Traumatic Stress Disorder
Anxiety and the destruction of self-confidence are natural responses
to the losses associated with brain injury. In that sense, there
would be few people with brain injury who do not suffer from post
It can seem odd to experience trauma in relation to an event
which the person may not even remember and therefore the possibility
of post traumatic stress disorder is often overlooked following
brain injury. Some people who have had horrific accidents have
no signs of post traumatic stress disorder because they have no
memory of the actual accident. On the other hand, sometimes medical
professionals have failed to diagnose the effects of mild brain
injury and claimed the the effects were due to post traumatic
stress disorder. The symptoms are similar.
Anyone who works with brain injury will recognize some of the
symptoms. For example, anxiety which can amount to panic arising
if the person is left alone, or finds themselves in an unfamiliar
environment. Some people become so dependent on their relatives
that they will not be separated from them for more than a few
minutes at a time. Other symptoms can easily be confused with
the organic effects of brain injury and so are not treated as
arising from post traumatic stress. These include, for example,
insomnia, aggressiveness, depression, dissociation, emotional
detachment and nightmares.
It is important to distinguish the symptom clusters of the post
traumatic stress disorder from the organic effects of brain injury.
- Intrusive symptoms refer to the way that
the person is plagued by flashbacks, where they graphically
re-experience the trauma.
- Hyperarousal refers to the state of nervousness
where the person is jumpy and constantly prepared for a fight
or flight response.
- Avoidance refers to the way that the above
symptoms become so distressing that the person tries to avoid
contact with everything and anything that would arouse memories
of the trauma.
- Finally, dissociation refers to a mechanism
whereby the person feels that they are in another world and
what is around them is not real.
All of these symptoms are associated with brain injury and there
is very little clear understanding of the relationship between
the organic effects of the brain injury and the post traumatic
There have been many treatments suggested for the treatment of
post traumatic disorder, but to my knowledge none of these have
been tested specifically with brain injury. For instance, Eye
Movement Desensitization and Reprocessing which is a non medical
psychotherapeutic method specifically targeted at post traumatic
stress disorder; a combination of psychotherapy and psychotropic
drug therapy is often used.
Other work has focused on reducing the stress hormones associated
with the traumatic memory. The drug Propranolol does not remove
the memory of the traumatic stress, but it makes the memory more
normal. It prevents an excessively strong memory from developing
by regulating memory through the action of hormones. Exposure
therapy methods have recently come to include the use of Virtual
reality and Integrated reality experiences, in the hope that training
in a virtual reality environment will eventually transfer to daily