Dynamic Phase-locking States and Personality in Sub-acute Mild Traumatic Brain Injury: an Exploratory Study

Harm J. van der Horn, Myrthe E. de Koning, Koen Visser, Marius G. J. Kok, Jacoba M. Spikman, Myrthe E. Scheenen, Remco J. Renken, Vince D. Calhoun, Victor M. Vergara, Joana Cabral, Andrew R. Mayer, Joukje van der Naalt


Research has shown that maladaptive personality characteristics, such as Neuroticism, are associated with poor outcome after mild traumatic brain injury (mTBI). The current exploratory study investigated the neural underpinnings of this process using dynamic functional network connectivity (dFNC) analyses of resting-state (rs) fMRI, and diffusion MRI (dMRI). Twenty-seven mTBI patients and 21 healthy controls (HC) were included. After measuring the Big Five personality dimensions, principal component analysis (PCA) was used to obtain a superordinate factor representing emotional instability, consisting of high Neuroticism, moderate Openness, and low Extraversion, Agreeableness, and Conscientiousness. Persistent symptoms were measured using the head injury symptom checklist at six months post-injury; symptom severity (i.e., sum of all items) was used for further analyses.


A mild traumatic brain injury (mTBI) can have a significant and long-lasting impact on a person’s life, but the exact pathophysiological mechanism remains a conundrum for clinicians and scientists. Especially, untangling the influence of traumatic injury on the brain in the light of pre-existent factors, such as personality, emotion regulation and coping, has proven to be very challenging [1,2]. Advanced neuroimaging techniques, such as resting-state functional MRI (rs-fMRI), have improved our understanding of mTBI and its sequelae.

Materials and method

In the period between January 17, 2020 and December 12, 2022, 27 patients with mTBI and 21 healthy controls were included in this neuroimaging study. This study was part of a larger prospective cohort study (AIM-TBI study, Dutch Trial Register/International Clinical Trials Registry Platform no. NL8484). Inclusion took place in the University Medical Center Groningen (UMCG), the Netherlands, which is a level 1 trauma center. Participants aged 18 years or older were included. Exclusion criteria were major neurologic or psychiatric comorbidity, admission for prior TBI (all severities included; this data was acquired during patient history at the Emergency Department and again via the two week questionnaire), drug or alcohol abuse, mental disability, language barriers or illiteracy prohibiting understanding and completion of questionnaires, and contraindications for MRI.


In Table 1 the general demographics and characteristics of both study groups are depicted. Patients showed a strong trend toward higher symptom severity at six months. Table 2 shows the other clinical characteristics of the mTBI patient group. Of the 14 patients who were admitted to the inpatient ward, 11 (79%) were discharged the following day.


Sustaining a mild TBI can be a highly stressful event, both in the acute phase and at later time points post-injury. Therefore, someone’s personality characteristics may determine the pattern of recovery to a great extent. In the current study we found preliminary evidence for an interaction between a personality trait representing emotional instability and dynamic state measures in the recovery process after mTBI. No differences in dynamic state measures were found between patients and healthy controls.


Thanks goes out to D.I. Larabi, B. Ćurčić-Blake, and J.R. Dalenberg for their valuable input during discussions regarding methodology, and A. Sibeijn-Kuiper, and J. Werdekker for their assistance during scanning.

Citation: van der Horn HJ, de Koning ME, Visser K, Kok MGJ, Spikman JM, Scheenen ME, et al. (2023) Dynamic phase-locking states and personality in sub-acute mild traumatic brain injury: An exploratory study. PLoS ONE 18(12): e0295984.

Editor: Wang Zhan, University of Maryland at College Park, UNITED STATES

Received: August 9, 2023; Accepted: December 1, 2023; Published: December 15, 2023

Copyright: © 2023 van der Horn et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Source data cannot be shared publicly because no formal consent was obtained to do so. Derivative data will be shared upon reasonable request to the corresponding author. Data requests and other questions can be sent to the Medical Ethical Committee of the UMCG, Groningen, The Netherlands (

Funding: This research was supported by a Mandema stipend (reference number MA 18-02) from the University Medical Center Groningen to Harm Jan van der Horn. This funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.


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