Page 71 - Journal of Special Operations Medicine - Winter 2015

OK, Doc . . . What Do I Really Have?
Posttraumatic Stress Disorder Versus Traumatic Brain Injury

Xavier A. Figueroa, PhD; James K. Wright, MD

ABSTRACT Different Wars, Same Hell

The authors review the diagnostic overlap that ex-
ists between posttraumatic stress disorder (PTSD) and
traumatic brain injury (TBI). Achieving the correct di-
agnosis is much more difficult and the potential to inap-
propriately treat patients is greater than most physicians
realize. The need to properly diagnose and select appro-
priate treatment strategies is essential, especially with
TBI cases. A number of new and experimental therapies
are being used to treat PTSD effectively and reverse the
neurological sequelae of TBI, potentially returning to
active duty Servicemembers who are undergoing a medi-
cal review board.

Keywords: posttraumatic stress disorder; traumatic brain
injury Sources: The 2000 Yard Stare, by Thomas Lea (left), 1944, World War
II. From http://imgur.com/ZYYujMI (right).

their communities. Readiness and the ability to function
Introduction
at the levels required to complete a mission or carry on
PTSD and TBI have been part of medicine and war with one’s duty can be compromised by these invisible
3–5
1,2
since recorded history. The major difference between wounds. Both PTSD and TBI are complex to manage;
preindustrial military campaigns and those that have they are wrapped in cultural biases that make it very
occurred within the last 150 years has been one of scale difficult to overcome feelings of shame or unworthiness
and the increase in the survival of wounded Servicemem- when given a diagnosis of either. A major impediment
bers. Injuries that would have rendered Servicemem- on the treatment and management of PTSD or TBI is the
6–8
bers unfit for duty only 100 years ago are now managed lack of objective clinical tests that can help with diagno-
and can enable the injured Servicemember to return to sis. On top of that, the issues of symptoms (of both PTSD
full or restricted active duty. Yet, the injuries of the brain and TBI) hamper the ability of sufferers to operate at the
and of the mind are notoriously difficult to detect and level to which they were accustomed prior to their injury.
to treat. The dividing line between a diagnosis of PTSD Given the complexity of healthcare delivery, managing
and a concussion or TBI is hair thin and dependent on the ins and outs of treatment and insurance can be stress
the training and temperament of the diagnosing physi- inducing. But in today’s modern healthcare system, if
9
cian. Diagnosis determines the prescribed treatment reg- you don’t have a diagnosis, you cannot access treatment
imen and if it is wrong, that regimen can do more harm easily (or, sometimes, have it covered by insurance).
to the individual.
10
The DSM-IV and the more recently updated DSM-V
11
Diagnostic and Statistical Manual, are the bibles for diagnosing psychiatric disorders and
4th and 5th Editions (DSM-IV, DSM-V) mental illnesses. If an illness is not in the book, there is
The effects of PTSD, TBI, and other mental condi- no diagnosis to be recognized (or treated). It lists all the
tions and injuries suffered by returning Servicemem- clinically identified mental disorders and the possible
bers have a major impact on the lives of the affected symptoms, durations, severities, and treatments associ-
individuals, their comrades-in-arms, their families, and ated with those disorders.

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