Purpose: To investigate the evidence for domain-specific deficits in self-awareness on the Patient Competency Rating Scale (PCRS) and the relationship to psychosocial outcomes after severe traumatic brain injury (TBI).

Methods: Fifty-six adults with severe TBI (75% males, M age =36.96, SD = 12.96), and 50 age- and gender-matched controls (72% male, M age =34.12, SD = 11.43) were administered the PCRS self-report form, and the Depression, Anxiety, Stress Scales. Relatives of TBI and control participants completed the PCRS informant version. Relatives of the TBI group also completed the Sydney Psychosocial Rating Scale.

Results: A within-group analysis indicated that self-awareness varied according to PCRS domain (p <.01). Relative to their own profile, TBI participants displayed significantly poorer self-awareness on the activities of daily living (ADLs) domain than on the interpersonal and emotional domains (p < 0.01). Further, TBI participants displayed significantly poorer self-awareness of ADLs than controls (p < 0.001), but there were no significant between-group differences in other domains. Hierarchical regression analyses revealed that poorer self-awareness of cognitive difficulties was related to lower occupational functioning (p = 0.01), whereas poorer self-awareness of difficulties with ADLs was related to lower independent living skills (p < 0.001).

Conclusions: The results provide only limited support for domain-specific deficits in self-awareness after severe TBI, with impairment most evident for ADLs. Poorer self-awareness in the ADLs and cognitive domains were associated with lower independence and occupational functioning, respectively. The findings highlight the potential benefits of targeting self-awareness related to difficulties with ADLs in the rehabilitation of people with severe TBI.