Internalizing disorders in adults with a history of childhood traumatic brain injury

While the presence of externalizing behavioral problems following traumatic brain injury (TBI) has been well established in the literature, less is known regarding internalizing disorders, and more specifically anxiety disorders, in such a population. This study explored the presence, rate, and incidence of internalizing behavior problems, including anxiety, depression, somatic complaints, avoidant personality symptomatology, and overall internalizing behavior problems in university students aged 18-25 years.

A convenience sample of 247 university students (197 non-TBI, 47 mild TBI, 2 moderate TBI, 1 severe TBI) aged 18-25 years was utilized. Participants completed a self-report measure on behavioral functioning, the Adult Self Report (ASR), to identify internalizing behaviors, and a questionnaire to identify TBI history.

Raw scores of behavior indicated that participants with a history of childhood TBI reported significantly higher levels of withdrawal, somatic complaints, and internalizing behavioral problems than the non-TBI participants. When analyzing standardized T-scores for borderline and clinically elevated ASR syndromes and Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented scales, individuals in the TBI group were significantly more likely to have higher rates of borderline anxiety, somatic complaints, avoidant personality problems, and overall internalizing disorders, and clinically elevated somatic complaints. Adults with a history of childhood TBI were also significantly more likely to report at least 1 or more DSM disorders.

These results clearly suggest that individuals with a childhood history of TBI are at a heightened risk for a range of internalizing disorders in early adulthood, which is particularly troubling in a university sample pursuing tertiary education.