Emotional Changes Associated with Brain Injury

Brain injury is a life-altering event which affects every area of a person’s life, including his or her relationship with family members and others close to him or her.  The effects of brain injury often change roles and responsibilities within the family.  Family members and others close to a person with brain injury may struggle to cope with behavioral changes caused by the brain injury.  The injured person also may struggle to adjust.  Family members to the person may feel stressed, burdened, even depressed by the major changes in activities, responsibilities, daily schedules, leisure and support that are required to adjust to the consequences of acquired brain injury.

Brain injury survivors may experience a range of neuropsychological problems following a traumatic brain injury.  Depending on the part of the brain affected and the severity of the injury, the result on any one individual can vary greatly.  Personality changes, memory and judgement deficits, lack of impulse control, and poor concentration are all common.  Behavioral changes can be stressful for families and caregivers who must learn to adapt their communication techniques, established relationships, and expectations of what the impaired person can or cannot do.

A person with a brain injury may experience changes in behavior, including self-control, self-awareness and response to social situations. The following are common behavioral problems for a person with a brain injury:

• Difficulty with self control – acts or speaks without all the information or without considering the consequences.  Impulsiveness or poor judgement, lack of inhibition, inappropriate comments to or about others, gets stuck on one idea or activity.
• Impaired self awareness – lack of awareness of deficits and limitations, overestimates abilities, underestimates problems, inaccurate self-image/self-perception.
• Difficulty participating in or being part of social situation – acts or speaks without all the information or without considering the consequences, difficulty taking turns, impulsiveness, socially inappropriate behavior or comments, not always sensitive to social boundaries, acting out of place in unfamiliar social or public settings.
• Difficulty controlling emotions – mood swings ranging from anxious to sad to angry, inappropriate laughing or crying, lower tolerance for frustrating situation.
• Intermittent distress – unhappiness and irritability, cries easily, responds angrily for no apparent reason.
• Grief – tearfulness, restless sleep, a change in appetite.

Depression

Feelings of sadness, frustration and loss are common after a brain injury. Such feelings often appear during the later stages of recovery, when confusion decreases and self-awareness improves. However, if these feelings become overwhelming or interfere with recovery, the person may be suffering from depression.

Depression can arise as the person struggles to adjust to temporary or lasting disability caused by a brain injury. Depression also may occur if the injury has affected areas of the brain that control emotions.

Being depressed is not a sign of weakness, nor is it anyones fault. Depression is an illness. Depression after brain injury may result from biochemical and structural changes in the brain. Fortunately, medication and other therapies can help most people who have depression.  These are symptoms of depression:

• Persistent sadness
• Irritability
• Anxiety
• Loss of interest or pleasure in life
• Neglect of personal responsibilities or personal care
• Changes in eating habits or sleeping patterns
• Fatigue, loss of energy, lack of motivation
• Extreme mood changes
• Feeling helpless, worthless
• Physical symptoms such as headaches or chronic pain that do not improve
• Withdrawal from others
• Thoughts of death or suicide

Coping with behavior problems after a head injury requires identification and acknowledgment of the impaired individuals deficits.  A comprehensive neuropsychological assessment is recommended.  This may help both the survivor and the family to better understand neurological and cognitive deficits.  In some cases, it may be easier for the family caregiver to recognize personality changes than to resolve the problem behavior.  Targeted strategies may be used to deal with specific behavioral issues.  Family members should seek and receive support in dealing with their own emotional responses to caring for a head injured loved one.