Axis II psychopathology in individuals with traumatic brain injury.
OBJECTIVE
To determine the frequency and nature of post-TBI personality disorders (PDs) in a community-based sample of individuals with TBI.


METHODS
One hundred individuals with TBI were administered a structural clinical interview to determine Axis II psychopathology. METHODS OF PROCEDURES: The Structured Clinical Interview for DSM-IV Personality Disorders, Clinician Version (SCID II) was used to determine 12 Axis II personality disorders. SCID II questions were modified so that symptom onset could be rated as occurring pre-injury vs. post-TBI. Data were analysed using student T-tests, chi-square analysis and one way analyses of variance.


RESULTS
Pre-TBI PDs were diagnosed in 24% of the sample; antisocial PD and obsessive-compulsive PD were the most common diagnoses. Post-TBI, 66% of the sample met criteria for at least one PD, with PDs independent of TBI severity, age at injury, and time since injury. The most common post-TBI PDs were: borderline, avoidant, paranoid, obsessive-compulsive and narcissistic. Men were more likely to be diagnosed with antisocial PD and narcissistic PD. Individuals with pre-TBI PDs were at greater risk of acquiring additional psychopathology post-TBI. Personality traits endorsed by more than 30% of the sample post-TBI reflected loss of self-confidence, attempts to cope with cognitive and interpersonal failures and negative affect.


CONCLUSIONS
These findings argue against a specific TBI personality syndrome, but rather a diversity of personality disorders reflective of the persistent challenges and compensatory coping strategies developed by individuals post-TBI. Prospective need for clinical assessment, pro-active education and focused treatment approaches are discussed.
Hibbard
M R
MR
Department of Rehabilitation Medicine, The Mount Sinai School of Medicine, New York, NY 10029, USA. mary.hibbard@mssm.edu
Bogdany
J
J
Uysal
S
S
Kepler
K
K
Silver
J M
JM
Gordon
W A
WA
Haddad
L
L
D000223:Adaptation, Psychological; D000328:Adult; D020208:Brain Injury, Chronic / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000175:diagnosis / Q000523:psychology; D010554:Personality Disorders / Q000175:diagnosis* / Q000523:psychology; D011569:Psychiatric Status Rating Scales