Brain Injury, Behavioral Challenges, and the Holidays

Ask the Expert: Behavioral Challenges and the Holidays

Ever since his TBI, my husband is sometimes a little inappropriate with his jokes and conversations. I can tell others feel embarrassed. And frankly, I'm embarrassed, too. How do I deal with this, especially with the added pressure of holiday gatherings?


The holidays can definitely come with more stress and more social challenges. As you probably know, when the part of the brain that controls a person's ability to self-monitor and inhibit inappropriate behavior is damaged, it can lead to difficulty managing social interactions. Your husband may also lack the ability to use feedback, such as reading other people’s facial expressions.

Rehearsing or role playing before attending a party or holiday gathering can be helpful. Practice some cueing strategies to use if your husband starts to say or do something that could become embarrassing to you or others. For example, you could use a gesture such as a raised palm to alert him to stop.

It also helps to discuss, well in advance, what your expectations are and act out a scene you might encounter. For example, New Year’s Eve parties can be fun, but they usually include alcohol and the expectation of a midnight kiss. You may want to rehearse your husband’s response if he’s offered a cocktail — "No, thank you. Since I was injured, I’m using medications that don't mix with alcohol." As for the midnight kiss, explaining and rehearsing proper etiquette before the party will help, especially since other party guests may be jovially hugging and kissing others. Unless he fully realizes that it is customary to kiss and be kissed "like a friend" on New Year's Eve, he may take offense. Rehearsal and reminders during the evening will hopefully lead to a Happy New Year.

Posted on BrainLine December 30, 2008.

Comments (7)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

I am a survivor of a severe TBI, and yes I may lack at times control of the language I use, but that is still no reason to treat me as a child and be embarrassed of me. Either love me thru thick and thin or dont at all. If you are uncomfortable with my actions, speak to me, simple as that

First, I applaud your desire to question and learn strategies to cope and manage and maintain a healthy, social lifestyle including your spouse while acknowledging these potentially awkward interactions. I have been learning strategies for many years by trial and error as the severity and significance of my TBI's went undiagnosed and untreated for years. As a couple you are fortunate to have the option to choose the gatherings which are more conducive to lower levels of stimulators. It is best to avoid gatherings with sensory overload which ultimately lowers inhibitions. Have break away, set times, when both of you meet up (if mingle separately) to breathe, close his eyes. (a bathroom is always a good place. You can even turn the lights off if necessary to bring himself back to neutral). If there is there is the opportunity to go outside on a balcony or porch just to not hear multiple voices and other sounds is always a good option. If having conversations with others together try holding hands and gently squeeze hand when there is a recognizable trigger thereby cueing him to respond in a predetermined, practiced or rehearsed way. 

My hubby does the inappropriate joke thing and I just shrug my shoulders and say "That's his brain injury" any one who doesn't understand isn't really worth my time. And nowadays, time is a hot commodity.

Thank you for this information. I am a TBI, an have said things by error . I worry some, but try hard to be prepared is key if going to parties . I however still avoid gatherings , since I can't take it in and filter things .

The more I read this response, the angrier I got!  If the ignorant people who know him do not understand the issue with his TBI, screw them!  I would NEVER want anyone embarrassed by my actions or words but I'll be damned if someone is going to look down on me because of their ignorance!  If you're embarrassed of your husband, maybe you need to check yourself or leave your marriage!  All you're doing is making him feel inadequate!

This situation can be hard on everyone including a caregiver; it is natural and okay for them to have emotions and reactions to their loved ones new normal. It is an adjustment for everyone.

My son has a severe TBI (diffuse axonal injury), and he has no sound in his voice. Sometimes he will say swears for what seems to be no apparent reason. Example, a lady at church was telling him she is praying for him, and that he is going to be a great man of God; she said it often, my son said "shutup" "shutup", when my husband heard he laughed, I was very surprised. Thank God the lady couldn't figure out what he was saying. Othertimes, he will say worse words when someone is being nice; I just say that isn't nice and its not appropriate. He seems to understand, not saying he didn't swear in the past, but not just when someone seems to being nice. He is 29 years old. Well any help would be helpful. He suffered a severe accident over 1 year ago, and I'm so blessed to have him beyond words.