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Low Self-Awareness of Individuals With Severe Traumatic Brain Injury Can Lead to Reduced Ability to Take Another Person's Perspective

Bivona, Umberto PhD; Riccio, Angela PsyD; Ciurli, Paola PsyD; Carlesimo, Giovanni Augusto PhD; Delle Donne, Valentina PsyD; Pizzonia, Elisa PsyD; Caltagirone, Carlo MD; Formisano, Rita PhD; Costa, Alberto PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: March/April 2014 - Volume 29 - Issue 2 - p 157–171
doi: 10.1097/HTR.0b013e3182864f0b
Original Articles

Aims of this study were (i) to verify whether a deficit or a lack of self-awareness can lead to difficulties in assuming another person's perspective after a severe traumatic brain injury (TBI); (ii) to verify whether perspective-taking deficits emerge more from performance-based tasks than self-reports; and (iii) to evaluate the possible relationships between perspective-taking difficulties and some clinical, neuropsychological, neuropsychiatric, and neuroimaging variables. The Interpersonal Reactivity Index, Empathy Quotient, first-order false-belief, and faux pas written stories were administered to 28 patients with severe TBI and 28 healthy controls. The Awareness Questionnaire was also administered to TBI patients and their caregivers. Patients were split into 2 groups (impaired self-awareness vs adequate self-awareness) on the basis of the discrepancy Awareness Questionnaire score. Both TBI groups obtained lower scores than healthy controls on the Fantasy subscale of the Interpersonal Reactivity Index, the reality question of the false-belief stories, and the memory questions of the faux pas test. Only impaired self-awareness patients tended to obtain lower scores in first-order false-belief detection. Impaired self-awareness patients also performed significantly worse than both healthy controls and adequate self-awareness patients on the faux pas tasks. The analysis suggests a causal relationship between low self-awareness and perspective-taking difficulties in this population of patients.

Santa Lucia Foundation (Drs Bivona, Riccio, Ciurli, Carlesimo, Delle Donne, Pizzonia, Caltagirone, Formisano, and Costa); and University of Rome Tor Vergata (Drs Carlesimo and Caltagirone), Rome, Italy.

Corresponding Author: Umberto Bivona, PhD, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy (

The authors thank Chiara Falletta Caravasso for her help in collecting some of the neuroimaging reports of the patients enrolled in this study.

The authors declare that no conflicts of interests and no funding has been received for this work, including from any of the following organizations with public or open access policies: National Institutes of Health, Wellcome Trust, and the Howard Hughes Medical Institute; and any acknowledgments credits, or disclaimers.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins