Research pertaining to the self-report of symptoms after traumatic brain injury was reviewed. Cognitive, emotional, and motivational factors have more relevance than demographic (except for female sex) and personality factors. Specific neuropsychological deficits in attention and memory have been found in the early stages after head injury of even mild severity. This is unlikely to be the only factor affecting symptom persistence. Exaggeration of cognitive dysfunction occurs in some cases, but appears unrelated to symptom overreport. Increased emotional distress typically accompanies symptom persistence. The psychological reaction of preoccupation with symptoms and emotional distress is not unique to concussion, but also occurs after severe head injury and back injury and relates more to the personal interpretation of the effect of the trauma than to objective indicators of brain injury severity.