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Chapter 13. Personality Change

Gregory J. O'Shanick, M.D.; Alison M. O'Shanick, M.S., C.C.C.-S.L.P.; Jennifer A. Znotens, M.A., C.C.C.-S.L.P.
DOI: 10.1176/appi.books.9781585624201.676578

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Excerpt

"Silent epidemic" was a term first coined in the 1980s to reflect the frustration of clinicians, patients, and families with the lack of public awareness regarding the multiple hidden consequences of traumatic brain injury (TBI). Early this century, military actions in both Operation Iraqi Freedom and Operation Enduring Freedom in Iraq and Afghanistan created a new type of combat-related injury due to exposure to blasts from improvised explosive devices. TBI became the signature injury of these campaigns, and with that, news accounts of (neuro)behavioral problems among returning soldiers became commonplace. Studies of behavioral change after TBI over the past two decades show the substantial increase in lifetime risk of psychiatric disturbance following TBI in both children and adults. One significant risk lies in the development of personality changes. In recognition of this problem, on August 28, 2008, the Department of Defense issued Instruction Number 1332.14, which revised procedure in Enlisted Administrative Separations from military service. This directive specifically addressed concerns regarding discharge from military service due to "personality disorder" when a soldier was currently or formerly deployed to an imminent danger area. Such a change in military regulation reflected the recognition of the impact of TBI on personality alteration in those who manifest no external evidence of injury.

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Table Reference Number
Table 13–1. Brain regions associated with personality traits
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Table 13–2. Manifestations of stress in hospitalized patients with traumatic brain injury
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Table 13–3. Secondary personality change subtypes by symptom presentation (DSM-IV-TR)
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Table 13–4. Pragmatic language dysfunction after traumatic brain injury
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Table 13–5. Erikson's stages of psychosocial development
Table Reference Number
Table 13–6. Basic stabilization requirements to facilitate pharmacotherapy

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