Behavioral Issues

“I think one of the first tools for dealing with TBI is to serve or focus on others. When we focus on ourselves, we tend to magnify our struggles.”
– from a reader who follows this blog

Behavioral issues can be one of the biggest and most confusing hurdles in brain injury. In some cases, the brain injury survivor may not even realize their behavior has changed, or that it is a problem. These issues affect everyone – not only the survivor. Sometimes they affect others even more than the survivor… until they find themself with fewer friends and having difficulties at work.

Behavioral Issues after Brain Injury can include:

Impulsiveness, Aggression (verbal and physical), and Raging Behavior. Few things after brain injury will make your life more difficult in the outside world than behavioral issues. They can cost you your job, land you in jail, get you divorced, isolate you, and basically make your life a living hell that you can’t figure out how to get out of.

Project LEARNet, which is “A Resource for Teachers, Clinicians, Parents, and Students by the Brain Injury Association of New York State”, has some great tutorials on Behavioral issues for students after TBI. Don’t let the focus on kids / students deter you – these are great resources for anyone who is seeking to better understand TBI. Check out the tutorials on Behavioral Issues here. They are downloadable PDFs that you can print and take with you – great stuff!

1. Impulsiveness – This can include being unable to stop yourself from doing or saying things, as well as getting distracted by every little thing and not being able to “block out” interruptions.

• What to do about Impulsiveness?

The first step is identifying whether or not it’s a problem. If it’s keeping you or a loved-one from living their life, and they end up spending all their energy on distractions and impulse, without getting anything done that they need to do, it could be a problem. Just knowing it’s getting in the way will help you manage it.

Some everyday tools you can use to keep impulsiveness in check are:

1. Keep a checklist of important to-do items, and double-check that list throughout the day (and at the end of the day), to make sure things are not getting out of hand. If they are, try again tomorrow to stay more on track.
2. Get plenty of rest. A tired brain that’s been injured can be more easily distracted. Meditation can help you relax, and so can progressive relaxation exercises. If you’re having trouble sleeping, talk to your doctor. Sleep is important – critical – with brain injury recovery.
3. Eat right and drink enough water. Nothing feeds fatigue and distractability like a crash after a junk food binge. Your brain needs good nutrition to “knit itself back together”, and it needs a lot of water to function well. Your brain needs glucose – high quality energy, not a lot of processed sugar crap. It might feel good at first to scarf a donut, but you — and your brain — are going to pay for it later. So be smart. And drink your water. If you keep forgetting, make a checklist and mark off each time you have 8 oz. Whatever it takes.
4. Keep motivated. Know why you are doing the things you are doing, and find an important reason to do them. Fatigue is very common with brain injury, so you need extra fuel – in the form of inspiration and motivation – to keep going. Google “motivational quotes” to find sites that provide a dose of inspiration. You may also find some apps out there to give you that extra boost.

You may need to find some outside help if you’re having trouble with any of the above. You might need to ask your doctor for help, or consult with a nutritionist. Or talk to friends and/or others who have had the same difficulties. Everyday people can have some great ideas you can use. Don’t be shy about asking for input. Everybody has their issues – and a lot of people are eager to help.

Resources to help with Impulsivity:

• For Survivors: Managing Impulsive and Inappropriate Propitiate Behavior – check this out for some great survivor info from Give Back LA — Summary: Nothing produces more interpersonal problems than impulsive behavior. It is the behavioral trademark of head injury. Impulsive behavior can be controlled much of the time if you anticipate doing it and prepare for it. Strategies can be very effective if they are planned out ahead of time. You can get even more control by role playing the situation ahead of time.

• For Family & Caregivers: Managing Impulsive and Inappropriate Behavior – check this out for some excellent caregiver information from Give Back LA — Impulsive behavior–actions not thought through–probably impacts your life and your loved one’s more than any other deficit. Impulsive behavior is what embarrasses the family in public places and social gatherings. It is why adolescent siblings and old friends don’t want to be seen with the survivor. It is the source of so many kinds of inconsiderate behavior, words or actions produced without any awareness of how you will feel or be affected…

2. Aggression (verbal/physical) – Someone who was always level-headed and “chill” before, can become aggressive… sometimes for apparently no reason. Their behavior can become unpredictable and scary and they can start “taking out their frustrations” on others — sometimes in dangerous ways.

• What to do about Aggression?

1. Do not tolerate abuse. If your spouse or loved-one or another individual is being a miserable S.O.B. to you, and if you do not feel safe, you need to not stay in that situation. That could mean anything from talking to the person who is brain injured and making them aware of their behavior so they stop it (they may not actually realize it’s abusive)… discussing the situation with a pastor or priest or rabbi or other spiritual counselor / therapist and figuring out what to do… or even leaving the situation, if you do not feel physically safe.
2. Recognize the aggression. Sometimes brain injury can overwhelm a person and make them feel like everyone and everything is against them — so they have to “fight back” with all their might. They may be getting aggressive because they feel threatened, and they don’t know what else to do.
3. Deal with it. This is NOT to say you should just put up with it – you need to deal with it so that you can manage the situation and be safe.
4. Make sure the brain injured individual is rested. If that’s you, get some sleep. If it’s your loved-one, help them get on a decent sleeping schedule. See the tips for “Impulsiveness” above. They can help with aggression, too.

3. Raging Behavior – As with aggression, raging behavior (such as “going off” over things, road rage, flying off the handle, and “going on a tear”) can accompany TBI. In some cases, partners and family members may not feel safe. This can be true of kids and adults, alike.

• What to do about Raging Behavior?

1. Recognize it, acknowledge it, make it clear that it’s not acceptable. Ending up in jail is a crappy way to spend your day. Figure out ways to deal with it, because raging behavior can have serious consequences for everyone involved.
2. Stay rested. Fatigue does not keep rage in check.
3. Find a way to calm down. That could be:
   1. Stepping away for a moment
   2. Counting to 10… or 50… or 100
   3. Distracting yourself with something that’s a lot more fun and chilled out
   4. Focusing on your breath and getting your heart rate under control
   5. Meditating or repeating some calming phrase to yourself (“I am calm” is a start)
   6. Talking to someone about what’s making you insane with rage
   7. Listening to music — calming, soothing music (not death metal, punk, thrash, or hard rock)
4. See the tips above for Impulsiveness and Aggression.