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A persistent personality disturbance representing a change from the individual's previous characteristic personality pattern, judged from history, physical exam, or laboratory findings to be the direct pathophysiological consequence of another medical condition (such as a frontal lobe lesion, traumatic brain injury, or an endocrine disorder).
Unlike the other personality disorders in this chapter, which describe long-standing patterns present since early adulthood, this diagnosis is for a genuine change in someone's personality -- becoming markedly more impulsive, apathetic, disinhibited, or paranoid, for example -- caused directly by a medical condition affecting the brain, most classically a frontal lobe injury or lesion. The defining feature is the change itself, documented against who the person was before.
By definition requires an established prior personality pattern to change from, so it applies to adults or older adolescents with a settled baseline personality rather than to children still developing their characteristic patterns.
Can be highly disruptive to relationships, occupational functioning, and social behavior, since the change is often noticed most acutely by family and close others who knew the person's prior baseline.
May co-occur with other neurological or cognitive signs of the underlying medical condition; specific personality change patterns (disinhibition and impulsivity vs. apathy and lack of initiative) can point toward which brain regions are affected.
What counts as a 'change' from baseline depends on collateral report from family or close others familiar with the person's prior characteristic pattern, and cultural norms around personality expression should inform how that change is interpreted.
A common misconception is that any personality disorder appearing in someone with a medical illness qualifies for this diagnosis. This category specifically requires documentation of a genuine change from a previously established, different personality pattern -- not a pre-existing personality disorder that simply continues alongside a later medical diagnosis.
If the personality pattern in question is later determined to have actually predated the medical condition, reconsider a specific personality disorder diagnosis instead of a medical-condition-related change.
A previously mild-mannered, reliable man sustains a traumatic frontal lobe injury and, in the following months, family reports a marked and persistent change to impulsive, disinhibited, and poor-judgment behavior clearly different from his baseline -- the documented change from a known prior pattern, linked temporally to the injury, supports Personality Change Due to Another Medical Condition.
Know
This diagnosis requires documented evidence of a genuine change from a previously established personality pattern, with a demonstrated direct link to a specific medical condition -- most classically a frontal lobe injury or lesion.
Notice
In a case, notice collateral information describing the person's personality before and after a medical event, and medical findings (imaging, injury history) supporting a direct link.
Distinguish
Distinguish this from a personality disorder that predates the medical condition (no genuine change) and from a major or mild neurocognitive disorder where cognitive decline, not personality change, is the dominant clinical feature.
Recognize
A persistent personality disturbance that represents a clear change from the individual's previous, established personality pattern, with a demonstrated direct pathophysiological link to a specific medical condition, most commonly one affecting the frontal lobes or related circuitry.
Distinguish
Distinguish this from a personality disorder that predates the medical condition (no genuine change) and from a major or mild neurocognitive disorder where cognitive decline, not personality change, is the dominant clinical feature.
A personality disorder that was already present before the medical condition (and is not a change) should be distinguished from a genuine change caused by the medical condition; a major or mild neurocognitive disorder should be considered when cognitive decline, not just personality change, is the dominant feature; mood or other mental disorders due to the same medical condition should also be considered.
Impulsive or emotionally volatile behavior appearing for the first time after a medical event (such as a brain injury) is sometimes mislabeled as Borderline Personality Disorder, when the defining feature — a documented change from a different prior baseline — actually points to the medical-condition category instead.
A personality change following a medical event can be misattributed to a primary personality disorder if the medical history is not carefully reviewed; conversely, a longstanding personality pattern can be mistakenly over-attributed to an incidental medical finding without clear evidence of direct physiological causation.
A new-onset paranoid presentation in an older adult can be mistakenly attributed to a primary Paranoid Personality Disorder if a medical workup (e.g., for a brain lesion or neurodegenerative process) is not pursued; conversely, a lifelong paranoid pattern should not be over-attributed to an incidental medical finding.
Reason
Apply
Distinguish a documented personality change caused by a medical condition from a long-standing personality disorder.
Retrieve
2 question(s) reference this disorder. Practice Personality Change Due to Another Medical Condition →
Master