Back to Top Skip to main content Skip to sub-navigation

Distinguishing between TBIs, psychological conditions key to treatment

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)

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Traumatic Brain Injury | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | TBI and Total Force Fitness

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...

MACE 2 Provider Training Refresher

Publication
4/5/2021

This version of the MACE 2 Provider Training is a shortened refresher of the full-length training slides.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Provider Resources | TBI Educators | Traumatic Brain Injury

TBI Hot Topics Bulletin March 2021

Publication
3/24/2021

Are you a busy health care provider? Not enough time to keep up with the latest TBI research trends and news? Stay informed with the TBI Hot Topics Bulletin. TBICoE tracks the latest TBI scientific studies, advances, and discoveries most relevant to health care providers. This issue covers the fourth quarter of calendar year 2020.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Research | Provider Resources | Traumatic Brain Injury

HEADS: Protect Your Strongest Weapon

Publication
3/11/2021

This flyer promotes awareness of the key symptoms of concussion/mild TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Traumatic Brain Injury

NICoE Brain Injury Awareness/March 2021Events

Publication
3/2/2021

The National Intrepid Center of Excellence (NICoE) is hosting a number of virtual events throughout March 2021 in observance of Brain Injury Awareness Month.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | TBI Education and Training Events

TBICoE 2020 Publications

Publication
2/25/2021

Master list of 2020 TBICoE Research Publications.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Research | Provider Resources

Progressive Return to Activity Following Acute Concussion/Mild TBI Provider Training

Publication
2/23/2021

The TBICoE revised the Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury Clinical Recommendation (PRA) and this updated provider training slide deck. The trainings objectives will help providers to identify the key changes to the updated 2021 PRA; explain the rationale for using a PRA protocol for service members post-concussion; understand the criteria for progression following a concussion or mild traumatic brain injury; identify appropriate activities at each stage of progression; understand how to apply primary care management strategies and specialty referral considerations to treat concussed service members who are not progressing as expected; utilize the Tri-Service Workflow mild TBI Alternate Input Method Form to document the PRA in the Armed Forces Health Longitudinal Application.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Provider Education | Provider Resources | TBI Educators | Traumatic Brain Injury | TBI Education and Training Events

Progressive Return to Activity Following Acute Concussion/Mild TBI

Publication
2/23/2021

The 2021 Progressive Return to Activity (PRA) Following Acute Concussion/Mild Traumatic Brain Injury Clinical Recommendation is an evidence-based return to activity protocol for primary care managers and concussion/traumatic brain injury (TBI) clinic providers. The PRA is a six-step approach that begins after the provider performs the Military Acute Concussion Evaluation 2 (MACE 2) and diagnoses the patient with a concussion/TBI. The PRA stages start with relative rest and allow service members to gradually increase activities until they receive clearance for return to full duty or activity. In each stage, it offers general and military specific activities and options to help providers manage their patients’ primary symptom clusters. The PRA also offers recommendations on specialty referrals and handouts are available for providers to give patients and leadership.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Provider Resources | Traumatic Brain Injury | TBI Resources

March 2021 Toolkit

Publication
2/22/2021

March is nationally recognized as Brain Injury Awareness Month, with the goal of increasing traumatic brain injury (TBI) awareness and improve health care providers’ ability to identify, care for, and treat all those who are affected by TBI. A TBI is a blow or jolt to the head that disrupts the normal function of the brain. According to the Defense Health Agency Traumatic Brain Injury Center of Excellence, 430,720 service members have been diagnosed with a first-time TBI since 2000. The toolkit also contains information on patient Safety Awareness Week, National Nutrition Month and many other graphics and messages you can use for holidays and observances during March.

Recommended Content:

Brain Injury Awareness Toolkit | Total Force Fitness | Traumatic Brain Injury | Brain Injury Awareness Month

2020 DoD Worldwide Numbers for TBI

Publication
1/28/2021

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis since 2000.

Recommended Content:

DoD TBI Worldwide Numbers | Traumatic Brain Injury Center of Excellence

2000-2020 DoD Worldwide Numbers for TBI

Publication
1/28/2021

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis since 2000.

Recommended Content:

DoD TBI Worldwide Numbers | Traumatic Brain Injury Center of Excellence

Progressive Return to Activity Clinical Support Tool Rehabilitation Providers

Publication
11/12/2020

This clinical support tool for rehabilitation providers details the algorithmic approach for enabling service members to return to pre-injury activity after sustaining a concussion/mild TBI. The tool is designed as a pocket-sized reference card, and supports the Progressive Return to Activity Following Acute Concussion/Mild TBI Clinical Recommendation for Rehabilitation Providers

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence

Progressive Return to Activity: Clinical Support Tool for Primary Care Managers

Publication
11/12/2020

This clinical support tool for primary care providers details the algorithmic approach for enabling service members to return to pre-injury activity after sustaining a concussion/mTBI. The tool is designed as a pocket-sized reference card, and supports the Progressive Return to Activity Following Acute Concussion/Mild TBI Clinical Recommendation for Primary Care Managers.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence

Progressive Return to Activity Following Concussion/Mild TBI: Rehabilitation Provider

Publication
11/12/2020

This clinical recommendation for rehabilitation providers details the importance of aiding service members to progressively return to pre-injury activity and promotes the standardization of care following a concussion/mild TBI.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence

2019 DoD Worldwide Numbers for TBI

Publication
9/30/2020

TBICoE is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis since 2000.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DoD TBI Worldwide Numbers | Traumatic Brain Injury

2000-2019 DoD Worldwide Numbers for TBI

Publication
9/30/2020

DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page 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 2000-2019.

Recommended Content:

Traumatic Brain Injury | TBI Resources | Worldwide TBI Numbers | Armed Forces Health Surveillance Branch | Traumatic Brain Injury Center of Excellence | TBI Educators | Provider Resources
<< < 1 2 3 4 5 > >> 
Showing results 1 - 15 Page 1 of 5

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.