Errors in self-report of post-traumatic stress disorder after severe traumatic brain injury

Abstract

Assessing PTSD by questionnaire can lead to false positive diagnosis after severe traumatic brain injury. Sumpter and McMillan, reported quantitative data on 34 people with severe TBI; 59% were PTSD 'cases' by questionnaire assessment, but only 3% using a structured interview. The present paper describes ways in which these individuals made errors on questionnaires. Some did not follow questionnaire instructions because of inattention and concrete thinking or instead reported effects of brain injury. Symptom overlap between TBI and PTSD, including insomnia, irritability and impaired concentration can cause errors. Brain injury can also provoke curiosity about loss of memory (during coma, retrograde and post-traumatic amnesia), decreased participation, social withdrawal and difficulty adjusting to injury that may be mistaken for fear-associated PTSD symptoms. Assessment of PTSD by questionnaire can lead to erroneous conclusions and factors related to brain injury must be carefully considered when investigating PTSD.

The Evolution of Post-Traumatic Stress Disorder following Moderate-to-Severe Traumatic Brain Injury

“…9 Further, clinical judgment was used to differentiate TBI and PTSD sequelae, with particular attention to common errors reported previously. 16,47 For example, individuals with TBI may misattribute functional avoidance behaviors (i.e., those necessitated by injury-related functional limitations) to fear-based avoidance associated with PTSD. 16 In 75.29% of cases, a proxy informant corroborated participants' preand post-injury psychiatric symptom reporting.…”

“…16,47 For example, individuals with TBI may misattribute functional avoidance behaviors (i.e., those necessitated by injury-related functional limitations) to fear-based avoidance associated with PTSD. 16 In 75.29% of cases, a proxy informant corroborated participants' preand post-injury psychiatric symptom reporting. Injury-related PTSD was classified as acute-onset when fullthreshold symptoms emerged within six months post-injury, after which it was classified as delayed-onset.…”

“…15 Consequently, the use of self-report PTSD measures results in high rates of false positive diagnoses, as respondents incorrectly attribute TBI sequelae to symptoms of PTSD. 16,17 Studies employing established diagnostic interviews arguably provide more rigorous understanding of PTSD following TBI 18 and will be the focus of this discussion.…”

Cognitive behavioural therapy and persistent post-concussional symptoms: Integrating conceptual issues and practical aspects in treatment

“…Comorbid depression may also increase the reporting of both the number and severity of symptoms after MTBI (Lange, Iverson, & Rose, 2011). A co-morbid psychiatric disorder does not necessarily imply that the PCS symptoms themselves are of psychiatric origin: it might reflect an epiphenomenal coincidence due to overlapping symptoms, as also suggested in relation to apparent post-traumatic stress disorder (PTSD) after severe TBI (Sumpter & McMillan, 2006) or a reflection of the consequences and attempts to manage and compensate for persisting direct effects of brain injury on cognition (Marsh & Smith, 1995;Van Zomeren, Brouwer, & Deelman, 1984). (Smith-Seemiller et al, 2003), and in healthy controls (Chan, 2001).…”

Deficit and defence – Gedächtnisstörungen nach Schödel-Hirn-Trauma unter Folter

“…In diesen Studien beträgt die PTSD-Prävalenz bei SHTPatienten 59 %, während Studien, die PTSD mittels eines klinischen Interviews diagnostizieren, auf eine Rate von lediglich 3 % kommen [17]. Diese Diskrepanz ist nicht spezifisch für die Diagnose einer PTSD, ist aber bei dieser mit hohem Leidensdruck assoziierten Erkrankung besonders häufig.…”