are often resistant to using them. Treatment for both disorders are becoming further refined, including the use of infrared light for TBI and new drugs for PTSD. But this makes correct diagnosis all the more critical, and providers must be aware of new and more sophisticated diagnostic techniques to ensure patients get appropriate care.

The types of sophisticated insight about TBI are clear in Alison Knopf’s article, “TBI ‘Sequelae’ Require Special Care by Behavioral Health Providers.” Knopf’s article likewise stresses the physicality inherent to a diagnosis of TBI, which is caused by an “external or penetrating injury that disrupts the normal function of the brain” (Knopf 42). The article acknowledges that TBI and PTSD can occur at the same time but while PTSD is an anxiety disorder which can be triggered by a psychological incident without any physical cause, a TBI can be caused by a purely physical incident such as a concussion without PTSD. The problem is that the symptoms can be so similar, including headaches, anxiety, memory loss, and concentration issues, a clinician may struggle if the triggering event is not immediately obvious. For veterans who have been exposed to multiple physical and emotional traumas in wartime, the challenges of differentiation become even more acute.

Knopf suggests that one of the most useful screening devices to distinguish the two disorders is that of analyzing loss of memory or the patient’s experience of memory. With TBI, the most frequent symptom is memory loss, due to changes in brain structure. “It is essential to go into detail about the time of the injuries…