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Impaired Behavioural Self-Awareness and Affective Theory of Mind Deficits Following Prefrontal Cortex Damage

Author(s): FA Jonker, MP Wattjes, EJA Scherder


The orbitofrontal cortex (OFC) and dorsomedial prefrontal cortex (dmPFC) are major subdivisions of the prefrontal cortex (PFC) involved in Theory of Mind (ToM) and behavioral selfawareness. Lesions of the OFC (Brodmann Area; 10,11,12,47) are associated with impairment in affective-ToM. Damage to dmPFC (Brodmann area: 8,9,10,24 and 32) is associated with the cognitive aspects of self-reference, including a consistent view of one’s own behavior.


we compared three dmPFC damaged patients (Brodmann Area; 8, 9, 10) with four OFC (Brodmann Area; 10, 11, 12) damaged patients, and compared them to a control group (N=22) on affective- ToM and behavioral self-awareness. Of the 20 patients in the pre-selection, only 7 patients had a lesion in a single sector of the PFC lesions. We measured behavioralawareness with the Frontal System Behavioral Scale (FrSBe) subscales. Neuropsychological tests, including social cognitive tests and questionnaires were administered to patients and controls.


The dmPFC group showed a significant difference with the control group concerning apathy (χ2(1, N=25) =5.319, p=0.021). The OFC group differed significantly (χ2(1, N=26)=7.552, p=0.006) from the control group concerning the Faux Pas empathy score (affective-ToM).


Both dmPFC and OFC are involved in a complex process of mentalizing with specific functions in relation to behavioral self-awareness irrespective of cognitive functioning.

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