Posttraumatic Stress Disorder Complicated by Traumatic Brain Injury: A Narrative Review

We reviewed the phenomenology of Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI), as well as the combined effects of PTSD + TBI comorbidity on functional outcomes. We also provide a series of research and treatment recommendations based on gaps in the literature with an emphasis on culture, interpersonal trauma, and treatment. Rates of PTSD + TBI are remarkably high. This comorbidity is especially common among combat-exposed military populations (with current estimates among Veterans returning from Afghanistan/Iraq at approximately 48%), as well as individuals who experience motor vehicle collisions (estimated base rate = 12%). These conditions often co-occur primarily because the events preceding the brain injury are both physically and psychologically traumatic. In many cases of PTSD + TBI, especially mild TBI, psychological factors largely account for accompanying functional outcomes (e.g., cognitive sequela, somatosensory health, quality of life, occupational functioning, social engagement). Overall, we suggest the importance of integrative teams in the early assessment, conceptualization, and treatment of PTSD + TBI. Psychological interventions and cognitive rehabilitation may synergistically improve psychological and functional outcomes for this patient population.