Brain Damage Can Provoke a Mental Disorder in the Military - Research Paper Example

Link Between Mild Traumatic Brain Injuries (MTBI) and Post Traumatic Stress Disorder (PTSD) in Returning Combat Veterans “Mild traumatic brain injury (MTBI) is common among military personnel and veterans who served in Operations Iraqi Freedom and Enduring Freedom (OIF/OEF). Among soldiers deployed in OIF, 22.8% had traumatic brain injury (TBI), predominantly MTBI” (Ruff et al., 2010). Different types of injuries may occur to soldiers while they participate in wars. Soldiers often have a habit of taking minor injuries lightly. However even minor head injuries may create chronic problems in the life of the soldier. Different researches and studies have proved that mild traumatic brain injury or MTBI may cause Post Traumatic Stress Disorder or PTSD. According to Sayer (2009), “PTSD is an anxiety disorder that follows exposure to life-threatening experiences such as war, sexual assault, homicide, motor vehicle crashes, and natural disasters. The sufferer vacillates between the intense distress associated with unwanted trauma-related memories and psychic numbness” (Sayer, 2009, p. 704). This paper reviews the literature available to establish the link between mild traumatic brain injuries (MTBI) and post-traumatic stress disorder (PTSD) in returning combat veterans. Literature Review The connections between MTBI and PTSD were well documented by Pietrzak et al., after conducting a survey on 277 OEF/OIF veterans. These results showed that those who experienced MTBI in the past have developed PTSD later in their life. The details and findings of this survey are given below. A total of 277 OEF/OIF veterans completed the Connecticut OEF/OIF Veterans Needs Assessment Survey; 18.8% of the sample screened positive for MTBI. Compared with respondents who screened negative for MTBI, respondents who screened positive for MTBI were younger, more likely to have PTSD, more likely to report fair/poor overall health and unmet medical and psychological needs, and scored higher on measures of psychosocial difficulties and perceived barriers to mental healthcare. Injuries involving loss of consciousness were associated with greater work-related difficulties and unmet psychological needs. PTSD mediated the relationship between MTBI and all of these outcomes (Pietrzak et al., 2009). The above results clearly establish the close relations between MTBI and PTSD. It is not necessary that all the people with PTSD may have experienced MTBI in their past life. At the same time, those who experience MTBI can most probably experience PTSD in future. Sayer (2009) also upheld the findings of Pietrzak et al. “Recent reports indicate that the rate of PTSD and other psychiatric disorders in returning OIF/ OEF service members is similar to the rate of TBI and that 37 to 44% of those with possible MTBI may also have PTSD” (Sayer, 2009, p. 704). Even after tremendous advancements in science and technology, we still don’t have many ideas about the functioning of brain and memory. It is assumed that we have conscious memory and an unconscious or subconscious memory. Things which were stored in the subconscious memory can appear quiet unexpectedly. In other words, MTBI can cause storing of some particular information in the subconscious memory which may appear later in the life of the person in the forms of PTSD. Jones et al. (2010) have pointed out that “majority of MTBIs acquired during combat in the current wars are closed brain injuries caused by exposure to a blast from improvised explosive devices, the makeshift bombs insurgents frequently use to attack U.S. forces” (Jones et al., 2010, p. 372). It is difficult for us to judge the impacts of these blasts on our brain systems at the time of occurrence of MTBI. Head injuries can create problems later in the life of a person. When some kind of external forces applied to the head, it is not necessary that the damages may visible immediately. In war fronts soldiers, often suffer different kinds of blows or mechanical forces on their heads and as a result of that they may suffer temporary loss of consciousness or disorientation. “Confusion or disorientation, loss of consciousness for 30 min or less, posttraumatic amnesia for less than 24 h, and/or other transient neurological abnormalities, such as focal signs, seizures, and intracranial lesions not requiring surgery are the major symptoms of MTBI” (Polito et al., 2010, p. 505). MTBIs may not appear too serous at the time of occurrence; however it can create problems later in the life of the person. “In most cases of mTBI the patient returns to their previous level of function within 3 to 6 months” (Summeral, 2010). However, it is not necessary that the victim may not any problems in future even if his injuries were cured. This is because of the fact that majority of the MTBIs causes “functional disturbance rather than a structural injury” (Polito et al., 2010, p. 505). It is difficult to identify the functional differences with the help of normal diagnosis methods. Only after few years from suffering MTBI, the veterans may develop symptoms with respect to PTSD. Ruff et al. (2010) have explained this point more clearly. Individuals with MTBI can manifest abnormal foci of neuronal activity or cerebral blood flow. Loci of injury or abnormal cerebral metabolism include the inferior medial frontal lobes, medial temporal lobes, occipital cortex, and cerebellum. Symptoms that are common to MTBI and PTSD include impaired concentration, tension headaches, mental slowness, and indecision (Ruff et al., 2010). Neuron activities play a vital role in maintaining a person in his normal behavioral pattern. Any problem occurs to neuron activity as a result of minor or major head injuries may lead towards abnormal behavior. For example, the bitter experiences in the war fronts may haunt the returning soldiers in one way or other even after years from the ending of the war. Ruff et al., Tan et al., and Vanderploeg et al. have explained the occurrence of PTSD as a result of MTBI, later in the life of the victim. “Distinct features of PTSD include intrusive flashbacks, recurrent nightmares, hyperarousal, and social avoidance” (Ruff et al., 2010). The mental processes of the soldiers in the war fronts and the returning soldiers are entirely different. At war fronts, they will think only about defeating the enemies. Humanitarian considerations may not be there. However, when they return from war fronts, humanitarian considerations may dominate the considerations or thinking pattern of a soldier and therefore guilty consciousness may develop. Because of that, “increased rates of headaches, sleep problems, and memory difficulties” (Vanderploeg et al., 2009) may occur in the later in the life of the returning soldiers. Tan et al. have pointed out that “autonomic nervous system (ANS) dysregulation, characterized by a high baseline state of hyperarousal and decreased parasympathetic activity, is a potential pathogenic mechanism in the development and maintenance of PTSD (Tan et al., 2009, p. 1238). The above observations clearly suggest that PTSD can occur in soldiers who return from war fronts. Wilson (2009) has suggested some reasons for the association of mTLB and PTSD. “The symptoms of headaches and insomnia evolve into progressive chronic patterns. This chronification process develops more readily in the presence of emotional vulnerability and autonomic nervous system (ANS) hyper reactivity” (Wilson, 2009, p. 132). It should be noted that headache and insomnia can be developed as a result of mTLB and subsequent development of PTSD. PTSD intensifies the symptoms of headaches and insomnia since returning soldiers may often develop emotional problems. “A recent study has reported that combat-related mTBI doubled the risk for PTSD. PTSD was the strongest factor associated with persistent post-concussive symptoms”(Cullen et al., 2010, p. 191). Even though soldiers show no signs of agony while mercilessly kill their enemies and innocent people, they may suffer terrible nightmares and disorientation in their life after the war. Man is a social animal who dislikes killing of others. However, circumstantial pressure forces them to engage in activities which they may otherwise don’t like to perform. Combat-related mTBI may add more to the agonies of the returning soldiers. Kennedy et al. (2010) have also supported the opinions of Cullen et al. In their opinion, “although PTSD symptoms in both blast and non-blast mTBI include re-experiencing symptoms, these may be more pronounced in individuals with traumatic blast injuries” (Kennedy et al., 2010, p. 229). The above finding suggests that traumatic blast injuries may cause more damage to a soldier later in his life in the form of PTSD. According to Bryant et al. (2000), “the predominance of emotional reactivity and the relative absence of traumatic memories in patients with PTSD who suffered impaired consciousness during trauma suggest that traumatic experiences can mediate PTSD at an implicit level” (Bryant et al., 2000). Emotional reactivity is seen more common among people who suffer PTSD after MTBI. At the same time they are not memorising the traumatic experience much. The above fact clearly shows that traumatic experience which is stored in the unconscious mind is causing the emotional reactivity unknowingly. In other words, the patient may not realise the connection between MTBI and PTSD. Helterness, (2011) has pointed out that “PTSD commonly coexists with MTBI because of the violent and life-threatening circumstances often associated with brain trauma. Studies have found prevalence rates of PTSD among those with MTBI from 13% to 84% (Helterness, 2011, p. 147). It should be noted that all soldiers returning from war fronts are not developing PTSD later in their life even if they had the experience of MTBI. This is because of the fact that some soldiers may have more mental power in dealing with complex conditions than other soldiers. References Bryant, R. A., Marosszeky, J. E., Crooks, J. & Gurka, J. A. (2000). Posttraumatic Stress Disorder After Severe Traumatic Brain Injury. Retrieved from http://ajp.psychiatryonline.org/cgi/content/abstract/157/4/629 Cullen, M. A., Kennedy, J. E., Amador, R. R., Huey, J. C. and Leal, F. O. (2010). Symptoms in military service members after blast mTBI with and without associated injuries NeuroRehabilitation 26 (2010), 191–197, DOI 10.3233/NRE-2010-0555. Heltemes, K. J., Dougherty A. L., MacGregor, A. J. & Galarneau, M. R. (2011). Alcohol Abuse Disorders Among U.S. Service Members With Mild Traumatic Brain Injury Military Medicine, 176(2011). Jones, K. D., Young, T. & Leppma, M. (2010). Posttraumatic Stress Disorder in Returning Iraq and Afghanistan War Veterans: Implications for Assessment and Diagnosis. Journal of Counseling & Development , 88. Kennedy, J. E., Leal, F. O., Lewis, J. D., Cullen, M. A. & Amador, R. R. (2010). Posttraumatic stress symptoms in OIF/OEF service members with blast-related and non-blast-related mild TBI. Neuro Rehabilitation, 26 (2010), 223–231, DOI 10.3233/NRE-2010-0558 Pietrzak, R. H., Johnson, D. C., Goldstein, M. B., Malley, J. C. & Southwick, S. M. (2009). Posttraumatic stress disorder mediates the relationship between mild traumatic brain injury and health and psychosocial functioning in veterans of Operations Enduring Freedom and Iraqi Freedom Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19829203 Polito, M. Z., Thompson, J. W. G. & DeFina, P. A. (2010) A review of the International Brain Research Foundation novel approach to mild traumatic brain injury presented at the International Conference on Behavioral Health and Traumatic Brain Injury. Journal of the American Academy of Nurse Practitioners. 22 (2010). doi: 10.1111/j.1745-7599.2010.00540.x Ruff, R. L., Riechers, R. G. & Ruff, S. S. (2010). Relationships between mild traumatic brain injury sustained in combat and post-traumatic stress disorder. Retrieved from http://f1000.com/reports/m/2/64 Sayer, N. A., Rettmann, N. A., Carlson, K. F., Bernardy, N., Sigford, B. J., Hamblen, J. L. & Friedman, M. J. (2009). Veterans with history of mild traumatic brain injury and posttraumatic stress disorder: Challenges from provider perspective. Journal of Rehabilitation Research & Development, 46 (6), 703–716, DOI:10.1682/JRRD.2009.01.0008. Summerall, E. L. (2010). Traumatic Brain Injury and PTSD. United States Department of veterans affairs. Retrieved from http://www.ptsd.va.gov/professional/pages/traumatic-brain-injury-ptsd.asp Tan, G., Fink, B., Dao, T. K., Hebert, R., Farmer, L. S., Sanders, A., Pastorek, N. & Gevirtz, R. (2009). Associations among Pain, PTSD, mTBI, and Heart Rate Variability in Veterans of Operation Enduring and Iraqi Freedom: A Pilot Study. Pain Medicine 10(7). 5 Vanderploeg, R. D., Belanger, H. G., Curtiss, G. (2009). Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19577020 Wilson, J. L. (2009). Return to Baseline: Psychophysiological Treatment of Postconcussive Symptoms in Combat-Injured Soldiers With Mild Traumatic Brain Injury and Comorbid Post Traumatic Stress Disorder. Biofeedback. 37(4), 132-136. Read More