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Open Access Highly Accessed Research article

Posttraumatic Stress Disorder in patients with traumatic brain injury

Judith Glaesser1*, Frank Neuner12, Ralph Lütgehetmann3, Roger Schmidt3 and Thomas Elbert12

Author Affiliations

1 Department of Psychology, University of Konstanz, 78457 Konstanz, Germany

2 vivo, Cupramontana, Italy

3 Kliniken Schmieder, Eichhornstraße 68, 78464 Konstanz, Germany

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BMC Psychiatry 2004, 4:5  doi:10.1186/1471-244X-4-5

Published: 9 March 2004



Severe traumatic stressors such as war, rape, or life-threatening accidents can result in a debilitating psychopathological development conceptualised as Posttraumatic Stress Disorder (PTSD). Pathological memory formation during an alarm response may set the precondition for PTSD to occur. If true, a lack of memory formation by extended unconsciousness in the course of the traumatic experience should preclude PTSD.


46 patients from a neurological rehabilitation clinic were examined by means of questionnaires and structured clinical interviews. All patients had suffered a TBI due to an accident, but varied with respect to falling unconscious during the traumatic event.


27% of the sub-sample who were not unconscious for an extended period but only 3% (1 of 31 patients) who were unconscious for more than 12 hours as a result of the accident were diagnosed as having current PTSD (P < .02). Furthermore, intrusive memories proved to be far more frequent in patients who had not been unconscious. This was also the case for other re-experiencing symptoms and for psychological distress and physiological reactivity to reminders of the traumatic event.


TBI and PTSD are not mutually exclusive. However, victims of accidents are unlikely to develop a PTSD if the impact to the head had resulted in an extended period of unconsciousness.