TBI and the Military

The Uniformed Services University of the Health Sciences’ Center for the Study of Traumatic Stress (CSTS) in Bethesda, MD, is working to improve communication around injuries and has released fact sheets for providers and families on intimacy after physical and invisible injuries.

The educational resources are a part of CSTS’s Courage to Care Courage to Talk campaign. This campaign focuses on facilitating and improving communication about injuries, both with the  healthcare providers and within the family of the injured servicemember. Resources to improve communication on various topics are available to both healthcare providers and families and can be found at http://www.couragetotalk.org.

“There are military unique health issues that we address. We then try to promote awareness of these issues,” says Nancy T. Vineburgh, assistant professor in the USUHS Department of Psychiatry and director of the CSTS Office of Public Education and Preparedness.

Fact sheets on intimacy that are tailored to providers treating injured troops recommend that providers educate themselves about sexuality and disability since doctors, nurses, rehab therapists and behavioral health providers can all play a role in helping patients with this topic. In addition, providers are reminded to ask patients if they have sexual intimacy concerns, since the patient is unlikely to bring it up unless asked.

“Even during an acute hospitalization or in an intensive-care unit, people are wondering as to the future of their marriage, the ability to have children or their future attractiveness. Sometimes patients are uncomfortable bringing up the topic, so healthcare providers may need to start the conversation,” the tip sheet, “Physical Injury and Intimacy: Helping Wounded Warriors and their Loved Ones Manage Relationship Challenges and Changes,” stated.

Providers are also encouraged to share with patients the potential impact of prescribed medications. The fact sheets advise clinicians to explain to patients that certain areas of the brain are important for regulating and controlling many aspects of sexuality and that any slight damage to these areas can affect how sexual urges are expressed and how the sexual organs will work.

“Some people with a TBI seem preoccupied with sex, speak about sex at inappropriate times or demonstrate inappropriate sexual behaviors, often without awareness that they are making others uncomfortable. They may appear to have greater sexual drive than before, but it is more likely that the part of the brain that helps us hold back or inhibit impulses and urges has been damaged,” according to the fact sheet.

The fact sheet further states that patients and spouses should know that, in some cases, TBI  “leads to apathy and passivity, resulting in seemingly less interest or motivation to engage in romantic or sexual activities.”

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