My sister was in a car crash a couple of years ago. Since the wreck, her temperament has changed drastically. She is very snappy toward her children and doesn’t seem to get any pleasure out of life. We are all worried about her lack of visible emotion. Any suggestions on how we might help her?
Personality changes like your sisters are not uncommon following a traumatic brain injury. After all, how we think and process the world is so much of who we are. Temperament is essentially the way our brain interprets the world around us. With a brain injury, the mechanisms we use to filter and understand information are disrupted. Personality changes can come from two sources following a brain injury:
- specific changes in how the brain experiences, understands, modulates, and expresses emotion
- emotional reactions to the changes brought about by the brain injury
Brain injury can affect connections that go from the cerebral cortex (the thinking part of the brain) to the limbic system (a series of inner brain structures that control and modulate emotion). These connections allow us to evaluate our emotional reactions, determine how important or minor events are, and decide on a response that matches the demands of the situation. When these connections are impaired, our emotional reactions are different from what they were prior to the injury, and are not always in tune with the situation at hand.
In addition to this, a brain injury can be emotionally traumatic. People respond with anxiety, frustration, anger, sadness, and depression to their changed capabilities and life circumstances. It’s normal for people to mourn the life they once had and try to find ways to cope with their new life and personality. These responses are affected by the potentially impaired connections described above, and may result in emotional extremes.
It is not unusual for the person with a brain injury and/or his or her family to need some counseling or therapy to understand this new identity, personality, and emotional reaction style. The person with TBI, like your sister, may work on learning strategies to better express emotions, avoid those situations likely to be particularly frustrating, read signs of emotional distress, and react in a calmer manner to emotionally charged situations. You can help by learning strategies to de-escalate your sister’s emotional outbursts, redirect her anger and frustration, understand the meaning behind a particular emotion (or lack thereof), and help create a calming environment for all concerned. A therapist or counselor may also recommend exploring the option of medication, depending on the nature and severity of your sister’s personality challenges.
Dr. Celeste Campbell is a neuropsychologist in the Polytrauma Program at the Washington, DC Veterans Administration Medical Center. She has a long history of providing cognitive psychotherapy and developing residential behavioral management programs for children and adults.