Changes in Personality

Running head: CHANGES IN PERSONALITY FOLLOWING FRONTAL LOBE INJURY1

Changes in Personality Following Frontal Lobe Injury

Sean Edwards

Florida Institute of Technology

CHANGES IN PERSONALITY FOLLOWING FRONTAL LOBE INJURY 2

Abstract

The current paper will discuss basic information regarding frontal lobe injury due

to traumatic brain injury and personality changes following. Research regarding how

changes in personality occur and what those personality changes are will be discussed.

The personality changes primarily being discussed will be lack of empathy, emotionality,

anger, aggression and disinhibition. From all prior research investigators have proven that

there is a correlation between frontal lobe injury and personality change.


Changes in Personality Following Frontal Lobe Injury

Research psychologists consistently study to try and get a firm grasp on this

strange and interesting concept of personality. Personality is usually defined in terms of

the traits a person has or the characteristics that make up a persons behavior. Popular

topics usually brought up by these psychologists is if a person can change their

personality or what plays a bigger impact, environment or biological factors. After

observing patients with frontal lobe injury relatives and doctors noticed that there was a

change. This purpose of this paper is to try and assess if and to what extent personality is

changed after a frontal lobe injury.

Frontal Lobe Injury and Associations with Personality Change

Traumatic brain injury is typically characterized by acceleration-deceleration with

impact causing neuronal damage, or white matter damage. This action disrupts messages

being sent to the rest of the body. Traumatic brain injury or TBI can occur in all parts of

the brain or in a localized region, although due to all of the interconnections within the

brain it could be said that regardless of the region injured everything is affected. After

suffering TBI many patients continue to experience debilitating cognitive and emotional

issues (Aharon-Peretz &Tomer, 2007). Attention and concentration are some of the

different symptoms following TBI. Memory impairment is most likely the most common

symptom occurring after TBI and also one of the most difficult to deal with because both

working memory and long-term memory are affected. Emotional expression is one of the

most noticeable changes is a patient who suffered TBI; because of the injury neuronal

pathways associated with negative feelings are affected. Patients unfortunately may not

have all of the feelings they once had which is why rehabilitation immediately following


injury is so critical because it can be improved with help. Empathy and social behavior

are also negatively impacted because loved ones perceive that the person with TBI no

longer cares or is being inconsiderate, when in reality they are just unaware. Mood

disorders can occur comorbidly with TBI because of the neuronal and environmental

changes happening, anxiety and depression are most common. These aspects just listed

are some changes that impact a person’s behavior or personality following frontal lobe

injury and will be discussed in more detail.

Hugh Jarvey (1954), wanted to examine what part the frontal lobe played on

disinhibition. In his study he took 43 cases of penetrating brain wounds from the military

which had noted changes in behavior as the experimental, and the control group had 50

soldiers approximately in the same age group who suffered head injuries from medical

and surgical injuries. It was proven from the experimental group that those who had

experienced head injuries showed significant changes after injury, for instance, one

patient was once shy and modest became boastful and loud. Dishinibition is the biggest

problem from frontal lobe injuries. Those who were once quiet cannot stop themselves

from yelling out. This particular study found that there is also a loss of initiative and

spontaneity, confusion and disorientation also associated with dishinibition that is closely

related. Dishinibition may not add to the personality but it does alter the way in which a

person thinks and acts. The patient has also been shown to be aware of the changes in

their personality but still has difficulty reining it in. This is just one example that frontal

lobe injury does have an effect on how we behave.

Stuss and Gow (1992) were interested in reviewing the literature of one of the

most infamous brain injury patients, Phineas Gage. He is such an interesting subject


because he was one of the first people to be evaluated after his injury and many of his

family and friends all agreed that he was not the same. Ever since doctors have tried to

understand the personality and behavioral changes and whether traumatic brain injury is

the culprit. Stuss and Gow decided to do their own review of executive dysfunction and

traumatic brain injury. From some of the research they showed that depression could

usually occur after an injury, altering mood or behavior. Depression in TBI could be due

to multiple factors but it still can significantly change the attitudes of the person dealing

with it. Emotional affect after TBI is a huge issue, researchers found that there is no

doubt a decrease in emotional expression after injury. Not showing emotion is definitely

change in behavior or personality, especially for instance for someone who may have

been loving and caring pre-injury. The event of the injury itself may also change a

persons behaviors, they know have to deal with life changing injury that will forever be

with them. After reviewing those with this injury it was concluded that there most

certainly is a change in personality due to frontal lobe dysfunction due to this injury. The

frontal lobe is our control center, it is where we make our judgments and decisions, when

that is altered we are bound to change.

In a study done by Rodriguez-Bailon, Trivino, Lupianez (2012), they aimed to

find the executive deficits of patients who have suffered traumatic brain injury (TBI). The

researchers administered different attention tasks to measure how severe the frontal lobe

damage had been in patients and observe any other changes. Nine patients who had

frontal lobe damage were used to try and understand what really happens. After testing

the patients it was the first study to show a greater difference in control. The difference

was related to cognitive and behavioral impulsivity in patients. The frontal lobe is our


main control center, it controls our judgments and impulses, when this is compromised it

threatens those abilities. The tests given to participants also concluded that attention

deficits are proven in the networks of those with TBI. An interesting idea that researchers

came up with in this particular study was a correlation between TBI and borderline

personality. Researchers wondered if it could be at all possible that those who suffered a

frontal lobe injury due to TBI could consequently suffer from borderline personality

disorder due to the lack of empathy and emotional expression that most people with TBI

suffer. Nothing significant along the lines of personality disorder could be concluded

from this study but it is interesting to consider for future review.

Frontal lobe injury has shown to have changes on a person and their behavior but

another change to the frontal lobe that can change a person but is not caused by injury is

aging. Mentioned earlier were the changes due to damage because of TBI but aging in

itself can cause problems. Parkin and Java (1999), studied two groups of older

participants (young-old and old-old) to try and see significant differences in cognitive

functioning and what affects they had. If older people had changes in the frontal lobe just

due to aging this could also lead to personality changes. The researchers wanted to

examine how people of different ages performed at different types of tasks that involved

executive functioning. There were 40 participants in the young-old group and 20

participants in the old-old group and all were tested on a verbal intelligence scale and

fluid intelligence. While deterioration in aging is different compared to personality

changes from injury it should be considered. What is similar in someone who suffered a

traumatic brain injury and an aging person? From all the tests run, it was confirmed that

there was an age related decline. Older people showed slower processing speeds and less


crystallized intelligence, proving that unfortunately there is a change as we age. This is

important to think about with those who have suffered TBI because they also show these

results in some cognitive tests and if we can pinpoint any of the reasons behind either of

these issues we can begin to solve those problems.

A good estimate of how a person may change after a frontal lobe injury is seeing

how they can hold a job once they are healed and able. For instance, it was documented

that after the famous Phineas Gage was physically able to go back to work he could not

hold a job because of his impulsivity and aggression. Simpson (2001) used a behavioral

measure to help predict the employment of a person following a closed head injury.

Simpson believed that the ability to work after TBI was greatly diminished. A

questionnaire was used to assess functioning on sixty-one TBI survivors and they also

answered a background information scale, so education level and previous employment

status were incorporated. After assessments were made it can be concluded that many

aspects of the person and their injury have an effect on employment. Injury

characteristics are a big factor that comes into play with employment status, for instance,

if the injury is severe enough to cause permanent damage and inability to be independent

then it is unlikely that patient would be able to go back to work. Social and physical

variables are important to consider, such as if the persons brain injury causes an inability

in motor function, or if they have a supportive and caring environment around them. The

level of education and pre-injury employment also plays a role on whether or not they

will be able to go back to work. A set back that rehabilitation counselors encounter is that

they do not have a lot of tools to be able to accurately assess whether or not a TBI

survivor will be able to go back to work. So it seems that patience and acceptance are the


only tools needed at the moment to help a patient feel like their former selves. The

measure of whether or not a person can return to work post-injury is a strong indication

of some type of change.

The problem with assessing personality differences is that the person who has

suffered TBI is usually unaware of the changes and wants to believe they are fine. But

who can blame them; they have just suffered a life threatening and life changing injury.

One of the characteristics of TBI is unawareness, so if there are significant personality

changes it is usually not reliable to ask the person directly. One study decided that it

might be more dependable to ask a close relative of the person who has suffered this

injury (Weddell & Leggett, 2005). To fully understand the differences in personality or

behavior 87 participants with TBI were taken and analyzed with a variety of cognitive

tests that involved memory function, senses and emotions; then a relative of each person

was taken and interviewed on their feelings regarding the injury and judgments of the

changes in their family member. The relatives rated the TBI patients ability to perform

tasks that were categorized as psychosocial roles, such as organizing a schedule or paying

a bill on time. Another way the relatives rated the TBI family member was on their

ability to process emotion, such as if they can be caring and loving. When the surveys

were evaluated it was found that relatives did report changes in personality along the

lines of disorganization (as mentioned before), and emotional cognitive functions.

Increased irritability and bad moods were also reported and depressive or anxious

symptoms. However, there were some limitations to this study – it could be interpreted

that just bringing this topic up with a relative could have put the idea in their mind that

the loved one who suffered TBI has suffered severe personality change. Relatives who


were rated highly neurotic seemed to over estimate the personality change in their loved

one, which could also lead to distorted statistics. Regardless of the previous limitations it

is hard to argue that there are not any personality changes, memory and certain cognitive

functioning are almost always impaired. As a result of this study it was found that

counseling with the patient and the family after the injury to help the patient cope and

improve the families supportiveness were proven to be tremendously helpful. This was

shown not only in TBI but also with those suffering from Alzheimer’s disease. Further

studies regarding counseling need to be explored to help bring back the person the family

once knew and loved.

The reason behind the idea of a personality or behavior change in frontal lobe

injury is because of the unawareness a person seems to suffer about his or her actions. To

help understand the level of unawareness researchers examined this phenomenon in

people with TBI (Doss, 1994). Sixty subjects were taken, one experimental group with

TBI and a control group without TBI, and three tasks were given to compare self-

awareness. Topics that jumped out in patients with TBI was controlling temper, and

recognizing when saying or doing something upsetting to another person. The problem is

that those who have suffered frontal lobe dysfunction do not see themselves as different

from those who have not suffered this injury and do not think that there is anything

wrong. These findings give a clear example of impaired self-awareness and obviously

lead to changes in behavior. There were also clear significant differences between control

and experimental groups, showing less self-awareness of their own personality traits and

slower response on tasks. There are some researchers that do not believe TBI or frontal


lobe dysfunction have an affect on cognition or behavior, but from all this research it is

hard to deny.

Kim and Johnson (2002), focused on a specific type of personality change after

TBI, aggression or dishinibition. Most researchers focused on the overall changes in

personality, but these two wanted to pinpoint those two aspects specifically and see how

much it affected a person. There were common findings of inferior frontal lobe

functioning related to disinhibition and aggression. As it has been mentioned before, the

type or severity of injury often depends on the severity of the symptoms as well.

Aggression usually occurs shortly after injury, the patient becomes extremely irritable

and may lash out at others and they themselves may not even understand why they are

angry. Many different factors play a role in aggression: anatomy of injury, neurochemical

factors, environmental factors, and social factors and that’s just to name a few. One

reason for aggression could be that because the frontal lobe is our control center and

since that has been compromised it may lead to the inability to control anger. The true

TBI induced reason is still unclear, most likely due to the complexity of the brain and this

injury. The same reasons could be said for disinhibition. One theory is that there is a loss

of tonic balance between the inhibitory pathways in the frontal cortex. These inhibitory

pathways intervene between impulses and drive expression. The role of family support

and understanding could also lead to issues with aggression just because of frustration

due to the unfortunate situation. Treatment can be helpful in dealing with these two

symptoms but only after addressing the needs of the patient and assessing them correctly,

which can be tricky because of the difficulties in health care. Many factors are to be

considered but with support, rehabilitation, and possibly the use of medication treatment


both the aggression and dishinibition can be treated. It is difficult to treat an agitated

patient when all you want is to help them. Although there may be some kind of

environmental ideas that are involved with TBI, the patient could just be trying to cope

with this injury that has forever changed the person they once were. In general, more

treatment options need to be made available with TBI and more awareness so patients

with TBI can get support from loved ones.

Conclusion

There has been much debate as to whether frontal lobe injury or TBI can actually

cause real personality changes. After reviewing literature and other research it is hard not

to see that there is some changes, the person may fundamentally be the same person they

once were but their behaviors have changed. It does not seem that the person changes but

that the chemical imbalance due to trauma causes them to become confused, angry,

irritable, and impulsive. That in itself may not be the personality change but it no doubt

changes behavior. Some researchers have argued in the past that there is no change

following frontal lobe injury but that the changes in environment due to the injury cause

the change. This argument could be considered because some patients seem to recover

well from TBI, but they may have been lucky enough to receive the proper care and

rehabilitation soon after. Now that specific technology has been developed to view the

brain and study the impact of lesions it is hard to argue the fact the neuronal

depolarization caused by TBI does not change a person, or at least their behavior. The

idea of no change in personality or behavior after an injury that is specifically responsible

for our behavior and thoughts is almost unbelievable. Brain trauma needs to be taken

more seriously because it is no small matter. A person’s entire brain chemistry is altered


after TBI, it would be strange is they did not have some kind of change. A patient who

has suffered TBI becomes reactive and may be unable to control what they say, the same

types of symptoms occur to those who have brain tumors. The people who suffer this

type of frontal lobe dysfunction need more sympathy toward their struggle and

understanding to help them back to a normal life.

Discussion

Much more further research needs to be done regarding frontal lobe dysfunction

and personality but brain injury overall, as well. The biology behind brain injury is

becoming more known but in some aspects is still a bit of a mystery because of the

complexity of the brain. Not only does more research need to be done in terms of the

injury itself but rehabilitation. There are too many people suffering from TBI and not

getting the correct care after. Some patients have seen tremendous improvement after this

debilitating injury, but rehabilitation was implemented soon after injury. Family and

loved one support has also shown to significantly help a patient who has a frontal lobe

injury. If the patient has family support it is possible for them to show more improvement

and return back to normal functioning. Research on personality after frontal lobe injury,

rehabilitation, family support, and overall effects of TBI are all factors that deserve

further review.


References

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