Acquired personality disturbances associated with bilateral damage to the ventromedial prefrontal region

Personality changes in 7 participants with bilateral ventromedial prefronta l lesions (PF-BVM), 14 participants with prefrontal lesions but not bilater al ventromedial. involvement (PF-NBVM), and 36 with nonprefrontal lesions ( NPF) were investigated with the Iowa Rating Scales of Personality Change. I nformants rated 30 specific characteristics for degree of disturbance and c hange from premorbid personality. PF-BVM participants showed a higher rate of acquired disturbances than NPF participants in blunted emotional experie nce, apathy, low emotional expressiveness, inappropriate affect, poor frust ration tolerance, irritability, lability, indecisiveness, poor judgment, so cial inappropriateness, lack of planning, lack of initiation and persistenc e, and lack of insight. Differences between the PF-BVM and PF-NBVM groups w ere significant for several of these characteristics. All 7 PF-BVM particip ants developed a syndrome, including general dampening of emotional experie nce; poorly modulated emotional reactions; defective decision making, espec ially in the social realm; impaired goal-directed behavior; and striking la ck of insight. Similarities between this syndrome of "acquired sociopathy" and developmental psychopathy in characteristic personality disturbances an d psychophysiological abnormalities suggest that diminished emotionality, i mpaired decision making, and psychosocial dysfunction may be related to ven tromedial prefrontal dysfunction in both groups.