The emotional and behavioural effects of Brian Injury can be the most difficult to understand and
treat. Many of the people who sustain a brain injury are left with some form of emotional or
behavioural change, which carers, family and society as a whole find embarrassing, difficult to
understand and hard to accept.
Agitation
This is often a major problem in the early stages of brain injury when the individual is usually
still in hospital. The agitated behaviour is normally unprovoked and is a result of neurological
damage rather than a reaction to events or problems.
Agitation may present as constant movement, pacing up and down, repetitive purposeless
activity, getting up and down constantly or inability to focus attention.
Explosive Anger and Irritability
Dramatic mood swings; outbursts of anger and irritability are likely if the brain injury has caused
damage to the parts of the brain involved in controlling emotional behaviour.
It can also be linked to someone’s frustration at not being able to express themselves or perform
at the level they previously expected.
Lack of Insight and Awareness
Insight and awareness are the abilities to recognise our own strengths and weaknesses and to
appreciate the effect our actions may have on others. Skills such as self-awareness, insight,
sensitivity and empathy can be lost if damage occurs in the frontal lobe area of the brain.
Denial is a mechanism that we use to protect ourselves from overwhelming or unpleasant
realities. It is a natural process that we all adopt when coping with situations such as loss or
bereavement.
Vicky Richards, Co-ordinator / CNS, CBIT
Emotional & Behavioural Effects of Brain Injury
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In someone with an injury to the brain a combination of loss of insight and a natural tendency to
avoid reality may make the person behave as if they were perfectly ok.
Anxiety and Apprehension
After brain injury, people often experience difficulties with employment, finances and
uncertainty about their future prospects and health. Many brain-injured people will feel anxious
and apprehensive; others may become obsessional in their thoughts and actions. Some develop
specific fears and experience feelings of panic, palpitations and breathlessness.
Depression
The most common psychological reaction to brain injury is depression. Brain injury can bring
about many losses – loss of job, loss of roles, physical and cognitive limitations. The depression
may intensify as the person struggles painfully and seemingly helplessly to regain lost skills and
roles. It may be that depression does not surface until some time after the brain injury, when the
hospital demes rehabilitation complete and the person returns home, only to be confronted with
the realisation that life can never be the same again.
For some, the depression may be severe and if the person experiences feelings of hopelessness
and starts to neglect his or her appearance, these may be sings of depression that require active
treatment. The persons General Practitioner should be able to provide effective treatment,
although referral to a Psychiatrist or Neuropsychiatrist may be necessary.
Impulsiveness and Lack of Inhibitions
An individual with brain injuries may lose the ability to control either their actions or speech.
They may act on impulse, say the first thing that comes into their head, and become excessively
demanding. They may also lose the ability to discriminate about how and when to express
feelings. This can result in mood swings or periods of sudden tearfulness.
This can be exacerbated if they also have a lack of awareness. An improvement may be possible
using a behaviour modification programme devised in conjunction with a Neuropsychologist.
Vicky Richards, Co-ordinator / CNS, CBIT
Emotional & Behavioural Effects of Brain Injury
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Sexual Problems
Sexual Problems experienced by a person who has suffered a brain injury can include
increased/decreased sex drive, promiscuity or misinterpretation of other people’s behaviour as
sexual advances. These problems are caused by damage to a small nerve centre in the middle of
the brain, which affects the sex drive and the release testosterone.
There are often difficult and embarrassing problems to admit to and talk about. However, it may
be beneficial for you to speak to your General Practitioner and / or Specialist Nurse.
Managing Your Anger and Irritability
People often feel there is little they can do to control their anger. Anger and irritability often feel
like they happen ‘out of the blue’ and people feel like they ‘just snap’. Usually however, there
are triggers that spark your anger, there are also warning signs from your body that you can learn
to spot. If you learn to recognise the kind of situations where you may become angry, and if you
learn the warning signs, you can manage your anger more effectively.
By using some of the following techniques you can learn more about your anger and how to
manage it better. These may take time to master, and you may need to enlist the help of family
and friends.
Learn to recognise the Triggers
There is usually a pattern to your anger. It may tend to happen in particular situations, with
particular people and with particular provocations, e.g. tiredness, noise, traffic, crowds, being
ignored. It is important to identify the causes of your anger.
Keep a diary and record a) each time you got angry, b) where you were, c) who was there, and d)
what was going on at the time.
You will notice that your anger is usually not random and not an ‘uncontrollable force’.
Vicky Richards, Co-ordinator / CNS, CBIT
Emotional & Behavioural Effects of Brain Injury
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Identify What is Upsetting You
Look at the records in your diary and ask yourself:
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What is it about the situation that I find annoying/irritating?
•
What am I thinking when these situations occur?
Make a list of the kinds of statements that go through your mind. Try to come up with
alternative ways of looking at the situation, which makes you angry.
Recognise the Physical Signs
Pay attention to your body, notice if you have any signs such as clenched fists, gritting teeth,
feeling hot or cold, feeling hot or cold feeling nauseous, sweating, or your pulse rate quickening.
When you notice the warning signs, combat by practicing deep breathing exercises (breathing
deeply and slowly).
Anticipate and Prepare
Once you become aware of the kinds of situations where you are more likely to become irritable
and angry, you can prepare by:
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Practicing what you are going to say and how.
•
Watching the physical signs and breathing deeply.
Be aware of the thoughts running through your mind. Replace them unhelpful thoughts with
helpful or useful questions: e.g. “I’m getting angry. How can I sort this so that everyone gets
what they want?”
Take Time Out
If you feel your anger is getting out of control, remove yourself from the situation and cool off;
count to 10, sleep on it, distract yourself, exercise, or relax.
Vicky Richards, Co-ordinator / CNS, CBIT
Emotional & Behavioural Effects of Brain Injury
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Ventilate and Explore Feelings
Your feelings are important. Don’t ‘bottle up‘ feelings until you ‘explode’? Talk to friends or
family, or discuss issues with a professional if necessary.
Vicky Richards, Co-ordinator / CNS, CBIT
Emotional & Behavioural Effects of Brain Injury
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