This study employed a multi-step, rational-empirical approach to identify dimensions of personality disturbance in brain-damaged individuals: (1) Five dimensions were hypothesized based on empirical literature and conceptual grounds. (2) Principal components analysis was performed on the Iowa Scales of Personality Change to determine the pattern of covariance among 30 personality characteristics. (3) When discrepancies existed between principal components analysis results and conceptually-based dimensions, empirical findings and clinical considerations were weighed to determine assignment of ISPC scales to dimensions. (4) The fit of data to the refined dimensions was assessed by examination of intercorrelations. (5) Differential predictions concerning the relationship of dimensions to ventromedial prefrontal (vmPFC) damage were tested. This process resulted in specification of five dimensions: Disturbed Social Behavior, Executive/Decision-Making Deficits, Diminished Motivation/Hypo-emotionality, Irascibility, and Distress. In accord with predictions, the 28 participants with vmPFC lesions, compared to 96 participants with focal lesions elsewhere in the brain, had significantly more Disturbed Social Behavior and Executive/Decision-Making Deficits, and tended to have more Diminished Motivation/Hypo-emotionality. Irascibility was not significantly higher among the vmPFC group, and the groups had very similar levels of Distress. The findings indicate that conceptually distinctive dimensions with differential relationships to vmPFC can be derived from the Iowa Scales of Personality Change.
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NIH-PA Author ManuscriptPersonality disturbances are common in individuals with brain dysfunction from a variety of etiologies, including traumatic brain injury (TBI) (Dywan & Segalowitz, 1996;Eslinger, Grattan, & Geder, 1996;Levin et al., 1987;Lezak, 1987), frontotemporal dementia (Kertesz, Nadkarni, Davidson, & Thomas, 2000;Malloy, Tremont, Grace, & Frakey, 2007;Miller, Darby, Benson, Cummings, & Miller, 1997), Huntington's disease (Cummings & Cunningham, 1992;Folstein, 1989), Alzheimer's disease (Malloy et al., 2007;Reisberg et al., 1987), Parkinson's disease (Kaasinen et al., 2001;Menza, 2000), epilepsy (Devinsky, 1991;Hermann, Wyler & Richey, 1987), brain tumors (Gleason, 2004Hunter, Blackwood, & Bull, 1968), and stroke (DeLuca & Diamond, 1995). Indeed, personality disturbances following brain damage can be devastating, and in regard to psychosocial functioning in particular, can have more profound impact than acquired cognitive impairments (Lezak, 1987;Nightingale, Soo, & Tate, 2007). In this paper, the term "personality" refers broadly to enduring behavioral tendencies, with "behavior" explicitly including characteristic tendencies of drive, affect and mood; pervasive attitudes and self-awareness; and cognitive tendencies which, if disturbed, adversely impact the individual's interpersonal or psychosocial functioning (Stuss, Gow, & Hetherington, 1992). In regards to a...