Our aim with this article is to clarify the concept of change in self-identity following traumatic brain injury (TBI). We used concept analysis methodology—predominantly concept clarification. We identified 110 articles using a systematic literature search, and used critical appraisal, content analysis, and analytical questioning to explore attributes and boundaries. A reported change in self-identity is the ultimate expression of a variety of cognitive, psychological, and social sequelae of TBI. We present an integrative model of this process, identifying three potential levels of change: (a) component parts (egocentric self, sociocentric self, and “identity as shared with others”); (b) integral processes (self-awareness and expression via meaningful occupation and narratives); and (c) whole-system disruption. Change in self-identity after TBI is a highly individualistic process. The driver of this process is “self-reflective meaning making,” giving a purpose and direction in life, providing motivation and goals for future behavior.
AbramsL. S.CurranL. (2011). Maternal identity negotiations among low-income women with symptoms of postpartum depression. Qualitative Health Research, 21, 373–385. doi:10.1177/1049732310385123
2.
AddisD.TippettL. (2008). The contributions of autobiographical memory to the content and continuity of identity: A social-cognitive neuroscience approach. In SaniF. (Ed.), Self continuity: Individual and collective perspectives (pp. 71–84). New York: Psychology Press.
3.
BachL. J.DavidA. S. (2006). Self-awareness after acquired and traumatic brain injury. Neuropsychological Rehabilitation, 16(4), 397–414. doi:10.1080/09602010500412830
4.
Barnes-HolmesY.HayesS. C.Barnes-HolmesD.RocheB. (2001). Relational Frame Theory: A post-Skinnerian account of human language and cognition. Advances in Child Development and Behaviour, 28, 101–138. doi:10.1016/S0065-2407(02)80063-5
5.
Ben-YishayY. (2000). Postacute neuropsychological rehabilitation: A holistic perspective. In ChristensenA.-L.UzzellB. P. (Eds.), International handbook of neuropsychological rehabilitation (pp. 127–135). Dordrecht, Netherlands: Kluwer Academic.
6.
BidermanD.Daniels-ZideE.ReyesA.MarksB. (2006). Ego-identity: Can it be reconstituted after a brain injury?International Journal of Psychology, 41(5), 355–361. doi:10.1080/00207590500345963
7.
BrennerL. A.HomaifarB. Y.AdlerL. E.WolfmanJ. H.KempJ. (2009). Suicidality and veterans with a history of traumatic brain injury: Precipitating events, protective factors, and prevention strategies. Rehabilitation Psychology, 54(4), 390–397. doi:10.1037/a0017802
8.
BrownD.LyonsE.RoseD. (2006). Recovery from brain injury: Finding the missing bits of the puzzle. Brain Injury, 20(9), 937–946. doi:10.1080/02699050600909821
9.
CantorJ. B.AshmanT. A.SchwartzM. E.GordonW. A.HibbardM. R.BrownM.. . . ChengZ. (2005). The role of self-discrepancy theory in understanding post-traumatic brain injury affective disorders: A pilot study. Journal of Head Trauma Rehabilitation, 20(6), 527–543. doi:10.1097/00001199-200511000-00005
10.
CarrollE.CoetzerR. (2011). Identity, grief and self-awareness after traumatic brain injury. Neuropsychological Rehabilitation, 21(3), 289–305. doi:10.1080/09602011.2011.555972
11.
ChamberlainD. J. (2006). The experience of surviving traumatic brain injury. Journal of Advanced Nursing, 54(4), 407–417. doi:10.1111/j.1365-2648.2006.03840.x
12.
CharmazK. (1995). The body, identity and self: Adapting to impairment. Sociological Quarterly, 36(4), 657–680. doi:10.1111/j.1533-8525.1995.tb00459.x
13.
ChristiansenC. H. (1999). Defining lives: Occupation as identity: An essay on competence, coherence, and the creation of meaning. American Journal of Occupational Therapy, 53(6), 547–558. doi:10.5014/ajot.53.6.547
14.
ChristmanJ. (2004). Narrative unity as a condition of personhood. Metaphilosophy, 35(5), 695–713. doi:10.1111/j.1467-9973.2004.00345.x
15.
ClouteK.MitchellA.YatesP. (2008). Traumatic brain injury and the construction of identity: A discursive approach. Neuropsychological Rehabilitation, 18(5-6), 651–670. doi:10.1080/09602010701306989
16.
CoetzerR. (2008). Holistic neuro-rehabilitation in the community: Is identity a key issue?Neuropsychological Rehabilitation, 18(5-6), 766–783. doi:10.1080/09602010701860266
17.
CoetzerR.CorneyM. (2001). Grief and self-awareness following brain injury and the effect of feedback as an intervention. Journal of Cognitive Rehabilitation, 19(4), 8–14. Retrieved from www.jofcr.com/home.html
18.
Collicutt McGrathJ. (2008). Recovery from brain injury and positive rehabilitation practice. In JosephS.LinleyP. A. (Eds.), Trauma, recovery, and growth: Positive psychological perspectives on post-traumatic stress (pp. 259–274). Hoboken, NJ: John Wiley & Sons.
ConwayM. A. (2005). Memory and the self. Journal of Memory and Language, 53(4), 594–628. doi:10.1016/j.jml.2005.08.005
21.
CooleyC. H. (1902). Human nature and the social order. New York: Scribner.
22.
CrispR. J. (1992). Awareness of deficit after traumatic brain injury: A literature review. Australian Occupational Therapy Journal, 39(1), 15–21. doi:10.1111/j.1440-1630.1992.tb01730.x
23.
DamasioA. R. (2003). Feelings of emotion and the self. Annals New York Academy Sciences, 1001(1), 253–261. doi:10.1196/annals.1279.014
24.
DamonW.HartD. (1982). The development of self-understanding from infancy through adolescence. Child Development, 53(4), 841–864. doi:10.2307/1129122
25.
DouglasJ. M. (2010). Placing brain injury rehabilitation in the context of the self and meaningful engagement. Seminars in Speech & Language, 31(3), 197–204. doi:10.1055/s-0030-1257536
26.
EriksonE. (1950). Childhood and society. New York: Norton.
27.
FittsW.WarrenW. (1996). Tennessee Self-Concept Scale: TSCS: 2. Los Angeles: Western Psychological Services.
28.
GazzanigaM. (2005). The ethical brain. New York: Dana Press
29.
GelechJ. M.DesjardinsM. (2010). I am many: The reconstruction of self following acquired brain injury. Qualitative Health Research, 21, 62–74. doi:10.1177/1049732310377454
30.
GraceyF.EvansJ. J.MalleyD. (2009). Capturing process and outcome in complex rehabilitation interventions: A “Y-shaped” model. Neuropsychological Rehabilitation, 19(6), 867–890. doi:10.1080/0960201090302776
31.
GraceyF.OwnsworthT. L. (2008). Editorial. Neuropsychological Rehabilitation, 18(5-6), 522–526. doi:10.1080/09602010802141509
32.
GraceyF.OwnsworthT. L. (2012). The experience of self in the world: The personal and social contexts of identity change after brain injury. In JettenJ.HaslamC.HaslamS. A. (Eds.), The social cure: Identity, health and well-being (pp. 273–295). Hove, United Kingdom: Psychology Press
33.
GraceyF.PalmerS.RousB.PsailaK.ShawK.O’DellJ.. . . MohamedS. (2008). “Feeling part of things”: Personal construction of self after brain injury. Neuropsychological Rehabilitation, 18(5-6), 627–650. doi:10.1080/09602010802041238
34.
GutmanS. A.Napier-KlemicJ. (1996). The experience of head injury on the impairment of gender identity and gender role. American Journal of Occupational Therapy, 50(7), 535–544. doi:10.5014/ajot.50.7.535
35.
HammellK. W. (2007). Quality of life after spinal cord injury: A meta-synthesis of qualitative findings. Spinal Cord, 45(2), 124–139. doi:10.1038/sj.sc.3101992
36.
HellerW.MukherjeeD.LevinR. L. R.ReisJ. P. J. (2006). Characters in contexts: Identity and personality processes that influences individual and family adjustment to brain injury. Journal of Rehabilitation, 72(2), 44–49.
JamesW. (1890). Principles of psychology: Briefer course. New York: Holt.
39.
JettenJ.HaslamS. A.HaslamC. (2012). The case for a social identity analysis of health and well-being. In JettenJ.HaslamC.HaslamS. A. (Eds.), The social cure: Identity, health and well-being (pp. 3–21). Hove, United Kingdom: Psychology Press
40.
JohanssonU.ThamK. (2006). The meaning of work after traumatic brain injury. American Journal of Occupational Therapy, 60(1), 60–69. Retrieved from http://ajot.aotapress.net/
41.
JonesJ. A.CurtinM. (2010). Traumatic brain injury, participation, and rural identity. Qualitative Health Research, 20, 942–951. doi:10.1177/1049732310365501
42.
JumiskoE.LexellJ.SöderbergS. (2005). The meaning of living with traumatic brain injury in people with moderate or severe brain injury. Journal of Neuroscience Nursing, 37(1), 42–49. doi:10.1097/01376517-200502000-00007
43.
KlingerL. (2005). Occupational adaptation: Perspectives of people with traumatic brain injury. Journal of Occupational Science, 12(1), 9–16. doi:10.1080/14427591.2005.9686543
44.
KreftingL. (1989). Reintegration into the community after head injury: The results of an ethnographic study. Occupational Therapy Journal of Research, 9(2), 67–83.
45.
LawsonS.DelamereF. M.HutchinsonS. L. (2008). A personal narrative of involvement in post-traumatic brain injury rehabillitation. What can we learn for therapeutic recreation practice?Therapeutic Recreation Journal, 42(4), 236–250. Retrieved from http://js.sagamorepub.com/trj/index
46.
LearyM. R.TangneyJ. P. (2012). Handbook of self and identity (2nd ed.). New York: Guilford Press.
47.
LeplegeA.GzilF.CammelliM.LefeveC.PachoudB.VilleI. (2007). Person-centredness: Conceptual and historical perspectives. Disability and Rehabilitation, 29(20-21), 1555–65. doi:10.1080/09638280701618661
48.
LevackW. M. M.BolandP.TaylorW. J.SiegertR. J.KayesN. M.FadylJ. K.McPhersonK. M. (2014). Establishing a person-centred frmaework of self-identity after traumatic brain injury: A grounded theory study to inform measure development. BMJ Open, 4, e004630. doi:10.1136/bmjopen-2013-004630
49.
LevackW. M. M.KayesN. M.FadylJ. K. (2010). Experience of recovery and outcome following traumatic brain injury: A metasynthesis of qualitative research. Disability & Rehabilitation, 32(12), 986–999. doi:10.3109/09638281003775394
50.
LevineM. J.Van HornK. R.CurtisA. B. (1993). Developmental models of social cognition in assessing psychosocial adjustments in head injury. Brain Injury, 7(2), 153–167. doi:10.3109/02699059309008169
51.
LinvilleP. W. (1987). Self-complexity as a cognitive buffer against stress-related illness and depression. Journal of Personality and Social Psychology, 52(4), 663–676. doi:10.1037//0022-3514.52.4.663
ManD. W.TamA. S.LiE. P. (2003). Exploring self-concepts of persons with brain injury. Brain Injury, 17(9), 775–788. doi:10.1080/0269905031000088577
54.
MarkusH.NuriusP. (1986). Possible selves. American Psychologist, 41(9), 954–969. doi:10.1037//0003-066X.41.9.954
55.
MattinglyC. (1998). Healing dramas and clinical plots: The narrative structure of experience. Cambridge: Cambridge University Press.
56.
McAdamsD. P. (1999). Personal narratives and the life story. In PervinL.JohnO. (Eds.), Handbook of personality: Theory and research (2nd ed., pp. 478–500). New York: Guilford Press.
57.
McGrathJ. (2004). Beyond restoration to transformation: Positive outcomes in the rehabilitation of acquired brain injury. Clinical Rehabilitation, 18(7), 767–775. doi:10.1191/0269215504cr802oa
58.
MeadG. (1934). Mind, self, and society from the standpoint of a social behaviorist. (MorrisC., Ed.). Chicago: University of Chicago Press.
59.
MedvedM. I.BrockmeierJ. (2008). Continuity amid chaos: Neurotrauma, loss of memory, and sense of self. Qualitative Health Research, 18, 469–479. doi:10.1177/1049732308315731
60.
MorrisS. D. (2004). Rebuilding identity through narrative following traumatic brain injury. Journal of Cognitive Rehabilitation, 22(2), 15–21. Retrieved from www.jofcr.com/home.html
61.
MorseJ. M. (1995). Exploring the theoretical basis of nursing using advanced techniques of concept analysis. Advances in Nursing Science, 17(3), 31–46.
62.
MorseJ. M. (2000). Exploring pragmatic utility: Concept analysis by critically appraising the literature. In RodgersB. L.KnaflK. A. (Eds.), Concept development in nursing: Foundations, techniques and applications (2nd ed., pp. 333–352). Philadelphia: Saunders.
63.
MorseJ. M.HupceyJ. E.MitchamC.LenzE. (1996). Concept analysis in nursing research: A critical appraisal. Scholarly Inquiry for Nursing Practice, 10(3), 253–277.
MuenchbergerH.KendallE.NealR. (2008). Identity transition following traumatic brain injury: A dynamic process of contraction, expansion and tentative balance. Brain Injury, 22(12), 979–992. doi:10.1080/02699050802530532
66.
MylesS. M. (2004). Understanding and treating loss of sense of self following brain injury: A behavior analytic approach. International Journal of Psychology and Psychological Therapy, 4(3), 487–504. Retrieved from www.ijpsy.com/
67.
NochiM. (1997). Dealing with the “void”: Traumatic brain injury as a story. Disability & Society, 12(4), 533–555. doi:10.1080/09687599727119
68.
NochiM. (1998a). “Loss of self” in the narratives of people with traumatic brain injuries: A qualitative analysis. Social Science & Medicine, 46(7), 869–878. doi:10.1016/S0277-9536(97)00211-6
69.
NochiM. (1998b). Struggling with the labeled self: People with traumatic brain injuries in social settings. Qualitative Health Research, 8, 665–681. doi:10.1177/104973239800800507
70.
NochiM. (2000). Reconstructing self-narratives in coping with traumatic brain injury. Social Science & Medicine, 51(12), 1795–1804. doi:10.1016/S0277-9536(00)00111-8
71.
NoggleR. (1999). Integrity, the self, and desire-based accounts of the good. Philosophical Studies, 96, 303–331. Retrieved from http://link.springer.com/journal/11098
72.
OkeM. (2008). Remaking self after domestic violence: Mongolian and Australian women’s narratives of recovery. Australian and New Zealand Journal of Family Therapy, 29(3), 148–155. doi:10.1375/anft.29.3.148
PadillaR. (2003). Clara: A phenomenology of disability. American Journal of Occupational Therapy, 57(4), 413–423. doi:10.5014/ajot.57.4.413
75.
PatersonJ.StewartJ. (2002). Adults with acquired brain injury: Perceptions of their social world. Rehabilitation Nursing, 27(1), 13–18. doi:10.1002/j.2048-7940.2002.tb01973.x
76.
PattersonF. L.StatonA. R. (2009). Adult-acquired traumatic brain injury: Existential implications and clinical considerations. Journal of Mental Health Counseling, 31(2), 149–163. Retrieved from www.amhca.org/news/journal.aspx
77.
PernaR. B.ErricoA. E. (2004). Neurological substrates of personal identity: Implications for neurorehabilitation. Journal of Cognitive Rehabilitation, 22(1), 10–12. Retrieved from www.jofcr.com/home.html
78.
PersingerM. A. (1993). Personality changes following brain injury as a grief response to the loss of sense of self: Phenomenological themes as indices of local lability and neurocognitive structuring as psychotherapy. Psychological Reports, 72, 1059–1068. doi:10.2466/pr0.1993.72.3c.1059
PiolinoP.DesgrangesB.ManningL.NorthP.JokicC.EustacheF. (2006). Autobiographical memory, the sense of recollection and executive functions after severe traumatic brain injury. Cortex, 42(2), 176–195. doi:10.1016/S0010-9452(08)70474-X
81.
Price-LackeyP.CashmanJ. (1996). Jenny’s story: Reinventing oneself through occupation and narrative configuration. American Journal of Occupational Therapy, 50(4), 306–314. doi:10.5014/ajot.50.4.306
82.
PrigatanoG.FordyceD.ZeinerH.RouecheJ.PeppingM.WoodB. (1986). Neuropsychological rehabilitation after brain injury. Baltimore, MD: John Hopkins University Press.
83.
PrigatanoG.SchacterD. (1991). Awareness of deficit after brain injury: Clinical and theoretical issues (PrigatanoG.SchacterD., Eds.). New York: Oxford University Press.
84.
RathboneC. J.MoulinC. J.ConwayM. A. (2009). Autobiographical memory and amnesia: Using conceptual knowledge to ground the self. Neurocase, 15(5), 405–418. doi:10.1080/13554790902849164
85.
RicoeurP. (1984). Time and narrative, Volume 1. (McLaughlinK.PellauerD., Eds.). Chicago: University of Chicago Press.
86.
RoscignoC. I.Van LiewK. (2008). Pushed to the margins and pushing back: A case study of one adult’s reflections on social interactions after a traumatic brain injury sustained as an adolescent. Journal of Neuroscience Nursing, 40(4), 212–221. doi:10.1097/01376517-200808000-00005
87.
RubinD.WetzlerS.NebesR. (1988). Autobiographical memory across the adult lifespan. In RubinD (Ed.), Autobiographical memory (pp. 202–221). Cambridge: Cambridge University Press.
88.
SchechtmanM. (1996). The constitution of selves. Ithaca, NY: Cornell University Press.
89.
SchmidtJ.LanninN.FlemingJ.OwnsworthT. L. (2011). Feedback interventions for impaired self-awareness following brain injury: A systematic review. Journal of Rehabilitation Medicine, 43(8), 673–680. doi:10.2340/16501977-0846
90.
SmithC. (2008). Performing my recovery: A play of chaos, restitution, and quest after traumatic brain injury. Forum: Qualitative Social Research, 9(2). Retrieved from www.qualitative-research.net/index.php/fqs
91.
SoekerM. S. (2011). Occupational adaptation: A return to work perspective of persons with mild to moderate brain injury in South Africa. Journal of Occupational Science, 18(1), 81–91. doi:10.1080/14427591.2011.554155
92.
StrawsonG. (2004). Against narrativity. Ratio, 17(4), 428–452. doi:10.1111/j.1467-9329.2004.00264.x
93.
TaylorC. (1989). Sources of the self: The making of the modern identity. Cambridge, MA: Harvard University Press.
94.
TyermanA.HumphreyM. (1984). Changes in self-concept following severe head injury. International Journal of Rehabilitation Research, 7(1), 11–23. doi:10.1097/00004356-198403000-00002
95.
VickeryC. D.GontkovskyS. T.CaroselliJ. S. (2005). Self-concept and quality of life following acquired brain injury: A pilot investigation. Brain Injury, 19(9), 657–665. doi:10.1080/02699050400005218
96.
WittK.KuhnJ.TimmermannL.ZurowskiM.WoopenC. (2011). Deep brain stimulation and the search for identity. Neuroethics, 1–13. doi:10.1007/s12152-011-9100-1
97.
YeatesG. N.GraceyF.Collicutt McGrathJ. (2008). A biopsychosocial deconstruction of “personality change” following acquired brain injury. Neuropsychological Rehabilitation, 18(5-6), 566–589. doi:10.1080/09602010802151532
98.
YlvisakerM.FeeneyT. (2000). Reconstruction of identity after brain injury. Brain Impairment, 1(1), 12–28. doi:10.1375/brim.1.1.12
99.
YlvisakerM.McphersonK.KayesN.PellettE. (2008). Metaphoric identity mapping: Facilitating goal setting and engagement in rehabilitation after traumatic brain injury. Neuropsychological Rehabilitation, 18(5-6), 713–741. doi:10.1080/09602010802201832
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
