Question:
Just a layperson's observation here, but it seems reasonable to me that it is indeed possible to have either a BI without PTSD *or* PTSD without a BI (as well as both). I think the problem is that so many of the symptoms appear to be the same and also that it's just easier somehow to attribute the persistent (long-term) problems of BI to either malingering or something that the docs think they have answers for (we all *know* that the last thing they want to deal with is a mild brain injury because they don't know what to *do* about it).

Now, as for treatment, it would be ideal if a truly accurate diagnosis could be given. This may never happen -- at least not in our lifetimes. So. . . . seems logical to me that if both are suspected, treatment for both could be prescribed -- simultaneously. After all, if someone doesn't need help for a "suspected" brain injury they won't use/internalize the strategies anyway and their PTSD treatment would "be there" and hopefully be useful. Similarly, if they don't need (don't respond to) PTSD treatment, but do need help for symptoms of their brain injury, they'd graviate toward what's helping, and that would be fine too. And if they've got both, the two-pronged attack could work, too, right?

Do any of the docs or other professionals see a problem with this kind of approach? Is it ever done? What are the results? What could be/is the downside?

Now as for the position that brain injury (or knowledge of a brain injury) exacerbates PTSD symptoms, or vice versa, I'll bet that the way this happens is this: When all the person gets is the diagnosis, but no help with learning how to deal with the BI, of course lots of things "get worse" -- depression, anxiety, any pre-existing psychological issue, tendency toward substance abuse -- you name it! Untreated brain injury pretty much ensures that life won't work very well, so it stands to reason that it would make PTSD worse. And if a person with BI doesn't learn how to live/think effectively (especially with respect to managing troubling feelings, putting things in perspective, making decisions, solving problems), getting hit with a diagnosis of PTSD would likely not be "processed" effectively either, and voila -- things get "worse".

Answer: I have seen many patients with both brain injury and PTSD. While some authors have stated that you can't have both (i.e., Sbordone), it is obvious to me and other professionals I work with that you can. I have a paper that will be published later this year describing several such cases, and Wayne Gordon, Ph.D., head of the brain injury program at Mt. Sinai in NY has performed structured psychiatric diagnostic interviews on individuals and TBI, and found that PTSD is not uncommon. Unfortunately, having both diagnosis makes treatment more complicated, because both need to be recognized and treated. Jonathan Silver, M.D. It's clear that a person with a misdiagnosis will not have information that enables them to get apprpriate treatment. But let's complicate it further (because this happens in real life) and let's say a person has both symptoms of PTSD *and* a brain injury (but they don't know about the brain