Is It Post-traumatic Stress or Traumatic Brain Injury?

How do we differentiate the diagnoses?

Posted Nov 19, 2018

Many of the symptoms of Post-traumatic Stress Disorder and Traumatic Brain Injury overlap. I believe the original developers of the diagnosis of PTSD were not well informed about TBI, and that many patients diagnosed with PTSD may, in fact, be exhibiting symptoms of traumatic brain injury. Many of the symptoms of PTSD are neurobehavioral or neurocognitive. The role of the endocrine system needs to be considered when making a diagnosis, particularly in what we refer to as “treatment resistant” cases, i.e., people whose conditions are not improving with traditional psychotherapy, medications, or other standard forms of practice.

The advancement of medicine is often fueled by the lessons of war, and this is particularly true with PTSD and TBI. In fact, we would not have the diagnosis of PTSD if it were not for the Vietnam War.  

Mark L. Gordon is an endocrinologist who has treated hundreds of patients who experienced personality or behavioral changes within various times following injuries with or without direct injury to the head. On his website, Gordon states that many of his patients had been placed on various medications to address symptoms of depression or anxiety without neurosteroids being evaluated and they remained symptomatic. In Gordon’s opinion, PTSD is a collection of symptoms that arises out of the sequala of a traumatic brain injury. When detailed patient histories are taken, head injuries are commonly identified that had been forgotten. For Gordon, PTSD is a manifestation of TBI. His approach is to treat patients with hormone replacement therapy to reduce the inflammation in the brain that has compromised functioning that has resulted from the injury. He has a number of very informative podcasts that can be viewed on YouTube. 

I first learned about Gordon’s work from a foreword he wrote for the book Tales from the Blast, by a Special Forces Green Beret, Andrew Marr. Marr had returned from deployments in Afghanistan a broken man. He was treated for PTSD by the VA and was continuing in a downward spiral until he received an evaluation and hormone replacement therapy from Gordon and quickly got his life back together. (You can hear a very informative discussion with Gordon and Andrew Marr on Joe Rogan's podcast.)

It is true there is a lot of cross-over of PTSD and TBI symptoms such as irritability, cognitive deficits, insomnia, depression, fatigue, and anxiety. It is also true that PTSD specialists and TBI specialists have traditionally looked at the conditions as separate and unrelated. However, this is starting to change and there have been several books addressing combined PTSD/TBI. 

From years of evaluating and working in psychotherapy with patients who have survived serious auto accidents, I believe there is clinical merit to the hypothesis that PTSD is on the TBI continuum and warrants further research. And, perhaps we are entering the Age of Endocrinology as some have suggested.

I think endocrinology may be the missing piece and the bridge that will better connect PTSD and TBI. Hormone replacement therapy after competent endocrinology evaluation is offering promising results for many, as it did for Andrew Marr. His book, with the subtitle, A Brain Injured Special Forces Green Beret’s Journey Back the Brink, is a must read for veterans as well as other people who have sustained head injuries, or who have developed PTSD and may not be aware of possible brain trauma in their histories.