Orbitofrontal Cortex and Social Behavior: Integrating
Self-monitoring and Emotion–Cognition Interactions
Jennifer S. Beer1, Oliver P. John2, Donatella Scabini2,
and Robert T. Knight2
& The role of the orbitofrontal cortex in social behavior re-
mains a puzzle. Various theories of the social functions of the
orbitofrontal cortex focus on the role of this area in either
emotional processing or its involvement in online monitoring
of behavior (i.e., self-monitoring). The present research at-
tempts to integrate these two theories by examining whether
improving the self-monitoring of patients with orbitofrontal
damage is associated with the generation of emotions needed
to guide interpersonal behavior. Patients with orbitofrontal
damage, patients with lateral prefrontal damage, and healthy
controls took part in an interpersonal task. After completing
the task, participants’ self-monitoring was increased by show-
ing them a videotape of their task performance. In comparison
to healthy controls and patients with lateral prefrontal damage,
orbitofrontal damage was associated with objectively inappro-
priate social behavior. Although patients with orbitofrontal
damage were aware of social norms of intimacy, they were
unaware that their task performance violated these norms. The
embarrassment typically associated with inappropriate social
behavior was elicited in these patients only after their self-
monitoring increased from viewing their videotaped perform-
ance. These findings suggest that damage to the orbitofrontal
cortex impairs self-insight that may preclude the generation
of helpful emotional information. The results highlight the role
of the orbitofrontal cortex in the interplay of self-monitoring
and emotional processing and suggest avenues for neurore-
habilitation of patients with social deficits subsequent to or-
bitofrontal damage. &
A host of clinical observations, case studies, and two
empirical studies show that orbitofrontal damage is
associated with impaired interpersonal behavior. De-
scriptions of orbitofrontal patients have associated dam-
age to this area with the impaired ability to prioritize
solutions to interpersonal problems (Saver & Damasio,
1991), a tendency to greet strangers in an overly familiar
manner (Rolls, Hornak,Wade, &McGrath, 1994),and dis-
ruptive behavior in a hospital setting (Blair & Cipolotti,
2000). Aside from the descriptive evidence, two empir-
ical studies show that orbitofrontal damage impairs in-
terpersonal behavior (Beer, Heerey, Keltner, Scabini, &
Knight, 2003; Kaczmarek, 1984). These studies suggest
that patients with orbitofrontal damage behave with
strangers in ways that are more appropriate for interac-
tions with close others. Patients with orbitofrontal dam-
age tease strangers in inappropriate ways and are more
likely to include unnecessary personal information or
tangential information when answering questions. Al-
though it is clear that the orbitofrontal region is critically
involved in adaptive interpersonal behavior, there has
been less agreement on the psychological mechanism
responsible for such adaptive behavior.
Social Function of the Orbitofrontal Cortex:
Emotion–Cognition Synthesis and Self-monitoring
Current theories suggest that two types of variables con-
tribute to the social deficits associated with orbitofron-
tal damage: deficient emotional systems or a lack of
online behavioral monitoring. Several theories propose
that emotional deficits, in one form or another, account
for the impaired interpersonal behavior associated with
orbitofrontal damage (e.g., Kringelbach & Rolls, 2004;
Bechara, Damasio, & Damasio, 2000; Elliott, Dolan, &
Frith, 2000). For example, the somatic marker hypoth-
esis proposes that the orbitofrontal cortex is critical for
interpreting somatic sensations (equated with emotion
in this framework) that are needed to make decisions
(e.g., Bechara et al., 2000; Bechara, Damasio, Tranel, &
Damasio, 1997). From this perspective, people avoid
making social blunders because particular physiological
sensations guide them toward adaptive behavior and
away from maladaptive behavior. Empirical support for
the somatic marker hypothesis comes from a series of
gambling studies that have found that patients with
1University of California, Davis,2University of California, Berkeley
D 2006 Massachusetts Institute of TechnologyJournal of Cognitive Neuroscience 18:6, pp. 871–879
orbitofrontal damage do not show anticipatory anxiety
before taking big risks (e.g., Bechara et al., 2000, 1997).
Similarly, the orbitofrontal cortex has been implicated in
guessing and theorized to be helpful for guiding behav-
ior in ambiguous situations by incorporating intuition or
‘‘gut feelings’’ into decision making (Elliott, Dolan, &
Frith, 2000). From this perspective, the orbitofrontal
cortex acts like the lateral prefrontal cortex by support-
ing response selection. In contrast to the lateral pre-
frontal cortex, the orbitofrontal cortex is recruited as
situations become more complex and uncertain, making
decisions more intuitive or emotional (Elliott, Rees, &
Reinforcement and reversal theory proposes that the
orbitofrontal cortex is necessary for evaluating what
behaviors will generate positive emotion (i.e., reward)
and negative emotion (i.e., punishment) in a given
context (Kringelbach & Rolls, 2004). Social mistakes
may occur if people fail to make the correct computa-
tions about what is appropriate (rewarding) and inap-
propriate (punishing) in a given context. Empirical
evidence for this position comes from research that
shows the orbitofrontal cortex is important for inhibiting
behavior that is not rewarded in go/no-go and reversal
tasks (Fellows & Farah, 2003; Roberts & Wallis, 2000;
Schultz, Tremblay, & Hollerman, 2000; Rolls et al., 1994).
Similarly, patients with orbitofrontal damage may not be
embarrassed by their inappropriate behavior and may
actually report increased pride after behaving inappro-
priately (Beer et al., 2003).
A second perspective emphasizes the importance of
the orbitofrontal cortex for self-monitoring (Prigatano,
1991; Stuss, 1991; Stuss & Benson, 1984) or the ability to
evaluate one’s behavior in the moment in reference to
higher order goals or the reactions of other people
(Duval & Wicklund, 1972). Self-monitoring has been
used to describe the (not always conscious) cognitive
process by which individuals evaluate their behavior in
the moment to make sure that the behavior is consistent
with how they want to behave and how other people
expect them to behave. This type of self-monitoring is
distinct from neglect syndromes in which individuals
do not attend to an entire visual hemifield and may
be anosognosic for this behavioral deficit. Rather, self-
monitoring is a social anosognosia; social mistakes may
occur because individuals lack self-insight into the in-
appropriateness of their behavior. Clinical characteriza-
tions and empirical research with lesion patients suggest
that the frontal lobes are intricately involved in self-
monitoring (Lhermitte, 1986; Luria & Homskaya, 1970).
The orbitofrontal cortex may be important for self-
insight into the appropriateness of behavior, whereas
the lateral prefrontal cortex has been more commonly
associated with motivation or execution of behavior
(Stuss, 1991; Stuss & Benson, 1984). Patients with fron-
tal lobe damage (including but not specific to the
orbitofrontal cortex) are frequently characterized as
knowing what is appropriate and what is inappropri-
ate but not applying this knowledge to their behavior
(Stuss, 1991). The stimulus-bound behavior typical of
frontal lobe patients (including but not specific to the
orbitofrontal cortex) exemplifies faulty monitoring pro-
cesses (Lhermitte, 1986; Lhermitte, Pillon, & Serdaru,
1986; Luria & Homskaya, 1970). For example, objects
placed in front of prefrontal patients may be picked
up and used (utilization behavior) without the patient
being asked to do so (Lhermitte, 1986). One case study
of a patient with bilateral frontal damage (not speci-
fied as orbitofrontal or lateral prefrontal) found that the
patient inappropriately approached members of the op-
posite sex and was bewildered to be told after the
fact that the behavior was offensive (Prigatano, 1991).
These studies suggest that prefrontal damage impairs
the ability to monitor the appropriateness of behavior
as a function of a given context. However, no previ-
ous empirical research has manipulated variables of self-
monitoring in relation to specific subdivisions of the
Although these theories have traditionally been stud-
ied separately, integration of the two perspectives is not
only possible but may have greater explanatory power
than either perspective on its own. Both the emotional
deficits literature and self-monitoring literature charac-
terize orbitofrontal function as important for applying
knowledge to behavior but diverge on the psychologi-
cal mechanism involved in this process (Kringelbach
& Rolls, 2004; Bechara et al., 2000; Stuss, 1991). A criti-
cal relation between these two theories is suggested
by functional accounts of emotion, which posit that
self-monitoring is necessary for generating social emo-
tions that help promote adaptive social behavior (Lewis,
1993). From an evolutionary perspective, social emo-
tions such as embarrassment have evolved to promote
survival and reproduction by motivating individuals to
repair social relations (Miller & Leary, 1992; Goffman,
1956). For example, the experience of embarrassment
signals that one has committed a social transgression
and action is needed to repair social relations. It could
be that orbitofrontal patients’ disinhibited social behav-
ior is accounted for by deficient online self-monitoring
that may preclude the generation of emotions neces-
sary to motivate appropriate behavior. In other words,
patients with orbitofrontal damage may not auto-
matically monitor their behavior and, therefore, do
not have emotional reactions when they make social
The present research brings together elements of all
of the perspectives on the orbitofrontal cortex to ex-
amine this area’s role in self-monitoring, appropriate
interpersonal behavior, and social emotions (i.e., embar-
rassment). Patients with orbitofrontal damage, patients
with lateral prefrontal damage (see Figure 2), and
healthy controls completed an interpersonal task. The
two patients groups were selected because although
872Journal of Cognitive NeuroscienceVolume 18, Number 6
both had lesions to the frontal lobe and executive
functioning deficits, only orbitofrontal damage has been
characterized primarily by social deficits (Beer et al.,
2003; Muller, Machado, & Knight, 2002; Stone, Baron-
Cohen, & Knight, 1998). Lateral prefrontal cortex dam-
age has been associated with impaired cognitive control,
attention, response monitoring, working memory, and
planning but has been less characterized by inap-
propriate, disinhibited social behavior (Beer, Knight,
& Shimamura, 2004; Wagner, Bunge, & Badre, 2004;
D’Esposito, Postle, & Rypma, 2000). However, as noted
above, much of the research on the self-monitoring and
frontal lobe damage was not derived from focal lesions
within specific subregions of the frontal cortex. There-
fore, the comparison of these two groups provides a
strong test of whether the orbitofrontal cortex is selec-
tively associated with impaired self-insight needed to
generate the social emotions that motivate adaptive
interpersonal behavior (or whether any kind of execu-
tive functioning deficits impact the appropriateness of
The present research took place in two parts. In Part I,
participants’ self-perceptions of their appropriateness
and emotions were assessed after they took part in a
self-disclosure task with a stranger (Aron, Melinat, Aron,
Vallone, & Bator, 1997). To measure accuracy of self-
monitoring, self-reports of appropriateness were com-
pared to expert judges’ ratings of appropriateness. In
Part II, participants watched a videotape of themselves
completing the self-disclosure task. Watching a video-
tape has been shown to increase the self-monitoring of
individuals who may not already be periodically moni-
toring their behavior by providing an objective, outside
observer’s perspective of their performance (Robins &
John, 1997). After watching the videotape, participants
reported on how they now felt about their task perform-
ance. To measure change in emotion as a function of
self-consciousness, the discrepancy between reports of
emotion from Part I and Part II was calculated.
A total of 16 participants were tested (none of the
participants were depressed as measured by the Center
for Epidemiology Studies Depression Scale (CES-D)
(Radloff, 1977; see Tables 1 and 2 for patient neuropsy-
chological characteristics): 4 patients with orbitofrontal
lesions (4 men), 4 patients with lateral prefrontal lesions
(2 men), and a total of 8 healthy controls (6 men).
Patients with orbitofrontal lesions had bilateral damage
to the orbitofrontal cortex; 2 patients had damage ex-
tending into the anterior temporal lobe and 1 may
possibly include the amygdala (see Figure 1). Patients
with lateral prefrontal lesions had unilateral damage to
either the left or right side of the lateral prefrontal cor-
tex (see Figure 2). Lesion size was comparable across the
All possible measures were taken to ensure the patients
differed from the comparison participants on the basis
of lesion alone. On average, the two patients groups
differed in age (orbitofrontal mean age = 56 years,
SD = 10.7; lateral prefrontal mean age = 76.0 years,
SD = 7.2) and gender (orbitofrontal = 4/4 men; lateral
prefrontal = 2/4 men). Therefore, two separate groups
of healthy comparison participants were created. A par-
ticular comparison participant was selected to match
a specific patient on the basis of age, gender, educa-
tion, community of residence, and Mini Mental Status
Exam performance. Therefore, there were four groups
of four participants entered into the repeated mea-
sures analyses: orbitofrontal patients, lateral prefrontal
patients, comparison participants for the orbitofrontal
Table 1. Background Information on Patients
PatientAge Gender Handedness Cause of Lesion
Time Since Lesion
Onset (Years) Area of Damage
M.R.47M Right Motorcycle accident26 Bilateral OFC
D.H.40M Right Motor scooter accident23 Bilateral OFC
R.B.56M RightClosed-head injury during
27 Bilateral OFC, ant.
R.V.63M Right Struck head on rock during
42 Bilateral OFC, ant.
W.E. 72M RightStroke7 Lateral frontal (left)
M.F.68M RightStroke6 Lateral frontal (left)
E.B.83F RightStroke18 Lateral frontal (right)
S.R. 81F Right Stroke8 Lateral frontal (right)
Ant. = anterior; OFC = orbitofrontal cortex.
Beer et al. 873
patients, and comparison participants for the lateral
Knowledge of Social Norms
Perceptions of social norms governing intimate conver-
sations with strangers were assessed to most closely
approximate the norms governing the upcoming self-
disclosure task. Participants were presented with 34
questions (9 of which were used in the self-disclosure
task; see below, Aron et al., 1997) and asked to rate each
one for how much intimate, personal information they
would reveal if they were posed the question by a
stranger (a = .82). Participants used a scale ranging
from 1 (no intimate information) to 5 (an extreme
amount of intimate information).
Participants then engaged in a structured conversation
with a stranger. The stranger was a graduate student
experimenter who interviewed all participants and was
unknown to the participants before the interview. All par-
ticipants were instructed that they would take part in a
conversation with the stranger. They were told that they
would be asked questions by the stranger but that it was
their decision how much information they volunteered
in their answers. Furthermore, they were instructed that
it was perfectly acceptable to completely pass on answer-
ing a question for any reason at any time. These instruc-
tions were designed to reduce any sort of experimental
demand toward excessive self-disclosure. The stranger
asked the participants a predetermined set of nine ques-
tions. Once participants stopped speaking after a ques-
tion prompt, the experimenter asked them if they had
anything else they wanted to say and if they did not,
the next question was posed. The conversations lasted
24 min 53 sec, on average (SD = 7 min 55 sec). The nine
questions were selected from a much larger set and some
concerned intimate topics that strangers do not typically
discuss so that participants had to monitor how much
intimate information they revealed (Aron et al., 1997).
Monitoring of Self-disclosure Appropriateness
After taking part in the task, participants reported on
how appropriate they felt their self-disclosure had been
taking into consideration that they had been speaking
with a stranger. This measure (three items measuring
intimacy, four items measuring appropriateness; a =
.73; see Appendix B, derived from Cozby, 1973) assessed
participants’ self-monitoring of their appropriateness.
To measure the accuracy of participants’ self-monitoring,
self-perceptions were compared to an objective mea-
sure of their appropriateness derived from the consen-
sus criterion approach (Robins & John, 1996). Objective
Table 2. Neuropsychological Data from the Patient Participants
(Percentile)Verbal IQ Performance IQ
Patients with orbitofrontal damage
M.R.10 29/3070 7120 50 5/092
D.H. 12 29/3065 6842 96 6/095
R.B.12 30/30 9245 1762 6/0 79
Patients with lateral frontal damage
15 27/30AQ = 96.3a
CQ = 93.4a
M.F. 12 26/304528 2475 3/414
E.B.12 28/3065 77 7175 6/070
S.R.13 27/30 756313 953/51
Barona = Estimate of premorbid IQ (Barona, Reynolds, & Chastain, 1984); CVLT = California Verbal Learning Test (Delis, Kramer, Kaplan, & Ober,
1987); GED = High School Diploma Equivalent; MMSE = Mini-Mental State Exam (Folstein, Folstein, & McHugh, 1975); WAIS-III = Wechsler Adult
Intelligence Scale III (Wechsler, 1997a); WMS-III = Wechsler Memory Scale III (Wechsler, 1997b); WCST = Wisconsin Card Sorting Test (Grant &
Berg, 1948); Trails B task from the Halstead–Reitan Neuropsychological Test Battery.
aNot all patients were able to participate in additional neuropsychological testing because of illness. For these patients, the MMSE measured the day
of the experimental session is reported and, for patient W.E., we report the Aphasia Quotient (AQ) and Cortical Quotient (CQ) measures from the
Western Aphasia Battery (Shewan & Kertesz, 1980) collected in 1996.
874 Journal of Cognitive NeuroscienceVolume 18, Number 6
measures were assessed using expert ratings of the par-
ticipants’ disclosures using the same scale that was used
to assess self-report. Whereas participants completed
the questionnaire with the stem, ‘‘I ...,’’ the judges
completed the same questions with the stem, ‘‘This par-
ticipant ....’’ In order to rate aspects of self-disclosure
independently of emotional expression, judges rated
transcripts of the conversations. Each judge rated each
Figure 2. Lesion
reconstructions of patients
with lateral prefrontal
damage (bottom). Lesion
are the same as in Figure 1.
The first four rows portray
an individual patient’s lesion
across contiguous slices,
whereas the bottom row
portrays overlap for each
slice across the sample. The
color bar represents the
percentage lesion overlap
in the group for specific
areas within the lateral
Figure 1. Lesion
reconstructions of patients
with orbitofrontal damage. In
order to reconstruct lesions,
212 isovolumetric contiguous
coronal slices, 5.0 mm thick,
are initially obtained on a
1.5-T Picker (New York)
Lesions are then transcribed
from scans onto sequential
axial templates in MRIcro.
A high degree of interrater
lesion reconstruction was
found between two behavioral
neurologists (Drs. Robert
Rafal and Robert Knight).
In previous cases using this
method, autopsies reinforced
the validity of this approach
for reconstructing lesions.
The first four rows portray
an individual patient’s lesion
across contiguous slices,
whereas the bottom row
portrays overlap for each
slice across the sample. The
color bar represents the
percentage lesion overlap in
the group for specific areas
within the orbitofrontal cortex.
Beer et al. 875
of the nine questions for each participant separately on
the seven items; these ratings were then averaged across
questions for each participant. An average rating across
questions for each participant from the judges was most
analogous to the self-report. Finally, a reliability analysis
was conducted across the three judges’ ratings for all
participants (a = .92). These ratings were made by ex-
pert judges who were blind to the purpose of the
study and that it included individuals with brain dam-
age. The judges were trained in norms of self-disclosure
through extensive literature review. A month-long in-
tensive course on transcript coding was required of all
judges. The course involved 10 practice transcripts from
the procedure used in the present study. Judges coded
each for the dimensions of self-disclosure appropriate-
ness and then discussed individual codes as a group.
Change in Emotion
After completing the self-disclosure task and again after
watching the videotapes, participants reported how much
they felt amused, embarrassed, afraid, angry, and disgusted
completing the self-disclosure task, the instructions read,
‘‘Below are a number of feelings that you may have felt
during the interaction you just participated in. Please rate
the extent to which you feel each emotion in relation
to the interaction you just had.’’ After watching the vid-
eotapes, the instructions read, ‘‘Please answer these
questions about emotion now that you’ve watched the
videotape of your study session. Please rate the extent to
how you feel this way about your interaction.’’ A change
in emotion score was computed by calculating the dis-
crepancy between prevideo and postvideo ratings.
The groups significantly differed in the appropriate-
ness of their self-disclosure, F(3,12) = 3.5, p < .05
(see Figure 3). In comparison to orbitofrontal compari-
son participants, t(1,6) = 3.3, p < .05, and patients with
lateral prefrontal lesions, t(1,6) = 3.1, p < .05, patients
with orbitofrontal lesions were judged as objectively
more inappropriate in their self-disclosure. It was not
the case that patients with orbitofrontal lesions failed
to understand that most people do not disclose person-
al information to strangers; there were no differences
between the groups on social norms governing con-
versations between strangers F(3,12) = 1.1, ns. How-
ever, there were group differences in self-insight into
appropriateness of behavior, F(3,12) = 4.8, p < .05 (see
Figure 4). In comparison to orbitofrontal comparison
participants, t(1, 6) = 3.2, p < .05, and lateral prefrontal
patients, t(1,6) = 7.13, p < .05, patients with orbito-
frontal damage underestimated their inappropriateness
in comparison to the judged inappropriateness of their
conversations. Upon watching their videotaped perform-
ance, the groups significantly differed in their change
in embarrassment, F(3,12) = 3.0, p < .05 (see Figure 5).
In comparison to orbitofrontal comparison participants,
t(1,6) = ?5.0, p < .05, and to lateral prefrontal patients,
t(1,6) = ?2.6, p < .05), orbitofrontal patients reported
Figure 3. Appropriateness of self-disclosure. Higher scores indicate
greater perceptions of inappropriateness by the judges.
Figure 4. Discrepancy between self-perception and actual
appropriateness. Negative scores reflect participants’ overestimation
of their appropriateness.
Figure 5. Change in emotion associated with increased
self-consciousness. Higher scores indicate an increase in
embarrassment after watching the videotape of the procedure.
876Journal of Cognitive NeuroscienceVolume 18, Number 6
a greater increase in embarrassment. It was not the case
that the self-monitoring manipulation increased all emo-
tions; no differences were found among the groups
for changes in nonsocial emotions such as amusement,
.18, ns; and disgust, F(3,12) = 1.0, ns.
The present research supports the hypothesis that
orbitofrontal damage impairs self-monitoring precluding
the generation of social emotions typically associated
with the resolution of social mistakes (Tangney, Miller,
Flicker, & Barlow, 1996). In comparison to patients
with lateral prefrontal damage and healthy compari-
son participants, patients with orbitofrontal damage
self-disclosed more inappropriately while talking with a
stranger. Even though patients with orbitofrontal dam-
age could successfully report the norms governing self-
disclosure with a stranger, they were unaware of their
inappropriateness after completing the self-disclosure
task. Only after watching a videotape focusing their
attention on their behavior did patients with orbitofron-
tal damage report embarrassment in relation to their
inappropriate social behavior.2
Together these findings suggest that integrating
the (a) emotion and (b) self-monitoring perspectives
is a crucial approach for understanding the role of
the orbitofrontal cortex in adaptive interpersonal behav-
ior. For example, the present findings suggest a richer
interpretation of the finding that patients with orbito-
frontal damage are proud of their inappropriate teas-
ing (Beer et al., 2003). In the present research, patients
tended to overestimate their appropriateness. There-
fore, the faulty monitoring processes associated with
orbitofrontal damage may result in appraisals of inappro-
priate behavior as not only acceptable but praiseworthy.
More research is needed to understand the nature of
the self-monitoring associated with orbitofrontal func-
tion. Orbitofrontal damage has been consistently asso-
ciated with the ability to state the rules of a task with a
seemingly paradoxical failure to apply these same rules
to actual behavior (e.g., Bechara et al., 2000; Rolls et al.,
1994; Stuss, 1991). These findings parallel the ability of
the patients in the present study to state the social
norms governing self-disclosure with strangers in com-
bination with a failure to apply them. Knowledge of
social norms or task rules is not enough to ensure
appropriate social behavior; it is necessary to monitor
or compare one’s behavior in the moment to these
abstract norms or rules in order to generate emotions.
What kinds of monitoring comparisons does the orbito-
frontal cortex support? Most of the current research on
the orbitofrontal cortex has focused on deficits in ap-
plying recently learned rules (i.e., such as in a gambling
task; Fellows & Farah, 2003; Bechara et al., 1997); very
few studies have examined orbitofrontal damage in
relation to well-learned social norms (Beer et al., 2003;
Stone et al., 1998). New directions for research are
suggested by models of self-regulation, which theorize
that individuals need to compare online behavior to a
multitude of references such as social norms (e.g., ‘‘it’s
impolite to insult someone’’), their own goals ranging in
degree from abstract (e.g., ‘‘be a good person’’) to
concrete (e.g., ‘‘do not hurt this person’s feelings by
telling them their new haircut is not flattering’’), as well
as the expectations of other people (e.g., ‘‘she won’t
want to hear the truth because there is nothing she can
do about it’’) (e.g., Vohs & Heatherton, 2000; Carver &
Scheier, 1990; Deci & Ryan, 1987; Vallacher & Wegner,
1987). The monitoring of the expectations of other
people is consistent with research associating orbito-
frontal damage with impaired judgments of the inten-
tions behind social faux pas (Stone et al., 1998).
Another direction suggested by an integrative per-
spective on the orbitofrontal cortex function is a greater
focus on empirical studies of interpersonal tasks and
social emotions. Much of the current research involves
risk-taking paradigms that are not interpersonal (e.g.,
Fellows & Farah, 2003; Bechara et al., 2000; Rolls et al.,
1994; but see Beer et al., 2003; Stone et al., 1998; Saver &
Damasio, 1991; Price, Daffner, Stowe, & Marsel-Mesulam,
1990). However, in everyday life, social blunders are
most often followed by social emotions such as embar-
rassment, shame, or guilt (Tangney et al., 1996).
One possible limitation to the interpretation of the
present study is the difference in etiology between the
two lesion groups. In contrast to damage arising from
stroke, damage arising from traumatic brain injury can
often be accompanied by diffuse axonal injury (DAI)
(Smith, Meaney, & Shull, 2003). DAI consists of white
matter lesions that mostly occur at the white matter–gray
matter junctions in the brain. These lesions are caused by
rotational forces upon the brain after high-speed colli-
sions. Two of the orbitofrontal patients in our sample
sustained their damage in high-speed collisions (M.R. and
D.H.). If the orbitofrontal patients have DAI extending
into the lateral regions of their frontal lobes, it would be
misleading to characterize the findings from the present
research as a functional dissociation between the orbito-
frontal and lateral frontal regions. Although we cannot
completely rule out the presence of axon shear in these
orbitofrontal patients (Inglese et al., 2005), no evidence
of axon shear is apparent in these patients either in ini-
tial CT scans and or later MRI scans, and the orbitofron-
tal patients perform better, on average, than the lateral
frontal group on neuropsychological tests associated with
lateral frontal functioning (see Table 2: Wisconsin Card
Sorting Test [WCST] and Trails B).
In summary, the orbitofrontal cortex is best con-
ceptualized as an area important for self-monitoring
processes that underlie the generation of emotions
useful for guiding behavior. This perspective suggests
Beer et al.877
that future research should focus on understanding the
exact nature of the monitoring processes (i.e., compar-
ing behavior to abstract social norms, self-expectations,
and/or the expectations of others) and employ more
interpersonal tasks that evoke social emotions such as
embarrassment, shame, guilt, and pride. Finally, the
present study suggests that training using videotaped
playback might be useful in treating the debilitating
social deficits seen in patients with acquired damage to
the orbitofrontal cortex.
APPENDIX A: QUESTIONS FROM SOCIAL
1. What would constitute a perfect day for you and
2. Tell me about an embarrassing moment you’ve had.
3. Given the choice of anyone in the world, whom
would you want to have as a dinner guest and why?
4. What is your most treasured memory and why?
5. When did you last cry in front of another person?
By yourself? Why?
6. Is there something you’ve dreamed of doing for a
long time? Why haven’t you done it?
7. Would you like to be famous, if no, why not? If yes,
in what way?
8. If you were going to pass this evening with no
opportunity to communicate with anyone what would
you most regret not having told someone? Why haven’t
you told them yet?
9. If a crystal ball could show you the truth about
yourself, your life, your future or anything else, what
would you want to know and why?
APPENDIX B: MEASURE OF INAPPROPRIATE
Intimacy (scored for inappropriate intimacy)
1. I hesitated to answer the questions very deeply be-
cause some of my answers contained personal informa-
2. I tried to keep many of my thoughts and feelings
to myself while answering the questions (R).
3. I held back my deeper feelings and thoughts while
answering the questions (R).
Perceived appropriateness (scored for inappropriateness)
1. Most people would reveal as much as I did while
talking with the interviewer (R).
2. While talking with the interviewer, I spoke can-
didly as I would with a close friend.
3. Considering that I don’t know the interviewer very
well, I disclosed an appropriate amount of information
about myself (R).
4. I shared things with the interviewer that I wouldn’t
tell most strangers (R).
This research was supported by a Doctoral Dissertation Improve-
ment Grant (NSF BCS 0121970) and National Research Service
NS40813,NIMH MH066737,and theMcDonnellFoundation Cog-
nitive and Neurobiological Research Consortium in Traumatic
Brain Injury to R.T.K. The authors thank Christine Hooker for her
help with the neuropsychological data.
Reprint requests should be sent to Jennifer Beer, Center for Mind
and Brain, 267 Cousteau Place, Davis, California 95616, or via
with the exception that amusement and fear were negatively
correlated prevideo (r = ?.45, p < .05), postvideo (r = ?.64,
p < .05), and for change in emotion (r = ?.59, p < .05). Given
their correlation, a composite score was calculated by aver-
aging amusement ratings and reverse-scored fear ratings. How-
ever, analyzing the data in this manner still did not yield group
differences, F(3,12) = 1.46, p > .05.
2. It should be noted that although participants were in-
structed after the videotape viewing to rate their emotions in
reference to how they felt about their task performance, they
may have ignored instructions. Additionally, insight into the
inappropriate of behavior was not assessed. In this case, the
increased embarrassment reported by patients with orbito-
frontal damage may not be explained by a sudden explicit
insight into their inappropriate behavior. Instead, the embar-
rassment may have arisen from a subconscious recognition
of their inappropriateness or embarrassment from watching
themselves on screen.
The emotion ratings were not correlated with one another
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