Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Brain Event

brain eventThe brain: In the DSM-5 (diagnostic and statistic manual of mental disorders – 2013), there are the developmental defects, referred to as personality disorders, with which most are familiar.

For the most part, these have not changed:

Paranoid

Schizoid

Schizotypal

Antisocial

Borderline

Histrionic

Narcissistic

Avoidant

Dependent

Obsessive Compulsive

In each case, they involve the way you see and interpret yourself, see others and perceive events, the range, intensity and appropriateness of emotional responses, impulse control and the management of interpersonal relationships.

When these factors are pervasive across a wide range of situations and interfere with occupational and social functioning, they are referred to as personality disorders.

However, there is a new reference to:

PERSONALITY CHANGE DUE TO ANOTHER MEDICAL CONDITION – there are medical conditions that impact how the nervous system functions. Since these changes in functioning can effect how an individual thinks, feels, acts or relates, then there is the potential for an organic/physically caused change in personality. These may be brain events.

The concern would be “does this apply to an injured worker whose behavior, mood and interactions are now dysfunctional?”

Simple answer: No. These are not personality changes that are the direct physical consequence of another medical condition such as temporal lobe epilepsy. Unless this global change in behavior, this personality disorder, can be traced to a specific medical condition or brain insult that can physically produce a change in personality, this disorder does not apply.

There may be a period of time during which some misinterpret this diagnosis to mean that because a patient is aggressive or disinhibited after a work related injury that the (back, neck, shoulder, leg, burn, amputation, etc) is the cause of a “change in personality.” A mere change in behavior is not a change in personality.  An insult to the brain can be such an event.

There will be a learning curve for all involved, but you should question this diagnosis if someone directly relates it to injury.

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