Restorative Neurology and Neuroscience 33 (2015) 335–345 DOI 10.3233/RNN-140484 IOS Press 335 Theory of mind impairment after severe traumatic brain injury and its relationship with caregivers’ quality of life Umberto Bivona a,∗ , Rita Formisano a , Sara De Laurentiis a , Natascia Accetta a , Maria Rita Di Cosimo a , Roberta Massicci a , Paola Ciurli a , Eva Azicnuda a , Daniela Silvestro a , Umberto Sabatini a , Chiara Falletta Caravasso a , Giovanni Augusto Carlesimo a,b , Carlo Caltagirone a,b and Alberto Costa a a Fondazione Santa Lucia – Rome, Italy b Universit` a di Roma Tor Vergata – Rome, Italy Abstract. Purpose: Theory of mind (ToM) deficits are common consequences of severe Traumatic Brain Injury (sTBI), but little is known about their impact on patients’ and their caregivers’ quality of life. This study aimed (i) to examine the presence of ToM difficulties in individuals with sTBI and adequate levels of self-awareness (SA); (ii) to investigate their relationship with perceived Health Related Quality of Life (HRQoL) in patients and their caregivers. Methods: Twenty individuals with sTBI and adequate levels of SA, and 20 healthy controls (HCs) were recruited. ToM was examined by the Faux-pas Recognition paradigm. The QOLIBRI questionnaire was administered to patients and their caregivers to assess their HRQoL. Cognitive functioning and psychopathology were evaluated. Results: Individuals with sTBI were less accurate than HCs on the Faux-pas Recognition paradigm. Patients’ satisfaction of HRQoL was related to their performance on the Wisconsin Card Sorting Test. Caregivers’ satisfaction was significantly predicted by patients’ score on the Faux-pas paradigm. Conclusions: ToM is impaired in individuals with sTBI and adequate levels of SA. Moreover, their ToM performance predicted HRQoL in the caregivers. From a clinical perspective, these results provide understanding of the potential impact of ToM impairment in subjects with sTBI and their social system. Keywords: Traumatic brain injury, theory of mind, self-awareness, quality of life, psychological support, neuropsychotherapeutic approach 1. Introduction Cognitive and emotional deficits are common seque- lae of severe traumatic brain injury (sTBI) that can negatively affect both patients’(Soberg et al., 2013) and their caregivers (Marsh et al., 1998; Ponsford et al., 2003; Wells et al., 1987). Indeed, it has long been ∗ Corresponding author: Umberto Bivona, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00100 – Rome, Italy. Tel.: +39 0651501749; Fax: +39 0651501752; E-mail: u.bivona@ hsantalucia.it. known that in patients with sTBI decreased cogni- tive functioning (i.e., disorders of attention, executive functioning, memory and information processing) and personality changes (e.g., disinhibition, irritability, egocentrism, low sensitivity to relatives’ needs) are strongly associated with poor social outcome (Pons- ford et al., 2003; Elsass & Kinsella, 1987). Moreover, many studies have pointed out the role of the neurobe- havioural deficits associated with TBI as significant predictors of caregivers’ distress (Marsh et al., 1998; Ponsford et al., 2003; Wells et al., 1987) and quality of life (Wells et al., 1987; Bullinger et al., 2002). 0922-6028/15/$35.00 © 2015 – IOS Press and the authors. All rights reserved