Post 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 traumatic stress.

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 stress disorder.

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 reality.