As a psychologist, do you treat TBI and PTSD together or separately?
[Lt. Col. Jeffrey Yarvis] PTSD and TBI share a a lot of common symptoms.
There is a very faint nosological or diagnostic boundary between the two.
And often they are treated separately, and so they can be
confounding and create confusion in the person with them.
And I guess the first thing I would say
is that these wounds in general because they are difficult to decipher
and they are invisible are different than a physical injury.
When somebody has a physical injury with a TBI
and there is intracranial involvement, I say this carefully, it's obvious,
and so their very appearance sort of rallys support to them.
So if they have an amputation—not that I would trade places
with that individual—but they are viewed as somebody who
has probably also sustained a TBI and probably has some kind of post-traumatic stress response.
And they are given a lot of social, emotional, and medical support
rightfully so, but when these wounds are invisible and—if you will—
your gray cells get mushed together and your marbles get rolled around,
it is very hard to describe, and it is very hard to know what is going on.
And you may not even know what is happening to you.
And so warriors know now that these are signature injuries
of the war that we have done a lot to reduce stigma,
but what we have done at Fort Belvoir is we have tried to
integrate the services together to address them simultaneously.
And that way the warrior does not feel confused about, "Why didn't they
address my TBI or PTSD."
And because they share symptoms what we typically like to do is
rule out the psychological symptoms first.
And part of that is also because sometimes when you wait with TBI
the symptoms abate a little bit, and so we also want to educate
them about those symptoms. So some of the shared symptoms
are the emotional dysregulation that might manifest itself
as anger or outbursts or impulsivity.
There is a certain degree of anxiety that comes with these changes and behaviors.
So PTSD is really an anxiety disorder—you know—with some other
unique features to it, but when you have a change in functioning
it is also anxiety producing on top of what
might have actually caused the initial injury.
And so those two things become confusing.
And then with those symptoms there is a certain degree
of masking your previous performance levels.
And so often there is an assumption that there is a traumatic
brain injury because my cognitive functioning or my ability to
concentrate, for example, is not quite the same.
And then as a result of that anxiety or that hypervigilance that they both share
there is often also sleeplessness which makes those symptoms worse as well.
And so we try to figure out whether it is organic
or whether it is psychological.
Now if we know there has been a physical injury
then we often will—you know—target right away the neurological
symptoms associated with TBI, but if there hasn't been
some kind of documented or pretty credible
report that that has happened then we may target the psychological symptoms first.
Show transcript | Print transcript
Click here to see other video Q&As with Lt. Col. Jeffrey Yarvis, PhD.
Click here to return to our BrainLine Military Ask the Expert feature.
Produced by Victoria Tilney McDonough and Erica Queen, BrainLine.
Lt. Col. Jeffrey Yarvis, PhD is the first integrated service chief of the Fort Belvoir Community Hospital. He is an assistant professor of Family Medicine and director of Social Work at the Uniformed Services University of the Health Sciences.
The contents of BrainLine Military (the “Web Site”), such as text, graphics, images, information obtained from the Web Site’s licensors and/or consultants, and other material contained on the Web Site (collectively, the “Content”) are for informational purposes only. The Content is not intended to be a substitute for medical, legal, or other professional advice, diagnosis, or treatment.
Specifically, with regards to medical issues, always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Web Site. If you think you may have a medical emergency, call your doctor or 911 immediately. The Web Site does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Web Site. Reliance on any information provided by the Web Site or by employees, volunteers or contractors or others associated with the Web Site and/or other visitors to the Web Site is solely at your own risk.