Post-traumatic stress disorder (PTSD) & brain injury
Post-traumatic stress disorder can
occur in countless ways, especially with a traumatic brain injury.
The events, setting and feelings at the time of the injury can lead
to ongoing stress.
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder
characterized by a collection of specific symptoms such as
hypervigilance, being easily startled, and sensitivity to loud
noise. PTSD can occur after a traumatic event that leads to a
traumatic brain injury (e.g. an assault, near drowning or a motor
vehicle accident). This is generally in the case of mild to
moderate traumatic brain injury (TBI), in which some of the
traumatic event may be remembered. Symptoms can develop if the
event is enough to cause significant shock or fear, or be seen as
Symptoms of PTSD
Signs of Post-Traumatic Stress include:
- Re-experiencing the trauma through nightmares and vivid
memories of the event
- Difficulty sleeping
- A person frequently thinking that they might die or that
something bad will happen
- A pounding heart, shortness of breath, dizziness, chest pain,
sweating, or flushes
- Feeling detached from the world or a sense of unreality
- Avoiding situations or thoughts related to the event
- Having a desire to escape
- A sense of losing control
- Being easily startled
- Experiencing episodes of panic.
A person experiencing both Post-Traumatic Stress and effects of a
TBI requires a high level of understanding and support. Due to the
unpleasant feelings a person may avoid various situations which act
as reminders of the trauma or avoid thoughts and feelings
associated the event. As the person continues to avoid these
feelings and situations, it is easy to maintain the idea that it is
unsafe to think about or be in such situations. As a result a
person may become restricted from various activities and maintain
high levels of anxiety.
PTSD and Traumatic Brain
In the past it was believed that Post -Traumatic Stress Disorder
(PTSD) could not occur following a traumatic brain injury. In fact
it has been considered a protective factor against PTSD as the loss
of consciousness was thought to prevent encoding of information
related to the event and therefore the ability to remember.
However, more recent studies have provided evidence of PTSD
following mild to moderate TBI in soldiers returning from war. One
study found that 11.3% of patients met the criteria for PTSD during
the first six months of recovery after mild to severe Traumatic
Brain Injury. These patients also showed greater impairments in
psychosocial well-being compared to those without PTSD.
Both Post-Traumatic Stress Disorder and mild brain injury are
prone to misdiagnosis. This is largely due to the similarity of
symptoms in brain injury and PTSD. The sleeping disorders,
irritability, depression and emotional problems that can be due to
a mild brain injury can be misdiagnosed as an effect of PTSD. This
may also occur in reverse, leading to inappropriate treatments.
After horrific accidents, a person with Traumatic Brain Injury
may have no signs of PTSD because they have no memories of the
actual accident-often their earliest memories are of being in
rehabilitation weeks later. However, it is important that any
suspicions of PTSD be checked thoroughly by professionals with an
understanding of Traumatic Brain Injury.
Treatment for Post Traumatic Stress
Treating and recovering from PTSD is often a gradual process. It
is a process of healing and gradually coming to terms with the
traumatic event and this can take time. It's about learning to cope
with the thoughts and feelings associated with the event and
continue with life without these thoughts or feelings of the event
interfering with daily life. Below are some common forms of
treatment for PTSD.
Two forms of therapy that are particularly helpful are
Behavioural and Cognitive-Behavioural Therapies. These involve
providing education and information about PTSD, learning ways to
control anxiety and anger, and being exposed to feared situations,
feelings and any memories related to the event5. Unhelpful thoughts
and beliefs are replaced with more rational thoughts. In the case
of mild TBI, simply talking to a psychologist about the traumatic
experience may help to manage difficult feelings.
Due to the effects of Traumatic Brain Injury it is preferable
that therapy be sought by a psychologist or psychiatrist with an
understanding of Traumatic Brain Injury. This way a program may be
tailored to your specific needs. Contact your Brain Injury
Association for options in your area.
Medications may be used to treat symptoms of PTSD such as
anxiety and depression. Selective Serotonin Reuptake Inhibitors
(SSRIs) have proved effective in open trials of PTSD. However, care
is needed to see if SSRIs interfere with other prescription
medications. Consult your GP or a psychiatrist about the potential
benefits and side effects of medication while maintaining awareness
of the effects of an existing brain injury.
There are several support groups available for people suffering
the effects of PTSD or an anxiety disorder. The links below provide
the contact details of groups in Brisbane and Queensland.
Coping methods for Post-Traumatic Stress
Educate yourself about PTSD
Learning about something you may be experience can promote
feelings of being in control and help you to understand what you
are feeling and what may help.
Talking to someone you trust and feel comfortable
Learning to talk about the trauma with someone you feel
comfortable and has an understanding of what you have been through
can have positive outcomes. This may help you to feel less alone
with your feelings and help to process some of the difficult
feelings associated with the event.
There are many professional counsellors and psychologists that
can provide support and guidance with coping with traumatic events.
Contact your Brain Injury Association for options.
Relaxation exercises include breathing exercises, medication,
yoga, swimming, listening to music and going for long walks. Each
of us will have the ones that best suit us, so work on finding the
one that is most helpful for you. Some exercises will take regular
practice. Also, many libraries will have relaxation CD's or tapes
with exercises that you can use to guide you in relaxation. Be
aware that is it possible for some relaxation exercise to increase
distress by focussing your attention on physical sensations that
you may find disturbing, so only continue with such exercises when
How family and friends can help
- If a family member feels comfortable tell your loved one or
friend that you are willing to listen if they would like to
- Educate yourself on PTSD and Traumatic Brain Injury, so you
have an understanding of each of the effects.
- Be aware of negative coping mechanisms such as social
withdrawal and alcohol and drug abuse or avoidance in your loved
one and encourage them to seek counselling.
- Maintain a non judgmental approach when providing support.
References and further information
- Bryant, R. A., Marosszeky, J. E., Crooks, J., & Gurka, J.
A. (2000), Post-traumatic Stress Disorder After Severe Traumatic
Brain Injury, AM J Psychiatry, 157, 629-631.
- Hoge, C. H, McGurk, D.,Thomas, J. L., Cox, A. L., Engel, C. C
and Castro, C. A. (2008), Mild Traumatic Brain Injury in U.S.
Soldiers Returning from Iraq, The New England Journal of Medicine,
- Bombardier, C. H., Fann, J, R., Temkin, N., Esselman, P. C.,
Pelzer, E., Keough, M., & Dikmen, S. (2006), Post-traumatic
Stress Disorder Symptoms During the First Six Months After
Traumatic Brain Injury, The Journal of Neuropsychiatry and Clinical
Neurosciences, 18, 501-508.
- MedicineNet (2007), Post-traumatic Stress Disorder (PTSD),
- Anxiety Australia, Post-Traumatic Stress Disorder,
- Brain Explorer, http://www.brainexplorer.org/ptsd/PTSD_Treatment.shtml
Australian Centre for post-traumatic mental health:
QLD Anxiety Disorder Support Groups: