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

Abstract

Personality changes in 7 participants with bilateral ventromedial prefrontal lesions (PF-BVM) 14 participants with prefrontal lesions but not bilateral ventromedial involvement (PF-NBVM) 36 with nonprefrontal lesions (NPF) were investigated with the Iowa Rating Scales of Personality Change. Informants rated 30 specific characteristics for degree of disturbance change from premorbid personality. PF-BVM participants showed a higher rate of acquired disturbances than NPF participants in blunted emotional experience apathy low emotional expressiveness inappropriate affect poor frustration tolerance irritability lability indecisiveness poor judgment social inappropriateness lack of planning lack of initiation persistence lack of insight. Differences between the PF-BVM PF-NBVM groups were significant for several of these characteristics. All 7 PF-BVM participants developed a syndrome including general dampening of emotional experience; poorly modulated emotional reactions; defective decision making especially in the social realm; impaired goal-directed behavior; striking lack of insight. Similarities between this syndrome of "acquired sociopathy" developmental psychopathy in characteristic personality disturbances psychophysiological abnormalities suggest that diminished emotionality impaired decision making psychosocial dysfunction may be related to ventromedial prefrontal dysfunction in bothgroups.