Traumatic brain injury. When a brain injury occurs in the context of a traumatic event (e.g., traumatic accident, bomb blast, acceleration/ deceleration trauma), symptoms of PTSD may appear. An event causing head trauma may also constitute a psychological traumatic event, and tramautic brain injury (TBI)—related neurocognitive symptoms are not mutually exclusive and may occur concurrently. Symptoms previously termed postcancussive (e.g., headaches, dizziness, sensitivity to light or sound, irritability, concentration deficits) can occur in brain- injured and non-brain—injured populations, including individuals with PTSD. Because symp- toms of PTSD and TBI-related neurocognitive symptoms can overlap, a differential diagnosis between PTSD and neurocognitive disorder symptoms attributable to TBI may be possible based on the presence of symptoms that are distinctive to each presentation. Whereas reexpe- riencing and avoidance are characteristic of PTSD and not the effects of TBI, persistent disori- entation and confusion are more specific to TBI (neurocognitive effects) than to PTSD.
Individuals with PTSD are 80% more likely than those without PTSD to have symptoms that meet diagnostic criteria for at least one other mental disorder (e.g., depressive, bipo- lar, anxiety, or substance use disorders). Comorbid substance use disorder and conduct disorder are more common among males than among females. Among US. military per- sonnel and combat veterans who have been deployed to recent wars in Afghanistan and
Iraq, co-occurrence of PTSD and mild TBI is 48%. Although most young children with
PTSD also have at least one other diagnosis, the patterns of comorbidity are different than in adults, with oppositional defiant disorder and separation anxiety disorder predominat- ing. Finally, there is considerable comorbidity between PTSD and major neurocognitive disorder and some overlapping symptoms between these disorders.
Diagnostic Criteria 308.3 (F43.0)
A. Exposure to actual or threatened death, serious injury. or sexual violation in one (or more) of the following ways: 1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the event(s) occurred to a close family member or close friend. Note:
In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse).
Note: This does not apply to exposure through electronic media, television, mov- ies, or pictures, unless this exposure is work related.
B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or wors- ening after the traumatic event(s) occurred: 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to, the event(s). Note: In children, there may be frightening dreams without recognizable content.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specitic reenactment may occur in play.
4. Intense or prolonged psychological distress or marked physiological reactions in re- sponse to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).