Abstract
Deep Brain Stimulation (DBS) has emerged as a safe, effective, and appealing treatment for Parkinson's Disease (PD), particularly for improving motor symptoms (e. g., tremor, bradykinesia, and rigidity). However, concerns have been raised about whether DBS causes psychological changes, including changes to personality: characteristic and relatively stable patterns of affect, behavior, cognition, and desire. In this article, after first presenting some background information about PD and DBS, we examined evidence obtained from various empirical research methods (quantitative, qualitative, and mixed methods for evaluating patient valued characteristics) pertaining to whether DBS causes personality change. General limitations across research methods include a lack of randomized clinical trials and small sample sizes. We organized our review of findings according to different layers of personality variables: dispositional traits (including personality pathology), characteristic adaptations, and narrative identity. Though most work has been done on dispositional traits, there is not much evidence that dispositional traits change following DBS. Little work has been done on characteristic adaptations, but there is somewhat consistent evidence for positive perceived progress toward goals across a number of domains: routine activities, work, social/relational, and leisure. Nascent work on narrative identity holds promise for revealing issues around self-image that may be common following DBS. We listed a number of strategies for advancing research, highlighting opportunities related to personality conceptualization, personality assessment, and interdisciplinary scholarship. Finally, we offer practical applications of our findings for the informed consent process and for ongoing treatment.
Highlights
Very little work has tapped constructs relevant to narrative identity
In addition to calling for larger sample sizes and RCTs that assess personality variables, we offer six suggestions for advancing research
We suggest taking a step back from studies that typically rely on one personality inventory to assess personality change; rather, it may be fruitful to frame research within integrative personality frameworks that define and describe interrelations between different parts of personality, such as traits, contextualized roles, and identity (e.g., McAdams and Pals, 2006; McCrae and Costa, 2008; Mayer, 2015)
Summary
Very little work has tapped constructs relevant to narrative identity. Findings from two qualitative studies suggest that issues around self-image and self-estrangement may be common for DBS patients: Some patients perceived improvements in these areas, whereas others perceived deficits. We suggest taking a step back from studies that typically rely on one personality inventory (or one qualitative method) to assess personality change; rather, it may be fruitful to frame research within integrative personality frameworks that define and describe interrelations between different parts of personality, such as traits, contextualized roles, and identity (e.g., McAdams and Pals, 2006; McCrae and Costa, 2008; Mayer, 2015).
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