The complications of traumatic brain injury (TBI) are so far reaching and influential that it is difficult to fully understand their extent and impact. Persons who sustain a TBI often experience significant negative life changes related to their disabilities including medical complications, loss of independence, interpersonal difficulties, loss of employment, and financial strains. Yet, a complete understanding of the source of these difficulties as it relates to the injury itself is difficult to achieve. An individual with TBI is faced with numerous changes in his or her life ranging from medical and self-care issues to difficulties with social interactions. Placing symptoms within a neurological framework, physical changes result in pain, seizures, and headaches, as well as difficulties with mobility, sensation, and perception. Cognitive deficits are common within a range of domains and with varied severity levels ranging from basic orientation and severe amnesic conditions to more subtle difficulties with planning and problem solving. Behavioral and personality changes further complicate the clinical picture along with disturbances in mood. Few authors have been able to capture the wide range of behavioral, emotional, and psychiatric consequences of TBI.

Part of a series on “Studies on Neuropsychology, Neurology and Cognition,” The Behavioral and Emotional Complications of Traumatic Brain Injury was able to capture these changes and presents a very thorough discussion of the existing literature on the behavioral and emotional effects of TBI. In addition, the author provides an in-depth discussion of challenging issues such as differential diagnosis and the neurobiological bases of these symptoms. Each chapter includes a section on “methodological issues,” which assists the reader in understanding the obstacles to the development of a full picture on the symptom(s) discussed in each particular chapter. This book will serve as an excellent resource for a wide range of researchers and clinicians in various health care professions including neurologists, clinical psychologists, neuropsychologists, psychiatrists, and those in various stages of advanced training.

Following an in-depth introduction to the definition and epidemiology of TBI and its characteristic properties, including post-traumatic amnesia, loss of consciousness (LOC), and mechanisms of measurement, as well as mechanisms of the injury and secondary injuries, the author delves into the heart of the emotional and behavioral concomitants that may ensue. Chapters are dedicated to many important consequences of TBI, starting with Chapter 2, The Postconcussional Syndrome (PCS). This chapter discusses many important facets of the PCS, including diagnostic criteria, origin (organic vs. functional), as well as the healing and recovery process. Also included in this chapter is a very useful discussion of the distinction between PCS and mild TBI, as well as the various definitions of mild TBI. Chapter 3 focuses on the personality changes commonly seen with TBI, and the author offers a comprehensive and organized discussion of this very challenging topic. This includes the role of the frontal lobe and frontal lobe pathology in the changing post-TBI personality, the multidimensional nature of these changes, as well as the neuroanatomical correlates of these changes. The prevalence and incidence of personality changes post-TBI are also discussed. This is a particularly thought-provoking chapter that not only comprehensively describes the current state of knowledge in the area but also is likely to stimulate the development of new ideas and fruitful areas for future research.

In Chapter 4, the authors move on to an examination of the emotional factors associated with TBI, presenting a stimulating review of our current knowledge of anxiety disorders following TBI. This chapter provides a comprehensive and well-written review of the literature on anxiety disorders post-TBI in an empathic manner. The reader leaves the chapter not only with increased knowledge on anxiety disorders in persons with TBI but also with an understanding of the potential reasons for these symptoms following such a significant life event. At the current time in history, with so many soldiers returning from war, the discussion of posttraumatic stress disorder (PTSD) and its relationship to TBI is particularly useful to the field and will serve our veterans well by increasing the level of understanding of our clinicians and researchers. One section of particular interest to the reader was the section on PTSD with significant LOC and the reasons why this combination is possible. As with so many other chapters, a discussion of the neurological underpinnings of anxiety disorders is also included. The emphasis on emotional functioning post-TBI is continued in Chapter 5 with a review of mood disorders. Once again, this is a comprehensive chapter that includes note of various severities of depression post-TBI, the neurological correlates of such mood alterations, and the influence of lesion location.

Chapters 6 and 7 represent a carefully planned clear discussion about the issue of reality distortion post-TBI. A table is presented at the outset of Chapter 6 to help orient the reader to the various types of reality distortions. This table is particularly useful in orienting the reader less familiar with reality distortions to the ensuing discussion. These chapters include not only a presentation of the more severe psychoses that may be seen following TBI but also more minor conditions that exert a significant influence on rehabilitation and everyday functioning including impaired self-awareness and malingering. They successfully review very sensitive topics in a humanistic yet objective manner, and the reader walks away with a solid understanding of the role of these behaviors in the TBI population.

Many of the most basic physical disturbances following TBI are addressed in Chapter 8, including disorders of eating and sleeping, increased pain, and substance abuse. Each topic is addressed individually with incidence rates in post-TBI populations presented along with a discussion of their impact on the person. A separate chapter (Chapter 9) devoted to disturbances in sexual functioning gives this topic its appropriate importance. A detailed discussion of the biological substrates of sexual dysfunction in persons with TBI is included, encompassing aspects of both the peripheral and the central nervous system. The detail with which this information is presented is particularly impressive, with an excellent merging of the presentation of scientific evidence and an understanding of the real-life impact on relationship and other related issues.

Perhaps the most useful chapter in this book is the last one, which truly does represent a synthesis of all the information presented in the text. In this chapter, the author examines TBI from a multidimensional perspective, merging the various aspects of the injury and attempting to relate the symptoms to the person and the experience. The author presents a neuropsychological model of functional outcome, which is particularly salient and advantageous to the reader who may be struggling to put the information together in a larger framework. This final chapter leaves the reader with a sense of closure while also acknowledging the need for future research.

The Behavioral and Emotional Complications of Traumatic Brain Injury is an excellent volume that would be useful to both the clinician or researcher at more advanced career levels and the advanced student beginning to focus his/her work on specific diagnostic entities. I highly recommend this book to all with a vested interest in increasing their understanding of persons with TBI.