Traumatic Brain Injury and Post-Traumatic Stress Disorder in Military Veterans: When Two Problems Collide

by Caitlin Kennedy, PhD

December 2013

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can occur as a result of experiencing a traumatic event. The symptoms of PTSD may include being constantly on-edge, frequently having a short temper, reliving the traumatic event through flashbacks or bad dreams, avoiding things related to the traumatic event, or losing interest in previously enjoyable activities.1 In people with PTSD, these symptoms last for more than a few weeks and become disruptive to the person’s daily living.

One of the largest groups of people who are diagnosed with PTSD consists of recent members of the U.S. military forces. An estimated 17%, or almost 142,000,2 of the living U.S. military veterans of the recent Iraq and Afghanistan wars currently have Post-Traumatic Stress Disorder (PTSD), and experts estimate that 35% may develop PTSD over time.3

Members of the military are also at risk for Traumatic Brain Injury (TBI). TBI is caused by a hit, bump, or other injury to the head. However, not all hits or bumps to the head are considered TBIs. A TBI may range from a “mild” injury, where the person has a short change in mental state or consciousness, to a “severe” injury, where the person has an extended period of unconsciousness or memory loss. TBI is common in military veterans, with almost 288,000 U.S. veterans having suffered one from 2000-2013.4 An estimated 10-20% of the Iraq and Afghanistan veterans have experienced a TBI.5

A recent study in JAMA Psychiatry, a publication of the American Medical Association, found a connection between TBI and PTSD.6 The study evaluated 1648 Marine and Navy servicemen one month before, one week after, and three months after a deployment. Those who reported little to no PTSD symptoms before deployment and who experienced a mild TBI during deployment had nearly twice the probability of having PTSD after deployment than what was predicted. Those who had the highest risk for post-deployment PTSD (34% likelihood) were those that reported PTSD symptoms before deployment and experienced high combat intensity and a TBI during deployment.

It’s likely that the events that cause a deployment-related TBI are emotionally traumatic and contribute to PTSD. Additionally, even a mild TBI can cause damage to areas of the brain that process fear memories – and thus make PTSD symptoms even worse.7 TBI has been connected to increased risk of suicide, and those with mental health problems, such as PTSD or depression, are particularly at risk.8, 910

If a military veteran you know is suffering from TBI and/or PTSD, visit this website on PTSD and this website for TBI for information and help. There is also an information page about both TBI and PTSD among veterans here. In the case of an urgent situation, call the Veterans Crisis Line at 1-800-273-8255.

  1. National Institute of Mental Health. Post-traumatic stress disorder.http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml. Accessed December 18, 2013.  
  2. Department of Veterans Affairs. Report on VA facility specific Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans coded with potential PTSD – revised. http://www.publichealth.va.gov/docs/epidemiology/ptsd-report-fy2012-qtr3.pdf. Accessed December 19, 2013.  
  3. Stanford Graduate School of Business. Research: High PTSD rates for Iraq war veterans. http://www.stanford.edu/group/knowledgebase/cgi-bin/2009/09/19/high-ptsd-rates/. Accessed December 19, 2013.  
  4. Defense and Veterans Brain Injury Center. DoD numbers for traumatic brain injury. http://www.dvbic.org/sites/default/files/uploads/dod-tbi-worldwide-2000-2013-Q3-as-of-05%20Nov-2013.pdf. Accessed December 19, 2013.  
  5. Iraq and Afghanistan Veterans of America. Traumatic brain injury (TBI). http://iava.org/content/traumatic-brain-injury-tbi. Accessed December 19, 2013.  
  6. Yurgil KA, Barkauskas DA, Vasterling JJ, et al. Association between traumatic brain injury and risk of Posttraumatic Stress Disorder in active-duty marines. JAMA Psychiatry 2013; online publication; E1-E9. doi:10.1001/jamapsychiatry.2013.3080  
  7. Bryant RA. Disentangling mild traumatic brain injury and stress reactions. N Engl J Med. 2008;358(5):525-527.  
  8. Brenner LA, Betthauser LM, Homaifar BY, et al. Posttraumatic stress disorder, traumatic brain injury, and suicide attempt history among veterans receiving mental health services. Suicide Life Threat Behav. 2011;41(4):416-423.  
  9. Bryan CJ, Clemans TA, Hernandez AM, Rudd MD. Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury. J Head Trauma Rehabil. 2013;28(1):13-20.  
  10. Bryan CJ, Clemans TA. Repetitive traumatic brain injury, psychological symptoms, and suicide risk in a clinical sample of deployed military personnel. JAMA Psychiatry. 2013;70(7):686-691.