Diamond, Barth, and Zillmer (1988) and others have suggested that psychological factors may be associated with head injury, which ultimately can complicate recovery. Along with the cognitive impairment noted in mild, moderate, and severe head injuries, emotional sequelae have been noted. Reported symptoms after head injury, both psychological and somatic, have included headache, fatigue, anxiety, emotional lability, and concentration impairment (Diamond et al., 1988).
Diamond et al. (1988) examined the overall level of psychological disturbance in 50 patients with minor head injury and 50 matched patients with documented brain damage. The authors excluded from their sample any patients with a history of major psychiatric disorders, neurological illness, or unemployment prior to their injuries. The subjects were administered the Minnesota Multiphasic Personality Inventory (MMPI). In order not to mask the effect of a variety of emotional reactions, Diamond et al. separated MMPI profiles into four discrete types. The results showed that patients with mild head injury showed significant emotional distress that was markedly similar to that of individuals with long-standing neurologic disease. Over half the sample reported an abnormal level of depression and had at least two MMPI scales that were elevated 2 standard deviations above normal. Not surprisingly, those who experienced significant emotional symptoms had the most difficulty resuming the pre-injury activities.
The results of a study that included 68 trau-matically brain-injured patients further supported the association between head injury and emotional symptoms (Dicesare, Parente, Anderson-Parente, 1990). The primary problems reported after head injury were obsessive-compulsive behavior, interpersonal sensitivity, depression, and phobic anxiety. The results of Dicesare et al.'s study were obtained from self-report measures, but the authors noted that the self-reports were consistent with the observations of family members. Over time, the emotional symptoms may lessen, but Dicesare et al. remark that the client's premorbid personality may never return.
The interaction of cognitive and emotional dysfunctions after head injury was noted by Parker and Rosenblum (1996). They studied the cognitive and emotional sequelae in 33 mild head- injury patients. In their sample, the emotional consequences of minor head injury were extremely varied, including personality disorders, persistent altered consciousness, stress reactions, sexual disorders, and psychiatric diagnoses. Parker and Rosenblum hypothesized that the effect of the lesion itself can be exacerbated by the emotional consequences, making post-injury functioning more difficult.
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