The Battle Within: TBI, PTSD and Violence Risk

Nov. 28, 2012; 1-2:30 p.m. (ET)


Many service members returning from Operations Enduring, Iraqi Freedom, and New Dawn continue to fight a battle within. Multiple deployments have increased the risk for blast exposure and combat-related psychological trauma, resulting in the signature wounds of these conflicts: traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).

In the acute stages of recovery from a TBI, physical symptoms and cognitive changes are expected. Changes in mood and behavior also can occur, and are described by some as having a “short fuse.” Emotional changes can manifest along a continuum ranging from increased irritability to acting-out behavior. An increased activation of the limbic system associated with post-traumatic stress disorder also can perpetuate aggressive and violent behavior. The violence reported is generally not predatory; instead it is reactionary, because of misperceived cues and overreactions. Co-morbid factors, such as alcohol use, can lower the impulse control threshold, increasing the risk of aggressive reactions. This has resulted in service members’ increasing involvement in the legal system across the U.S.

This presentation will examine the physiological changes that occur after TBI, and with PTSD, which increase service members’ risk for aggressive and violent behavior. Case examples from clinical practice, along with treatment recommendations and interventions, will be discussed.


Cynthia Boyd, Ph.D.
Co-Senior Scientific Director and Clinical Neuropsychologist, DVBIC, Naval Medical Center San Diego Dr. Cynthia Boyd has been involved in clinical and educational efforts at DVBIC, Naval Medical Center San Diego for the past nine years. She has focused not only on TBI, but also the overlap of TBI and PTSD affecting physical, cognitive and behavioral issues. She is a subject matter expert on violence associated with these disorders. She has been actively involved in the legal/forensic arena, specifically regarding TBI and legal issues in returning troops. Since 2008, she has participated with the legal community to establish a Veteran’s Court in San Diego. Under California Penal Code 1170.9, the law allows for judges to offer treatment as alternative sentencing to veterans diagnosed with TBI, PTSD, substance abuse, and other qualifying conditions associated with combat exposure. As a representative of DVBIC, she has been invited to provide TBI and PTSD educational trainings to members of law enforcement, district attorneys, public defenders, Navy JAG and California superior court judges. Dr. Boyd also has an independent practice in forensic neuropsychology specializing in forensic evaluations of TBI, PTSD and violent offenders. She has been retained as an expert witness in capital cases involving veterans with TBI and PTSD.

Continuing Education

This webinar has been approved for the following:
1.5 AMA PRA Category 1 Credits™
1.5 Credits by the American Psychological Association
1.5 Nursing contact hours as a co-provider with the American Nurses Credentialing Center
1.75 CE Contact hours for Physical and Occupational Therapists approved by the State of Illinois
1.5 CEHs for Social Work approved by the Missouri Division of Professional Registration Committee for Social Work

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