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A particularly challenging form of anxiety is post-traumatic stress disorder (PTSD). Many returning service personnel have developed PTSD. Current estimates of the prevalence of TBI among Veterans range from 9.6% to 20%. Many also experience PTSD or traumatic memories. Approximately 50% of Veterans had witnessed the death or injury of a friend, 10% had been injured themselves, and over 19% had symptoms consistent with PTSD according to a recent survey. An earlier study found that 90% of combatants had experienced a traumatizing event. Moreover, traumatic brain injury (TBI) and PTSD can co-occur in military populations and have many shared symptoms, making it a challenge to distinguish the two conditions from one another (Hoge et al. 2008). Clinically, these populations may overlap by 33% to 42% (Lew 2005). A recent study in Veterans Administration facilities revealed 73% of patients reporting TBI were comorbid for PTSD (Taylor et al. 2012), while 13.5% of military personnel from recent conflicts reported PTSD (Dursa et al. 2014). For patients who have both TBI and PTSD, which generate many of the same symptoms, the VA acknowledges that the patient is often diagnosed with only one of the conditions. The VA recently concluded there was a lack of diagnostic accuracy for the dually affected veteran (CBO 2012). In addition, a mismatch often exists between performance on neuropsychological testing and the patient’s experience of their deficits in those with mild TBI, which is the most common form of TBI (Brenner et al. 2010). Some evidence suggests recruitment of additional cortical areas during a task may contribute to performance on neuropsychological testing in those with TBI (Van Boven et al. 2009).

Symptoms of PTSD overlap with those of TBI and can include: headache, dizziness, irritability, memory impairment, slowed reaction time, fatigue, sleep disturbances, sensitivity to light and noise, impulsivity, anxiety and depressive symptoms. Soldiers who experience blast related TBI are at greater than double the risk for developing PTSD. While the mechanism of injury is quite different, victims of head injury in motor vehicle accidents also have a higher rate of PTSD compared to other injuries.

Veterans with TBI and/or post-traumatic stress disorder (PTSD) have struggled with the search for effective treatments. PTSD and or TBI are believed to be major contributing factors for the approximately 22 Veterans who commit suicide every day in the United States. Over 400,000 military personnel and veterans have been diagnosed with PTSD or TBI since 2001, but many more have not been diagnosed because they have not sought treatment. A recent report published in JAMA showed that the traditional treatments of PTSD, such as cognitive behavioral therapy or prolonged exposure therapy, are largely ineffective. This study by Steenkamp and colleagues found only one-third of patients had clinically significant improvement in their symptoms. Civilians also experience PTSD and over 7.7 million Americans reportedly suffer from PTSD.

The currently available treatments of PTSD and TBI are different. Moreover, the treatments for PTSD may be harmful or, at best, not helpful in the case of TBI. The pharmacological treatments for PTSD include the serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, benzodiazepines, mood stabilizers, and atypical antipsychotics (Jain et al. 2012; Watts et al. 2013). These medications can be ineffective or even harmful for those with TBI (Silver 2011; Phelps 2014).

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