A Systematic Review of Personality changes after Mild-to-Severe traumatic brain injury
International Journal of Applied Behavioral Sciences,
Vol. 11 No. 3 (2024),
19 September 2024
,
Page 45-60
https://doi.org/10.22037/ijabs.v11i3.46722
Abstract
Background and Aim:Personality changes (PCs) following traumatic brain injury (TBI) can exacerbate a frequently widespread range of symptoms, including problems in behavioral responses and emotion and reduced activity levels. This study aimed to systematically review the PCs in people with mild to severe TBI.Materials and Methods:A systematic literature search was conducted in PubMed, Web of Science, Scopus, and Google Scholar using MeSH and free text terms between 1998 and 2024. Of the 1160 articles identified, 768 studies remained after duplicate studies were removed. The abstracts and full text of the search results were screened using Rayyan QCRI Intelligent Systematic Review.Results:A final 67 studies were retrieved for full-text screening that met the inclusion criteria. After renewed screening, 27 studies were included in this review. The pooled sample size was 50369 participants aged 16-79 years. In addition, 25, 11, and 3 percent of the studies included all intense, severe, and mild TBI, respectively. Although several studies recognized personality changes between 3.5 and 88% in individuals with TBI, aggressiveness with 33% frequency is the most common personality change following traumatic brain injury in all intensities.Conclusion:Research showed that changes in personality and behavior can be due to the injury at a natural level, as well as the patient's response to the injury and the subsequent disabilities they may encounter. Moreover, the high frequency of reported personality disorders indicates that there is no distinct personality syndrome after TBI, which is personalized for each person and has an effect on their quality of life and daily functioning. Hence, to accurately diagnose and implement treatment interventions early and effectively, it is crucial to acknowledge and explain the symptoms, outcomes, phenomenology, and characteristics of deficits caused by TBI.
How to Cite
References
- Meyfroidt G, Bouzat P, Casaer MP, Chesnut R, Hamada SR, Helbok R, et al. Management of moderate to severe traumatic brain injury: an update for the intensivist. Intensive Care Med. 2022;48(6):649–66.
- Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung Y-C, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018;130(4):1080–97.
- Mohammed S, Traumatic Brain Injury and Spinal Cord Injury Collaborators. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study. Lancet Neurol. 2016;18(12):E7.
- Menon DK, Schwab K, Wright DW, Maas AI, Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. Arch Phys Med Rehabil. 2010;91(11):1637–40.
- Zetterberg H, Smith DH, Blennow K. Biomarkers of mild traumatic brain injury in cerebrospinal fluid and blood. Nat Rev Neurol. 2013;9(4):201–10.
- Cristofori I, Grafman J. Executive functions after traumatic brain injury: from deficit to recovery. In: Executive Functions in Health and Disease. Academic Press; 2017. p. 421–43.
- Beadle EJ, Ownsworth T, Fleming J, Shum DHK. Personality characteristics and cognitive appraisals associated with self-discrepancy after severe traumatic brain injury. Neuropsychol Rehabil. 2020;30(3):393–411.
- McIntyre A, Mehta S, Janzen S, Rice D, Harnett A, MacKenzie HM, et al. Coping strategies and personality traits among individuals with brain injury and depressive symptoms. Neurorehabilitation. 2020;47(1):25–34.
- Wilson L, Stewart W, Dams-O’Connor K, Diaz-Arrastia R, Horton L, Menon DK, et al. The chronic and evolving neurological consequences of traumatic brain injury. Lancet Neurol. 2017;16(10):813–25.
- Tenovuo O, Diaz-Arrastia R, Goldstein LE, Sharp DJ, van der Naalt J, Zasler ND. Assessing the severity of traumatic brain injury: time for a change? J Clin Med. 2021;10(1):148.
- Pavlovic D, Pekic S, Stojanovic M, Popovic V. Traumatic brain injury: neuropathological, neurocognitive and neurobehavioral sequelae. Pituitary. 2019;22(3):270–82.
- Dwan T, Ownsworth T. The Big Five personality factors and psychological well-being following stroke: a systematic review. Disabil Rehabil. 2019;41(10):1119–30.
- Butcher JN, Rouse SV. Personality: individual differences and clinical assessment. Annu Rev Psychol. 1996;47(1):87–111.
- Howlett JR, Nelson LD, Stein MB. Mental health consequences of traumatic brain injury. Biol Psychiatry. 2022;91(5):413–20.
- Ponsford JL. Psychological sequelae of closed head injury: time to redress the imbalance. Brain Inj. 1990;4(2):111–4.
- McAllister TW. Neurobehavioral sequelae of traumatic brain injury: evaluation and management. World Psychiatry. 2008;7(1):3–10.
- Jackson JJ, Wright AJ. The process and mechanisms of personality change. Nat Rev Psychol. 2024;3(5):305–18.
- Dwan T, Ownsworth T, Donovan C, Lo AHY. Reliability of the NEO Five Factor Inventory short form for assessing personality after stroke. Int Psychogeriatr. 2017;29(7):1157–68.
- Stuss DT. New approaches to prefrontal lobe testing. The Human Frontal Lobes: Functions and Disorders. 2007;2:292–305.
- Norup A, Mortensen EL. Prevalence and predictors of personality change after severe brain injury. Arch Phys Med Rehabil. 2015;96(1):56–62.
- Baer S. Predicting long-term personality changes following TBI. 2023.
- Bodley-Scott SE, Riley GA. How partners experience personality change after traumatic brain injury: its impact on their emotions and their relationship. Brain Impairment. 2015;16(3):205–20.
- Beadle EJ, Ownsworth T, Fleming J, Shum D. The impact of traumatic brain injury on self-identity: a systematic review of the evidence for self-concept changes. J Head Trauma Rehabil. 2016;31(2):E12–25.
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 2013.
- Vutakuri N. Detection of emotional and behavioural changes after traumatic brain injury: a comprehensive survey. Cognitive Comput Syst. 2023;5(1):42–63.
- Jokela M, Hakulinen C, Singh-Manoux A, Kivimäki M. Personality change associated with chronic diseases: pooled analysis of four prospective cohort studies. Psychol Med. 2014;44:2629–40.
- McKee AC, Stein TD, Kiernan PT, Alvarez VE. The neuropathology of chronic traumatic encephalopathy: CTE neuropathology. Brain Pathol. 2015;25(3):350–64.
- Broshek DK, De Marco AP, Freeman JR. A review of post-concussion syndrome and psychological factors associated with concussion. Brain Inj. 2015;29(2):228–37.
- Parker HA, Ranson J, McCrea MA, Hoelzle J, deRoon-Cassini T, Nelson LD. Personality characteristics and acute symptom response predict chronic symptoms after mild traumatic brain injury. J Int Neuropsychol Soc. 2021;27(10):992–1003.
- Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906.
- Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.
- Rezaei S, Salehi I, Yousefzadeh S, Moosavi H, Rahnama N. Aggressive personality characteristics and their determinant factors in patients with traumatic brain injury. J Kermanshah Univ Med Sci. 2012;16(1):49–62.
- Velikonja D, Warriner E, Brum C. Profiles of emotional and behavioral sequelae following acquired brain injury: cluster analysis of the Personality Assessment Inventory. J Clin Exp Neuropsychol. 2010;32(6):610–21.
- Seel RT, Kreutzer JS. Depression assessment after traumatic brain injury: an empirically based classification method. Arch Phys Med Rehabil. 2003;84(11):1621–8.
- Konop M, Sobański JA, Klasa K, Dembińska E, Mielimąka M, Citkowska-Kisielewska A, et al. Neurotic symptoms profile in day hospital patients with an anamnesis of head injury in the past. Psychiatr Pol. 2022;56(4):805–21.
- Ruocco AC, Swirsky-Sacchetti T, Choca JP. Assessing personality and psychopathology after traumatic brain injury with the Millon Clinical Multiaxial Inventory-III. Brain Inj. 2007;21(12):1233–44.
- Rodríguez-Bailón M, Triviño M, Lupiáñez J. Executive attention and personality variables in patients with frontal lobe damage. Span J Psychol. 2012;15(3):967–77.
- Weddell RA, Wood RL. Exploration of correlates of self-reported personality change after moderate-severe traumatic brain injury. Brain Inj. 2016;30(11):1362–71.
- Diaz AP, Schwarzbold ML, Thais ME, Cavallazzi GG, Schmoeller R, Nunes JC, et al. Personality changes and return to work after severe traumatic brain injury: a prospective study. Rev Bras Psiquiatr. 2014;36(3):213–9.
- Till C, Christensen BK, Green RE. Use of the Personality Assessment Inventory (PAI) in individuals with traumatic brain injury. Brain Inj. 2009;23(7):655–65.
- Greve KW, Sherwin E, Stanford MS, Mathias C, Love J, Ramzinski P. Personality and neurocognitive correlates of impulsive aggression in long-term survivors of severe traumatic brain injury. Brain Inj. 2001;15(3):255–62.
- Demakis GJ, Hammond F, Knotts A, Cooper DB, Clement P, Kennedy J, et al. The Personality Assessment Inventory in individuals with traumatic brain injury. Arch Clin Neuropsychol. 2007;22(1):123–30.
- Udala M, Clark J, Miller H, Leitner D, Libben M. Psychological disturbance and cognitive functioning in TBI patients. Appl Neuropsychol Adult. 2019;26(6):581–90.
- Mendez MF, Owens EM, Jimenez EE, Peppers D, Licht EA. Changes in personality after mild traumatic brain injury from primary blast vs. blunt forces. Brain Inj. 2013;27(1):10–8.
- Rush BK, Malec JF, Brown AW, Moessner AM. Personality and functional outcome following traumatic brain injury. Rehabil Psychol. 2006;51(3):257–64.
- Koponen S, Taiminen T, Portin R, Himanen L, Isoniemi H, Heinonen H, et al. Axis I and II psychiatric disorders after traumatic brain injury: a 30-year follow-up study. Am J Psychiatry. 2002;159(8):1315–21.
- Holzer KJ, Carbone JT, DeLisi M, Vaughn MG. Traumatic brain injury and coextensive psychopathology: new evidence from the 2016 Nationwide Emergency Department Sample (NEDS). J Psychiatr Res. 2019;114:149–52.
- Diaz AP, Schwarzbold ML, Thais ME, Hohl A, Bertotti MM, Schmoeller R, et al. Psychiatric disorders and health-related quality of life after severe traumatic brain injury: a prospective study. J Neurotrauma. 2012;29(6):1029–37.
- Gagnon J, Bouchard M-A, Rainville C, Lecours S, St-Amand J. Inhibition and object relations in borderline personality traits after traumatic brain injury. Brain Inj. 2006;20(1):67–81.
- Moley JP, Norman JL, Coccaro EF. Personality disorder and mild traumatic brain injury. Personal Ment Health. 2022;16(4):331–7.
- Albicini M, McKinlay A. Internalizing disorders in adults with a history of childhood traumatic brain injury. J Clin Exp Neuropsychol. 2015;37(7):776–84.
- Weddell RA, Wood RL. Perceived personality change after traumatic brain injury II: comparing participant and informant perspectives. Brain Inj. 2018;32(4):442–52.
- Lange RT, Brickell TA, French LM, Merritt VC, Bhagwat A, Pancholi S, et al. Neuropsychological outcome from uncomplicated mild, complicated mild, and moderate traumatic brain injury in US military personnel. Arch Clin Neuropsychol. 2012;27(5):480–94.
- Hibbard MR, Bogdany J, Uysal S, Kepler K, Silver JM, Gordon WA, et al. Axis II psychopathology in individuals with traumatic brain injury. Brain Inj. 2000;14(1):45–61.
- Obonsawin MC, Jefferis S, Lowe R, Crawford JR, Fernandes J, Holland L, et al. A model of personality change after traumatic brain injury and the development of the Brain Injury Personality Scales. J Neurol Neurosurg Psychiatry. 2007;78(11):1239–47.
- Tate RL. Impact of pre-injury factors on outcome after severe traumatic brain injury: does post-traumatic personality change represent an exacerbation of premorbid traits? Neuropsychol Rehabil. 2003;13(1–2):43–64.
- Nelson LD, Drebing C, Satz P, Uchiyama C. Personality change in head trauma: a validity study of the neuropsychology behaviour and affect profile. Arch Clin Neuropsychol. 1998;13(6):549–60.
- Torregrossa W, Raciti L, Rifici C, Rizzo G, Raciti G, Casella C, et al. Behavioral and psychiatric symptoms in patients with severe traumatic brain injury: a comprehensive overview. Biomedicines. 2023;11(5).
- Kennedy JE, Cooper DB, Reid MW, Tate DF, Lange RT. Profile analyses of the Personality Assessment Inventory following military-related traumatic brain injury. Arch Clin Neuropsychol. 2015;30(3):236–47.
- Neumann D, Zupan B, Babbage DR, Radnovich AJ, Tomita M, Hammond F, et al. Affect recognition, empathy, and dysosmia after traumatic brain injury. Arch Phys Med Rehabil. 2012;93(8):1414–20.
- Koponen S, Taiminen T, Hiekkanen H, Tenovuo O. Axis I and II psychiatric disorders in patients with traumatic brain injury: a 12-month follow-up study. Brain Inj. 2011;25(11):1029–34.
- Max JE, Schachar RJ, Landis J, Bigler ED, Wilde EA, Saunders AE, et al. Psychiatric disorders in children and adolescents in the first six months after mild traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2013 Summer;25(3):187–97.
- Sponheim SR, et al. Evidence of disrupted functional connectivity in the brain after combat-related blast injury. Neuroimage. 2011;54: S21-S29.
- Heltemes KJ, Holbrook TL, Macgregor AJ, Galarneau MR. Blast-related mild traumatic brain injury is associated with a decline in self-rated health amongst US military personnel. Injury. 2012;43(12):1990–5.
- Yeates GN, Gracey F, McGrath JC. A biopsychosocial deconstruction of “personality change” following acquired brain injury. Neuropsychol Rehabil. 2008;18:566–89.
- Lezak MD. Relationships between personality disorders, social disturbances, and physical disability following traumatic brain injury. J Head Trauma Rehabil. 1987;2(1):57–69.
- Max JE, Wilde EA, Bigler ED, Hanten G, Dennis M, Schachar RJ, et al. Personality change due to traumatic brain injury in children and adolescents: neurocognitive correlates. J Neuropsychiatry Clin Neurosci. 2015 Autumn;27(4):272–9.
- Siegel JS, Snyder AZ, Metcalf NV, Fucetola RP, Hacker CD, Shimony JS, et al. The circuitry of abulia: insights from functional connectivity MRI. NeuroImage Clin. 2014;6:320–6.
- Jang SH, Kwon YH. Abulia due to injury of the prefrontocaudate tract in a stroke patient. Am J Phys Med Rehabil. 2018;97(8):e76–7.
- Marin RS, Wilkosz PA. Disorders of diminished motivation. J Head Trauma Rehabil. 2005;20(4):377–88.
- Worthington A, Wood RL. Apathy following traumatic brain injury: a review. Neuropsychologia. 2018;118(Pt B):40–7.
- Starkstein SE, Leentjens AFG. The nosological position of apathy in clinical practice. J Neurol Neurosurg Psychiatry. 2008;79(10):1088–92.
- Tateno A, Jorge RE, Robinson RG. Clinical correlates of aggressive behavior after traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2003 Spring;15(2):155–60.
- Nathan DE, Oakes TR, Yeh PH, French LM, Harper JF, Liu W, et al. Exploring variations in functional connectivity of the resting state default mode network in mild traumatic brain injury. Brain Connect. 2015;5(2):102–14.
- Moore RD, Sauve W, Ellemberg D. Neurophysiological correlates of persistent psycho-affective alterations in athletes with a history of concussion. Brain Imaging Behav. 2016;10(4):1108–16.
- Dailey NS, Smith R, Vanuk JR, Raikes AC, Killgore WDS. Resting-state functional connectivity as a biomarker of aggression in mild traumatic brain injury. Neuroreport. 2018;29(16):1413–7.
- Mosti C, Coccaro EF. Mild traumatic brain injury and aggression, impulsivity, and history of other- and self-directed aggression. J Neuropsychiatry Clin Neurosci. 2018;30(3):220–7.
- Albicini M, McKinlay A. A systematic review of anxiety disorders following mild, moderate and severe TBI in children and adolescents. In: A Fresh Look at Anxiety Disorders. InTech; 2015:119-224.
- Grados MA, Vasa RA, Riddle MA, Slomine BS, Salorio C, Christensen J, et al. New onset obsessive-compulsive symptoms in children and adolescents with severe traumatic brain injury. Depress Anxiety. 2008;25(5):398–407.
- Vasa RA, Grados MA, Slomine BS, Herskovits EH, Thompson RE, Salorio C, et al. Neuroimaging correlates of anxiety after pediatric traumatic brain injury. Biol Psychiatry. 2004;55(3):208–16.
- Starkstein SE, Pahissa J. Apathy following traumatic brain injury. Psychiatr Clin North Am. 2014;37(1):103–12.
- Max JE, Keatley E, Wilde EA, Bigler ED, Levin HS, Schachar RJ, et al. Anxiety disorders in children and adolescents in the first six months after traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2011;23(1):29–39.
- Barrash J, Stuss DT, Aksan N, Anderson SW, Jones RD, Manzel K. Frontal lobe syndrome? Subtypes of acquired personality disturbances in patients with focal brain damage. Cortex. 2018;106:65–80.
- Cooper-Evans S, Alderman N, Knight C, Oddy M. Self-esteem as a predictor of psychological distress after severe acquired brain injury: an exploratory study. Neuropsychol Rehabil. 2008;18(5–6):607–26.
- Koliatsos VE, Rao V. The behavioral neuroscience of traumatic brain injury. Psychiatr Clin North Am. 2020;43(2):305–30.
- Schwartz JA, Connolly EJ, Valgardson BA. An evaluation of the directional relationship between head injuries and subsequent changes in impulse control and delinquency in a sample of previously adjudicated males. J Crim Justice. 2018;56:70–80.
- Abstract Viewed: 122 times
- PdF Downloaded: 203 times