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So often people talk about the effects of traumatic brain injury or the consequences of post-traumatic stress disorder as separate conditions — which they are. But for the person who is living with the dual diagnosis of TBI and PTSD, it can be hard to separate them. The person with TBI and PTSD is living in a state unlike anything previously experienced. For the family, home is no longer the safe haven but an unfamiliar front with unpredictable and sometimes frightening currents and events. While awareness of PTSD has greatly increased with recently returning service members and veterans, it is not new and nor limited to combat. Anyone — children, adolescents, adults, elderly — who is exposed to a life-threatening trauma can develop PTSD. Car crashes, shootings, floods, fires, assaults, or kidnapping can happen to anyone anywhere. But the rate of PTSD after brain injury is much higher in veterans than civilians due to their multiple and prolonged exposure to combat. Individuals with PTSD are at increased risk for depression, physical injuries, substance abuse, and sleep problems, which in turn can affect thoughts and actions. These risk factors also occur with brain injury. PTSD is a mental disorder, but the associated stress can cause physical damage. TBI is a neurological disorder caused by trauma to the brain. It can cause a wide range of impairments and changes in physical abilities, thinking and learning, vision, hearing, smell, taste, social skills, behaviors, and communication. The brain is so complex, the possible effects of a traumatic injury are extensive and different for each person. Changes in cognition such as memory and concentration, depression, anxiety, insomnia, and fatigue are common with both diagnoses. It may help to consider and compare changes commonly seen with TBI and PTSD. Memory TBI: A period of amnesia for what went on just before retrograde amnesia or after anterograde amnesia the injury occurred is common. The length of time minutes, hours, days, or weeks of amnesia is an indicator of the severity of the brain injury. For example, the person may have no memory of what happened just before or after the car crash or IED explosion. PTSD: In contrast, the person with PTSD is plagued and often haunted by unwanted and continuing intrusive thoughts and memories of what happened. The memories keep coming at any time of day or night in such excruciating detail that the person relives the trauma over and over again. Sleep TBI: Sleep disorders are very common after brain injury. Whether it is trouble falling asleep, staying asleep, or waking early, normal sleep patterns are disrupted, making it hard to get the restorative rest of sleep so badly needed. PTSD: The mental state of hypervigilance interferes with slowing the body and mind down for sleep. Waking up with night sweats so drenching that sheets and clothing are soaked. Flashbacks so powerful that bed partners have been struck or strangled while sleep battles waged. Isolation TBI: Many survivors of TBI recall the early support and visits of friends, relatives, and coworkers who gradually visited or called less often over time. Loss of friends and coworkers leads to social isolation, one of the most common long-term consequences of TBI. PTSD: The isolation with PTSD is different as it is self-imposed. For many it is simply too hard to interact with people. The feeling of exposure outside the safe confines of the house is simply too great. The person may avoid leaving the house as a way of containing stimuli and limiting exposure to possible triggers of memories. The person may unexpectedly burst into tears or laughter for no apparent reason. This can give the mistaken impression that the person is mentally ill or unstable. PTSD: Emotional numbness and deadened feelings are a major symptom of PTSD. This emotional shutdown creates distance and conflicts with spouses, partners and children. It is a major cause of loss of intimacy with spouses. Fatigue TBI: Cognitive fatigue is a hallmark of brain injury. Thinking and learning are simply harder. Building rest periods or naps into a daily routine helps prevent cognitive fatigue and restore alertness. The fatigue is physical, cognitive, and emotional. Feeling wrung out, tempers shorten, frustration mounts, concentration lessens, and behaviors escalate. Depression TBI: Depression is the most common psychiatric diagnosis after brain injury; the rate is close to 50%. Depression can affect every aspect of life. While people with more severe brain injuries have higher rates of depression, those with mild brain injuries have higher rates of depression than persons without brain injuries. PTSD: Depression is the second most common diagnosis after PTSD in OEF and OIF veterans. Anxiety TBI: Rather than appearing anxious, the person acts as if nothing matters. Brain injury can affect the ability to initiate or start an activity; the person needs cues, prompts, and structure to get started. PTSD: Anxiety can rise to such levels that the person cannot contain it and becomes overwhelmed by feelings of panic and stress. It may be prompted by a specific event, such as being left alone, or it can occur for no apparent reason, but the enveloping wave of anxiety makes it difficult to think, reason or act clearly. Talking about the Trauma TBI: The person may retell an experience repetitively in excruciating detail to anyone who will listen. Such repetition may be symptomatic of a cognitive communication disorder, but it may also be due to a memory impairment. Events and stories are repeated endlessly to the frustration and exasperation of caregivers, friends, and families who have heard it all before. PTSD: Avoidance and reluctance to talk about the trauma of what was seen and done is a classic symptom of PTSD, especially among combat veterans. Anger TBI: Damage to the frontal lobes of the brain can cause more volatile behavior. The person may be more irritable and anger more easily, especially when overloaded or frustrated. Arguments can escalate quickly, and attempts to reason or calm the person are often not effective. PTSD: Domestic violence is a pattern of controlling abusive behavior. PTSD does not cause domestic violence, but it can increase physical aggression against partners. Weapons or guns in the home increase the risks for family members. Any spouse or partner who feels fearful or threatened should have an emergency safety plan for protection. Substance Abuse TBI: The effects of alcohol are magnified after a brain injury. Drinking alcohol increases the risks of seizures, slows reactions, affects cognition, alters judgment, interacts with medications, and increases the risk for another brain injury. The only safe amount of alcohol after a brain injury is none. PTSD: Using alcohol and drugs to self-medicate is dangerous. Military veterans drink more heavily and binge drink more often than civilian peers. Alcohol and drugs are being used often by veterans to cope with and dull symptoms of PTSD and depression, but in fact create further problems with memory, thinking, and behavior. Suicide TBI: Suicide is unusual in civilians with TBI. PTSD: Rates of suicide have risen among veterans of OEF and OIF. Contributing factors include difficult and dangerous nature of operations; long deployments and multiple redeployments; combat exposure; and diagnoses of traumatic brain injury, chronic pain, post-traumatic stress disorder, and depression; poor continuity of mental health care; and strain on marital and family relationships. Veterans use guns to commit suicide more frequently than civilians. While each diagnosis has distinguishing characteristics, there is an enormous overlap and interplay among the symptoms. By pursuing the quest for effective treatment by experienced clinicians, gathering accurate information, and enlisting the support of peers and family, it is possible to chart a course through the troubled waters to a safe haven. Veterans and Brain Injury. In Living Life Fully after Brain Injury: A workbook for survivors, families and caregivers, Eds. Managing Depression, Anxiety, and Emotional Challenges. In Living Life Fully after Brain Injury: A workbook for survivors, families and caregivers, Eds. Marilyn Lash, MSW has more than 35 years experience working with individuals with disabilities and their families in medical, rehabilitation, educational, and vocational settings. Her primary focus is supporting families and developing community programs along with user-friendly publications for families, educators, and clinicians. Marilyn recently joined a team of specialists who facilitate retreats for wives of wounded warriors, which take place near military bases around the country. She is a former chair of the Board for the Brain Injury Association of North Carolina and former chair of the Brain Injury Advisory Council for North Carolina. She continues to share her insights as a keynote speaker at many brain injury conferences. The doctor told me I'm going to have seizures when I get older but in 2000 I was shot plus my son was killed. I have a hard time remember which was first and the dates? An administration appeal judge has ordered the county to reevaluate my case and my social worker denied benefits and closed my case so I reappeared. This new administration judge is making me prove my disability now. I was given SSI benefits for PTSD in 2000 well that when I applied. So when my epilepsy seizure started I told SSI and IHSS about my new disorder, now this is 2018 I have to prove my PTSD to the administration appeal judge and social worker, my TBI and PTSD disorders, Chronic kidney disease and TB is the perfect storm, now my special needs are being denied I need compensation for court orders denials, mental abuse and physical abuse, I'm in Los Angeles Ca. Skid row my case now is in Rancho Dominguez office 75 case number 0661533, I think my memory cognitive abilities are gone, I've stressed out to the maximum no families support couple with I fine it hard to trusts anyone. Please help with any ear. Our lives have been destroyed.. I always say because I love him and I want to know that I did everything that I could possibly do to help him... Sometimes we have to learn to let go and let them make that decision of help on their own.. I often cry knowing that our youngest child has never known what an awesome, loving and caring father he once had but those memories have long faded away for him.. I often wonder if it would be easier for me to let go if I had never known that kind, caring, wonderful, full of love person that was so great... I'd like to offer one bit of info. I've been a volunteer with therapy horseback riding centers for several years and my horse is a therapy horse at this time. I have seen such dramatic improvements in Military people who have tried this, and some have never touched a horse ever in their lives. Find a PATH center in your area and just give it a try. Military are NEVER charged for a session. Negative, even suicidal people have come out with a whole new outlook. Not a guarantee, just some possible hope. Thanks so much for opening my eyes!!!! The VA in Illinois has had me flying blind! Like it's an issue of attitude or something I have the ability to control. Sorry but after reading this, Yes, I am here to rant about the VA! They are either horribly under-educated or just want to push meds! They downplay everything so when it's time for a re-evaluation they can try to get your rating reduced! Seems like everyone who is good and understands is fired or let go! Replaced with someone that tries to convince you that there's an ordinary explanation for every individual symptom you have other then being real with you about your condition! Like trying to cover up the fact that military service, blasts, and fighting in Iraq had everything to do with it! I was always told horror stories about the VA but I never would have dreamed that I would be experiencing it firsthand! I thought these people were here to help us! I guess in Illinois they are setting us up for failure! Sorry for the long vent! They keep denying my tbi which is in my records. They finally approved me for ptsd after years of denials and me being pretty much homeless and broke and lost. Bad enough dealing with ptsd after a 15 months deployment where you left the wire daily, but then we have TBi which they downplay and are trying to blame a mood disorder like bipolar which i never had before. My cognitive functions have been getting worse and worse over the years after multiple blasts and concussions to the head. My head even swells up. They also employ trainees it seems or people who can't get jobs in other hospitals so they come to the VA i believe and take the lower pay. Something really needs to be done about our VA healthcare. They frustrate the veteran to a point where they feel hopeless and just give up altogether. I can imagine what the ww2 and nam vets went through. Keep your head up brother and stay strong. US army combat veteran. In 2006 I was denied treatment. Evidently, the hospital was not prepared to handle The National Guard and reserve coming home from tours from Iraq and Afghanistan. And it is my opinion today that the general lay personnel and nurse practitioners primary have the training to do what is needed for these dual diagnosis. Plus the other physical ailments compressed spine, TBI, dislocated shoulders. VA will say only one diagnosis for every 6 months which has been my case. I received my wounds in 2005 and I'm still just starting to get treated for some of them. But the TBI and PTSD have made me homeless, isolated, and embarrassed to show my face to anybody that I once cared for including my children and family. I do have the fake world of Facebook though. I was treated terrible in service with an attack. I have always suppressed this and it took 23 years before I was even aware of the help I might seek from the V. I was diagnosed rather quickly with PTSD and started council. The first psychological council seemed to help but she retired and I was left with another that seemed to not understand. The next was group therapy. This only onset more of my depression. One-on-one worked a little better but she has been out due to her life threatening challenges. I'm back to myself with no help with council. I do not feel suicidal and try real hard to stay positive but looking at medical records the headaches that are debilitating for few days at a time. The headaches have increase with physical and or mental stress so I just do what I can to stay calm and try not to push. I do not and cannot work but I could use a more steady councilor that is more in tune with head trauma and PTSD. I also have a neck injury that leaves me with plenty of reasons not to do too much. After 6 years with the VA no one has helped me understand this. Thanks for your article. Have a nice day. The VA could use more councilors trained in this area. She has developed possible p. From the voids in her life she wants badly. Her delusions seem to be caused from her desires and scary night terrors. Said we had to do this or they stop paying that was more like an interrogation.. She was happy and easier for 7 years and now personalty changing to depression seclusion and combative. Difficult to trust anyone docs anymore. We've come so far and to just let go is not an option, I don't want her to get hurt or hurt anyone. Reply if you have advice or support, thanks! And you are right you have to earn the right to hear about my PTSD and my TBI I'm going to tell you every time. Depression is death when and how. The only thing keeping me alive are my heavy medications. There is too much to say about all of this and it's hard finding people that understand the extent of these injuries. I felt so ashamed and so alone at tines. I couldnt do enough to make my moms boy friends happy enough. I was hit by a speeding car when I was 5yrs of age beat with a 22 cal pistol when I was 20. I've attempted suicide I've atenpted in 2012 and thank God the chamber had locked up. Thoughts of depression and suicide run thorough mind everyday uncomfortable feeling. I don't like it. December 7 2012 scares me. I wish there were support groups for those who struggle with this same thing I do. I found out i have lived with ptsd and tbi for 27 years. Thank god i went too er was having hallucinations unrelated to tbi but was found then. I was an explosion in 1987 in lav.. To my knowledge now was first time used in our unit. I was a test dummy so too speak. I was medic at time. Treating others and unknowing my self.. Im lucky im alive and back in Va care. It helps me every day make a difference in a positive way. I am a person who was assaulted. After the assault I was a functioning alcoholic. I know too well that would be catastrophic! I never asked for this life, however I have two options 1. Keep fighting or 2. I was a high achiever that lived a very successful fulfilling life! One thing though the choice is mine to keep fighting or give up! I truly understand the battles each any everyone of you face! I have joined a number of support groups on Facebook which have validated my illness! I am building the 'guts' up to so a 12 week program at one of the most successful programs in Australia. I accept I will never have what I had but I need at least half of my old life back! I'm not surprised as I picked up on some cognitive issues, mood swings and withdrawal. His injuries were sustain while serving. He called to tell me and he is now pushing away from me. Telling me to move on with my life. He is fearful he will harm me unintentionally, or be a burden. My position is I love him... Should I give him his space to sort out the implications if the diagnosis. I can't imagine being with any other man; I love him deeply. Am I being foolish?? I can't begin to imagine what he is experiencing. I just know that he needs me to be there. Sometimes you can read articles like this one in an attempt to understand what she or he is living, sometimes are you trying to convince yourself that you can love them enough. I think it's a testament of strength and loyalty to have the back of your beloved vet. Given the sacrifice and the emotional and physical that may constitute the new version of your amazing person. Don't take it to heart, be proud them and yourself. He tells me to go away and leave him alone..... Like that's going to happen.... Love him to much. I've been a serious opiate addict from '99 on! Last xmas the woman i've lived w died. I found my best friend August 8, after 2days and it wasn't pretty! I think about suicide practically every day! I don't take chemicals pharmaceutical anymore,... I am a female veteran with PTSD and TBI. No big surprise I'm single. Those who have significant others... They know you have problems but they love you away. Don't jump on them for not understanding... We all the PTSD and TBI combination sucks but that doesn't mean life has to. I know finding enjoyment in life can be like trying to find a needle in a hay stack but keep digging. The process will keep you alive and the findings will keep you grateful for life. Keep fighting the good fight friends and comrads. And when you can't fight take a nap and when you can't take a nap tell someone you who loves you and knows you that you need a hug. I don't know yall but I love you all and you're not alone. I've been dealing with what I believe to be Both, TBI and PTSD on my own, since 2003. I just cannot get myself to go to the VA. I hate that place so much. I hate everything about them. I get one to two migraines a week from an injury sustained in Iraq. When I was in the Army, I never had an issue getting my meds, they were always on time, and as I grew immune, they would change it up. When I ETS'ed out of the Army, and the VA took over, I was without meds for 3 months. They messed everything up and what really bothered me the most, was their apathy for the whole situation. I finally walked out and never went back. I've been struggling out here on my own with migraines, anxiety so bad that I throw up in the morning if I know I have to leave my house that day. My memory, and thinking are shot and I am just burnt out. I am afraid to tell the VA about my condition in fear that they will use it against me and treat me like I am some kind of liability. I am not a violent person. I would never harm another person or animal. I just don't trust them and I don't know how much longer I can keep doing this on my own. Civilians could care less about my injuries, and its hard to keep a job, and keep an employer happy with 1 to 2 migraines a week. I get nervous, and at times I have to be alone so I can calm down and steady my nerves. I am sick of apologizing for my condition and working through the pain day after day. I won an award for the last company I worked for. I was one of only a couple of reps in the nation this is a Forbes company to achieve this goal. I couldn't even go to the dinner with the top leadership because I was afraid I would not be able to handle it and look like an ass in front of them. I even asked if I could use my personal days for migraine days instead of vacation days like everyone else uses them for and my manager said no. I was new to the company so I had to wait one year before I was eligible for FMLA. How am I supposed to live like this? I have no choice but to return to the VA and everything inside of me cringes at the idea of that. I am no longer near Detroit though, so perhaps a different location will be better. Sorry for the babble… just need to vent sometimes. I have both PTSD and a TBI I spent 2. I have been a fish out of water since. I have spent over half my life this way. I am very intelligent, and find most of this life a bore. I listen to everyone, but find most to be myopic. People who are supposed to help are to busy trying to label you, for then they don't need to spend time thinking about me, or more often they want to give you more medicine so you lose free thought. They want to manage you as if you are a pet that can learn tricks, and point to as a success. I want more, and in fact need more. This life is becoming a waste of time. We might suffer from TBI and PTSD. It is simply the attitude of some people towards folks like us. This has always occurred in the past and present for all war vets and regular folks with no combat time. This the main cause. People Factor is the Key. So to all my fellow sufferers It is not you ,it is the attitude of the people above you that just don't to give what you need; just out of greed and selfishness. Eventually it will catch up with them. I have met them all. IT S NOT YOUR FAULT,IT IS NOT OUR FAULT! They are the perpetrators! From all nationalities and races. Corrupt to the max! I suffer mostly from night terrors and major night sweats... It is a blood pressure medicine that makes it hard for your brain receive signals from adrenaline that increase with nightmares and flash backs... Thought this might help you... Getting decent sleep is the corner stone to combating this illness and Prazosin has had a tremendous positive effect for many suffering like us... Ask your doctor about it if you haven't already been offered this as an option. Very generic response here, cant list all info or would take a full website. It was the result of a car wreck, I was not driving. I also suffered a DVT in my left leg. I have been diagnosed with anxiety, depression, PTSD, TBI, and a few other issues, but still do not qualify for disability when it comes to the US Government. I was considered a disabled student, but that's about it. Since the accident, I've been able to find work for a total of maybe 3 years out of 16 years. I've graduated college, with honors, but no one wants to hire me. I try to do my best, but every employer views me as a liability because I'm not like everyone else. Talk about feeling completely useless! I've kept to myself and held in 96% of all of my emotions over the years, but I'm almost to a breaking point. I just want to let others that have TBI's know one thing.... Please don't ever give up. Life may suck, but it is still life and something to complain about. Not a day goes by that I do not think about taking the easy way out, but I found an understanding and loving girl and have a wonderful family to keep me going. Without them, I know for a fact that I would have ended my life long ago. I guess I'm just still struggling with dealing with the fact that it probably will be all I ever have... I want to work, I want to design, I want to market, I want to live. O how i curse the dreaded TBI. Subarachnoid hemorrhaging, not a day goes by that I do not feel your presence bulging through my mind; preventing me from living the life I obsess over each and every day... If anyone reads this and wants to help out, then please by all means do. My family and my therapist are my support system. I am not a veteran and am paying out of pocket for my treatment. I have done exposure therapy, bounce therapy, EMDR, talk therapy and do lots of cardiovascular exercise. I have two dogs that help me motivate even on really tough days to get out and move. They are also wonderful for loving me unconditionally. I would never wish anyone to have to live with this combination. I dont know if I would say navigating would be the way I would describe what I and others like me am living.... I would call it SURVIVING. Remember not to take it personal if your loved one has TBI and PTSD. If you stigmatize PTSD as the article does anger, confusion, anger, suicide, blaming the Veteran for the loss of intimacy, ETC do you think that may contribute to: The Veteran being isolated by others, furthering the isolation? The fear of talking to brainiacs, who can institutionalize you, resulting in losing of RIGHTS, ETC, the Veteran fought for? And that has a negative effect on all the rest!!! So, brainiacs, maybe getting input from actual combat veterans, who also might have also have an education not to mention COMMON SENSE just might help? Sadly, he suffers from PTSD and TBI due to an explosion that he was victim to while serving. He has depression and social anxiety, so it's been difficult getting through to him lately. But just during the few wonderful times we've spent together, I truly know he's the one for me. He's had a hard time dating because a lot of women don't see past his challenges. I can see straight into his heart. And there I see the most loving, kind, intelligent, funny, creative, gentle, brave and handsome man I've ever met in my life. I know he's going through a very hard time right now... I pray for him every single day, morning and night. He's always on my mind. I won't ever give up on him or ever stop praying for his full recovery and restoration. I would give anything to hear him laugh, see his amazing smile and stare into his beautiful brown eyes again. One day with him would be worth a lifetime of waiting... Most difficult of all, however, is getting THAT person to understand the likely cause, especially when you live in an area where all the so-called healthcare agencies and social services DENY the existence of TBI and refuse to read anything like this excellent article. Extremely frustrating to KNOW this and not receive the help you need to help your loved one -- on the contrary - we are being assaulted by local agencies - I am in particular, simply because I believe what I see and what has happened - because I am the only one NOT in denial in this scenario. I had issues accessing the VA system after I got hurt. Went elsewhere in the meantime. They had no clue how to assess me. I was directed to the Vet Center in my area. They took me right away. It was maybe 2 weeks until they'd figured out that I had both and started treating me for both. They even assigned me to a counselor who'd had similar experiences. Probably saved my life. To anyone coming home and wondering if they might have PTSD or TBI or just having trouble transitioning to civilian life, there are folks out there who will help! These are NOT the VA. Though they are Federal, they have a level of confidentiality for help issues that the VA does not AND you will be among other veterans who KNOW the 'theater of war', which is very different than what a stateside or peacetime veteran can really comprehemd! The reps and cpunselors at the vet center's WILL help ypu! I suffered for many years with increasing isolation and a boatload of other negative stuff I am still trying to get through. The VA hospitals can help up to point but... I wish someone had bothered, including my caregivers at the VA's to be more positive about and point the way but truth is, most VA's don't really 'like' vet centers because they can't bully them. So many war vets suffer... So you women war veterans don't fall for that MST game they try to lay on the sisters in arms. That's the few 'old brass' dude's in the DOD trying to get political. The old men who still living with WW2 mentalities. I ain't talking about the vets, I'm talking about dudes who live in a time gone by and want everyone else to as well. But if you did suffer MST, and that happens to ALOT of dudes too btw, then say so cause any POS that would harass a brother or sister in arms don't belong with those who 'stand strong'. They offend our dead. And ANY vet can go to a VA ER if need be, so long as you have your dd214 and were honorable. Don't find reasons to die, find reasons to live. Those who fell are with us always. Let their lights shine above you when it gets dark and don't stay alone for too long in that dark. You do NOT have to talk about n e thing too tough at a vet center, so don't worry about feeling over exposed. But the reps at these places can help make sure you get in safe housing if you need or want it and help with just Life stuff. AND btw, PTSD is horrible. Ignoring it for years for whatever reason, could result in it becoming entrenched and trust me when I say that is a bad, bad thing. Combine that with a brain injury, and even the people you think would never leave your back, will. It's imperative you get help to put a buffer, neutral zone, anything between your symptoms and your friends and family. I won't ever tell my fam all the bad ðetails, but I might tell an objective party, see? So, just don't be the lone wolf. There's nothing sexy or romantic about it and NO ONE is waiting to give you a medal for suffering all alone. And you'll find that out all by yourself too. Get your physical done at a VA and the rest? Get to a Vet Center. Nothing's easy about this my brothers and sisters in arms. But, it might be more bearable if we watch each others six. You either been in one or you ain't. Those of us who have might respect you peacetime or stateside support service, but don't you even try to front. I put any female in a war up against any stateside peacey bro in a ny minute. If you can't muster respect, keep your yaps shut and go play golf. Heads up to all my war fam. We're survivors,so let's survive together! And don't vote for any punk clown who tries to subtract or sneak on the VA, VBA, or vet center budgets!