Understanding Behavior Changes with TBI

Produced by Victoria Tilney McDonough and Brian King. Dr. Tedd Judd shares his experience and advice about culture, ethnicity, and brain injury rehab. Transcript of this video.

There are a lot of different ways that people understand or try to understand or think to themselves about what may be going on with some of the behavior changes we often see with traumatic brain injuries. And it's often handy to talk particularly about the example of impulsive anger. Maybe two examples will serve. The other one, the one I've mentioned before, is the lack of initiation. And I picked these two because they're enduring problems that tend to be very disruptive to someone's return to their usual role and they're very frequent problems. And they are also very treatable. They can be made better. There are lots of other problems too, but we'll pick those. When we consider the different-- I'm going to talk from a neuropsychological perspective first and then go on to some of the other cultural things that can go on. From a neuropsychological perspective, we can think of three major components of the personality of someone who's had a significant brain injury. There's the personality they already had before the injury, and an injury can happen to anybody, so there's the full range. There are the reactions they have to that, and I put that in two parts. One is the reaction to the experience of the injury itself. So you might be really angry at the driver or the person who assaulted you or you might feel really guilty because you were responsible for the accident, or you might have post-traumatic stress disorder from the ambulances coming and from seeing the car coming at you at the last moment, all kinds of reactive things to the accident itself. Then there's also a reaction to being disabled and to what life is like now-- the embarrassment, the fears of the future, the depression and so on. And there's a third component. So we've had personality prior to the injury, reactions to the injury which we can understand from the point of view of people with intact brains, and the third is the changes in personality and emotions that result from injury to the brain itself because the brain is the organ of emotion, it's the organ of personality. And so when it's changed, emotion and personality are changed. Impulsive anger comes in large part from that third component when we see it as a change, that the person who gets angry very suddenly out of proportion to whatever the event is that's triggering the anger and when they calm down suddenly afterwards and when it's out of character, often people say, "Why am I acting like this? I never used to be this way before." "Please help me get rid of this anger." I know we're talking about the organic impulsive anger of brain injury. When it has those kinds of components and when it doesn't serve a purpose very often, it doesn't get them anything. Anger serves a purpose in our lives much of the time. It can get you something, and there are times when it's appropriate to get angry. But the impulsive anger of brain injury often doesn't get you anything. So those are some of the characteristics of that. Most people, when they first see it, will tend to assume that either the person was like that before, if they didn't know them well and haven't seen it as a change, or perhaps that this is a reaction to either the injury, "Well, they're angry because they were in an auto accident," or "They're angry about being disabled." They'll see it as reactive to that. And that's a possibility, but much more often it's something else. Likewise, people will tend to see that lack of initiation, that dead battery in the car kind of experience, as, "Well, they must be depressed or they're unmotivated "or they don't really want to get better," rather than seeing it as a brain problem. Those are common interpretations to see in any culture. In addition to those interpretations, we may also see people who put a spiritual interpretation on it, who see it as fate or who see it as a punishment from God or from the gods or the ancestral spirits or various other sources for something that either they or someone in their family did or one of their ancestors did. There are people who may see it as something that's part of a past life of their own that's responsible for it or who may not attribute it to anything in particular, just chance and life happens this way. And one of the things that sometimes we have difficulty understanding from a Western perspective, even though we do it ourselves, is that many people hold several interpretations at the same time and it's not contradictory for them. Actually, that's true of us, although we don't recognize it. What caused the accident? Well, what caused the accident was that the car ran off the road. But what caused the accident was that the road wasn't well marked. But what caused the accident was that it was rainy that night or that the driver was drunk or that the person at the bar didn't recognize they were drunk and let them go out or that we have a society such that blah, blah, blah. Causality can have many different levels, and they can all be operating. And that person themselves may say, "Well, this is a punishment for my terrible ways," and that may also be another level of explanation that likewise applies. And that's okay, and we can work with all of those, and sometimes you just pick the one that's going to serve the purpose now as best you can.
Posted on BrainLine April 29, 2009.

Comments (9)

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*May cause triggers. My ex was abusive. On one occasion, he repeatedly beat my head on a cement floor, which was covered with indoor/outdoor carpeting. Maybe 1/4" thick. The back of my head, and behind my ear was swollen at a minimum of three days. The back of my head was also "introduced" to walls regularly. The Neurologist said that I was fine. I am not. I have little to no time recollection (I say it was a month ago, when it was last week), and I have a great challenge with remembering simple items. Please advise me. I have also become very antisocial and am brutally honest with zero filter.

How do I as a person, with an diagnosis of PTSD before my TBI; differentiate the symptoms? How do I or my physician treat the symptoms medicinally if the symptoms are caused by 2 different factors?

I had a head injury two years ago. My life has changed. I feel alone in my battle. Once I was a clear thinker, calm, kind and loved life. I have a wonderful family but I find myself lashing out, in a fog or confused, forgetting the simplest tasks and fear this will be the rest of my life. I have been seen by many doctors who are wonderful yet this invisible injury is one only I understand.

I had a head injury in 2012 from a blast in Afghanistan. I struggle with the same problems. I have also seen a lot of doctors and received some great help. I do feel like the only people who know what it's really like are other people with a TBI.

I hope you can find someone you can talk openly with.

Please check to see if there is a local chapter of the ‘Brian Injury Association’ for your state. Or look online, go to Brain Injury Association of America (biausa.org) for information and resources. It was 2 years before I discovered this organization, their resources and the support systems that are available. Best thing I could have done for myself and my husband. Best wishes for continued recovery.

I need help, a little over a year ago I was hit in face/head by a tree, it knocked me out for several minutes. I was cleared at the hospital the day of, but since then I have changed and not really noticed but yet have noticed. I'm a self-employed plumber, I'm losing customers because I forget a lot, I will take drugs time to time, pain pills mainly, I lie for no reason, told wife and family I had cancer, don't have reason for it, they think I'm on drugs, I have seizures, cry for no reason. I'm losing everything, my family, work now in debt wasn't like this before. I need direction. Please help?

Ask your Primary care doctor for a Neurology consult. You probably need an EEG to define brain damage and possibly an MRI if there is one from before your head injury that they can compare it to. Anything you were (emotionally) before the accident can be intensified or changed. Your abilitites to reason and cope can be decreased. Behavioral therapy and family can help with that but commitment is they key. You have to do your part. My husband suffers from TBI post car accident. He was out a short time but he has had several concusions in past years and the effects at 47 years old are showing up. He's angry, unreasonable, short term memory is shot, and he suffers from sleep apnea. When you sleep your body restores so everything has to be in alignment. Medications can help a lot. Please see a doctor. Your issues are legitimate post TBI symptoms. It can get worse before it gets better. Find a support group. They have tons of resources. I hope you can find the answers you need.

My boyfriend of almost 2 years fell about 13 feet knocking himself unconscious. The next day, a copper pipe fell and hit his head leaving a cut on his eyebrow. He started getting intense headaches and sharp pains in his head. Then he started being cruel to me and saying things that you don't say to people. He loses things all the time. The last thing I noticed is after yelling at me five minutes later he didn't understand why I was mad at him. He has never seen a doctor. Now I don't know if I could get him to go. He acts like he hates me. What can I do?

He either goes to the doctor, and starts dealing with his issues, or you end the relationship. Give him the choice and let him make the decision.