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Traumatic Brain Injury

Traumatic Brain Injury leads to problems with emotional processing

Traumatic Brain Injury leads to problems in emotional processing

The subject of Traumatic Brain Injury is back in the news after the accident suffered by top snowboarder Kevin Pearce. Some timely new research has revealed some of the personality changes that can occur after a TBI, including profound problems in the ability to process emotions.

Traumatic Brain Injury (TBI) can, like any injury, range in severity from a simple bump on the head to something much more serious. As I wrote in an earlier post TBI is unfortunately a growth area, especially in the military. Nearly six out of 10 casualties entering the military hospital at the Walter Reed Medical Center in Washington DC have been diagnosed with some degree of traumatic brain injury, an indication of the nature of the conflicts in Iraq and Afghanistan.

Many victims of traumatic brain injury experience personality changes, some subtle, some severe. A set of recent studies from the UK have examined these personality changes and found that TBI sufferers show a much higher incidence of some specific problems in emotional processing, leading to relationship problems at home and difficulty in recovery.

These studies began when Professor Roger Wood a head injury specialist at the University of Swansea in Wales, UK, noticed a recurrent problem with many of his TBI patients; a loss of emotional attachment with friends and family. Reports from family remembers described a "lack of warmth or love as a postaccident development that placed a burden on their relationship", suggesting a causal link between TBI and empathy problems. Together with colleague Claire Williams, Wood set out to examine this phenomenon objectively.

In the neurology literature, "empathy" is classified into three broad categories, (1) cognitive empathy; knowing what another person is feeling, (2) emotional empathy; feeling what another person is feeling and (3) compassionate empathy, which is responding compassionately to another persons distress (see here for a review (Interestingly, that book was written by Professor Simon Baron Cohen, cousin of Borat-creator Sacha Baron Cohen. I guess the ability to understand what makes people uncomfrotable must run in the family)).

Initially, the empathy deficits in TBI-patients appeared to be most related to emotional empathy, so Wood and Williams asked their patients to fill in a "Balanced Emotional Empathy Scale", a neuropsychological test questionnaire aimed at identifying patients with low empathy. They consistently found that patients who had suffered TBI exhibited low empathy scores. In fact the incidence of low empathy scores was twice that of control subjects. (Full paper is here).

In a related study, they also found TBI patients were also impaired in their ability to recognize the emotions of people in pictures or video. These problems appeared to be specific for emotions and empathy and were not associated with more general cognitive deficits such as information processing. They also appeared to be independent of the severity of the head injury, or the time since the injury.

Expanding these studies, Wood and Williams then hypothesized that alexithymia might also be more common in TBI patients. Alexithymia is a personality trait in which persons have difficulty recognizing and/or describing their own emotions. Sure enough, alexithymia was found in a remarkable 60% of TBI patients, compared to 11% in a control population. Careful analysis of the statistics indicated that this increase in alexithymia may be independent of the low empathy scores seen in TBI patients.

Thus a picture emerges where TBI-patients have real difficulty in recognizing emotions, both in themselves and others, as well as having a problem empathizing. Some of the emotion-processing regions of the brain, such as the frontal cortex, are especially susceptible to damage in TBI due to their location and the front of the brain. The authors conclude that the elevated occurrence of these emotional problems should be carefully considered in the treatment and care of TBI patients, since they may negatively impact recovery and later quality-of-life.

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