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Personality Change and TBI: The Devastating Effects of Brain Damage Localization


Traumatic Brain Injury (TBI) can lead to many dramatic and debilitating neuropsychiatric symptoms. One such neuropsychiatric change that can occur are personality changes (Warriner & Velikonja, 2006). A personality change can be defined as a difference in a person’s affect and motivations, though numerous construct definitions have been proposed over the years by researchers (Prigatano, 1992). These changes can vary from subjective complaints of the patients that aren’t noticeable using neuropsychological assessment, to severe personality changes that alter everyday activities and relationships. These changes can also be temporary or permanent depending on the severity of the brain injury (Balan et al.2021).

Phineas Gage: A case study on severe frontal lobe damage

The most famous example of personality changes after a brain injury is the story of Phineas Gage. Phineas Gage was a run of the mill railroad worker until one day he had a devastating accident at work. A nail pin went flying into his face right into his frontal lobe. Yet, somehow despite severe brain damage, he survived. Physicians at the time were shocked. Not only did Phineas Gage survive the blow, he also retained physical and cognitive functioning despite the nail still being lodged in his frontal lobe. However, soon after the incident a change was noticeable. Before, Phineas Gage was enjoyable to be around and a hard worker. Afterward, Phineas Gage became irascible, argumentative, mean-spirited, and impulsive. For the first time, medicine discovered the localization (i.e. the specific area that governs a specific function) of these higher order executive functions.

Meaning, the world of medicine had finally discovered that a large portion of the set of skills required in tasks such as self-control and flexibility known as executive function occurred in the frontal lobe. This Phineas Gage case study is the backbone behind current thought in personality changes in TBI. With the help of this case study, modern science is slowly getting closer to understanding and treating personality changes in those who have had a TBI.

So, what causes these devastating changes in personality?

While consequences of TBI such as Post Traumatic Stress Disorder (PTSD) and adjustment disorders cannot be ruled out in a large subset of patients experiencing personality changes after TBI, there is a biological underpinning to many cases as well (Yeates et al., 2008). No matter the pathophysiology, TBI most often affects the frontal and temporal lobes.

This sort of localized damage can cause personality changes because these larger brain domains govern personality. When these areas are affected, depending on the severity of the damage, personality is mildly to drastically altered (Stuss, 2011).

What happens in a personality change?

Personality changes, ranging in severity and length, are devastating and demonstrate the wide-ranging and impactful consequences of TBIs. Many new emotions, difficulties, and adaptive strategies can occur in their wake. Patients experiencing negative personality changes are often noted as more depressed and anxious (Diaz et al., 2014). On the more severe side of personality changes, agitation, aggressiveness, disinhibition, and apathy are noticed (Balan et al., 2021). At the most severe end, patients suffer from complete lack of awareness or insight into their new-found deficits, which is often referred to anosognosia (Golden & Golden, 2003). All in all, these changes which often go against the very personhood of the TBI survivor can cause:

  • long-term work disability

  • interpersonal difficulties

  • communication deficits

  • and even diminishing everyday functioning.

These effects can be seen even when separated from cognitive and physical limitations of TBI not related to personality changes.

Where does Power of Patients fit in?

Power of Patients is here to support you in this tough time. Power of Patients is also committed to driving more research. Power of Patients is especially concerned in improving the welfare of those suffering from debilitating symptoms such as personality changes. Using the Power of Patients customized symptom tracker to track one’s symptoms and healing will not only help you and your clinician better understand your symptoms in a broader context, but it will also give Power of Patients the opportunity to use your de-identified information to study effective treatments for TBI patients. Overall, it is a win-win situation for patients, caregivers, clinicians, and medical researchers. See how Power of Patient’s symptom tracker can help you or your loved one today! We are here with you every step of your journey.

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