A. A history of head trauma that has caused significant cerebral concussion. Note: The manifestations of concussion include loss of consciousness, posttraumatic amnesia, and, less commonly, posttraumatic onset of seizures. The specific method of defining this criterion needs to be established by further research.
B. Evidence form neuropsychological testing or quantified cognitive assessment of difficulty in attention (concentrating, shifting focus of attention, performing simultaneous cognitive tasks) or memory (learning or recalling information).
C. Three (or more) of the following occur shortly after the trauma and last at least 3 months:
- becoming fatigued easily
- disordered sleep
- vertigo or dizziness
- irritability or aggression on little or no provocation
- anxiety, depression, or affective lability
- changes in personality (e.g., social or sexual inappropriateness)
- apathy or lack of spontaneity
D. The symptoms in Criterion B and C have their onset following head trauma or else represent a substantial worsening of preexisting symptoms.
E. The disturbance causes significant impairment in social or occupational functioning and represents a significant decline from a previous level of functioning. In school-age children, the impairment may be manifested by a significant worsening in school or academic performance dating from the trauma.
F. The symptoms do not meet criteria for Dementia Due to Head Trauma and are not better accounted for by another mental disorder (e.g., Amnestic Disorder Due to Head Trauma, Personality Change Due to Head Trauma).
In DSM-IV, individuals whose presentation meets these research criteria would be diagnosed as having Cognitive Disorder Not Otherwise Specified.
If the head trauma results in a dementia (e.g., memory impairment and at least one other cognitive impairment), postconcussional disorder should not be considered.
Postconcussional disorder can be differentialted from mild neurocognitive disorder by the specific pattern of cognitive, somatic, and behavioral symptoms and the presence of a specific etiology (i.e., closed head injury).
Individuals with Somatization Disorder and Undifferentiated Somatoform Disorder may manifest similar behavioral or somatic symptoms; however, these disorders do not have a specific etiology (i.e., closed head injury) or measurable impairment in cognitive functioning.
Factitious Disorder and Malingering
Postconcussional disorder must be distinguished from Factitious Disorder (the need to assume the sick role) and Malingering (in which the desire for compensation may lead to the production or prolongation of symptoms due to closed head injury).