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Emotional Problems After Traumatic Brain Injury

Comments [16]

Tessa Hart, PhD and Keith Cicerone, PhD, Model Systems Knowledge Translation Center

Emotional Problems After Traumatic Brain Injury
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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.

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.

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.
  • 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.
  • 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.

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.
  • 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.
  • Counseling for the family can be reassuring and allow them to cope better
  • on a daily basis.
  • Several medications may help improve or stabilize mood. You should consult a physician familiar with the emotional problems caused by brain injury.

What family members and others can do:

  • Remain calm if an emotional outburst occurs, and avoid reacting emotionally yourself.
  • Take the person to a quiet area to help him or her calm down and regain control.
  • Acknowledge feelings and give the person a chance to talk about feelings.
  • Provide feedback gently and supportively after the person gains control.
  • Gently redirect attention to a different topic or activity.

Anxiety

Anxiety is a feeling of fear or nervousness that is out of proportion to the situation. People with brain injury may feel anxious without exactly knowing why. Or they may worry and become anxious about making too many mistakes, or “failing” at a task, or if they feel they are being criticized. Many situations can be harder to handle after brain injury and cause anxiety, such as being in crowds, being rushed, or adjusting to sudden changes in plan.

Some people may have sudden onset of anxiety that can be overwhelming (“panic attacks”). Anxiety may be related to a very stressful situation — sometimes the situation that caused the injury — that gets “replayed” in the person’s mind over and over and interferes with sleep (“post traumatic stress disorder”). Since each form of anxiety calls for a different treatment, anxiety should always be diagnosed by a mental health professional or physician.

What causes anxiety after TBI?

  • Difficulty reasoning and concentrating can make it hard for the person with TBI to solve problems. This can make the person feel overwhelmed, especially if he or she is being asked to make decisions.
  • Anxiety often happens when there are too many demands on the injured person, such as returning to employment too soon after injury. Time pressure can also heighten anxiety.
  • Situations that require a lot of attention and information-processing can make people with TBI anxious. Examples of such situations might be crowded environments, heavy traffic or noisy children.

What can be done about anxiety?

  • Try to reduce the environmental demands and unnecessary stresses that may be causing anxiety.
  • Provide reassurance to help calm the person and allow them to reduce their feelings of anxiety when they occur.
  • Add structured activities into the daily routine, such as exercising, volunteering, church activities or self-help groups.
  • Anxiety can be helped by certain medications, by psychotherapy (counseling) from a mental health professional who is familiar with TBI, or a combination of medications and counseling.

Depression

Feeling sad is a normal response to the losses and changes a person faces after TBI. Feelings of sadness, frustration and loss are common after brain injury. These feelings often appear during the later stages of recovery, after the individual has become more aware of the long-term situation. If these feelings become overwhelming or interfere with recovery, the person may be suffering from depression.

Symptoms of depression include feeling sad or worthless, changes in sleep or appetite, difficulty concentrating, withdrawing from others, loss of interest or pleasure in life, lethargy (feeling tired and sluggish), or thoughts of death or suicide.

Because signs of depression are also symptoms of a brain injury itself, having these symptoms doesn’t necessarily mean the injured person is depressed. The problems are more likely to mean depression if they show up a few months after the injury rather than soon after it.

What causes depression?

  • Depression can arise as the person struggles to adjust to temporary or lasting disability and loss or to changes in one’s roles in the family and society caused by the brain injury.
  • Depression may also occur if the injury has affected areas of the brain that control emotions. Both biochemical and physical changes in the brain can cause depression.

What can be done about depression?

  • Anti-depressant medications, psychotherapy (counseling) from a mental health professional who is familiar with TBI, or a combination of the two, can help most people who have depression.
  • Aerobic exercise and structured activities during each day can sometimes help reduce depression.
  • Depression is not a sign of weakness, and it is not anyone’s fault. Depression is an illness. A person cannot get over depression by simply wishing it away, using more willpower or “toughening up.”
  • It is best to get treatment early to prevent needless suffering. Don’t wait.

Temper outbursts and irritability

Family members of individuals with TBI often describe the injured person as having a “short fuse,” “flying off the handle” easily, being irritable or having a quick temper. Studies show that up to 71% of people with TBI are frequently irritable. The injured person may yell, use bad language, throw objects, slam fists into things, slam doors, or threaten or hurt family members or others.

What causes this problem?

Temper outbursts after TBI are likely caused by several factors, including:

  • Injury to the parts of the brain that control emotional expression.
  • Frustration and dissatisfaction with the changes in life brought on by the injury, such as loss of one’s job and independence.
  • Feeling isolated, depressed or misunderstood.
  • Difficulty concentrating, remembering, expressing oneself or following conversations, all of which can lead to frustration.
  • Tiring easily.
  • Pain.

What can be done about temper problems?

  • Reducing stress and decreasing irritating situations can remove some of the triggers for temper outbursts and irritability.
  • People with brain injury can learn some basic anger management skills such as self-calming strategies, relaxation and better communication methods. A psychologist or other mental health professional familiar with TBI can help.
  • Certain medications can be prescribed to help control temper outbursts.

Family members can help by changing the way they react to the temper outbursts:

  • Understand that being irritable and getting angry easily is due to the brain injury. Try not to take it personally.
  • Do not try to argue with the injured person during an outburst. Instead, let him or her cool down for a few minutes first.
  • Do not try to calm the person down by giving into his or her demands.
  • Set some rules for communication. Let the injured person know that it is not acceptable to yell at, threaten or hurt others. Refuse to talk to the injured person when he or she is yelling or throwing a temper tantrum.
  • After the outburst is over, talk about what might have led to the outburst. Encourage the injured person to discuss the problem in a calm way. Suggest other outlets, such as leaving the room and taking a walk (after letting others know when he/she will return) when the person feels anger coming on.

Questions to ask your physician or treatment provider to better understand your problem

If you or your family members are experiencing anxiety, feelings of sadness or depression, irritability or mood swings, consider asking your doctor:

  • Would psychological counseling be helpful?
  • Would an evaluation by a psychiatrist be helpful?
  • Are there medications that can help?

More about medications

If you or your family member tries a medication for one of these problems, it is very important to work closely with the physician or other health care provider who prescribes them. Always make a follow-up appointment to let him or her know how the medication is working, and report any unusual reactions between appointments. Remember that:

  • There can be a delay until the beneficial effects of medications are felt.
  • Doses might need to be adjusted by your doctor for maximum benefit.
  • You may need to try one or more different medications to find the one that works best
  • for you.
  • Except in an emergency, you should not stop taking a prescribed medication without consulting your doctor.

Peer and other support

Remember, too, that not all help comes from professionals! You may benefit from:

  • A brain injury support group — some are specialized for the person with TBI, others are for family members, and others are open to everyone affected by brain injury.
  • Peer mentoring, in which a person who has coped with brain injury for a long time gives support and suggestions to someone who is struggling with similar problems.
  • Check with your local Brain Injury Association chapter to find out more about these resources. Go to http://www.biausa.org/ to find brain injury resources near you.
  • Talk to a friend, family member, member of the clergy or someone else who is a good listener.

Recommended reading

 

Emotional Problems after TBI was developed by Tessa Hart, PhD and Keith Cicerone, PhD, in collaboration with the Model Systems Knowledge Translation Center. Portions of this document were adapted from materials developed by the UAB TBI Model System, the Mayo Clinic TBI Model System, the New York TBI Model System, the Carolinas Rehabilitation and Research System, and from Picking up the Pieces after TBI: A Guide for Family Members, by Angelle M. Sander, PhD, Baylor College of Medicine (2002). Copyright © 2010 by University of Washington/MSKTC. 

Please check the MSKTC site for any recent updates on this article.

Comments [16]

I suffered a tbi 7 years ago. For the first couple of years i would uncontrollably laugh at any little thing while feeling sad and depressed at the same time. Now i have levelled out pretty well and i almost behave like a normal person only I continue being eccentric in my own adorable way.

Jun 14th, 2014 11:59pm

I am a 32 year old man that experienced Traumatic brain injury 2 years ago. I feel like the Brain injury has fixed my emotions.

Jun 11th, 2014 10:01pm

Hi my daughter who is now 9 had a accident a year ago which resulted in her fracturing her skull and having a bruise and two bleeds on her left frontal lobe of the brain. This past year has been a difficult year, as my daughter has now been assessed to have adhd but we have also noticed within this year my daughter has been having rapid emotional mood changes and without a trigger can become very very upset or angry . I'm just wundering if anybody could say weather this will be due to her adhd or her brain injury ... Many thanx ..x

Apr 24th, 2014 5:54pm

My daughter, Anna now 15 years old suffered brain damage from epilepsy when she was 2 and 3 years old. She find so much difficult. We have 4 other children and home life is becoming so awful and sad, she cannot cope with any demands and freaks out at going to bed or people coming round or basically any demands on her. I am becoming as her mother very exhausted by it all and do not know how to make her happy. She laughs hysterically and the next minute she is sreaming / crying uncontrollably. I have a 4 year old whom finds this very very disturbing. I am trying to get her into a residential school where she would have 24 hour care and come home every other weekend. She would learn to sleep there and receive the one on one care she so needs. However, the council will not support this idea. I feel so sorry for her as she is becoming so withdrawn at home with all the other siblings and so needs some one on one care and a social life that this school would provide. All very sad. She is so beautiful but so unhappy a lot of the time. A hard life for her and the people that love her. Help!! Ali

Nov 2nd, 2013 3:43pm

My name is Sean, I had a traumatic brain injury 28 years ago, coma 11 days, stroke. I just wish I looked different, I appear normal, but what is normal? I too wish I would've died, life can be a struggle everyday. Take care of yourselves fellow T.B.I. survivors.

Oct 29th, 2013 5:35pm

This article "hit the nail on the head" so speak regarding my granddaughter. This has increase her difficulty in dealing with her siblings who have difficulty applying the above suggestions. We will need to help them understand the help this can give. However sibling rivalry sometimes get in the way.

Sep 16th, 2013 7:27am

Iv had some bumps to the head growing up but it been afew years but i just sarted get dizzy eyes get blery i just feel like every thangs rong drs say depreson i dont beleve that im on pils for that im 38yearsold and this freks me out

Aug 28th, 2013 6:50pm

I had accident 2 yrs ago I was disabled im getting better maybe undisabled soon but I suffered head injury too and I would rather hav no tbi symtons than walk I too feel that pain havin moments of clarity which feels so good is my only solace

Aug 15th, 2013 9:53am

“The changes that TBI survivors wake-up to after the injury are frightening and confusing; those emotions mark the basis and the beginning of life with a brain injury. We feel like a patient coming out of anesthesia, waiting for the fog to clear, certain that it will. But it never really does. Sometimes the fog lifts a bit in one area and clouds another, casting shadows of doubt as to what is real, imagined, or remembered. Thoughts zip by before you can grab them; short term memory no longer efficient enough to save and process half of what you are used to, like all the other people around you still can. The noise, the crowds, the confusion, the panic of not being sure who you are now, questioning if you can trust this new person, yet really having no choice but to deal with it all. Overwhelmed. Alone. No one else really ‘gets it’ and you sure as hell can’t explain it to them.” “Today, a great deal is known about brain structure and function, and just about anything to do with TBI can be found on the Internet and in books. I was amazed to find the answers to so many of the questions that had caused me confusion and despair. Learning the different parts of the brain and what they do helped me understand why I had certain deficits. If you know the enemy, you can make a plan. With a plan, you can set goals, and with goals, you just keep rolling forward at your own pace. My prefrontal injury makes planning an elusive activity. Once I understood the reason why my plans began to hit a wall or whiz by before I could act on them, life opened up again. Did you know that there is a special part of the brain that allows us to recognize faces? If damaged or temporarily blocked, it will not send the messages that say ‘oh that’s mom!’ to the right places in your brain. Simple as that! Most people with TBI have PTSD symptoms, also. Learn about the difference. Make strategies for remembering routines, color code everything, go back to school or learn something new.” “My neurologist urged me to begin yoga and meditation after the surgery and it has been a lifeline to sanity. Injured brains can be easily overstimulated; they need more sleep and more periods of rest. I’ve learned to smile and excuse myself for a few minutes when I need a ‘brain break’. Very focused work, like coloring, can be as good as meditation. By all means possible, stay away from abusive people; even if it is friends and family who are being hurtful or cruel. Most people will never get what it’s like to be inside your new brain, but you can explain to them why certain things have changed. If they love you, they will listen and try to understand.”

Jul 26th, 2013 2:07pm

I was in a motorcycle accident, suffered many serious injuries. From broken bones, punctured lung, spleen ectemy, lacerated liver, and a very unfortunate TBI and induced comma to reduce the swelling of my brain, I even had a tracheotomy. I have nerve damage and occasional muscle spasms. I spent months in the hospital. I had icu-psychosis. I've been told while I was there I had the mindset of a child because of my TBI. I couldn't remember who my parents where. Over the course of the following year I regained some memories. I was eventually able to remember who friends/family are. While in the hospital I very much missed my dog, when I arrived home I was surprised that she was a different color than I remembered, she growled at me because I was in a wheelchair. I remember how mad this made me, how betrayed it felt to miss her so much and then to be growled and barked at as if I was truly someone else. I couldn't remember how I combed my hair, I had to ask my mom for a picture pre-accident for help. I'm sorry for putting my parents through so much stress and pain. It was an accident - prescialla trajio hit me with her minivan if I could have avoided her I would have, I'm sorry. I'm here because I feel isolated. I've been able to hide how I feel from people. I am lucky, thankful to be alive after my accident. I had to go through all the speech and physical therapy. I went through neuropsychological testing. I didn't like/enjoy any of it. Years later. I've lost my best friend. No family friends visit me. My parents live on the other end of the country. People say I'm a different person than before my accident - I always uncomfortably play it off and try to make lite of it but I can't remember much of my past or what i enjoyed prior to my accident. I am married and have a daughter. But my wife is unkind, and cruel to me at times. She yells at me for forgetting things and says I blame everything on my head injury. She gets very mad at me when i mention I can smell things she can't, she says I'm crazy. But there are days that I can't remember what I had for breakfast yesterday ------ no one understand these small cases of amnesia. They are frightening and cause me to panic and pause while I search, in my mind but feel hopeless and lost within my own thoughts. Its frustrating, like having a song stuck in your head but not being able to recall the artist. I have a career in which I can access guidelines and use reference material so my memory issue is overcome with the use of these tools. That's a brief summery. I reached this website in search of help. I feel isolated. I feel disconnected. I feel ashamed for feeling sad at all because I am a father and I have someone who greatly depends on me. I feel hopeless. I feel frustrated. I feel removed. I feel a very deep sadness for the disappointment and shame I have brought to my mother and father, I could not stop my bike in time. I'm sorry I couldn't remember you, I know that must have hurt you deeply. I have felt and now feel suicidal. I feel like I let my best friend Alan down because I was released from the Marines because of my injuries, I'm sorry I couldn't be there for you. Would it have been easier for everyone if I would have simply died in my motorcycle wreak, perhaps. This is with me everyday.

Jul 18th, 2013 2:09am

thank you very much.. it was indeed a very helpful article as i myself is a TBI victim and i am doing research on it..

May 3rd, 2013 6:11am

Thank you for helping me to understand why I'm suffering on an emotional roller coaster following what was supposed to be a minor concussion two months ago. The slightest thing sets me off, I get upset very easily and I'm having trouble with short-term memory, aphasia, writing, typing, even singing, something I was gifted at before the concussion 2 months ago. My family hasn't been too kind or understanding about it at all. They expect me go on waiting on them and helping them regardless of my physical condition. I have to take care of a lot of people in my family and our dog is dying -- the only family member who loves me unconditionally. Your kind words have given me some hope and I will try to be more patient with myself as I recover. This was extremely hard to type. I had a left frontal lobe concussion, two black eyes, I was black and blue -- all from a hard sneeze when my left forehead smashed into the wall while I was trying to carefully put on my slippers (I have a partial clubfoot) just before going to bed and I don't drink or get loaded! My doctor said sometimes it takes longer than 2 - 4 weeks for these things to heal completely and we've run all the necessary vision and brain scan tests without seeing any real damage. I need to try to be patient. Thank you for your help. Candace Mc

Mar 21st, 2013 7:41am

I am a post injury TBI survivor, 3 yrs out this New Year Eve. Coma 6 weeks, 6 weeks rehabilitation. I am having trouble with anxiety and addiction to the anti-anxiety meds. I NEED HELP...good luck getting any on Medicaid. please friend me on facebook if you can help. Stephanie Martin. ps I cared for my daughter who suffered a cardiac arrest and suffered anoxic encephalopthy. frontal lobe damage. I know more than most because I researched everything after her injury...I coulc go on and on. Thanks

Dec 17th, 2012 6:44pm

One item that was overlooked other than saying "adjust medication", is that medication can make a Person with TBI to the suicide and that should be careful monitored and noted immediately to the Physician

Dec 17th, 2012 6:16pm

Very helpful information and advices. Thank you.

Dec 6th, 2012 5:08pm

Excellent article. I will link to it on my website on brain injury in daily life. Here you can find more reality stories about emotional changes after brain injury in more simple terms. You can visit how-psychology-tests-brain-injury.com and look for yourself. Thanks. Feri Kovács Neuropsychologist in the Netherlands

Feb 4th, 2011 5:52pm


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