“This isn’t Sue. She’s normally reserved. It’s really quite embarrassing because this is so out of character for her…”
Personality change due to another medical condition—or medical personality change—is a codable diagnosis (F07.0) that can cause substantial functional impairment related to behavioral disruption, dysdecorum, and occasionally even bafflingly poor judgment. However, it receives far less consideration than other secondary conditions such as cognitive, mood, or psychotic disorders, which are better operationalized. Medical personality change is also difficult to evaluate given the absence of widely accepted assessment tools or clinical pathways. Further confounding clinical recognition, patients may unintentionally misrepresent symptoms or behaviors due to a functional lack of awareness of change or due to frank anosognosia. Family may underemphasize symptoms because of embarrassment or consternation, because the changes are difficult to articulate, or because they may simply not be aware of how or whether to broach the subject.
Accurate identification may provide clarity to patients and their families, offering them language to understand their experiences; it can also direct clinicians to a body of literature on personality-related treatments and guide them to a range of potentially causative underlying medical conditions. Despite the clinical import of this condition, there are several gaps in the literature regarding optimal assessment and clinical decision-making. Our aim in this session is to provide a practical review of medical personality change that emphasizes a systematic clinical approach and that reviews the evidence base on managing features of this condition. Accordingly, we will: