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Study Suggests Post-Concussion Syndrome May Be PTSD

A new study from the University of Bordeaux in France suggests that a condition classified in the DSM-IV as post-concussion syndrome (PCS) may actually be post-traumatic stress disorder (PTSD). Post-concussion syndrome is the name for long-term symptoms that some patients experience after suffering a concussion. Many experts have expressed dissatisfaction with this label, objecting that the symptoms of post-concussion syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders are not distinct enough to differentiate them from other forms of mental illness. For years, medical professionals have struggled to understand PCS—how it progresses, how it should be treated and how long the symptoms are expected to continue. New research suggests that part of the reason details about PCS have been so difficult to pin down is that it is not a distinct condition at all. The study from the University of Bordeaux shows evidence that symptoms that persist months after a concussion may actually be PTSD rather than a direct result of the concussion. The results of this new study were published in July 2014 in the journal JAMA Psychiatry.

PCS ‘Not Specific Enough’ to Be Distinct

The research team assessed 1,361 patients who visited the University Hospital of Bordeaux between December 2007 and February 2009. Of these patients, 534 had sustained a concussion at least three months prior, and 827 of those in the study were control patients with no concussion or other head injury. The symptoms of a concussion—a mild traumatic brain injury (TBI)—are usually short-lived. However, some people report symptoms months after their injury, which can include headache, blurry vision, trouble concentrating, depressed mood, trouble sleeping, sensitivity to light or sound, nausea and dizziness. The study found that 21.2 percent of the post-concussion patients met the diagnostic criteria laid out for PCS, while 8.8 percent met the diagnostic criteria for PTSD. Of the patients with no recent history of head injury, 16.3 percent met the criteria for PCS, while 2.2 percent met the criteria for PTSD. These results led the researchers to conclude that the symptoms of PCS are not distinct enough to reliably distinguish this condition from complaints that are not related to head injury. They argued that the idea of PCS as a distinct condition should be discarded, and that lingering symptoms following a concussion should instead “be considered part of the hyperarousal dimension of PTSD.” Hyperarousal is a feature of PTSD that involves an increase in physical and psychological tension. The National Institute of Mental Health says that hyperarousal can include symptoms such as startling easily, feeling “on edge,” having trouble sleeping or displaying sudden outbursts of anger.

Concussion Events Can Be Traumatic

In advocating that PCS be discarded in favor of PTSD, the team of Bordeaux researchers point out that the events that lead to concussions are often serious and distressing. Such events might include major falls, car accidents, violent encounters and other situations that could easily lead to the development of PTSD. They make the argument that the history of concussion in patients who until now have been diagnosed with PCS is misleading. By claiming that PTSD fits these symptoms better, they are claiming that symptoms lasting three months after a mild TBI are actually due to the events that surrounded the injury, rather than the TBI itself. If further research supports the conclusions of the Bordeaux study, it could lead to changes in the ways concussions are treated. It could emphasize the importance of considering the psychological impact of the events surrounding TBIs, which could lead to increased screening for PTSD among post-concussion patients or even counseling or other treatment that could help to prevent traumatic incidents from developing into full-blown PTSD.

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