Axis II psychopathology in individuals with traumatic brain injury

Primary Objectives: To determine the frequency and nature of post-TBI perso nality disorders (PDs) in a community-based sample of individuals with TBI. Research design: One hundred individuals with TBI were administered a struc tural clinical interview to determine Axis II psychopathology. Methods of procedures: The Structured Clinical Interview for DSM-IV Persona lity Disorders, Clinician Version (SCID II) was used to determine 12 Axis I I personality disorders. SCID II questions were modified so that symptom on set could be rated as occurring pre-injury vs. posr-TBI Data were analysed using student T-tests, chi-square analysis and one way analyses of variance . Outcomes and results: Pre-TBI PDs were diagnosed in 24% of the sample; anti social PD and obsessive-compulsive PD were the most common diagnoses. Post- TBI, 66% of the: sample met criteria for at least une PD, with PDs independ ent 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 acqui ring additional psychopathology posr-TBI. Personalty traits endorsed by mor e than 30% of the sample post-TBI reflected loss of self-confidence, attemp ts to cope with cognitive and interpersonal failures and negative affect. Conclusion: These findings argue against a specific TBI personality syndrom e,but rather a diversity of personality disorders reflective of the: persis tent challenges and compensatory coping strategies developed by individuals post-TBI. Prospective need for clinical assessment, pro-active education a nd focused treatment. approaches are discussed.