Post-concussion syndrome and PTSD frequently follow the same injury. In civilians, a traumatic brain injury raises the risk of PTSD by roughly 70%. Complex PTSD adds emotional dysregulation (trouble controlling emotions). It also adds a negative self-concept and relationship difficulties. Complex PTSD routinely goes unrecognized. The two conditions share most of their symptoms. But they are treated differently, so both have to be identified first.
Headache, dizziness, disrupted sleep, irritability, trouble concentrating. That symptom list belongs equally to post-concussion syndrome and to post-traumatic stress disorder. And the event that caused one is frequently the event that caused the other.
Can a concussion cause PTSD?
A systematic review and meta-analysis found that in civilian populations, PTSD after TBI occurred in 12.2% at three months, 16.3% at six months and 18.6% at twelve months. The relative risk was 1.67 at three months and 1.70 at twelve. That is roughly a 70% increase over comparable people without a TBI. In military populations, the pooled frequency was 48.2%, with a relative risk of 2.33.
The authors are explicit that between-study heterogeneity was high (results varied widely from study to study). They say their findings should be read with caution. We repeat that rather than quoting the numbers as precise. Still, the direction is consistent.
Iljazi A, Ashina H, Al-Khazali HM, Lipton RB, Ashina M, Schytz HW, Ashina S. Neurol Sci. 2020;41(10):2737–2746. doi:10.1007/s10072-020-04458-7
What is complex PTSD after a brain injury?
Complex PTSD (cPTSD) is recognized as a distinct diagnosis in ICD-11. It requires the core PTSD features: re-experiencing, avoidance, and a persistent sense of current threat. It also requires three more disturbances that PTSD alone does not capture:
- Affect dysregulation: emotional reactions that are hard to control, with heightened reactivity or emotional numbing
- Negative self-concept: persistent beliefs about being diminished, defeated or worthless, often carrying shame or guilt
- Disturbances in relationships: trouble staying close to, or feeling connected to, other people
cPTSD typically follows prolonged or repeated trauma that was hard to escape, rather than a single incident. That matters more in an injury population than it might appear. A person’s concussion may have happened in a single crash. But then come the years that follow: not being believed, cycling through clinicians, fighting a claim, and losing work and role. Those years are themselves a prolonged and inescapable stressor.
When it goes unrecognized, the affect dysregulation gets blamed on the brain injury. The negative self-concept is read as depression. The relationship difficulties are treated as a personality problem. Naming it correctly changes the treatment plan. It also changes how the person understands what is happening to them.
How do you tell post-concussion syndrome from PTSD?
Someone who is irritable, sleeping badly and losing their train of thought after a crash could be describing a concussion, a stress reaction, or both. What separates them is pattern rather than any single symptom. What provokes the symptoms? How do they change with thinking load versus emotional load? Are there objective vestibular (balance) or oculomotor (eye-movement) findings? How does the picture move over time?
What tests screen for PTSD and post-concussion syndrome?
- CAPS-5: the Clinician-Administered PTSD Scale. It is a structured interview based on DSM-5 criteria
- PCL-5: the PTSD Checklist for DSM-5. It is a 20-item self-report for screening and tracking change
- RPQ: the Rivermead Post-Concussion Symptoms Questionnaire. It scores 16 symptoms for severity
- BC-PSI: the British Columbia Post-Concussion Symptom Inventory. It scores how often symptoms happen and how intense they are, against ICD-10 criteria
Repeating the same instrument over time turns “I still don’t feel right” into a documented trend. That matters clinically. It matters again if the injury is connected to a claim.
Should PTSD and post-concussion syndrome be treated together?
If the vestibular dysfunction is treated but the trauma response is not, the patient still has symptoms. Now flip it. Say the trauma response is treated, while an untreated oculomotor problem keeps causing headaches every time they try to read. Then the therapy is fighting a physical injury it cannot reach. Both have to be identified before either plan is built.
Sometimes avoidance has become the main obstacle. Then we use Acceptance and Commitment Therapy, in-house. It runs alongside the physical rehab, not on a separate track.
Common questions
What is the difference between PTSD and complex PTSD?
Complex PTSD is recognized in ICD-11. It includes all the core PTSD features. It adds three further problems: trouble regulating emotion, a persistently negative self-concept, and trouble sustaining relationships. It usually follows prolonged or repeated trauma rather than a single event.
Could a long injury claim itself contribute to complex PTSD?
The prolonged, inescapable stressors associated with cPTSD are not limited to the original incident. Years of not being believed count. So do repeated exams and the loss of work and role. Together they are a sustained stressor in their own right. We assess for it. We do not assume every change comes from the brain injury.
Do I need a psychiatrist as well?
Sometimes. We screen with structured instruments and treat the overlap directly, including ACT in-house. When a case calls for psychiatric care, we say so. We help you get there rather than managing around it.
Can a concussion affect your mood?
Yes. Irritability sits on the symptom list of both post-concussion syndrome and PTSD. Some changes point elsewhere: emotional reactions become hard to control, a sense of being worthless or defeated sets in, or closeness with other people becomes difficult. When that happens, the cause may be complex PTSD rather than the brain injury alone. Those changes are often mislabeled as depression or a personality problem. That is why we screen for them with structured instruments.
What symptoms do PTSD and post-concussion syndrome share?
Headache, dizziness, disrupted sleep, irritability and trouble concentrating belong to both conditions. The crash or fall that caused one often caused the other. No single symptom tells them apart. The pattern does: what sets the symptoms off, how they change under mental versus emotional strain, whether there are objective balance or eye-movement findings, and how the picture shifts over time.