Becoming more oneself? Changes in personality following DBS treatment for psychiatric disorders: Experiences of OCD patients and general considerations

Abstract

Does DBS change a patient’s personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson’s disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality.

Neuroethics of neuromodulation: An update

“…Gilbert et al’s study has generated a significant critical response literature focused on this understanding of self-estrangement and related methodological questions [26] [27]. de Haan et al report on similar themes in their own patient population, in particular how patients employ the idea of “becoming a different person” as a result of DBS[28]. de Haan et al argue that patients deploy this idea in a number of incompatible ways such that its clinical significance is unclear.…”

Clarifying the Normative Significance of ‘Personality Changes’ Following Deep Brain Stimulation

“…However, data from Gilbert and colleagues and De Haan and colleagues suggests that patients do not always experience these change as negative. More importantly though, their data supports the idea that merely considering whether a change is liked by the patient is not sufficient for fully elucidating the moral significance of changes following DBS (de Haan et al 2017).…”

“…A considerable number of theorists invoke the concept of identity in their discussions of psycho-socical changes following DBS (Baylis 2013;Goddard 2017;Lipsman and Glannon 2013;Müller et al 2017;Witt et al 2013). This is quite natural, given that some patients have used the phrase of "becoming a different person" following DBS treatment (de Haan et al 2017). However, it is widely agreed that there are (at least) two different senses in which it is possible to understand identity 1 3…”

“…The empirical literature also lumps together these concepts. In a recent patient interview study, Sanneke de Hann and colleagues acknowledge that there may be technical differences between the concepts of personality, self and personal identity, but employ these terms interchangeably in their study (de Haan et al 2017).…”

Open-label trial of anterior limb of internal capsule–nucleus accumbens deep brain stimulation for obsessive-compulsive disorder: insights gained

“…Our study did not show any effect of ALIC-NAcc-DBS on both measurements of personality traits and executive function. Notably, the concept of personality may differ between psychiatrists and the popular point of view,23 and alterations in OCD symptoms may already imply changes in behaviour and, therefore, in the personality concept of patients. However, standardised measurements of personality traits are suitable tools for facing these concerns, indicating that, although behaviour may change through symptom improvement, trait-based personality as a concept of emotional pattern, self-concept and interaction with one’s surroundings is not altered.…”