Skip to main content

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

Distinguishing between TBIs, psychological conditions key to treatment

Image of Military personnel holding a gun. A soldier assigned to Charlie Company, 2nd Battalion, 35th Infantry Regiment, 3rd Infantry Brigade Combat Team, 25th Infantry Division conducts battle drill training at Schofield Barracks, Hawaii on Feb. 10. PHCoE section chief Dr. Marjorie Campbell said injuries experienced in battle, including firefights and improvised explosive device explosions, can result in both TBI and conditions such as PTSD (Photo by: Army 1st Lt. Angelo Mejia)

Dr. Marjorie Campbell, section chief for prevention and early intervention at the Defense Health Agency's Psychological Health Center of Excellence , says traumatic brain injuries and the psychological effects of experiencing a traumatic event can go hand in hand, but they don't have to.

Campbell, a clinical psychologist at the Silver Spring, Maryland-based PHCoE, has studied the overlap between psychological health and TBI extensively, including being embedded at Naval Hospital Camp Pendleton's Concussion Care Clinic in California. The key, she explained, is figuring out which adverse outcomes can be attributed to TBIs, which can be attributed to conditions like post-traumatic stress disorder, and where there is potential overlap.

"There are three severity levels of TBIs - mild, moderate, and severe," Campbell said. "Over 82% of TBIs in the military are actually considered mild and are better known as concussions."

The severity of a TBI is based on factors including length of loss of consciousness and post-event amnesia, with concussions being at the low end of severity.

Although technically true, referring to concussions as TBIs carries with it an expectation that there is no chance of recovery, which is usually not the case, she explained.

"Within three weeks or so, 90% of individuals sustaining concussions will recover," Campbell said. "Only about 10% go on to develop post-concussion syndrome."

Campbell specializes in studying that 10%.

"When they don't recover, we want to know why," Campbell said. "What's in that group that's continuing to have post-concussive symptoms versus those that get better? I strongly believe it's the psychological health component."

She explained that the possibility likely rests in how that individual sustained the injury. A fall or a sports injury obviously does not carry with it the amount of psychological trauma that an automobile accident or an improvised explosive device explosion during combat does.

"It seems to be that element of trauma that might explain who goes on to develop longer-lasting symptoms," Campbell said.

Symptoms like headaches, sensitivity to light and sound, malaise, fatigue, irritability, depression, anxiety, and dizziness can be associated with a TBI, but are not TBI-specific.

These symptoms are, however, more prevalent in people who have suffered both a concussion and psychological trauma at the same time, Campbell noted.

"What people don’t realize is that there isn’t a strict division between the consequences of experiencing a traumatic brain injury, that seem physically concrete and therefore compelling, and an emotional trauma, which is invisible and might seem 'airy-fairy'," Campbell said.

Watching the World Trade Center fall, being in a motor vehicle accident or experiencing an intense firefight while in combat have the potential to change the brain "without being hit on the head," Campbell explained.

"Trauma alone can change the brain, but when you have the double whammy of a traumatic event and a concussion, determining to which degree psychological aspects versus brain aspects affect them can be difficult to figure out." Campbell said. "We try and do that, and what research has found is that it's the psychological health component that causes these lingering symptoms."

The tendency, she said, is to separate the two, and this does a disservice to everyone, especially the patient.

"The psychological component is probably the bigger burden in terms of outcomes. If you compare someone with post-traumatic stress disorder, or PTSD, and someone with PTSD and a concussion, the person with PTSD and a concussion generally does worse," Campbell said. "But it's counterproductive to over-focus on the concussion when they should have recovered from the acute effects within the first month. If they're not recovering, there's a different reason than the concussion."

Campbell also said that the study of psychological health is integral to the study of TBI and understanding what TBI is.

Her advice to anyone who experiences the short-term impacts of a concussion, whether that be the individual or those around them, is that the symptoms should go away. If they don't, that may be an indicator of another issue.

"The main thing to know is that a bump on the head can distress you and can cause some mild symptoms that should resolve themselves relatively quickly," Campbell said. "In the event that you've had a traumatic event, then you're already compounding the concussion with psychological trauma. If symptoms last longer than four weeks or get worse, the psychological part of it needs to be tended to."

Individuals with lasting symptoms may not necessarily have PTSD, she said, but they're probably experiencing post-concussive symptoms. The bottom line is that a person suffering from the combination of a concussion and a traumatic event usually fares worse.

"People need to know that these two things are related, and they should have someone to talk to," Campbell said.

Looking beyond Campbell's studies, the Psychological Health Center of Excellence is uniquely positioned to collaborate across the Department of Defense, Department of Veterans Affairs, and other agencies to provide leadership and expertise, inform policy and drive improvements in psychological health outcomes.

PHCoE initiatives, such as the Real Warriors Campaign and the inTransition program, address concussions and TBIs in their efforts to help ensure that active-duty and reserve service members, veterans, and retirees have access to both short- and long-term mental health care. PHCoE also collaborates with the Traumatic Brain Injury Center of Excellence to study the overlap of psychological health and TBI conditions.

You also may be interested in...

Article Around MHS
Nov 29, 2023

Green Beret Teams Up with the US Southern Command Warrior Care Program Care Coalition Competes in Department of Defenses Warrior Games Challenge and International Invictus Games

U.S. Army Sgt. 1st Class Jacob “Jake” Anthony competing in the 2023 Invictus Games held in Dusseldorf, Germany. (Courtesy photo)

Green Beret U.S. Army Sgt. 1st Class Jacob "Jake” Anthony was deployed to Afghanistan in 2005 on a mission to find a target. His team was breaching a door that turned out to be booby-trapped, resulting in an explosion that killed his teammate in front of him. Anthony would take shrapnel to the right frontal lobe to his brain and had to be initially ...

Publication
Nov 29, 2023

TBICoE's Low-Level Blast Research Efforts Infographic

.PDF | 2.12 MB

This infographic illustrates TBICoE's work to better understand how low-level blast influences warfighter brain health. These efforts directly support Line of Effort 2 of the Warfighter Brain Health Initiative.

Infographic
Nov 29, 2023

TBICoE's Low-Level Blast Research Infographic

What is TBICoE doing to help warfighters exposed to low-level blast? Leading the charge: 1. Collaborated on Military weapons training studies and Epidemiology studies 2. Led health and performance efforts in support of the Section 734 Program Advancing the science: 1. Measured LLB exposure effects on performance 2. Provided recommendations on LLB surveillance 3. Advanced DOD’s understanding of LLB health and performance effects Answering the call: 1. Outlined next steps for LLB research 2. Helped to develop guidance for managing brain health risk from blast overexposure 3. Recommended the development of a tool to capture career blast exposure These efforts are in support of the Warfighter Brain Health Initiative LLB Relevant Aims 1. Understand the known and emerging threats and hazards to brain health 2. Monitor warfighters for brain exposures 3. Reduce risk of brain exposures that may negatively impact brain health

This infographic illustrates TBICoE's research activity on understanding how low-level blast influences warfighter brain health. This work directly supports Line of Effort 2 of the Warfighter Brain Health Initiative. Learn more about low-level blast exposure and TBI at health.mil/LLB.

Calendar Event
Nov 21, 2023

TBICoE's Anomalous Health Incident Acute Assessment Training

This virtual training, hosted by the Traumatic Brain Injury Center of Excellence, will introduce learners to Anomalous Health Incidents and review assessment and treatment strategies. Detailed guidance on how to complete a medical evaluation using Anomalous Health Incident Acute Assessment (DHA Form 244), will be provided.

Calendar Event
Nov 21, 2023

TBICoE's Anomalous Health Incident Acute Assessment Training

This virtual training, hosted by the Traumatic Brain Injury Center of Excellence, will introduce learners to Anomalous Health Incidents and review assessment and treatment strategies. Detailed guidance on how to complete a medical evaluation using Anomalous Health Incident Acute Assessment (DHA Form 244), will be provided.

Calendar Event
Nov 21, 2023

TBICoE's Anomalous Health Incident Acute Assessment Training

This virtual training, hosted by the Traumatic Brain Injury Center of Excellence, will introduce learners to Anomalous Health Incidents and review assessment and treatment strategies. Detailed guidance on how to complete a medical evaluation using Anomalous Health Incident Acute Assessment (DHA Form 244), will be provided.

Calendar Event
Nov 21, 2023

TBICoE's Anomalous Health Incident Acute Assessment Training

This virtual training, hosted by the Traumatic Brain Injury Center of Excellence, will introduce learners to Anomalous Health Incidents and review assessment and treatment strategies. Detailed guidance on how to complete a medical evaluation using Anomalous Health Incident Acute Assessment (DHA Form 244), will be provided.

Calendar Event
Nov 21, 2023

Acute Concussion Care Pathway: MACE 2 & PRA Training

The Traumatic Brain Injury Center of Excellence hosts a combined Military Acute Concussion Evaluation 2 and Progressive Return to Activity clinical recommendation virtual training. Attendees may earn two CEUs through the Defense Health Agency Continuing Education Program Office.

Report
Nov 21, 2023

2023 Q2 DOD Worldwide Numbers for TBI

.PDF | 1005.91 KB

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in the second quarter of calendar year 2023. The data is also broken down by each branch of the ...

Report
Nov 21, 2023

2022 DOD Worldwide Numbers for TBI

.PDF | 1002.29 KB

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in the calendar year 2022. The data is also broken down by each branch of the armed services.

Report
Nov 21, 2023

2000-2023 Q2 DOD Worldwide Numbers for TBI

.PDF | 1.13 MB

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis from calendar year 2000 through the second quarter of calendar year 2023. The data is also broken ...

Refine your search
Last Updated: July 11, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery