Subjective symptomatology after traumatic head injury

Background: Controversy persists regarding the reasons for persistent subjective complaints after mild traumatic head injury (THI). Statement of purpose: To evaluate the influence of injury severity, psychological factors, and financial contingencies on symptomatology after THI. Methods: Subjective complaints about cognitive, emotional, and somatic symptoms, as assessed by a standardized self-report inventory (Minnesota Multiphasic Personality Inventory-2; MMPI-2) were evaluated in 150 patients with THI. Results: Individuals with mild THI demonstrated paradoxically greater symptomatology on the MMPI-2 than patients with moderate-to-severe THI. Furthermore, specific actuarial criteria for possible symptom magnification (Fake Bad Scale) were met about twice as often in patients with mild THI who were seeking financial compensation for alleged acquired dysfunction than in patients with mild THI without such external contingencies. Conclusion: The evaluation of persistent subjective complaints after THI should consider injury severity in concert with psychological and financial/motivational factors. Great caution should be taken in attributing persistent symptomatology after mild THI to cerebral dysfunction.