Emotional Problems After Traumatic Brain Injury

From the Model Systems Knowledge Translation Center (MSKTC) comes this great information – which especially pertains to me, today.

My comments are in Bold like this.

Brain injury and emotions

A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems.

BB: Fantastic (sarcasm). There's not just one, but several emotional problems I can have.

Difficulty controlling emotions or “mood swings”

Some people may experience emotions very quickly and intensely but with very little lasting effect. For example, they may get angry easily but get over it quickly. Or they may seem to be “on an emotional roller coaster” in which they are happy one moment, sad the next and then angry. This is called emotional lability.

BB: This just happened to me this morning. I'm still fatigued from my trip, and while I was making my breakfast, my thoughts were interrupted, and I blew up. My spouse really wanted to talk to me, go over what we were going to be doing today, plans for how to organize the house, etc. And that's completely understandable, because I've been away for four days, and they had a lot of time to think. Plus, they missed me. 

I got overloaded and blew up, slammed around in the kitchen, broke down and cried for a few minutes, then regrouped and managed to eat my breakfast in peace, then joined them in the living room to talk about the day and our plans. 

Roller coaster, for sure.

What causes this problem?

  • Mood swings and emotional lability are often caused by damage to the part of the brain that controls emotions and behavior.
BB: Brainline says:  The frontal lobe ... helps govern personality and impulsivity. If damaged, there might be no “braking mechanism” for self-control. A person may find [they] cannot control [their] anger or aggression. 

That's what happened to me this morning. I got irritated, and my irritation picked up speed like a freight train until I was pretty upset... then really furious. And then I got furious at myself. And then I got furious at my spouse for not cutting me a break. And then I felt generally broken and useless, which spiralled into a bit of a freak-out meltdown. A small one, but still a scary one, because I was slamming stuff around, and that makes my spouse feel unsafe in our home.
  • Often there is no specific event that triggers a sudden emotional response. This may be confusing for family members who may think they accidently did something that upset the injured person.
BB: It can be hard to know when I'm going to "go off", because I'll be working hard to keep it together, and I'll seem to be fine, then all of a sudden, I'm blowing up, apparently "over nothing". There is a sequence of events that sets me off and triggers that sudden emotional response, but it's all internal, so nobody can see it building up.
  • In some cases the brain injury can cause sudden episodes of crying or laughing. These emotional expressions or outbursts may not have any relationship to the way the persons feels (in other words, they may cry without feeling sad or laugh without feeling happy). In some cases the emotional expression may not match the situation (such as laughing at a sad story). Usually the person cannot control these expressions of emotion.
BB: I hate the episodes of crying. That's what happens to me most. I don't cry or laugh unless I'm feeling sad or happy, but it can come up very quickly, and it's not always clear to others just how or why I'm reacting the way I am.

Come to think of it, there have been an number of times when I've laughed for no apparent reason -- usually under the worst of circumstances... usually when an authority figure is either nearby or the "target" of my laughter. I've laughed at people telling me how their child was diagnosed with a terrible, life-threatening disease (and my boss was standing nearby and got so pissed off at me that they had to walk away). I've laughed at things bosses have said, seeming to ridicule them. I may have misunderstood their meaning, to begin with, but it could also be due to my brain mis-firing. The really noticeable times when that happened, were within a few weeks of having had mild TBIs from car accidents. I could read and write normally again, but my inexplicably jocular emotional lability was a real problem. For me and everyone arounnd me.

What can be done about it?

  • Fortunately, this situation often improves in the first few months after injury, and people often return to a more normal emotional balance and expression.
BB: I found this to be true. I did start to act and react more normally over time. However, if I don't get enough sleep, I'm back to where I was before -- sometimes worse. Sleep is the key for me. If I don't get enough of it over an extended period of time, I suffer, along with everyone around me. 
  • If you are having problems controlling your emotions, it is important to talk to a physician or psychologist to find out the cause and get help with treatment.
BB: For me, talking to a neuropsych on a regular basis really made all the difference. It was bad enough that it happened, but not understanding why it was happening, and not having a clue about how to help it made things worse. But when I learned that I need to get more sleep and cut myself a break, it really put me on the right path.
  • Counseling for the family can be reassuring and allow them to cope better on a daily basis.
BB: My spouse has a therapist they talk to, and that therapist has dealt with brain-injured people in their own practice, so it's really helpful for my spouse to have access to that information. It's rare, to find a therapist who really understands TBI, and we're both lucky that this person came into our lives. My spouse has become so much more tolerant and understanding of me, as well as appreciative of the progress I've made over the years. And that appreciation has made a lot of things easier for both of us.
  • Several medications may help improve or stabilize mood. You should consult a physician familiar with the emotional problems caused by brain injury.
BB: The problem is, brain injury can affect how you react to medications. It can make you more sensitive, or less, and some of the medications (Benzos) actually make things worse. Some mood stabilizers can make the brain more tired -- and that's a recipe for more emotional outbursts, and the pain and suffering that follows. So, your doctor needs to know about TBI and its effects on how the brain handles meds, before he/she prescribes them to you. And if you're not feeling right or you're having more trouble due to meds, let your doctor know. Be smart. Protect yourself.

What family members and others can do:

  • Remain calm if an emotional outburst occurs, and avoid reacting emotionally yourself.
BB: This is one of the biggest challenges for me. I always prided myself on how even-keeled I am, and how I kept my head on straight during a crisis. Watching myself get all emotional and overwrought over things that I don't believe warrant all that emotion can be very upsetting for me. And I know I'm not alone. We may have injured brains, but we still have our pride.
  • Take the person to a quiet area to help him or her calm down and regain control.
BB: I have to take myself to a quiet area and let myself calm down. I need to remove myself from the situation and get my system leveled out. Then I can rejoin civilized society. But not before. If I go back too soon, I can freak out even more, the next time.
  • Acknowledge feelings and give the person a chance to talk about feelings.
BB: I need to talk about my feelings in terms of "I". As in "I feel upset because I feel like everything is spinning out of control, and my brain can't keep up, and then I feel stupid and helpless."
It does no good to lay blame -- to say "You made me feel bad because ____________" Especially because the other person usually has NO idea what they did to provoke me. The fact is, they may not have provoked me - my brain provoked itself, and I need to talk about how I feel in a way that doesn't blame the other person who already feels defensive and vulnerable to my emotional over-reaction.
  • Provide feedback gently and supportively after the person gains control.
BB: It often helps, if I can come up with a clear explanation of why I freaked out (I'm tired, I'm frustrated, I'm overworked, I'm hungry), and then I come up with clear steps to fixing that. I tell whoever I freaked out at, what I'm going to do, to stop my behavior ASAP. And I make sure they know I'm going to take more steps to fix it over the long term. Sometimes it helps if I tell someone how they can help me in the future. Like my spouse helping me to get to bed at a decent time. And take naps during the day, when I can.
  • Gently redirect attention to a different topic or activity.
BB: I just shift my attention to other things. I do something I've been wanting to do for a while, and that makes me feel better, because I'm using my overabundance of energy for something productive. It always helps, when I channel my energy into other things that have productive uses, like cleaning and organizing. And when I'm done, I have something to show for it. 

I just need to make that shift, which isn't always easy.

Read the rest of this great article at: Emotional Problems After Traumatic Brain Injury

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Author: brokenbrilliant

I am a long-term multiple (mild) Traumatic Brain Injury (mTBI or TBI) survivor who experienced assaults, falls, car accidents, sports-related injuries in the 1960s, '70s, '80s, and '90s. My last mild TBI was in 2004, but it was definitely the worst of the lot. I never received medical treatment for my injuries, some of which were sports injuries (and you have to get back in the game!), but I have been living very successfully with cognitive/behavioral (social, emotional, functional) symptoms and complications since I was a young kid. I’ve done it so well, in fact, that virtually nobody knows that I sustained those injuries… and the folks who do know, haven’t fully realized just how it’s impacted my life. It has impacted my life, however. In serious and debilitating ways. I’m coming out from behind the shields I’ve put up, in hopes of successfully addressing my own (invisible) challenges and helping others to see that sustaining a TBI is not the end of the world, and they can, in fact, live happy, fulfilled, productive lives in spite of it all.

21 thoughts on “Emotional Problems After Traumatic Brain Injury”

  1. Witnessing Fear in Others Can Physically Change the Brain
    NEUROSCIENCE NEWSJANUARY 4, 2017

    Summary: A new study reports traumatic experiences can alter the brain, leaving people more vulnerable to psychological problems.
    Source: Virginia Tech.
    Virginia Tech Carilion Research Insitute scientists say observing trauma has PTSD implications.
    Scientists at the Virginia Tech Carilion Research Institute have discovered that observing fear in others may change how information flows in the brain.
    The results of their study were scheduled for advance online publication today in Neuropsychopharmacology.
    “Negative emotional experience leaves a trace in the brain, which makes us more vulnerable,” said Alexei Morozov, an assistant professor at the Virginia Tech Carilion Research Institute and lead author of the study. “Traumatic experiences, even those without physical pain, are a risk factor for mental disorders.”
    Post-traumatic stress disorder, also called PTSD, is an anxiety disorder that can develop in some people after they experience a shocking, scary, or dangerous event, according to the National Institute of Mental Health.
    Most people who live through dangerous events do not develop the disorder, but about 7 or 8 out of every 100 people will experience post-traumatic stress disorder at some point in their lives, according to the U.S. Department of Veterans Affairs’ National Center for PTSD.
    “PTSD doesn’t stop at direct victims of illness, injury, or a terrorist attack; it can also affect their loved ones, caregivers, even bystanders – the people who witness or learn about others’ suffering,” said Morozov, who is also a faculty member in the Department of Biomedical Engineering and Mechanics in Virginia Tech’s College of Engineering.
    He also noted that while a traumatic event may not immediately lead to the disorder, it increases odds of developing the disorder.
    “There’s evidence that children who watched media coverage of the Sept. 11 terrorist attacks are more likely to develop PTSD later in life when subjected to another adverse event,” Morozov said.
    According to a 2008 RAND Corp. assessment of multiple studies of post-traumatic stress and depression in previously deployed service members, people who heard about a serious incident — such as a gunfire exchange– were just as likely to develop post-traumatic stress disorder as the people who actually lived through the incident.
    In previous studies, Morozov with Wataru Ito, a research assistant professor at the Virginia Tech Carilion Research Institute, found that rodents who witnessed stress in their counterparts but did not experience it firsthand formed stronger than normal memories of their own fear experiences — a behavioral trait relevant to some humans who experience traumatic stress.
    Based on these findings, the researchers investigated whether the part of the brain responsible for empathizing and understanding the mental state of others, called the prefrontal cortex, physically changes after witnessing fear in another.
    Lei Liu, a postdoctoral researcher in the lab, measured transmission through inhibitory synapses that regulate strength of the signals arriving in the prefrontal cortex from other parts of the brain in mice who had witnessed a stressful event in another mouse.
    “Liu’s measures suggest that observational fear physically redistributes the flow of information,” Morozov said. “And this redistribution is achieved by stress, not just observed, but communicated through social cues, such as body language, sound, and smell.”
    According to Morozov, this shift may potentially enable more communications via the synapses in the deep cellular layers of the cerebral cortex, but less so in the superficial ones. It’s not yet clear exactly how the circuits have altered, only that they have indeed changed.
    “That’s the next step,” Morozov said. “Once we understand the mechanism of this change in the brain in the person who has these experiences, we could potentially know how something like post-traumatic stress disorder is caused.”

    Liked by 1 person

  2. As long as my days are mundane, emotional issues don’t come up. However, life cannot be just the same day after day. I developed General Anxiety Disorder. I take a pill for it now that doesn’t seem to affect my ability to feel happy, sad, excited, angry, whatever. It just keeps me from feeling overwhelmed by whatever is going on in my life.

    Liked by 1 person

  3. I hear you. For me bursting into tears about anything and everything was crazy-lady hormone related. The pill helped for several years. These days I find being over-stimulated brings on blank looks and eventually a miagraine. A grizzled child while out shopping, a young man talking on his phone and 3-way convo on speaker phone to negotiate rostering of carers all while doing induction and getting to know a new carer and them knowing how best to assist me! It’s any bloody wonder I fight the urge to kill people…..no one has died yet. But just saying…….

    Liked by 1 person

  4. Over-stimulation is the worst. And nobody around you ever seems to realize its effect. It’s like some kind of weird Darwinian thing – if you can’t take the heat, get out of the kitchen… while they make things that much worse. I saw something on Twitter earlier that sounds familiar — I don’t hate people, but I’m happier when they aren’t around. The same is often true for me.

    Then again, I do have my good days, so that’s positive.

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