Journal of the International Neuropsychological Society

Journal of the International Neuropsychological Society (2003), 9:4:663-676 Cambridge University Press
Copyright © 2003 The International Neuropsychological Society
doi:10.1017/S1355617703940069

CRITICAL REVIEW

Coexistence of posttraumatic stress disorder and traumatic brain injury: Towards a resolution of the paradox


ALLISON G.  HARVEY  a1 c1, CHRIS R.  BREWIN  a2, CHARLIE  JONES  a1 and MICHAEL D.  KOPELMAN  a3
a1 Department of Experimental Psychology, University of Oxford, Oxford, UK
a2 Subdepartment of Clinical Health Psychology, University College London, UK
a3 University Department of Psychiatry and Psychology, Guy's, King's and St. Thomas's School of Medicine, Kings College London

Abstract

The coexistence of posttraumatic stress disorder (PTSD) and traumatic head or brain injury (TBI) in the same individual has been proposed to be paradoxical. It has been argued that individuals who sustain a TBI and have no conscious memory of their trauma will not experience fear, helplessness and horror during the trauma, nor will they develop reexperiencing symptoms or establish the negative associations that underlie avoidance symptoms. However, single case reports and incidence studies suggest that PTSD can be diagnosed following TBI. We highlight critical issues in assessment, definitions, and research methods, and propose two possible resolutions of the paradox. One resolution focuses on ambiguity in the criteria for diagnosing PTSD. The other involves accepting that TBI patients do experience similar symptoms to other PTSD patients, but that there are crucial differences in symptom content. (JINS, 2003, 9, 663–676.)

(Received December 20 2000)
(Revised May 13 2002)
(Accepted June 29 2002)


Key Words: Posttraumatic stress disorder; Traumatic brain injury; Memory.

Correspondence:
c1 Reprint requests to: Allison Harvey, Department of Experimental Psychology, University of Oxford, South Parks Road, Oxford OX1 3UD, UK. E-mail: allison.harvey@psy.ox.ac.uk


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