Reflections on the Psychopathology of Acquired Brain Injury

When discussing the psychopathology of acquired brain injury (ABI), we need to reflect on the adequacy of our models of human psyche and our psychopathological tools. Here, we present data from clinical samples and four single cases in order to show that neuropsychiatric symptoms, such as apathy and disinhibition, include emotional, cognitive, and volitional components that interact to produce particular types of behavioral presentations. Classical cognitive functions such as memory need to include emotional components such as familiarity in order to be able to account for “Capgras syndrome” or “deja vu.” We argue that the “trilogy of mind” model and the structure of psychopathology predispose to “truncated clinical accounts” with a tendency for the cognitive components to be overrepresented at the expense of emotional information. Neuropsychiatry needs to contribute with a more sophisticated psychopathology of emotions fully integrated with cognitive functioning. Lack of empathy or compassion, disorders of familiarity, absence or reduction of spontaneous reactive emotions or affective states, and brief and fleeting outbursts of anger or excitement are some of the symptoms that will need to be explained. The new model should consider a number of dimensions: affective versus emotional, content and expression, duration and intensity, stability, and impact on quality of life.