In order to address recent debates on the extent to which deep brain stimulation (DBS) causes changes to core personal traits, Zuk and colleagues (2022) interviewed researchers about their experience with changes in personality, mood, and behavior while using DBS to treat a variety of neurological and psychiatric disorders. Here, we explore how considering these issues with respect to key neuroscientific and clinical details such as conditions and brain regions can aid interpretations of changes in core personal traits. We describe how clinicians treating Parkinson’s disease or obsessive-compulsive disorder tailor DBS within the same region, the subthalamic nucleus, to either avoid or target limbic circuitry linked to mood and emotion, respectively. This demonstrates how similar effects can be considered negative or positive depending on the condition and treatment goals. We then outline how patient and caregiver perspectives and computational models of behavior may help identify and characterize potential changes in core personal traits. Finally, we highlight the need to avoid reductionist views that obscure the role of psychosocial components of neuropsychiatric symptoms that are critical for clinical management and ethical analysis and warn against uni-dimensional neurotechnological solutions for complex psychiatric conditions. Overall, we argue that identifying and managing changes in core personal traits in the context of DBS requires careful accounting for the neuroscientific and clinical context of each case.