Personality and Mental Health 3: 295–301 (2009) Published online in Wiley InterScience (interscience.wiley) DOI: 10.1002/pmh.95 Complex Case Head trauma, dissociation and possible development of multiple personalities KATHLEEN A. DIEHL, Department of Psychiatry, Introduction It is not unusual for individuals diagnosed with borderline personality disorder (BPD) to experi- ence temporary disconnection from a situation that is emotionally painful. Such disconnections can include lapses in reality testing such as disso- ciation, depersonalization, derealization and para- noid or confused thinking (American Psychiatric Association, 2000). When a patient who has BPD is in a state of turmoil due to psychosocial crisis, it is usually not difficult to pinpoint the specific stressor(s) that precipitated regression and/or tran- sient dissociative symptoms. But when a BPD patient sustains head trauma, the sequelae of traumatic brain injury (TBI) can complicate or confound the ability to determine the aetiology of the patient’s emotional discon- nects and dissociative episodes (Gagnon, Bouchard, & Rainville, 2006). There is a broad spectrum of TBI symptoms that include problems with cogni- tion (thinking, memory problems, attention defi- cits and reasoning), communication (expression and understanding) and behaviour or mental health symptoms (mood swings, depression, anxiety, personality changes, frustration and aggression, acting out and social inappropriate- Copyright © 2009 John Wiley & Sons, Ltd University of Michigan, Michigan, USA ness.) Some of these TBI symptoms manifest in a manner that look identical to, or can closely mimic, BPD symptoms (van Reekum, Conway, Gansler, White, & Bachman, 1993). When BPD and a TBI coexist, symptoms overlap and the clini- cian is faced with a complex clinical picture. This case report demonstrates the challenge in trying to sort out whether BPD or TBI is the major contributor to the patient’s symptomatology and presentation. The patient described here carried a previous, long-standing diagnosis of BPD, then sustained a closed-head injury and subsequently developed symptoms that did not exist or manifest prior to the TBI.
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