SUMMARY A close relative of each of 42 severely head injured patients was interviewed at 5 years after injury, following initial study at 3, 6, and 12 months. Persisting severe deficits, in some cases worse than at 1 year, were primarily psychological and behavioural, although minor physical deficits, for example in vision, were also common. Relatives were under great strain; significantly more so than at 1 year. The best predictor of strain in the relative was the magnitude of behavioural and personality change in the patient.The purely physical sequelae of severe head injury (sensorimotor disturbance, gait disturbance, cranial nerve lesions, etc) are well documented,1 2 but it is becoming increasingly recognised that often the most serious long term morbidity after head injury is psychological; involving cognitive, behavioural, and social and family disturbance.Research into psychological sequelae has produced reports of both short term (1-2 years),3 9 and long terml0o 17 outcome. The reports are based on widely varying samples of patients ranging from those admitted to one neurosurgical unit,3 to those admitted to a variety of hospital units,7 and those in a rehabilitation unit. those with the most severe brain damage.17 Thomsen's 10-15 year follow-up of cases initially examined within 2 years of injury, disclosed a high incidence of divorce, continuing dependency, communication disturbance, and psychosocial sequelae including personality change and emotional disturbance. These late sequelae related to the presence and degree of brain stem damage (presumably reflecting the severity of damage throughout the cerebrum).The present authors reported a detailed study of psychosocial outcome 1 year after injury,3 in which attempts were made to describe the natural history of psychosocial disturbance in patient and family, and to relate changes in the patient to distress in the family. By one year after injury emotional and behavioural disturbances in the patient were frequently described by a relative, and these rather than continuing physical or communication disturbances were the best predictors of stress in the relative who had the main responsibility for caring for the patient. The present study reports the 5 year outcome of a sample of these patients. The aims were firstly to identify the patterns of change in behavioural disturbance in the patient and distress in the family during the first 5 years after injury; and secondly, to identify predictors of behavioural disturbance in the patient and continuing distress in the caring relative.

The rate and prediction of return to work was examined in 98 severely head injured patients during the first seven years after injury. The employment rate dropped from 86% before injury to 29% after. Younger patients, and those with technical/managerial jobs before injury were more likely to return to work than those over 45 years of age, or in unskilled occupations. Physical deficits were not related to return to work, but the presence of cognitive, behavioural, and personality changes was significantly related to a failure to return to work.

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Anorexic and bulimic patients were compared to obese dieters, nonobese dieters, and normal controls on measures of perceived control, assertiveness, self‐esteem, self‐directed hostility, and psychiatric caseness. The anorexic and bulimic groups both scored significantly differently in the expected direction from the other three groups on all measures. There were no significant differences between the anorexic and bulimic groups and in turn, no significant differences among the obese, nonobese dieters, and normal controls. Results are in keeping with the notion that perceived control, low assertiveness, low self‐esteem, and selfdirected hostility are characteristics of eating disorder patients that differentiate them from individuals who display dietary/weight features, as well as from normal controls. © 1993 by John Wiley & Sons, Inc.

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