High rates of comorbidity between traumatic brain injury (TBI) and combat-related Post Traumatic Stress Disorder (PTSD) have been shown among many veterans from the conflicts of Iraq and Afghanistan.

According to Psychiatry Weekly (2011), mild traumatic brain injury and PTSD often co-occur, thus, indicating the need to raise awareness and to know the distinctions between both diagnoses.

However, controversy in regards to the co-existence of TBI and PTSD has been documented, in particular when TBI involves loss of consciousness and/or amnesia. The inability to develop PTSD because of the inability to experience feelings of fear, helplessness or horror as a result of losing consciousness or amnesia has been argued.

On the other hand, other investigators have argued that those who have suffered from TBI can develop PTSD and that as trauma causes a TBI, it is not uncommon to develop PTSD following a TBI.

Concerns in regards to brain injuries being misdiagnosed as PTSD have also been reported.

It is important to receive a comprehensive assessment, to be screened and assessed in regards to both TBI and PTSD as common symptoms following a traumatic brain injury (TBI) tend to overlap with some of the symptoms of trauma. Understanding these distinct diagnoses and their interactions with one another is crucial in order to be provided with the best care and evidence based treatments and for recovery.

Common symptoms of TBI are for instance, memory and concentration problems, headache, fatigue, sleep disturbance, dizziness and vision problems, depression, feelings of anger, anxiety, worries, and personality changes.

Common reactions to trauma include distressing thoughts and memories of the trauma; nightmares; psychological distress and intense physical reactions when reminded of trauma; avoiding reminders of the trauma; feeling detached from others; difficulty sleeping; mood irritability; feelings of anger; difficulty concentrating; hypervigilance; and exaggerated startle response.

A recent study by Zatzick and colleagues (2010) within the Archive of General Psychiatry ran a large-scale multisite investigation to assess the development of PTSD symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe TBI.

The objectives of the study were to better understand the risk of PTSD development and the impact of PTSD on the development of health and cognitive (i.e., reasoning and problem solving, memory, attention, and concentration and thinking) impairments across the spectrum of TBI severity. A total of 3,047 injured survivors with multiple traumatic injuries between the ages of 18 and 84 years completed the study.

The findings indicated that patients with severe and moderate TBI, but not mild TBI, showed a significantly diminished risk of PTSD symptoms compared with patients with no TBI. Across the TBI spectrum, patients with PTSD showed increased risk of health status and cognitive impairments compared with patients without PTSD.

The study concluded that:

• More severe TBI was associated with a diminished risk of developing PTSD

• Severe facial and spinal cord injuries are independently associated with increased risk of PTSD

• Injured patients with PTSD showed the greatest impairments in self-reported health and cognitive function regardless of the severity of TBI.

The researchers also indicated that misattributing health and cognitive functional impairments to brain injury alone could negatively signify that recovery from TBI primarily relies on neurologic factors. It was, therefore, suggested that patients with the full spectrum of TBI severity need to have treatment programs that also include PTSD interventions.

Providing education to patients and family from screening to diagnosis to treatment in regards to PTSD and TBI and/or pain was recommended.