Navigating the Overlapping Symptoms of PTSD and TBI for Veterans
Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are conditions that often affect veterans simultaneously. While each condition presents its own challenges, overlapping symptoms can complicate diagnosis and treatment. Understanding the similarities and differences between PTSD and TBI is critical to ensuring veterans receive the care they need.
Two Unseen Wounds of War
In 2004, U.S. Army veteran Frank Sonntag went on a routine security assignment in Iraq. When he was just north of Baghdad, an explosion from an insurgent mortar round rocked the ground nearby. Frank felt the shockwaves, hunkering down with his heart racing and ears ringing from the deafening blast. After the danger had passed and he confirmed he had no visible wounds, Frank got up and kept working, unaware of invisible injuries that would shape his future.
“I thought I was fine,” Frank recalled. “But a year later, I began having nightmares every night and headaches all day. I didn’t know it then, but I was dealing with two of the most common post-9/11 ‘signature wounds.’: traumatic brain injury and post-traumatic stress disorder.”
Frank's story is not unique. Many veterans face similar challenges, often struggling in silence. But thanks to organizations like Wounded Warrior Project® (WWP), there is hope for warriors like Frank and others living with PTSD and TBI.
Understanding PTSD and TBI
Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing traumatic events. The National Center for PTSD estimates that about 6% of the general population will develop PTSD sometime in their lives. Symptoms may not appear for weeks to months or years after an event.
PTSD has wide-ranging effects, and the general public often misunderstands it, leading to a sense of isolation for those affected.
While car accidents and falls are the most common causes of TBI, other causes may include impact-related injuries, gunshot wounds, and blast repercussions. Concussions are the most well-known TBI.
According to the Department of Veterans Affairs (VA), it is not uncommon to have both TBI-related symptoms and PTSD from the same event. Research shows that patients with head injuries are more likely to develop PTSD than those without a TBI history.
The Prevalence of PTSD and TBI Among Veterans
Military service members face greater exposure to hazards, increasing the risk of brain injuries from training exercises, blasts, or combat-related incidents. Deployment also increases the risk of PTSD, with some studies indicating that deployed service members are three times more likely to develop PTSD than those who did not.
Veterans are at a higher risk for PTSD, according to The National Center for PTSD. Estimates indicate at least 7% of veterans will develop the condition, with female service members having almost twice as much risk as male veterans.
In Wounded Warrior Project’s most recent Warrior Survey*, 76% of respondents reported having PTSD because of their military service. Over 36% of warriors reported a traumatic brain injury, while 17% said they sustained a head injury other than TBI because of service.
For many veterans like Frank, TBI and PTSD co-exist, but a complex web of symptoms can make it challenging to diagnose, which prolongs access to care and treatment. TBI can affect physical, cognitive, and mental health. So can PTSD. The most common overlapping symptoms include:
Fatigue
Sleep issues
Trouble with memory and attention
Feeling depressed
Feeling anxious
Irritability or aggression
Early Intervention Can Lead to Better Outcomes
The WWP™ Warrior Survey* underscores the importance of early intervention and care for those with TBI and PTSD. Warriors who reported some form of head-related trauma also indicated its negative impact on their quality of life, including increased risk of developing depression and anxiety.
There are many misconceptions about TBI (including that a person must lose consciousness to have a TBI), so many veterans like Frank may not realize they suffered a head injury until years later. A delayed TBI diagnosis, coupled with PTSD, makes it more challenging for warriors and their loved ones to seek appropriate care.
Treatment options for TBIs and PTSD are constantly evolving, and research is ongoing. Many veterans, like Frank, experience significant improvement thanks to proper medical care, mental health support, and rehabilitation.
Frank’s Experience with PTSD and TBI
"PTSD doesn't start the day you leave a combat zone," said Frank. "When I got home, I thought I was fine. But then I started having nightmares, flashbacks, and night terrors. It was like being back in Iraq, but I was in my own bedroom.”
Daytime wasn’t any better for Frank, who was still on active duty at the time.
"There's this misconception that admitting you need help is a sign of weakness... It's not about being weak; it's about being human."
"I had daily headaches for 40 or 50 days straight, and I started to lose my memory. I forgot the names of people who worked for me, I forgot how to drive home,” he said.
The nightmares and sleeplessness didn’t stop either. Frank tried to fight the symptoms, but the confusion and uncertainty took over. “I felt like I was trapped in a fog, and I couldn’t find my way out. By the time I walked into a hospital for treatment in 2008, I was on the brink of suicide,” he revealed.
But asking for help ultimately led to Frank’s TBI diagnosis, which put him on a path to healing.
"I wish I had known earlier I had TBI and PTSD," Frank reflected. "Maybe I could have avoided some of the darkest moments. That's why I'm so passionate about sharing my story now. I want other veterans to know they don't have to wait until they hit rock bottom to seek help."
Care and Management of PTSD and TBI
Due to the complexity and overlap of symptoms, a multifaceted care approach is often necessary for veterans trying to manage past trauma and live with cognitive impairments from a brain injury.
The VA’s Office of Research and Development has extensive data on advancements, including ongoing research around diagnostics and innovative treatment options for post-9/11 military personnel with both PTSD and TBI.
While medications may be useful for controlling specific symptoms, a combination of treatments may be valuable. VA indicates common therapies include:
Recognizing the importance of individualizing care for each warrior, WWP offers access to customized clinical programs andlong-term care resources that provide individualized treatment based on the actual symptoms and severity of the veteran's brain injury and/or PTSD. In addition, WWP offers services for family members and caregivers.
Overcoming Doubts to Ask for Help
One of the biggest challenges in helping veterans who have TBI and PTSD is overcoming the stigma associated with seeking and receiving care. Frank said many veterans, trained to be tough and self-reliant, find it difficult to ask for help.
Connecting with other warriors helped Frank improve his quality of life.
"There is this misconception that admitting you need help is a sign of weakness," Frank said. "But I've learned that it takes incredible strength to face these challenges and ask for support. It's not about being weak; it's about being human."
WWP works to combat this stigma through education and awareness campaigns and by linking veterans and their loved ones to unique health and wellness programs that can help them improve their quality of life while living with TBI, PTSD, and other concerns.
The Healing Power of Connection
Frank attended a WWP connection event two months before his separation from the Army.
“When I went to that first WWP event, I was very broken, and I wondered how I was going to live after 25 years of active duty,” said Frank. “But that event changed my whole life. I found people who had similar problems and knew exactly what I had been through. They had dramatically improved their lives. It showed me there was hope, and I could have a better life than I ever thought possible.”
With WWP's help, Frank navigated VA benefits and enhanced his quality of life. He also bonded with other veterans through Soldier Ride and other alumni activities.
"Wounded Warrior Project was a lifesaver for me," Frank said with gratitude, adding that his experiences inspired him to become a leader, as he had been in the Army. Today, Frank is a WWP peer mentor, helping other veterans navigate their recovery journeys. "It's about paying it forward. Someone was there for me when I needed it most, and now I want to be that person for others."
How Frank Balances Living with PTSD and TBI
Maintaining a good quality of life with both PTSD and a TBI is possible, but it requires effort. "For me, it’s a battle I fight every day,” said Frank. “The head injury and the PTSD are married to each other.”
For continued care, Frank relies on a combination of strategies:
Regular medical care: "For continued care, I see two doctors on a regular basis – a neurologist and a psychiatrist."
Engaging in meaningful activities: Frank found solace in learning and playing the piano. "There's something about focusing on the notes and the rhythm that quiets all the noise in my head," he explained. Additionally, he found golf to be a great outlet for dealing with anxiety.
Frank says golf helps to maintain his physical and mental health.
“Being out on a beautiful green course and enjoying nature’s beauty is quite the opposite of my Middle East experiences and the memories I brought back from combat.” He encourages other warriors to find activities that can help alleviate stress.
Staying socially active: Frank regularly connects with other veterans from all eras. "I learn from them and how they manage things, which also helps me," he said, noting that he recently met with the oldest Medal of Honor winner who lives near him in Arizona. The immense life and death trauma of his Medal of Honor actions gave me confidence I could deal with my challenges better than I ever imagined.”
Utilizing WWP resources: Frank continues to benefit from WWP's comprehensive support system, including connection events and physical health and wellness. He's hopeful to complete another Soldier Ride in the near future.
Words of Wisdom: Frank’s Advice for Fellow Veterans
Frank's journey from contemplating suicide to becoming a mentor for other veterans is a reminder that anyone can reclaim their life and find a new purpose."It's never too late to seek help and start the journey towards healing," said Frank, adding that he encourages other veterans to reach out to WWP and connect with fellow servicemen and women.
“Go find other warriors so you’re not alone. There are dozens of programs and events you and your family can attend – and it’s free."
He adds: "The road may be rocky some days, but thanks to the tools and support that I have now, I'm not just surviving, I'm living."
How to Get Help and Treatment for PTSD and TBI
If you, or someone you know, need urgent support, you can call, text, or chat with the National Suicide Prevention Lifeline at 988, or contact the Crisis Text Line by texting "TALK" to 741741.
Since 2003, Wounded Warrior Project® (WWP) has been meeting the growing needs of warriors, their families, and caregivers — helping them achieve their highest ambition. Learn more about Wounded Warrior Project.
Traumatic brain injury (TBI) affects 2.8 million Americans every year. Falls and accidents are the leading causes of TBI-related ER visits among the general...
Returning from Iraq after a convoy accident, Army veteran Lisa Crutch remembered many things that happened during deployment but could not recall many memories from life at home. Her children...
Jenna Malone was helping her husband Issac navigate his post-traumatic stress disorder (PTSD) when she noticed her own behavior changing. Eventually, she learned she was experiencing secondary PTSD.
Here are Wounded Warriors Social Links, if you want to share this page content on social media then select the media you would like to share to from the list below
