PTSD and Mild Traumatic Brain Injury

The text PTSD and Mild Traumatic Brain Injury, edited by Jennifer J. Vasterling and colleagues, is a well-written, informative review of a complex, but unfortunately increasingly common, clinical condition. The editors and contributors represent a broad array of clinical and academic leaders in the fields of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI), many of whom work in military settings, including Veterans Affairs medical centers.

The text, comprising 14 chapters across five sections, covers clinical presentations, mechanisms, associated conditions, and clinical management. The Clinical Presentations and Mechanisms section reviews the underpinnings and clinical expressions of PTSD and mild TBI, both individually and in combination. A chapter on mild TBI reviews definitions, the mechanics of injury, cellular and chemical neuropathology, and neuroimaging. A chapter on poor outcome in mild TBI provides an analysis of the complex factors that have an impact on brain injury, examining the issue from a combined biological, psychological, and social perspective. The later chapters in this section review clinical and neurobiological aspects of PTSD, how they integrate and change in the presence of mild TBI, and their impact on cognition in combined PTSD and mild TBI.

The combination of PTSD and mild TBI can occur in different settings, including combat, car crashes, and assaults. In the context of the past decade’s tempo of military engagements and increasing levels of violence in society, the combination is a growing concern, involving military personnel, veterans, and civilians. There are numerous comorbid conditions that can present with PTSD and mild TBI, including other anxiety symptoms, mood disorder, cognitive deficits, and sleep disturbance, along with substance abuse and pain issues. The latter two comorbid conditions are reviewed in detail in the text in separate chapters.

A longer section in the last half of the text reviews clinical management. A chapter on assessment reviews clinical evaluation, history, and treatment approach to PTSD and mild TBI individually and in combination, along with assessment of functioning and recovery. One important chapter in relation to forensic psychiatry, “Assessment in Contexts That Threaten Response Validity,” examines underlying motives that may exaggerate symptoms or reduce effort; it provides relevant strategies to improve the accuracy of the assessment process. The latter chapters provide excellent reviews of several treatment strategies for mild TBI and combined PTSD and mild TBI. The text concludes with more focused reviews of the impact of PTSD and mild TBI on service delivery in the military and on health care costs.

I found this text useful in a number of ways. It is readable and addresses a complex and growing clinical problem. The chapters cover an array of topics, including epidemiology, neurobiology, imaging, biopsychosocial models, cognition, comorbidity, evaluation and assessment, forensic issues, and treatment interventions. Each chapter provides a manageable number of pages to review, yet the content is sufficiently detailed and supported by numerous references. The text provides a broad review of mild TBI and PTSD and provides background in specific areas related to topics in teaching and research. I would recommend this text without reservation for use in clinical and academic settings.