Differential Diagnosis and Treatment of Comorbid PTSD and TBI in Combat Veterans


  • Jennifer Clees




undergraduate research, PTSD, TBI, comorbid, combat veteran


The purpose of this paper was to summarize what is currently known about diagnosing and treating comorbid PTSD and TBI in combat veterans, beginning with a focus on differential diagnosis of the two disorders in order to elucidate any obfuscation by overlaps in symptomology, and concluding with possible treatment plans, as informed by the diagnostic process.  Differential diagnosis was evaluated via self-reported and clinician-administered questionnaires, oculomotor testing, and neuroimaging, while the discussion of treatment options acknowledged the necessity of adjustments to traditional treatment paradigms when a comorbid diagnosis is involved.  Self-reporting diagnostic tools are quick and easy to screen for PTSD and TBI, but these methods may over-report PTSD, and under-report TBI.   Clinician-administered questionnaires are longer and require a trained professional, but accuracy is gained. The oculomotor testing and SPECT scanning hold promise if the experiments can be repeated with larger sample sizes by additional researchers, but they do appease a more impartial evidence-based approach.  Psychotherapy is generally the number one recommended treatment for PTSD and TBI, due to its efficacy compared to pharmaceuticals, and further studies elucidating the efficacy of varieties of psychotherapy treatment may benefit individuals with this comorbid diagnosis.



Metrics Loading ...


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. 2014;71(2):149-157. doi: 10.1001/jamapsychiatry.2013.3080.

Strom TQ, Wolf GK, Crawford E, Blahnik M, Kretzmer T. Implementing Prolonged Exposure for Veterans with Comorbid PTSD and Traumatic Brain Injury: Two Case Studies. Cogn Behav Pract. 2016;23:148-161. doi: 10.1016/j.cbpra.2015.03.003.

Capehart B, Bass D. Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury. J Rehabil Res Dev. 2012;49(5):789-812. doi: 10.1682/JRRD.2011.10.0185.

Jak A, Aupperle R, Rodgers C, et al. Evaluation of a hybrid treatment for veterans with comorbid traumatic brain injury and posttraumatic stress disorder: Study protocol for a randomized controlled trial. Contemp Clin Trials. 2015;45(Part B):210-216. doi: 10.1016/j.cct.2015.10.009.

Raji CA, Willeumier K, Taylor D, et al. Functional neuroimaging with default mode network regions distinguishes PTSD from TBI in a military veteran population. Brain Imaging and Behavior. 2015;9:527-534. doi:10.1007/s11682-015-9385-5.

King NS. PTSD and traumatic brain injury: Folklore and fact? Brain Injury. 2008;22(1):1-5. doi: 10.1080/02699050701829696.

Huggins JM, Brown JN, Capehart B, Townsend ML, Legge J, Melnyk SD. Medication adherence in combat veterans with traumatic brain injury. Am J Health-Syst Pharm. 2011;68:254-258. doi: 10.2146/ajhp090629.

Aralis H, Macera C, Rauh M, MacGregor A. Traumatic Brain Injury and PTSD Screening Efforts Evaluated Using Latent Class Analysis. Rehabil Psychol. 2014;59:68-78. doi: 10.1037/a0035263.

Fortier C, Amick M, Kenna A, Milberg W, McGlinchey R. Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) Clinical Interview and the VA TBI Screen. J Head Trauma Rehab. 2015;2013;30:E1-E7. doi: 10.1097/HTR.0000000000000008

Davis JJ, Walter KH, Chard KM, Parkinson RB, Houston WS. Treatment adherence in cognitive processing therapy for combat-related PTSD with history of mild TBI. Rehabil Psychol. 2013;58(1):36-42. doi: 10.1037/a0031525.

Walter KH, Dickstein BD, Barnes SM, Chard KM. Comparing effectiveness of CPT to CPT-C among U.S. veterans in an interdisciplinary residential PTSD/TBI treatment program. J Trauma Stress. 2014;27(4):438-445. doi: 10.1002/jts.21934.