Post Traumatic Stress Disorder and Mild Traumatic Brain Injury
Can someone have post traumatic stress disorder and mild traumatic brain injury at the same time from the same event? Some experts say no while others say yes.
Approximately 7.7 million Americans suffer from PTSD, according to recent population-based survey research. The most common causes of PTSD in the civilian sector are motor vehicle crashes and assaults (including domestic violence and rape), with women approximately
twice as likely as men to suffer from PTSD.
Surveys of military personnel returning from deployments to Iraq and Afghanistan find prevalence rates of PTSD ranging from 8% to 16%; it is likely that these rates are underestimates, given the many barriers to reporting mental health problems in the military . Approximately 15% of
these veterans seeking care at Veterans Administration hospitals in the United States have been given a diagnosis of PTSD.
One train of thought says that in order to have post traumatic stress disorder you must remember the traumatic event. Indeed it is the very memory of the event that causes the post traumatic stress. Yet others opine that mild traumatic brain injury must involve some loss of consciousness and therefore memory of the event is missing. Hence you can not have mild traumatic brain injury and post traumatic stress disorder. However the fact of realizing what happened when revived leaves the post traumatic stress question wide open for discussion.
An estimated 1.5 million brain injuries occur every year in the United States, and over 5 million Americans (2% of the population) live with disabilities resulting from TBI. In the civilian sector, the leading causes of TBI are falls, motor vehicle crashes, struck-by-or-against events, and assaults . Interestingly, motor vehicle crashes and assaults are also two of the most common causes of PTSD in the U.S. civilian population, highlighting the overlap in exposures to TBI- and PTSD-causative events.
In the U.S. military, TBI is the most common type of physical injury sustained by combatants in Afghanistan and Iraq, and explosion or blast injury is the most common cause. In a 2006 survey of more than 2,500 recently returned army infantry soldiers, 5% reported injuries with loss of consciousness during a yearlong deployment to Iraq, and 10% reported injuries with altered mental status. A recent RAND report suggested even higher rates of probable TBI in a 2007 telephone survey of almost 2,000 previously deployed service personnel. A similarly high rate (23%) of clinician-confirmed TBI history in a U.S. Army brigade combat team with at least one deployment corroborates these findings.
It is important clinically to recognize that both disorders are associated with higher rates of other psychological health problems, including depression, substance abuse, and suicidal behavior in both civilian and military populations . Furthermore, the presence of these comorbid conditions may have an impact on conventional treatments, lending additional impetus to the need to understand these interactions more completely.
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This week saw major activity occur on H.R. 5613, legislation recently introduced which would place a moratorium until March 2009 on seven Medicaid regulations issued by the Department of Health and Human Services. On Wednesday, the bill was unanimously approved by the full House Energy and Commerce Committee, setting up a potential veto showdown with the White House. BIAA has strongly endorsed this legislation and submitted an official letter of endorsement to the bill’s sponsors, Rep. Dingell (D-MI) and Rep. Murphy (R-PA), last week. 
