As I have been researching PTSD and TBI/ABI for some time now, I was pretty shocked to read the conclusions from this 'study' by Hoge. I wonder where the funding came from as it is a clearly biased study. My guess would be funding from the military, and/or drug companies (who are making millions of dollars fom medications such as antidepressants that actually CAUSE some brain/neurological/neurotransmitter etc damage) perhaps supported by medics (who get taken on 'jollies' by the drug companies in their efforts to get as many patients as possible onto their medications)? I haven't yet checked the sources used here but there is a lot of conflicting 'evidence' in all these areas: it appears possible to 'prove' whatever is required, the more I learn in this area the less I trust just one piece of research!

1. It says:"one recent study showed that postconcussive symptoms occur at similar rates in persons with mild traumatic brain injury and in those with no traumatic brain injury".
This is ridiculous! MRI scans often do no show mild TBI/ABI - is that the 'evidence' used for determining which people had brain injury & which didn't, or WHAT was used? 'Postconcussive symptoms' are caused by concussion - a brain injury. There is generally a very high incidence of brain injury going undetected (up to 50%) - doctors (if they even bother to do an MRI scan) use the apparent lack of 'evidence' of injury as 'there is no injury' - a dreadful fallacy that has been proved bad practice for many years now and doesn't even hold up in court. Most often, if any scan is done, it is done too soon after the event, with incorrect settings, and/or only with CT.

2.It says: "There are no reliable means to differentiate between symptoms involving impaired awareness that are caused by severe stress or mild traumatic brain injury, so differential diagnosis is problematic."
Yes, it can be problematic and it requires a WILL to WANT to find the difference, and for various reasons, this will is often lacking, but there are however neuropsychological tests that if done properly & at the correct time, can differentiate between the two (& including Aquired, non-traumatic brain injury fom eg anoxia/toxins etc). There are several studies that have looked at this. Also, to suddenly have a brain injury and the terror that can cause: to not be able to do or see or understand all the things you could before, is VERY shocking and that can cause very severe stress reactions and depression etc, as can DENIAL that this is the case, on top of the injury. Betrayal trauma on top of brain injury is extremly damaging, treating a patient as if they are 'somatising' their symptoms is one of the cruellest things a doctor or psychologist can do. I have come across many people whose brain tumours were not 'diagnosed' early on by medics who chose not to listen to their patients - thinking they, the docs, of course know better! Instead these people were prescribed antidepressants and told they were 'imagining' their symptoms for so long that their tumours grew so large that eventual surgery was much more dangerous as extensive brain damage had occurred from the greatly enlarged tumour.

3. It says: "After the first Gulf War, many soldiers had unexplained somatic symptoms — the so-called Gulf War syndrome — which many commentators ascribed to concern about chemical agents, even though exhaustive tests failed to determine a neurologic basis for the symptoms."
To call these purely SOMATIC symptoms is ridiculous now, there is too much evidence to the contrary, although the military (from both sides) has done its best to cover up info on the neurotoxins etc they used, just as in Portan Down, England. Whose 'exhaustive tests' are being referred to? There is clear neurological involvement in very many (probably almost all if truth were actually told) of Gulf War syndome sufferers. This smacks rather of early medical views on ME: some yars ago patients were told they were somatising symptoms & were 'psychiatric' cases whereas now it's clear there are clusters of what is now known to be a real physical illness (with CNS damage) & evidence of virus involvement etc - rather sad that soldiers are being tarred with this same brush by psychologists who should know better. Interestingly, neurotoxic damage often does not show on MRI scan and the best tests that would show it are often not done at all, eg muscle biopsy, specific blood tests - I wonder why?! Yes, it might frighten soldiers, frighten & educate & mak them AWARE, NOT make them somatise, it mght also allow them to not be afraid to REPORT! Clearly because it is cheaper for the military to 'treat' PTSD, rather than brain damage. It is true that it's good for patients to HOPE that they can recover when 'only' PTSD rather than brain damage, but when this is a wrong diagnosis it is preventing correct treatment & rehab, that if done early on would ensure maximum possible recovery. The more I find out about PTSD & TBI/ABI/neurological damage, the more I am led to believe that many many more cases of 'just' PTSD now will, with correct diagnosis, turn out to be TBI/ABI/neurological damage - including damage to neurotransmitters - but of course the military and medical & motor insurance companies etc all have enormous financial incentives to NOT 'recognise' an even more serious diagnosis than PTSD.