Emotional/Behavioural Changes after Brain Injury – Part 1

lightning striking the ground under dark clouds
Sometimes the storm seems to come out of nowhere.

From The Toronto Acquired Brain Injury Network.

My comments are in bold like this.

Emotional/Behavioural Changes

Some people are left with changes in emotional reaction or behaviour after a brain injury. These are more difficult to see than physical or cognitive changes. However, they can be the most difficult for the person and their family to deal with.

BB: I had no idea that a TBI would affect me emotionally, or change the way I acted. Like so many people, I figured that a bump on the head was just an external thing. I'd feel pain on my scalp, and maybe I'd feel a little woozy, but it would clear up in a few minutes... or hours. How wrong I was - so many times. Emotional and behavioral issues have been the bane of my existence (and my family's) for years and years, starting back in my childhood when my behavior was erratic, and my emotions were volatile.

Not everybody will experience these problems and their severity will also vary.

BB: The severity can vary from person to person, as well as from situation to situation. With me, I can be fine, one day... be not-so-great (but seem fine), the next... and then completely lose it a few days later. It's often cumulative, but nobody on the outside sees it building up. That happens inside. Where nobody can see. And when it erupts... hooo boy.
fireball explosion
The problem for me, is that when I blow up, it puts people off, and then they think that's how I always am... and then they walk on eggshells about it, all the time.

And I sometimes never get a second chance, because they've made up their minds about me in a negative way.


This frequently occurs at a very early stage after the injury. It can be a coping mechanism for the person, who may be disorientated and very confused. It is most often a stage a person passes through, rather than a permanent change. Examples include: restlessness, pacing and pulling at intravenous tubes.

BB: I've been extremely fortunate to never having had intravenous tubes to pull at, but I know the feeling of not being able to sit still, being extremely agitated - especially after a TBI. A number of times, I can recollect getting hit in the head, and then being flooded with agitation and an overpowering need to MOVE! Like when I got hurt during an informal pick-up soccer game in high school, after the hit, when I was lying there, dazed and confused, I suddenly felt like I'd been given super-powers, and I leaped up and started playing like a crazy person. I don't think I played better than I had before I got hit, but I felt like I did. And I was ON FIRE - or so I thought.

In another soccer game, when I got my bell rung, I knew I'd been hurt, but I felt this incredible urge to GET UP AND GO!!! And I started racing around the field -- in the wrong direction, no less. I nearly scored on my own team, which I think was a red flag for everybody on the sidelines. I did get taken out of that game, and I paced the sidelines in confusion and anger, because I NEEDED TO BE IN THERE! But it was wise to pull me from the game. I was not in good shape, at all.

So, while agitation may be a coping mechanism for some, as they say above, I suspect it also has to do with the mechanism of the brain - the release of all those chemicals, and the general confusion that causes. The brain is trying to figure things out - plus, it's firing on ALL cylinders, like there's no tomorrow. In addition to being a behavioral coping mechanism, it's a result of the brain's basic function.

Explosive anger and irritability

If there has been damage to the part of the brain that controls emotional behaviour and the ability to tolerate frustration, emotions can swing to extremes. The stress of coping with even minor crises, such as misplaced shoes or a noisy vacuum cleaner, can be too much and trigger an angry outburst. If these stresses can be identified, it may be possible to reduce them.

BB: Amen to this. The part of the brain that controls emotions is particularly susceptible, as it's out in front and there are so many types of injury that can affect it. Car accidents, where your brain slams up against the inside of the skull... or tackles that snap your head back and forth... falls, etc. Minor events can turn into crises -- just being blindsided by a sudden change or something unexpected happening, can set me off. Little things can turn into huge things, in an instant. One minute, I'm fine, then all of a sudden, it's off to the races with emotional overload and over-reaction.
galloping horse
Prolonged stress will also do a number on me, as will fatigue. The more tired I am, the more irritable I get - a tired brain is an agitated brain. And when I get too agitated, it's not cool.

Sudden outbursts... extreme reactions... it's all part of a day in the life for me, sometimes. Unless I can get enough sleep and take good care of myself. If I can keep on my schedule and be smart about eating and drinking enough water, that helps. So does meditation and just taking time to chill out. 

Lack of awareness and insight

The ability to recognize your own behaviours and change them when needed is a sophisticated skill that can be affected by brain injury. This can affect someone’s ability to: be self-aware; have insight into the effects of personal actions; show sensitivity; or feel empathy. It also means that a person may not fully appreciate or understand the effect that the accident is having on their life, health or family.

BB: I honestly had no idea how my TBI was affecting my household, back in 2005. I'd gotten injured at the end of 2004, and 2005 was the start of the downhill slide. I became incredibly self-centered and obsessed with myself. Small wonder - I had to recover and build myself back up, as my Sense-Of-Self had taken a huge hit. I didn't know who I was or what I was about, anymore, and it was devastating. I didn't recognize myself, and I was so caught up in figuring it out inside my head, that I never realized the extent of the changes on people closest to me (who were outside my head).

It took talking with someone on a regular basis about what was going on with me, to help me see what an ass**** I was being, and to do something about it. Until I started talking to a neuropsych on a regular basis, I had no way to understand myself and objectively examine my behavior, because nobody I talked to actually understood how TBI affects the mind, body, and spirit... so they made all kinds of flawed assumptions about who I was and how I was. It was incredibly unhelpful for me, and it did more harm than good. 

I got lucky. A lot of others don't have that opportunity. And that's a damned shame. It's criminal, really.

I’ll continue this post in Part 2. Watch this space for notifications.

Source: www.headway.org.uk

Source: Emotional/Behavioural Changes | ABI Network

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.

4 thoughts on “Emotional/Behavioural Changes after Brain Injury – Part 1”

  1. Thank you for posting this BB! I have said for decades that our issues aren’t behavioral but emotions. I say this because it’s easier to give us medications (Medical Model) instead of the services (Social Model) in the community. Many doctors and brain injury professionals are unwilling to understand the difference.

    Here are some things for the discussion:

    The Brain is in Constant Conflict https://youtu.be/kg-HGtMKzKQ
    Learning to Turn Down Your Amygdala Can Modify Your Emotions http://neurosciencenews.com/amygdala-emotion-neuroscience-5018/
    Mindfulness holds promise for treating depression:
    Mindfulness and neuroplasticity – summary of my recent …

    My hospital records show that I was in a Posey Jacket and wrist restraints all the time I was in the hospital. One day when I was in the bathroom I ranked out my catheter and a few days later was sent home with my parents because I started to get loose (3 times in 6 days). On my last day in the hospital I was found urinating in a planter in the hallway.

    For my safety and the liability of the hospital, I was sent home with my family who were told if they couldn’t handle me to put me in a nursing home. Luckily, my family spared me the fate that awaits many young people who sustain these types of injuries today: long term confinement to a nursing home, long term rehabilitation facility or state institution – unless they have good insurance, but when that runs out and they become “poor”, many will be forced to have the government (Medicaid) pick up the tab.

    The tab for my stay in the hospital was paid by welfare because the snowmobile I was on was uninsured, the car I ran into was uninsured and I didn’t have any insurance. When I awoke a month after the accident I came out of darkness through a fog to about six inches from the mirror in my parent’s bathroom picking the wires in my mouth that was wired shut because of my broken jaw.

    My recovery process has faced many peaks and valleys over the last 40 years. This experience has lead me to believe the issues all of us face after our brain injuries is based in the limbic system fight of flight response. This biologic process has been ignored by many brain injury professionals and the industry that supports them. Controlling stress is the key the improving the lives of people with brain injuries. Being confined to a brain injury facility far from home and family causes too much stress and keeps the limbic system fight or flight response and the Amygdala in play.

    Liked by 1 person

  2. Thanks for sharing that, Ken. Fight-flight is a real deal with us – given the injury to such a central part of ourselves, it’s a very real threat to us, and on top of our neurology, that whole limbic thing is a force to be reckoned with. Thanks for sharing your own experiences. It’s so important for people to hear about this, especially from someone who’s been there.


  3. You’re very welcome BB! Many of our problems after brain injury are in the limbic system. Managing stress is the key to controlling the limbic system and the fight or flight response. Memory, problem solving, decision making and anger are all part of this. As we know first hand from living with our brain injuries these problems are said to be a result of our brain injuries. Yes they are – but it’s the stress that triggers the fight or flight response is the real problem. On January 11th, I did Trauma Rounds here for our two hospitals. Trauma Rounds is a monthly hour long educational meeting for doctors, nurses, case managers, discharge planners, hospital administrators and staff to learn about ways to better serve their patients. My talk: “What is brain injury or What 40 years living with a brain injury has taoght me” went very well. They were expecting 40 – 50 people and we had 50 handouts but ran out. It was standing room only with at least 60 -70 hospital staff there. I got my evaluations last week and everything was 4 or 5 out of a 1 to 5 rating. What I presented was the same thing I’m saying at the detox center, detention center DWI program and two alcohol and drug treatmnet centers. Tomorrow I’m doing a training for staff and counselors at the Na’Nizhoozhi Treatment Center. This is a traditional treatment center for Native Americans (Navajo, Zuni and Hopi). I’ve done one training there for folks in treatment but this time it will be for staff and counselors too. Everything is going great and am very proud to be getting some traction for what I’m living!

    Liked by 1 person

  4. Hey Ken, that’s incredible. Congratulations on a job well-done, and thank you for representing “us” so well. It’s wonderful that you’re getting good traction. I think people are ready for it – ready for answers – ready to take action. We’ve been idle too long in this regard. Thank you again.


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