Living with TBI & PTSD

Most of the Veterans we talked to experienced ongoing symptoms of both TBI and post-traumatic stress disorder (PTSD). Some described the differences in how they experienced TBI and PTSD, whereas others weren’t sure how to distinguish between the two, or wished there was a better way to identify which symptoms could be treated and which needed to be managed.

What it feels like to have TBI and PTSD

Many Veterans talked about what it was like to live with both TBI and PTSD, how they experienced the differences between the two, or how the symptoms would interact. Ben said he knew he had PTSD “for the simple fact that, you know, my job was to kill…it wasn’t to make sandwiches.” For him, the primary difference was that with the PTSD his “threshold for bullshit is lower,” but with the TBI “I can be having a conversation with somebody and forget an aspect of what they’re saying or, because I’m a little foggy upstairs, interpret it differently.” For Max, the TBI has had a significant impact on his neurological and cognitive functions – like his ability to do mathematical equations - whereas PTSD has had more of an impact on his “emotional psyche.”

 

Max says that TBI impacts his neurological and cognitive functions, whereas the PTSD has more of an emotional impact.

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Max says that TBI impacts his neurological and cognitive functions, whereas the PTSD has more of an emotional impact.

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You know traumatic brain injury, you know, it’s going to impact the neurological, cognitive, the psyche, the, for me, it’s the mathematical equations. Before I left I was a respiratory therapist and was the lead RT. I was on flight teams. I went to codes, I ran to codes. I can, you give me a patient weight and I can give you the dosage that quick in my mind. I come back and I could barely remember - I know the dosage, one mg per kg, but I can’t calculate. It was so difficult for me to combine the calculation, and even as, even as a decade has passed, it’s still masking itself. It’s still difficult. People would say, you know, “That’s easy to know, you know, it’s eight times one” or whatever and to break it down I can see it, but the cognitive, the psychological, the remembering things, the basic remembering things, they were difficult, they were difficult for me. Driving, I know I had to drive to work, you know, the same route over, and I, you know, the cognitive process of just passing work and not even knowing that I, you’re supposed to stop here, you know.

So those were things that I saw, but the realm of PTSD was such a big thing in 2004. “Oh everyone’s getting PTSD,” that they were really trying to determine was it, and maybe it was, maybe it was PTSD because I, you know I, in 2004 in Iraq, I, 149 coalition members died in my hands. I literally tried to save 149 that I could not, they died. And that’s not even, that’s not even the ones that were, that were wounded. So there was PTS that I dealt with. But I just think that also, you know your head, your head is not trained to take jolts of RPGs and IEDs daily, nor is it trained to be in a concussion with a car explosion. And you’re wearing these helmets that causes an impact. Very similar to a football player, the high intensity impact that they’re seeing now. So yeah, that’s where I think the cognitive issue was a big issue with traumatic brain injury. I think the emotional psyche was the PTS. And I think that I‘m doing well with, but it’s the cognitive concepts, the remembering things. Just the basic stuff that people take for granted is, it was difficult. You know I, so my daughter is autistic - so I kind of come back to the point of that attention deficit issues with myself. I look at myself and I’m like, sort of, you know, I’m not getting that attention. I’m having a hard time concentrating - so it’s some of that right left brain balance is what I’m seeing with that traumatic brain injury. The fine motor skills sometimes. 

 

Ben has both PTSD and TBI and says his TBI has made him a bit foggy upstairs and causes him to interpret things differently.

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Ben has both PTSD and TBI and says his TBI has made him a bit foggy upstairs and causes him to interpret things differently.

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Well, I know I suffer from PTSD just from the simple fact that, you know, my job was to kill.
You know, it wasn’t to make sandwiches. So, and the TBI, I can definitely see that both sides. Like the PTSD I can see like when I’m dealing with somebody, my threshold for bullshit is lower. But with the TBI, they kind of, I mean, I can be having a conversation with somebody
and forget an aspect of what they’re saying or, because I’m a little foggy upstairs, interpret it differently, then the PTSD might come into it with, you know, like a little bit of the aggression. And, I would say with the TBI, not necessarily and I think people associate it with the PTSD, is my interpretation of things is very skewed now. And it’s not because of the PTSD that I’m like, oh, I’m always angry. It’s because I can’t necessarily understand the verbals or the non-verbals that someone’s displaying, and sometimes I’ll take it as they’re being offensive, and they’re not paying attention, you know. And I’m kind of being blown off. I’ll be honest, I’ve had a few times where, because I can’t convey my message, I’ll kind of start getting teary eyed because I’m embarrassed.

Several Veterans discussed how PTSD symptoms, like irrational fear, were compounded by TBI because the brain injury interfered with their ability to form a rational response to the fear.

One Veteran explained that when you have PTSD and TBI “not only do you perceive the world wrong, you think the world thinks you’re wrong, too, so there’s a, there’s a double-edged sword.” Alan said that in contrast to the cognitive issues associated with his TBI, his PTSD stemmed from things that happened during his deployment, and the feeling that he “could have done more, should have done more, could have done this better.”

 

John explains that PTSD is like an innate fear and TBI means that you don’t have a rational way of reacting to your fear.

John explains that PTSD is like an innate fear and TBI means that you don’t have a rational way of reacting to your fear.

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PTSD is like an innate fear, all the time. You’re afraid something’s going to blow up, you’re afraid something’s going to hit you, you’re afraid you’re going to be shot at. You’re afraid you’re going to have to perform medical procedures on your squad mates that you know so well, and you’re always - even though, rationally, yes, I’m here at home, I’m walking down the street. You see a car coming outside, you hear an explosion, anything like that, the fear factor goes in. And what happens when you’re really scared? You either fight or you run, and that’s what happens to them. So, for them, you’ve got that, plus you’ve got an impaired brain. Okay, you’ve got TBI, you’ve got an impaired brain. So, you’ve got the fear, but you don’t really have a rational way of even reacting like you would pre-TBI.

 

Alan describes feeling guilt about the times he couldn’t do more to help other guys on his team.

Alan describes feeling guilt about the times he couldn’t do more to help other guys on his team.

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Well, it feels. At first it feels like I could have done more, should have done more, could have done this better, so like, guilt. You know, watching somebody hit the ground, there’s nothing you can do about it. And then almost saying to yourself, god he hit right on the cement, maybe he should, he’s hurt so bad maybe we should just call it. You know, for him. It’s like oh my gosh this is, and it was pretty I mean, you didn’t know…so that type of feeling. That’s my buddy and I’m scared, you know, that feeling. Did I land my parachute close enough to him to help out, and other guys got to him first, and trying to get an airway, and I’m trying to think what are the drugs we need to give him to, so it’s just like I didn’t do enough. That was…

One night when we were flying in Iraq, I think back to a night we almost crashed. We were out looking for a helicopter that was missing and it was an army helicopter and they found it the next day. Because the weather was horrible, we lost sight of each other, two helicopters, almost hit the ground. Thank goodness for an American Airlines civilian pilot in the co-pilot seat. He’s like I’m taking over from the pilot who was in a group flying helicopters in the Army, never did instruments really, I mean knew about it but - this American Airlines guy that flew F16s and then helicopters was like, climbed out of there. Whew. That kind of haunts me back.

And then when this retirement thing happened, I was like I’m off the hook. I don’t have to go fly at night, even though I found it exciting. And I don’t have to go overseas, although I found that exciting, exhilarating. But, we almost died and there’s probably a few times that our flight, the guys in our helicopter, the flight engineers that were on com the whole time while we were getting ready, there’s time that - well we had other times where we thought you guys were on the com and you know, so…so all this pressure came off.

For others the distinctions were blurred, and although they knew – or had been told – that they had symptoms of both, it was harder to distinguish one from the other.

 

Although her memory issues are pretty clearly linked to TBI, Sarah attributes her short temper and anger to both TBI and PTSD.

Although her memory issues are pretty clearly linked to TBI, Sarah attributes her short temper and anger to both TBI and PTSD.

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It’s just one massive - because I haven’t really been able to evaluate enough what is, what, like I say, the memory issues I think are pretty clearly TBI because it’s beyond just like “Oh, I was stressed when that happened.” I know, I can be really calm and still not remember, you know, more than 12 hours ago. Long term memory is fine, it’s just the short-term memory that seems to be the issue. Like the, you know, “Where did I put my keys” and “What is it that I have next on my agenda” and if it’s not on my calendar it doesn’t exist. Because I, I won’t remember. I put like “Go to the grocery store after work” because if I don’t, I autopilot, I get home and like “Crap I was supposed to stop at the grocery store.” So yeah, I think the memory issues, the short, kind of the short temper and getting angry is, I think, a little harder to separate. Because definitely, I think, can be attributed to both. I think the severity of it is probably what I think distinguishes it from just PTSD. It’s not just a general like “Oh I’m angry all the time.” It’s like, I get, like I said there’s that switch, like, this is how I am 90% of the time. Like just very kind of, and then, and then it will just trigger it and so extreme, and it’s like, it’s, hear myself and like I, I’m aware of what’s happening but there’s a disconnect between how I’m feeling when I’m saying what I’m thinking, like even in the midst of it I think to myself like “Why am I so angry about this? Why are you freaking out about this” and it just like goes on autopilot and I can’t reel it in. 

 

Brian has ongoing symptoms from both his PTSD and TBI including speech problems and trouble with memory and concentration.

Brian has ongoing symptoms from both his PTSD and TBI including speech problems and trouble with memory and concentration.

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I don’t know if it’s more relevant to your study but I’ll mention it anyways, just nightmares, having flashbacks, still battling alcoholism. Alcohol abuse wasn’t a problem when I was in the military, but now it is, and just avoidance, isolation. But in terms of TBI thing, what I’ve noticed, sometimes it feels like I have a speech impediment or, I don’t know, jittery sort of deal, and also definitely memory and concentration which again could be PTSD or whatever. 

Finding better ways to understand the differences between TBI and PTSD

Some of the Veterans we talked to voiced frustration that their doctors were unable to tell them which symptoms could be attributed to which condition or how to move forward with treatment.

 

Andrew describes not knowing if his symptoms, like feeling disoriented in urban areas, are associated with TBI or PTSD.

Andrew describes not knowing if his symptoms, like feeling disoriented in urban areas, are associated with TBI or PTSD.

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Yes, I don’t think the way that other people do, and I don’t know if it’s a result of the TBI but my creative centers are pretty much gone. It’s funny because the doctor who studies the PTSD said it’s a result of the TBI, and the people who have TBI say it’s a problem with the PTSD. So, I have problems when I come into the city. It’s too much for me. I can’t handle it, and I’m trying to watch everything, and I can’t do it, and I just kind of flip out. So, the TBI guys said no it’s the PTSD. The PTSD guys say no it’s the TBI. Well, somebody take responsibility. I never ever, ever had to use a MapQuest before, and then this last couple of years I’ve had to start using MapQuest because I just - especially if it’s an urban environment. I can’t do it, remembering - because I used to be really - I mean, still if you get me in the back country and you tell me you want to go somewhere I’ll get there without ever looking at a map. I can’t do it in cities anymore.

 

Sarah wishes there was a way to distinguish between the symptoms of PTSD and TBI and to know which symptoms can be treated.

Sarah wishes there was a way to distinguish between the symptoms of PTSD and TBI and to know which symptoms can be treated.

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I would love to be able to distinguish between the two. I would love there to be like some sort of diagnostic test. Particularly for PTSD which, there again, there’s a branch of the Cohen Veteran Network that has been kind of really venturing into that kind of research and study. I have her card I’ll give to you too. Kind of trying to formulate some sort of diagnostic approach to, “Yes, you have PTSD” and like, “Yes you have TBI, and this is where that line is.”  Like, “This is what your TBI is affecting, this we can clinically treat. This is what your PTSD is affecting. This is what you can treat through counseling.” Because it’s very frustrating, I think, a lot of the times when you’re getting counseling for PTSD but these symptoms, just like nothing’s happening with this, and so you, kind of, you feel like you’re hitting this wall in treatment, when in reality you’re treating the PTSD, there’s just has nothing to do with it. And I think it would be, it would be helpful, and a lot less discouraging if I could say, “OK, this, this is what I’m going to be able to treat through counseling, and then these are the things that I’m just going to have to learn to manage.”

Others told us that, over time, they learned how to distinguish between the symptoms of PTSD and TBI, and that being able to tell the difference has helped in coping with both. David said that a lot of it comes down to “educating the Veteran on what the differences are.” He told us that he “had no idea what was what, until they literally broke it down for me and my wife, and then we started noticing and trying to see, you know, when I had TBI problems and when I had PTSD problems.” This has been helpful for him, and now that he is 10 years out from his injury, he tries to share this information with other Veterans.

 

David talks about learning to distinguish between the symptoms of TBI and PTSD.

David talks about learning to distinguish between the symptoms of TBI and PTSD.

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I think the initial onset, you know, is very similar. The same thing always. But once you, you get bounced out, and you start getting medication and treatment that you can actually see and distinguish a difference between the conditions that are caused by the TBI and conditions that are caused by PTSD. It has a lot, it also has a lot to do, educating the Veteran on what the differences are. Because I had no idea what was what, until they literally broke it down for me and my wife, and then we started noticing and trying to see, you know, when I had TBI problems and when I had PTSD problems.

I: How did they break it down for you? Like what was the way they categorized between the two?

So, when it started we were breaking down, like single symptoms, you know, the different symptoms, like, it might have an indication of balance for my PTSD, then that obviously, if you already know the side effects, so if you have balance problems that’s not attributable to the medication you’re taking, because you know what the side effects are, you know how to execute things like that. You know, if you know that the stuff you’re taking for something else, PTSD doesn’t cause headaches, then obviously most of the time you know. And I’ve been taking meds for years so I know that the stuff doesn’t adversely affect me with, you know, headaches or balance or visual problems, you know, those types of things. And then I also, you know, I have seasonal allergies so you know, I know when, I know if my headache caused by my allergies feels like or, you know, how to notice that versus a headache that might be caused because I’m high stress on PTSD at the time. 

I: Is it helpful for you to be able to kind of distinguish between the two? 

To me it is, but again, I’m at ten years from my injury, so it’s a lot different than other guys. And I was forced to kind of live and deal with what I have, where a lot of guys with TBI, let’s say they’ve been in, you know, multiple grenades or IED attacks, and walk away from them, they’re just starting to try and figure out what’s what, you know, and getting treatment for both at the same time. But for me, generally speaking, it is very helpful and, you know, I share that information with other guys who, you know, have that problem or are told that they have that problem. 

 

(See also: TBI Screening & Diagnosis; Evolution of TBI Understanding; Ongoing Physical Symptoms)