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Understanding Orbitofrontal Cortex Damage and How to Treat It

medical illustration of brain highlighting orbitofrontal cortex damage

Orbitofrontal cortex damage can cause a person to experience many behavioral changes.

Today you will learn what some of the symptoms of orbitofrontal damage look like. Then, at the end, we’ll discuss different treatment options.

Let’s begin.

What is the Orbitofrontal Cortex?

The orbitofrontal cortex (OFC) sits at the very front of the brain just above the eye sockets. It connects to the sensory areas of the brain as well as the areas involved in memory and emotions.

Very little is known for certain about the exact role of the orbitofrontal cortex. However, neuroscientists have assigned several functions to it based on the behavior of people who have experienced frontal lobe injuries.

Some cognitive functions commonly associated with the orbitofrontal cortex include:

  • Impulse control
  • Value-based decision making
  • Emotional reactions
  • Social behavior

As you can see, the orbitofrontal cortex plays a huge role in how we interact with the world. Therefore, damage to it can cause serious issues.

Symptoms of Orbitofrontal Cortex Damage

The following are some behavioral changes you might notice in a person with orbitofrontal cortex damage.

1. Impulsive Behavior

Decreased impulse control is one of the major symptoms of orbitofrontal damage.

People with this symptom will display inappropriate behavior. For example, they may share personal information too freely or make rude remarks. They may even become aggressive.

This impulsiveness can also cause them to become reckless and take part in dangerous activities.

2. Poor Decision-Making

man struggling to choose between salad or donut because he has orbitofrontal cortex damage

The orbitofrontal cortex also helps people make decisions based on the value of each option.

However, the orbitofrontal cortex might do more than just help with basic decisions. Recent research shows that the OFC helps make predictions about decisions based on prior experience.

Therefore, when it becomes damaged, people tend to make poor decisions, even if they know what will happen.

This fact may explain why most people with orbitofrontal cortex damage seem blind to consequences and motivated by immediate gratification only.

3. Decreased Emotional Responses

Damage to the OFC can change the way the body responds to emotions, which may contribute to impulsivity and poor decision making.

For example, when making a risky decision, healthy patients showed physical signs of anxiety, such as sweaty palms. Patients with orbitofrontal cortex damage, on the other hand, did not. Healthy patients also made fewer risky choices.

This suggests that the orbitofrontal cortex provides signals that help people know when they are about to make a poor decision. Therefore, if it becomes damaged, the person does not receive any warning when making a decision, which can lead to risky choices.

4. Personality Changes

man in wheelchair pouting and looking upset, a sign of orbitofrontal cortex damage

Finally, damage to the orbitofrontal cortex can cause personality changes.

The connection between frontal lobe damage and personality change was discovered in the mid-1800s with the case of Phineas Gage. In 1848, Gage, a railroad worker, was using a tamping iron to pack explosives into a drill hole when the powder accidentally detonated.

The explosion caused the iron bar to shoot through Gage’s left cheek, penetrate his orbitofrontal cortex, and exit through the top of his skull. While Gage survived the initial injury, his friends would call him “no longer Gage” because of the drastic change to his personality that followed.

While most TBI patients do not experience as extreme a personality shift as Gage, many family members do report that their loved one seems “different” after their injury. Some common personality changes associated with orbital damage include:

  • Childish behavior
  • Apathy or low motivation
  • Disinhibition
  • Aggressive behavior
  • Decreased empathy and concern for others

If these behaviors cause harm to others, the person is said to have an orbital personality and might be diagnosed with acquired antisocial personality disorder.

However, this condition is rare, and most orbitofrontal patients can improve their behavior.

In addition, not all personality changes are negative. Some become more cheerful and engaging after their injury. This fact demonstrates just how unpredictable brain injury symptoms can be.

Treatments for Orbitofrontal Cortex Damage

Since most of the problems that orbitofrontal cortex damage causes are behavioral, a psychotherapist will be the best person to help you find treatment.

Some possible treatments that a therapist might recommend include:

  • Cognitive-behavioral therapy (CBT). CBT helps people develop positive strategies to avoid harmful actions. It can be especially helpful for patients who struggle with impulsivity.
  • Social skills training. Social skills training can help you improve your social interactions and learn proper behavior.
  • Medications. While there are no specific drugs to treat orbitofrontal damage, there are medications that can treat the most harmful symptoms. For example, ADHD drugs such as methylphenidate can help reduce impulsive behavior.

Coping with Orbitofrontal Damage

Orbitofrontal damage can be one of the hardest secondary effects of brain injury for family members to deal with. It can make the person you know and love seem so different from what they once were.

The following are some helpful things to keep in mind when dealing with personality and behavioral changes:

  • Remember they are not totally in control. If your loved one says something cruel, keep in mind that they are not in complete control. The person you love still exists, they just have a lot more emotions and fewer inhibitions than they used to.
  • Set boundaries. If they do something rude or inappropriate, gently but firmly let them know. Try your best not to embarrass them, but make sure they understand they can’t do that anymore.
  • Do not give up. Even though it may seem like the person will never be the same, it is possible for TBI patients to regain empathy with the right treatment. Therefore, ask your neuropsychologist what you can do to help your loved one improve their behavior.

Orbitofrontal Cortex Damage: Conclusion

The effects of orbitofrontal cortex damage are distressing. But while you may never be the exact same person you were before your injury, this shouldn’t cause you to lose hope.

Thanks to the brain’s ability to heal itself, you can recover effective ways to deal with unruly behavior, and even relearn how to emotionally connect with others.

It all comes down to how much you are willing to work on it.

You may even find, after learning new coping methods, that you are a stronger and more resilient person than you ever thought possible.


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