Reconstruction of Self-Identity and Its Impact on Psychosocial Adjustment to Traumatic Brain Injury

Background and Purpose:Traumatic brain injury (TBI) is a debilitating condition that affects millions of individuals in the United States years after injury, with an annual incidence rate of 506.4 per 100,000 population. Individuals are impacted by the physical, emotional, cognitive, social, and behavior consequences associated with injury. Persons with TBI may experience a loss of sense of self or total disconnect from one’s pre-injury self-identity. Based on the Self-discrepancy theory, discrepancies about self may result in decreased emotional functioning. Few studies assess the impact of changes in self-identity after TBI. This study aimed to explore the experiences of changes in self-identity after injury, differences by ethnicity and gender, and its impact on the psychosocial adjustment process of a diverse sample of adults with TBI. It was hypothesized that persons with TBI experience changes in their self-identity, which may also vary by gender and ethnicity.

Methods:This study used an equal-status, concurrent mixed-method triangulation design. A convenience sample of 60 persons with TBI who were at least three months post injury completed the study. Exclusion criteria included having pre-existing neurological, developmental, psychiatric and behavioral disorders; individuals under the age of 18; institutionalized. Quota sampling based on recovery time point (i.e., less than one year, 2-5 years, and greater than 5 year post injury), race/ethnicity (i.e., Black, Hispanic/Latino, White), and gender (i.e., male or female). Participants completed an in-depth semi-structured interview regarding changes in self after injury at the research center or at their home. The Head Injury Differential Scale (HISD), Sense of Self Scale (SoSS), Acceptance of Disability Scale (AD), 9-item Patient Health Questionnaire (PHQ) and the 7-item Generalized Anxiety Disorder (GAD) were completed by the participants. Grounded theory guided the qualitative analysis of the data using NVivo 18. T-tests, ANCOVAs, and multiple regression analyses were conducted to analyze changes in self-identity, differences based on gender and ethnicity, and its impact on psychosocial adjustment to TBI. 

Results:  Several key themes were identified: (a) achieved versus weakened self, (b) fear, uncertainty and a lack of control, (c) loss of autonomy, (d) injury appraisal, (e) benevolence and empathy after injury, (f) appreciation for life and positive self-concept, and (g) role of religion and spirituality to self-identity. Participants viewed themselves more negatively after injury. Changes in self-identity after injury were not different based on the participants’ gender or race/ethnicity. Changes in self-identity is significantly associated with adjustment to TBI and emotional functioning.

Conclusions and Implications: Changes in self-identity after injury were significantly associated with increased anxiety and depressive symptoms and poorer adjustment to TBI. Based on the narratives of persons with TBI, they are reconstructing their self-identity after injury, which may be accompanied with negative emotions and difficulty with accepting the consequences of their injury. Interventions are warranted to help clients with TBI acknowledge the consequences of their injuries and reduce their emotional distress, while guiding them to achieve self-compassion and acceptance during the reconstruction of self after injury.