What are the health concerns for soldiers who have a diagnosis of Post-Traumatic Stress Disorder and Traumatic Brain Injury?
Setting and Population of Interest
The effects of Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) are often considered as separate conditions, but for people living with the dual diagnosis of the two conditions, it may be difficult to separate the conditions. PTSD and TBI are considered under DSM-5 as separate conditions, whereby PTSD is included as a new category under the Trauma and Stressor-Related Disorders requiring exposure to a traumatic or stressful event as a diagnostic criterion, and TBI is addressed in the chapter entitled Neurocognitive Disorders, with diagnostic criteria for mild or major Neurocognitive Disorder (American Psychological Association, 2013).
PTSD and TBI are common disorders in the US with highest prevalence rates among veterans. Given that the conditions are often sustained in traumatic experiences (Bryant, 2011), the number of veterans that have experienced TBI and PTSD increased significantly following conflicts in Iraq and Afghanistan (Summerall & McAllister, 2010). According to the Defense and Veteran’s Brain Injury Center, about 22% of all combat casualties from such conflicts are brain injuries (Summerall & McAllister, 2010). Summerall and McAllister also report that about 60% to 80% of soldiers with blast injuries may also experience traumatic brain injuries. Epidemiological studies indicate that in the US, 21% of women, and 8% of men develop PTSD (Bryant, 2011). Similarly, studies focusing on Detroit alone indicate that 13% of women and 6% of men develop PTSD. This alone shows that while men are more exposed to traumatic events as compared to women, women have a higher risk of developing the condition compared to men. It is also estimated that close to 5.3 million people in the US alone live with disabilities due to TBI, and the TBI risk among the military personnel is estimated to be between 10% and 20% (Bryant, 2011). More studies indicate that PTSD can develop following a mild TBI (Cited by Bryant, 2011).
Rationale and Significance of the Problem
A common postwar experience across generations of veterans encompasses a range of symptoms involving fatigue, headaches, memory and concentration problems (Hoge, & Castro, 2014). Service members returning from various peace-keeping missions and other military deployment have often experienced comparable to those of prior wars, and as Hoge and Castro report, the focus has now narrowed down to two concerns: PTSD and TBI. While most TBI cases are mild, their screening, treatment, and research efforts have surrounded on the interactions of TBI and PTSD after exposure to combat events such as blasts (Bryant, 2011; Hoge, & Castro, 2014).
Post-Traumatic Stress Disorder and TBI are not limited to service members exposed to combat, but their prevalence rates among the military service members are much higher compared to civilians (Wall, 2012). Besides, when PTSD co-exists with TBI, it becomes even more difficult to sort out what an individual is going through. In the presence of the two conditions, one condition basically feeds and reinforces the other, resulting in a complex mix that is difficult to isolate. Individuals with these disorders tend to be hypervigilant to somatic cues since they believe that they represent a threat to their physical well-being (Bryant, 2011). Therefore, to address the confusion due to the interaction of TBI and PTSD, it is crucial to explore the health concerns of soldiers with a dual diagnosis of TBI and PTSD.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Publishers.
Bryant, R. (2011). Post-traumatic stress disorder vs traumatic brain injury. Dialogues in clinical neuroscience, 13(3), 251.
Hoge, C. W., & Castro, C. A. (2014). Treatment of generalized war-related health concerns: placing TBI and PTSD in context. Jama, 312(16), 168g5-1686.
Summerall, E. L., & McAllister, T. W. (2010). Comorbid posttraumatic stress disorder and traumatic brain injury in the military population. Psychiatric Annals, 40(11), 563-580.
Wall, P. L. (2012). Posttraumatic stress disorder and traumatic brain injury in current military populations: a critical analysis. Journal of the American Psychiatric Nurses Association, 18(5), 278-298.