60) offer a rationale for understanding the link between TBIs and PTSD: “Unlike other psychiatric disorders, PTSD is unique, in that its onset is tied to a discrete event, namely a psychologically traumatic stressor. Second, brain injuries resulting from biomechanical trauma are frequently sustained in the midst of psychologically traumatic experiences.” A TBI is defined as an injury to the brain that affects how the brain works (e.g., resulting in loss of consciousness or altered mental status; Centers for Disease Control and Prevention [CDC], 2022). It is important to note that a TBI can occur even if there is no direct contact with the head (NCPTSD, 2022). The severity of a TBI can range from mild to severe, depending on the symptoms. Although there are a multitude of definitions across organizations, a mild TBI is primarily categorized by a loss or alteration of consciousness for less than 30 minutes and loss of memory for less than 24 hours, an impaired mental state at the time of the accident, and transient neurological deficit (Lefevre- Dognin et al., 2021). If the symptoms persist for an extended period of time and neurological deficits do not subside, the TBI would be considered moderate or severe (NCPTSD, 2022c). Approximately 80% of TBIs in nonmilitary populations are mild (NCPTSD, 2022c). There are a range of causes and symptoms associated with TBIs. The main causes of TBIs in the general population are motor vehicle crashes, falls, and physical assaults (Alway et al., 2016). Main causes differ for the military population, where blasts, motor vehicle crashes, and gunshot wounds are the main culprits (NCPTSD, 2022c). Individuals suffering from TBIs may exhibit cognitive deficits, impaired memory, insomnia, dizziness, headaches, irritability, sensitivity to noise and light, and somatic and affective problems (Bahraini et al., 2014; NCPTSD, 2022c). The majority of people who have a mild TBI will be back to normal within three months without any special treatment (NCPTSD, 2022c), however, in some cases, symptoms are sustained. Practitioners face challenges in discriminating between PTSD and TBI symptoms. By nature of the memory impairments of TBI, some individuals do not recall even experiencing a head injury, so practitioners may not have the needed criteria to diagnose co-occurring TBI. Also, self-reported TBI symptoms may be vague, and can therefore be confused with PTSD symptoms. For instance, reports of dizziness or headaches could easily be viewed as indirect effects of PTSD symptoms (Summerall, 2017). Diagnostic false positives between PTSD and TBI are also common. Individuals with TBI may meet criteria for PTSD, and some PTSD symptoms get misdiagnosed as TBI symptoms (Alway et al., 2016; Summerall, 2017). This problem likely results from the overlap between PTSD and TBI symptoms, Suicide The suffering and pain associated with traumatic experiences and PTSD can result in increased suicidal ideation and suicide attempts. Individuals with PTSD are 14 times more likely to have attempted suicide than people without the diagnosis (Rojas et al., 2014). One longitudinal nationwide study of 3.1 million people in Sweden found that individuals diagnosed with PTSD were twice as likely to die by suicide (Fox et al., 2021). The link between PTSD and suicidality is found across trauma types, including combat, physical/sexual abuse, and natural disasters (van Minnen et al., 2015). The potential for suicide is compounded when individuals are affected by more than one PTSD comorbidity (e.g., MDD and substance use disorder; Rojas et al., 2014). As with other problems concurrent with PTSD, there is more than one plausible theoretical explanation, particularly given that both PTSD and suicide risk factors are related to aspects that involve behavior, emotion, cognition, and physiology (Rugo-Cook et al., 2021). In some cases, PTSD symptoms may cause suicidal thoughts and behaviors (Hudenko et al., 2021; van Minnen
such as irritability, disturbances in memory, and difficulties with concentration and sleep (Summerall, 2017). Because head traumas are by definition traumas, the high comorbidity of PTSD and TBIs could be related to a shared etiology (Bahraini et al., 2014). For example, combat exposure can simultaneously cause physical trauma that causes TBI and psychological trauma that develops into PTSD. Some researchers debate the shared etiology perspective, suggesting that the amnesia central to TBI classification would prevent the re-experiencing aspects of PTSD (Alway et al., 2016). Rates of PTSD do appear to be higher in mild TBI samples compared to moderate to severe TBI; however, PTSD has been diagnosed across the range of TBI severity (Ponsford et al., 2018). Even without memory of the traumatic injury, individuals may reconstruct narratives about the event that result in intrusive memories and the re-experiencing of symptoms (Alway et al., 2016). Additionally, traumatic memories may be encoded in unconscious memory, triggering physiological arousal symptoms regardless of conscious perception (Alway et al., 2016). There has been shown to be a higher frequency of delayed-onset PTSD in individuals with TBI (Ponsford et al., 2018). TBIs may also confer risk of or vulnerability to future traumas. Impairments to frontal regions of the brain involved in executive function and emotional control may induce behavioral impulsivity and risk-taking that increase the likelihood of traumatic experiences and subsequent PTSD (Bahraini et al., 2014). Practitioners should be aware of the similarities between PTSD and TBI symptoms. When assessing for trauma symptoms, they should obtain detailed injury histories and consider neurocognitive tests. Case Example Peng was in a serious car crash that resulted in a severe concussion. He had been discharged from the emergency department without additional treatment for the brain injury beyond resting and monitoring his symptoms. Two months after the accident, Peng entered therapy to treat his PTSD symptoms. He was not able to drive without feeling completely flooded by fear and would become stressed any time his wife went driving on her own, worrying about her safety. When he saw cars going by, he would experience a quick flashback of his accident and notice a slight throb in his head. Peng was also more reactive and irritable in his interactions with his wife. Peng was referred to a neurology specialist, and the approach to his trauma treatment became integrative and interdisciplinary. He received medical treatment for his TBI, and after a few months, his irritability, impulsivity, and headaches subsided. Although he still experienced anxiety and avoidance in relation to driving, Peng was able to slowly desensitize his fears and eventually drive again. et al., 2015). Intrusive memories, frequent re-experiencing of trauma, and the inability to shut off physiological reactivity may leave individuals feeling so exhausted and helpless to relieve symptoms that they consider something that was previously unthinkable (Hudenko et al., 2021). In other instances, the cognitive-affective impairments of PTSD (e.g., shame, guilt, and negative self-appraisals) may account for the suicidal ideation (van Minnen et al., 2015). Also, certain coping styles deployed to alleviate trauma symptoms, such as suppression, may intensify suicidal behaviors (Hudenko et al., 2021). Finally, particular traumas (e.g., sexual abuse), even without the presence of PTSD, increase suicide risk, so it is possible that both the suicidality and PTSD are rooted in the same traumatic experience but occur independently (Hudenko et al., 2017). Given the complexity of these factors, it has been recommended that suicidal ideation as it relates to PTSD be considered using fluid vulnerability theory (Rudd, 2006), a diathesis–stress perspective that views suicide risk as a fluid and dynamic process (Rugo-Cook et al., 2021).
EliteLearning.com/Psychology
Book Code: PYFL4024
Page 87
Powered by FlippingBook