Emotional effects of brain injury
Everyone who has had a brain injury can be left with some changes in emotional reaction. These are more difficult to see than the more obvious problems such as those which affect movement and speech, for example, but can be the most difficult for the individual concerned and their family to deal with.
You can find out more about the behavioural effects of a brain injury below. Our Psychological effects of brain injury and Managing anger after brain injury booklets provides more detail, and the Headway helpline will be happy to talk through any specific questions you may have.
It is important to be sensitive to extreme emotional changes after brain injury, as they may indicate a developing mental illness. Our Mental health and brain injury factsheet provides more information on this topic.
For many families, the worst consequence of brain injury is feeling as if the person who was once known and loved has somehow slipped away, together with their character and their individual ways. For the person with a brain injury, losing a sense of their own identity is traumatic and frightening.
For this reason, experiencing brain injury can be similar to going through bereavement: the healing process is made up of grief, denial, anger, acceptance, and finally, resolution. However, this process can take many years to run its course, and the feelings experienced may not present in any particular order.
Sometimes the impact of brain injury means that the individual remains unaware of what has happened to them and how they have been affected. If they are free from physical effects, other people may also fail to appreciate the ‘hidden disability’, such as the cognitive or personality changes that have taken place. This can leave both brain injury survivors and their families feeling very isolated.
It can be particularly difficult if the person with brain injury has children. While children are often surprisingly able to come to terms with changes in their lives, they may not be able to fully understand what has happened to their mum or dad and why they are different from before.
Mood swings or ‘emotional lability’.
The person may have rapidly changing moods, otherwise known as 'emotional lability'. For example, they may be happy and joking one minute and tearful the next. Emotional states might also be more extreme than normal, so a person might get very distressed about something that would have only upset them slightly before the injury, or something minor may trigger off anger. A person may also respond to situations with inappropriate emotions, for instance they may laugh at bad news.
Depression and sense of loss
Depression and sense of loss are common. Depression may be caused by damage to the brain’s emotional control regions, but can also be associated with the person gaining an insight into the effects of their own injury
After a serious accident or illness, many things that are precious to the individual may be lost forever. There may be much sadness, anger, guilt and confusion, surrounding this. There may be lost skills such as cooking, writing or sport; lost independence (getting dressed, going shopping, driving); lost lifestyle (friends move on and no longer include the injured person in their plans); lost career (most severe brain injury survivors are unable to go back to work); lost companionship (many brain injured people say that they feel very lonely).
Many people suffer from anxiety after brain injury, which impacts upon their daily lives and may obstruct their rehabilitation. Those with a less severe injury may be anxious early in recovery, feeling disturbed by the changes to their cognitive skills and personality. People with a more severe injury may become anxious later on, when they come to appreciate the extent of their long-term disability and feel anxious about the future. A few who suffer anxiety may become obsessional in their thoughts and actions.
Frustration and anger
Many people become frustrated by their failings and their slow rate of recovery from brain injury. Some are bitter about their accident, and some feel intensely angry, either at themselves for not progressing as they think they should, or at others whom they hold responsible for their injuries. Impaired impulse control can also reduce control of anger, irritability and aggression.
Post-traumatic stress disorder
Some people may experience post-traumatic stress disorder (PTSD). This is a severe psychological reaction to a traumatic event. It involves the persistent re-experiencing of the trauma, avoidance of stimuli which remind the person of the event, increased arousal, and a numbing of emotional responses. Loss of memory for the circumstances of the injury means that most people with severe brain injuries are not troubled by disturbing memories of the event. As such, PTSD is most commonly experienced after mild brain injuries when memories of the circumstances surrounding the injury are retained. However, some others develop a fear of circumstances similar to that of their injury (e.g. being assaulted), and a small number of people have disturbing memories of the early stages of their recovery.