Combat Stress & Co-Occurring Conditions

Combat Stress & Co-Occurring Conditions

TBI Basics

Criterion A

Traumatic Brain Injury (TBI) is a disruption of normal brain function caused by a blow or jolt to the head.

Post-Traumatic Stress Disorder (PTSD) is a major mental health disorder based on four criteria.

Warning Signs

Criterion B

Symptoms

Criterion C

Criterion D

TBI & Aggression

Substance Use Disorder (SUD) covers a range of disorders connected to substance use (alcohol and both legal & illegal drugs).

Depression is a common issue for both servicemembers and veterans.

Statistics

SUD & Veterans

Symptoms

Warning Signs

tRAUMATIC bRAIN iNJURY

TBI Basics

• Not all blows or jolts to the head result in a traumatic brain injury.
• TBIs can be classified as mild, moderate, severe, or penetrating. The most common form of TBI in the military is mild. Another word for a mild TBI is a concussion.
• In 2017, almost 18,000 service members were diagnosed with TBI. The highest concentration of TBIs is within the Army.
• The leading causes of TBIs are blasts, bullets, fragments, falls, motor vehicle crashes or rollovers, sports, and assaults. The leading cause of TBIs for deployed servicemembers are blasts.

Depression & The Military

Symptoms

Major depression is when a person experiences 5 or more of these symptoms and a depressed mood or loss of interest for at least 2 weeks:

• Depressed mood
• Diminished interest or pleasure
• Significant weight change
• Sleep disturbances
• Slowed responses
• Agitated behavior
• Fatigue or loss of energy
• Feeling worthless
• Impaired concentration
• Thoughts of death or self-harm

Substance Use Disorder

SUD and Veterans

It is common for servicemembers and veterans to use drugs & alcohol after deployments to cope with combat stress, relax, sleep, or forget. For some, this may turn into misusing substances to the point where it affects ther life. We know that while substance misuse does not cause abuse, it can affect the frequency & severity of abuse.

tRAUMATIC bRAIN iNJURY

Symptoms

• Headaches
• Sleep disturbances
• Dizziness, balance problems
• Visual disturbances
• Nausea/vomiting
• Fatigue
• Sensitivity to light
• Ringing in the ears
• Concentration problems
• Gaps in memory
• Slowed thinking
• Irritability
• Anxiety
• Depression
• Mood swings

tRAUMATIC bRAIN iNJURY

Warning Signs

• Worsening headaches
• Worsening balance
• Double vision or other vision changes
• Decreased level of alertness Increased disorientation
• Repeated vomiting
• Seizures
• Unusual behavior
• Amnesia/memory problems

If someone has any of these symptoms after experiencing a blow or jolt to the head, they should seek medical assessment for TBI.

PTSD Criterion C

Avoidance

• Efforts to avoid thoughts of original events
• Efforts to avoid activities, places, and reminders that arouse memories
• Inability to recall important parts of the trauma
• Decreased interest in activities
• Feeling detached or separate from others
• Restricted ability to feel and express feelings
• Sense of a shorter future

Depression & The Military

Statistics

Of the servicemembers who have served in combat since 2003, 13 - 15% have reported symptoms of depression. Veterans have high rates of depression, with lifetime prevalence rates 2 - 3 times higher than the general population. A 2009 study showed that veterans of the wars in Iraq & Afghanistan with major depression had a suicide rate 9 times higher than those without major depression.

PTSD Criterion D

Increased Arousal

• Sleep disturbances
• Irritability or outbursts of anger
• Difficulty concentrating
• Hypervigilance (constantly being tense or on-guard)
• Easily startled

In addition to meeting Criteria A - D, a person must have experienced these symptoms for at least one month, and must have experienced significant distress or impairment in social, occupational, or other important areas of functioning.

tRAUMATIC bRAIN iNJURY

TBI and Aggression

It is common for people with a moderate-to-severe TBI to exhibit aggressive behavior within the first year after injury. Aggressive behavior can also be a symptom of other pre-existing issues, like severe mental illness or substance misuse. TBI can also change how a person interacts with others. For example, a person with TBI may have trouble interpreting social cues, or may have behavioral reactions that are out of line with what’s happening. Small incidents may be misinterpreted and responded to with aggression. Like with PTSD, we want to assess for a pattern of coercive, controlling, or abusive behavior in addition to the TBI symptoms to determine if there is abuse present or not.

PTSD Criterion A

Original Experience

A person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others AND A person’s response involved intense fear, helplessness, or horror

PTSD Criterion B

Re-Experiencing

• Intrusive, distressing memories
• Distressful dreams or nightmares
• Acting or feeling as if the traumatic event were recurring (flashbacks, hallucinations, illusions, etc.)
• Intense psychological distress when exposed to triggers
• Physical reaction when exposed to triggers

Substance Use Disorder

Warning Signs

• Decreased energy, loss of appetite
• Unexplained injuries & falls
• Denial of substance use problem
• Irritability, agitation, anxiety, mood swings, depression, difficulty concentrating, memory lapses, blackouts
• Poor work performance
• Spending more time in activities involving alcohol or drugs