Sudden panic flashes, nightmares, and anxiety sweats often incapacitate the lives of persons who have experienced or witnessed an extremely emotional event—a car wreck that is particularly gruesome, or a co-worker nearly decapitated by an exploding pressure valve. Posttraumatic stress disorder (PTSD) results from the intense memory of the blood, the screams, and the utter helplessness and may overcome some people for a long time.

PTSD may produce, in addition to intense anxiety, a variety of cognitive problems—forgetfulness, inattention, a sense of being overwhelmed with even simple tasks, and clouded thinking. These symptoms are often mistaken for signs of brain injury, especially when there also has been a suspected blow to the head..

Mild traumatic brain injury (MTBI), a physical as opposed to an emotional injury, is caused from a relatively mild blow to the brain that causes just enough physical injury that normal brain functions of memory, attention, mental organization, and logical thinking may be compromised. Usually, brain injury is caused by a direct blow to the head. However, violent movement of the brain inside the head—as in severe whiplash—can cause injury without a direct blow. MTBI, as opposed to more severe brain injury, is diagnosed when the length of unconsciousness is less than 30 minutes and when there is no more than a 24-hour loss of memory for the event. Sometimes loss of consciousness can be momentary and amnesia only fragmented for a few hours. With virtually no alteration in consciousness nor amnesia, occurrence of brain injury should be highly suspect.

So, how can a person who is suspected of MTBI from an accident, perhaps only resulting in minimal confusion or partial loss of consciousness, have sufficient memory of the event to develop PTSD as well? Indeed, it is the amnesia for the injury event that is a key diagnostic criterion for brain injury, mild or otherwise. In rare instances, a person can actually exhibit signs of both PTSD and MTBI, with overlapping cognitive symptoms. (Anxiety, fear, withdrawal, and panic are related to PTSD, not to MTBI.)

There are likely two causes for this to occur. People who are predisposed to anxiety may develop ruminations and fears from what they have been told about the accident or from pictures of the mangled car they were in. Or, amnesia for a mild physically traumatic injury may be incomplete, the person retaining fleeting moments of the accident that were very frightening, such as the moments just before when the feeling of utter helplessness and impending doom makes the blood rush from your body.

Whenever an individual presents with coincident MTBI and PTSD, treatment should offer the individual strategies for regaining a sense of self-control. Educating the individual about anxiety and about mild cognitive changes, emphasizing the fact that these things will heal, is usually the best approach to treatment. Unabated lingering of either MTBI or PTSD is a sign that something else, perhaps secondary gain, is going on.

Sorting out the differentiation or co-existence of PTSD and MTBI requires understanding of the emotional history and predisposition of the individual, and the actual onset and quality of the amnesia that might support the memories for producing PTSD. Neuropsychological testing must evaluate history, anxiety and personality traits, and cognitive functioning. Treating PTSD in cases of (real or suspected) MTBI is usually successful since first-hand experience of the traumatic event is incomplete and partially subconsciously fabricated. It is almost always the case, when PTSD exists concurrently with possible MTBI, that with treatment and/or resolution of PTSD cognitive complaints typically associated with brain injury usually abate as well.

Usually, PTSD and/or MTBI treatment is successful if initiated promptly after an incident. Treatment consists of reassurance and education and is relatively brief, sometimes consisting of one to three sessions, with essential resolution of symptoms within a couple of months, in most cases.