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Brain, Environmental and Psychological Trauma: TBI and PTSD Markers, Mechanisms, and Interactions
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Barone, Frank
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Spring 2025
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2025-06-26
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Abstract
Traumatic brain injury (TBI) and Post-traumatic stress disorder (PTSD) are significant public health concerns, particularly among individuals exposed to high-stress environments such as military combat. However, they can also occur anytime due to various head injuries and stress. This review examines the interplay between TBI and PTSD, highlighting their prevalence, symptoms, potential biomarkers, pathological mechanisms, and the interactions that occur with exposure to both conditions. Worldwide, an estimated 69 million individuals per year sustain TBI, while approximately 13 million people per year exhibit PTSD. Notably, PTSD is markedly higher among individuals with TBI, particularly in veterans, where an estimated 28% of patients with mild TBI also exhibit PTSD. Although each alone results in significant symptoms and pathology, the co-occurrence of PTSD and TBI exacerbates the situation due to overlapping symptoms and bidirectionally interacting pathological changes. The occurrence of both TBI and PTSD increased cognitive impairments, emotional dysregulation, and disability with reduced function and health. Here, I provide a synthesis of current literature and assess the relationships between TBI and PTSD. We draw upon clinical and preclinical data to provide this critical overview. TBI increases the risk of developing PTSD, and PTSD increases susceptibility to the consequences of TBI. This interaction is due primarily to several overlapping mechanisms, including disrupted fronto-limbic brain circuits, neuroinflammation, and dysregulation of the HPA axis and specific neurotransmitter systems. White matter and brain area changes affect neural connectivity and functioning. Stress systems, inflammation, neurotransmitter imbalances, and structural brain changes interact closely in both TBI and PTSD. For example, chronic stress dysregulates the HPA axis, amplifying neuroinflammation and altering cortisol levels, further impacting neurotransmitter systems like serotonin and dopamine. This biochemical cascade contributes to white matter degradation and reduced brain volume, especially in regions like the hippocampus and prefrontal cortex, worsening cognitive and emotional symptoms. These interconnected changes create a feedback loop that sustains dysfunction across neural networks, complicating recovery. These changes worsen cognitive and emotional symptoms and create a feedback loop that hinders recovery. Continued research is required to understand TBI and PTSD interactions better. Additional pathological mechanisms and targets for intervention using appropriately designed studies in experimental models and in the clinic. This “translational research” approach will help us discover future risk prevention, intervention, and rehabilitation strategies that can improve the quality of life for those impacted by these comorbid and disabling disorders.
Citation
Biswas, A. (2025). Brain, Environmental and Psychological Trauma: TBI and PTSD Markers, Mechanisms, and Interactions [Masters Thesis, SUNY Downstate Health Sciences University]. SUNY Open Access Repository. https://soar.suny.edu/handle/20.500.12648/16990