Orbitofrontal Cortex

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Despite being a poorly understood brain region, the orbitofrontal cortex (OFC) generates much interest because of some of the roles it is speculated to play in higher-order cognition, such as decision-making. The prefrontal cortex and frontal lobes are believed to be necessary for reasoning, logical thought, and personality.

A prefrontal cortex portion of the brain, the orbitofrontal cortex (OFC), plays a role in cognitive functions. Emotion, taste, olfaction, and reward are assumed to be represented by the medial dorsal nucleus of the thalamus, which receives projections from this prefrontal cortex region.

The orbitofrontal cortex is a very complicated part of our brain. This article will discuss what the orbitofrontal cortex is, its functions, the consequences if it is damaged, the diagnosis and causes of damage, and treatment.

What Is An Orbitofrontal Cortex?

The orbitofrontal cortex (OFC) is located directly above the eye sockets in the front part of the brain. It connects to the brain's sensory regions, memory, and emotion centers. The orbitofrontal cortex is crucial in how we interact with the world.

Consequently, when damaged, it can result in severe problems. The exact function of the orbitofrontal cortex is still only partially understood.

Neuroscientists have ascribed many functions to this region based on the behavior of individuals with frontal lobe damage. Among the cognitive functions usually associated with the orbitofrontal cortex are the following:

  • Affective responses (emotional reactions)
  • Decision making
  • Impulse control
  • Social behavior (how you interact with others and situations)

Orbitofrontal Cortex - Cognition And Behavior

The orbitofrontal cortex (OFC) is important for behavior and frequently suffers damage from various injuries, including closed head trauma, cerebrovascular accidents, malignancies, and neurosurgical procedures.

People with injury to the OFC appear to remain cognitively intact regardless of the (severe) behavioral alterations that result from OFC injuries, at least when evaluated using common neuropsychological measures. Neuropsychological tests that examine reversal learning, social cognition, and gambling in these patients reveal a deterioration.

This review aims to establish a causal relationship between these recent neuropsychological test results and behavior.

The findings imply that behavioral disinhibition and impaired perception of expressive emotion are more frequently related to socially unacceptable behavior in patients with orbitofrontal lesions. The theory of mind test (the faux pas test) does not seem responsive to orbitofrontal lesions.

Future research should include a greater number of patients with well-defined sites in the OFC to better understand the role of the OFC in cognition and behavior. It should integrate quantitative behavioral measurements and specialized neuropsychological tests.

What Causes Damage To The Orbitofrontal Cortex?

A stroke commonly causes severe damage to the frontal lobe. It could also be triggered by a debilitating disease, which is a progressive illness. There are further, less frequent disorders that can damage the frontal lobe as well.

Brain Tumors

When abnormal cells develop within the brain, they produce a brain tumor. Tumors are classified into benign (non-cancerous) and malignant (cancerous) tumors. 

These are further subdivided into primary tumors, which begin inside the brain, and secondary tumors, which usually spread from cancers outside the brain (metastasis tumors). Symptoms of all forms of brain tumors vary according to the size of the tumor and the portion of the brain affected.  

Headaches, seizures, eye problems, vomiting, and mental abnormalities are all possible symptoms. Additional symptoms may include difficulties walking, speaking, experiencing sensations, or becoming unconscious.

Cerebral Palsy

Cerebral Palsy is caused by brain abnormality or damage. Cerebral Palsy is most likely inherited, though some people get it later in life. Cerebral Palsy was once assumed to be caused by problems during childbirth. While this does occur, it is now commonly accepted that birth problems account for just a small number (10%) of Cerebral Palsy cases.

According to current research, most Cerebral Palsy cases are caused by brain injury or abnormal brain development before birth or during labor and delivery. Some known risk factors for Cerebral Palsy include medical malpractice, accidents, abuse, neglect, infections, and injuries.


Dementia is a word used to describe illnesses that result in memory loss and other cognitive difficulties. Frontotemporal dementia (FTD) is a collection of frontal and temporal lobe abnormalities. 

FTD is the second most prevalent cause of dementia among individuals under 65. Typically, people with FTD exhibit altered behavior and personality. They could also have language difficulties. They could also have language difficulties. Sometimes, this kind of Alzheimer's disease is mistaken as FTD.

Huntington’s Disease

Huntington's disease (HD), (also called Huntington's chorea), is a hereditary neurological disease. The first indications are frequently minor changes in mood or mental ability.  

A general loss of coordination and an unstable walk is usually the result. It is also a basal ganglia condition that causes chorea, a hyperkinetic movement disorder.   Chorea, or uncoordinated, uncontrollable body motions, becomes more noticeable as the condition progresses. 

Physical abilities deteriorate gradually until coordinated movement becomes impossible and the patient cannot speak. As people age, their mental capacities deteriorate and result in dementia.

Parkinson’s Disease

Parkinson's disease (PD), often known as Parkinson's disease, is a chronic degenerative condition of the central nervous system that primarily affects the motor system.

Non-motor symptoms normally appear gradually, and as the disease progresses, they become more common. Tremor, slow movement, rigidity, and trouble walking are the most noticeable early symptoms.

Many patients with Parkinson's disease experience despair, anxiety, and apathy, which can lead to cognitive and behavioral issues. Parkinson's disease dementia becomes prevalent as the condition progresses. Parkinson's patients could also experience issues with their sensory systems and sleeping patterns.


When the blood supply to the frontal lobe is disrupted, this brain region loses function. This could occur as a result of a brain hemorrhage.

Vascular dementia can develop after several minor strokes. This is the most prevalent cause of frontal lobe dysfunction. Vascular dementia has been associated with Alzheimer's disease and other neurodegenerative conditions.

How To Diagnose Orbitofrontal Cortex Damage?

Diagnostic scans help medical professionals identify frontal lobe infections and strokes. Computed tomography (CT or CAT) and magnetic resonance imaging (MRI) are possibilities. An MRI produces a 2- or 3-dimensional image of the brain using radio waves and a magnetic field.

A CT scan combines many X-rays to produce a 3D image. On a scan, some causes, such as a traumatic brain injury or dementia, may show up as atrophy or loss of brain tissue. The scan could come up blank. Both MRI and CT scans are reliable methods for vascular dementia diagnosis.

A healthcare professional can determine frontal lobe injury with a thorough neuropsychological assessment or a concussion test. These exams examine:

  • Impulse control
  • Language
  • Memory
  • Motor skills
  • Problem-solving
  • Social behavior
  • Speech skills
  • Spontaneity

What Happens If The Orbitofrontal Cortex Is Damaged?

The following behavioral abnormalities may be seen in someone who has suffered damage to their orbitofrontal cortex.

Character Changes

Finally, personality changes might result from damage to the orbitofrontal cortex. The mid-1800s instance of Phineas Gage led to the discovery of the link between frontal lobe injury and personality change.

When Gage, a railroad worker, was tamping explosives into a drill hole in 1848, the powder unintentionally exploded. The iron rod shot through Gage's left cheek, into his orbitofrontal brain, and out the top of his skull due to the explosion.

Although Gage managed to survive the original injuries, the profound personality shift that followed led his friends to refer to him as "no longer Gage." Many family members note that their loved ones seem somewhat "different" after their accident, even though most TBI patients don't undergo the kind of drastic personality change that Gage did.

The following are some typical personality alterations brought on by orbital damage:

  • Aggression
  • Childish conduct
  • Disinhibition
  • Low motivation or apathy
  • Reduced concern and empathy for others

Impetuous Action

One of the main signs of orbitofrontal injury is a decrease in impulse control. People who experience this symptom will act improperly.

For instance, they might say offensive things or divulge personal information too readily. They might even start acting violently. Additionally, impulsivity may lead them to behave recklessly and engage in risky, life-threatening activities.

Reduced Emotional Reactions

Damage to the OFC may alter how the body reacts to emotions, leading to impulsivity and bad judgment. For instance, when making a bold decision, healthy patients exhibit physical symptoms of worry, such as sweaty palms. Patients with injury to the orbitofrontal cortex, however, did not.

Additionally, healthy patients made less dangerous, more rational decisions. This shows that signals from the orbitofrontal cortex help people recognize if they're about to make a bad judgment. As a result, if it is injured, the person cannot get a warning before acting, which may result in unsafe decisions.

Poor Judgement

The orbitofrontal cortex also assists decision-making based on the relative merits of several options. However, the orbitofrontal cortex might be involved in more complex judgments than simple ones. According to recent studies, the OFC aids in forecasting decisions based on experience.

Therefore, as it deteriorates, people frequently make bad choices even though they are aware of the consequences. This finding might help to explain why most persons with injury to the orbitofrontal cortex seem oblivious to the repercussions and driven primarily by their current needs.

The individual is considered to have an orbital personality and may be diagnosed with acquired ASPD (antisocial personality disorder) if their actions hurt others. Since most orbitofrontal individuals can behave better, this condition is uncommon.

Furthermore, not all behavioral changes are unfavorable. Some people find that their injury makes them happier and more animated. This fact exemplifies how unpredictable the signs of a brain injury may be.

How To Treat Orbitofrontal Cortex Damage?

Depending on the etiology, several treatments are used for frontal lobe damage. For instance, antibiotics can be used to treat an infection. Radiation, chemotherapy, or surgery are all options for treating brain tumors.

Degenerative illnesses like dementia, Huntington's disease, and Parkinson's disease currently have no known cures. Symptoms can be improved with medication and way of life adjustments. Treatment of orbitofrontal cortex damage includes;


Rehabilitation can be utilized to cure motor weakness brought by my frontal lobe injury. To achieve this, the remaining motor abilities must be strengthened and optimized.

Cognitive Behavioral Therapy (CBT)

Rehabilitation for frontal lobe damage-related cognitive and interpersonal issues can be challenging. Therapy that assists clients in controlling their emotions and reining impulsive conduct might be beneficial.

Coping With A Loved One With Orbitofrontal Cortex Damage

One of the most challenging post-concussive complications for family and friends to deal with is orbitofrontal damage. The person they once knew and loved may appear drastically different from how they once were.

To help you cope with the behavior and personality changes of a loved one with orbitofrontal cortex damage, the following tips can be of assistance;

Never give up! This can be extremely difficult and emotionally challenging, and it is normal for you to feel hopeless. However, even though it could appear as though your loved one will never be the same, TBI patients can acquire empathy with the proper care. Therefore, find out what you can do to assist your loved one in changing their behavior by asking your neuropsychologist.

Keep in mind that they don't have ultimate control. Remember that your loved ones may not be fully in control when they say anything hurtful. The person you love is still there, but they are far more emotional and expressive than they once were.

Establish limits. You should kindly but firmly correct them if they act impolitely or inappropriately. Calmly explain and ensure they understand they can't continue to act in such a way while doing your best to avoid embarrassing them.


The brain's frontal lobe regulates various crucial processes, such as emotions, movement, self-restraint/control, language, and reasoning. Any of these processes may be impacted by orbitofrontal cortex injury.

Sometimes imaging scans can be used to identify frontal lobe injury. A neuropsychological assessment might be required in other circumstances. Medication, rehabilitation, surgery, or counseling are possible treatments for orbitofrontal cortex damage.


Know Your Brain: Orbitofrontal Cortex (neuroscientificallychallenged.com)

Frontal Lobe Damage: Symptoms, Cause, Diagnosis, Treatment (verywellhealth.com)

Stimulating Brain Area May Ease Tough Depression (webmd.com)

Reference this article:

Practical Psychology. (2022, July). Orbitofrontal Cortex. Retrieved from https://practicalpie.com/orbitofrontal-cortex/.

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