Relationships

What are relationships?

Relationships are a very important part of life. We have relationships with our partners, families, friends, colleagues and even people who we see on a regular basis such as people in our communities. 

Relationships give us a feeling of comfort, support and security, and can contribute towards our sense of self-identity and belonging. It is often our closest relationships that provide the emotional and practical support needed when hardships are faced, such as when a brain injury occurs.

A brain injury can often affect the survivor's personality, social skills, skills and interests, that relationships may be built on. This can result in the dynamics of some relationships changing. Relationships may strengthen, whereas others may become strained over time or even completely break down.

How can brain injury affect relationships?

Injury to parts of the brain involved in managing relationships

Our brains are specialised in connecting with others through social relationships. There are a number of specific brain structures that are responsible for processing the emotional and social skills that form the basis of all relationships, described below.

• The limbic system, insula and cingulate - this is a group of brain structures that are collectively responsible for generating and processing emotions of self and others.
  

• The frontal lobes - this part of the brain is responsible for managing emotions and behaviour through a number of cognitive skills such as motivation, planning, making decisions and inhibiting behaviour, collectively known as the executive function. Parts of the frontal lobe are also involved in anticipating other people’s emotions and monitoring one’s own behaviour accordingly.
  

• The temporal lobes - parts of the temporal lobes are involved in thinking about things from another perspective, focusing on the same thing as others in a group situation, and keeping social rules and conventions in mind.
  

• The brainstem - this part of the brain is responsible for reflex emotions, including social reflexes such as smiling, as well as basic functions such as breathing and sleep/ wake cycles.

Injury to these areas can affect the skills needed to maintain relationships.

Effects of brain injury 

Emotional, behavioural, physical and cognitive effects can all have an impact on relationships. The following section describes in more detail how common effects of brain injury can have an impact on relationships.

Depression

A brain injury survivor experiencing depression might find it more difficult to socialise. They might stop socialising altogether and become withdrawn, spending less time with people they have existing relationships with and minimising opportunities to meet new people. Depression can also cause tiredness and lethargy which might affect a survivor’s interest or ability to partake in social activities, especially if fatigue is already a problem.

Relatives, partners and friends might try to offer support or encouragement, but this may be resisted, causing relationships to become strained.

Sexual relationships can also be affected, as depression might cause the survivor to lose interest in sex.

Mood swings

It might become difficult for people to maintain positive relationships with a brain injury survivor who experiences mood swings. Unpredictable outbursts of anger or other emotions can cause embarrassment or upset to people the survivor is socialising with, and may cause them to socialise with the survivor less. The brain injury survivor themselves may find it frustrating when others are unable to understand how they are feeling, and this may cause further problems in relationships.

Inappropriate emotions

Emotions that are inappropriate to the setting might be displayed by some brain injury survivors, for example laughing if they have been told bad news. This can cause embarrassment in social situations and people may stop socialising with the survivor in order to avoid such situations.

Partners and relatives may particularly struggle if the survivor’s display of inappropriate emotions occurs regularly or appears insensitive.

Anger

Brain injury survivors might experience more frustration or anger, or struggle with controlling their anger. Anger is often directed to those nearest to them, such as relatives and partners. This can have a serious impact on relationships, especially if the anger leads to recurring arguments.

Relatives, partners, friends, colleagues and others who the survivor has a relationship with might become anxious about triggering the anger, and the survivor in turn may feel negatively towards their loved ones during periods of anger outbursts.

Children may become especially fearful of a parent who frequently becomes angry, especially if the parent did not have an angry temperament before the injury.

Issues with empathy

A brain injury survivor may no longer be able to understand and appropriately respond to how others are feeling, and their behaviour may seem distant. For example, the survivor may fail to recognise when a partner is upset and therefore not understand that they are expected to provide comfort and support. Or they may not realise that if they have upset a friend, the appropriate response would be to apologise. The survivor themselves may feel quite confused about what to do in these instances but choose to keep this confusion to themselves.

Mobility problems

Mobility problems can make it difficult for people to easily and comfortably socialise. They may be unable to attend social gatherings in places that are not accessible, or join in with activities such as sports that they previously did with friends. These sorts of situations may cause the survivor to spend less time with others.

A child’s relationship with their parent might be affected if the parent is no longer able to play with them in the same way as before their injury.

Mobility problems might make it more difficult for the brain injury survivor to engage in sexual activity with their partner or spouse; regular intimacy may be lost between the couple, which might affect their relationship.

Communication problems

We use communication to express how we are feeling about things, find out how others are feeling and discuss day-to-day things that we think are important. Communication is a very important part of relationships as it allows us to connect with others and express ourselves.

Some people develop problems with their communication skills after brain injury. Speech may become slurred or slow - this is known as dysarthria. Others in the survivor’s life may struggle to understand what they are saying, which can cause upset and frustration to both the survivor and others. The survivor may speak less as it requires effort to make themselves understood, which can affect the closeness of their relationships. Some people do, however, learn to ‘tune in’ to the survivor’s speech and communication can be improved over time, which in turn may improve the relationship.

Sexual dysfunction

A brain injury may affect a survivor’s ability to engage in sex. Sex might become uncomfortable or difficult to initiate. Some survivors or their sexual partners may lose interest in sex, either as a direct consequence of the brain injury or because they are more focused on the many changes that life with brain injury can bring. Depression after brain injury can also affect a survivor’s interest in sex. Such changes can cause the survivor to become less intimate with their partner, which in turn might impact on their relationship and closeness.

Hormonal imbalances

Injury to parts of the brain called the hypothalamus and the pituitary gland can cause hormonal problems. This can lead to a range of issues such as depression, sexual difficulties, muscle weakness, reduced body hair, increased sensitivity to cold, mood swings, low blood pressure/ dizziness (among many others). Opportunities for socialising and nurturing relationships might be impacted by such effects.

Pain

Pain can be experienced anywhere in the body following brain injury, with headaches being the most commonly reported pain problem. Pain might be experienced occasionally, regularly or most of the time. Pain can be very distracting and impact on the survivor’s enjoyment of activities or socialising. Experiencing regular pain can make people feel depressed or irritable, both of which can also affect relationships.

Fatigue

Brain injury survivors experiencing fatigue may struggle with committing to and attending social events, as these might make them feel fatigued for hours or days afterwards; they may therefore see less of friends and family.

People in the survivor’s life who do not understand the nature of fatigue might take the survivor’s reluctance to commit to plans or cancellations personally, which may cause fall-outs.

Survivors with young children may find it harder to spend time with their children due to the high energy they often demand.

Memory problems

Memory problems after brain injury may cause someone to forget key dates such as birthdays or social commitments such as meeting a friend for lunch. People in the survivor’s life who do not understand the nature of memory problems might take these issues personally and think the survivor is being neglectful, which can impact on the relationship.

Being unable to remember significant events such as a wedding day or the birth of a child can make the survivor feel less attached to some people in their life, although it is of course possible to rebuild connections by forming new memories together and introducing memory aids and systems to help.

Problems with attention and concentration

It might be difficult for the brain injury survivor to attend to or concentrate on things for sustained periods of time, for example, following a conversation or watching a TV programme. They may appear to ‘tune out’, even when people are talking to them.

Being able to attend to something is linked with our ability to remember it. If the brain injury survivor is unable to attend to information, they will probably be unable to remember it afterwards.

People in the survivor’s life who do not understand the nature of attention and concentration problems might take these issues personally and think the survivor is being disinterested, which can affect the relationship.

Executive dysfunction

Executive dysfunction is the name for a collection of thinking skills that can be affected after brain injury, that impair the survivor’s ability to make decisions, plan, organise themselves, motivate themselves, multitask, prioritise, complete tasks and reflect on their activity.

These difficulties can make a brain injury survivor impulsive, unpredictable or unable to make appropriate decisions. This may affect their ability to socialise, as decisions about social behaviour are often complex, and many people rely on ‘gut-feeling’ and intuition to assess whether a behaviour is appropriate or inappropriate in a certain social situation. Without these skills, a brain injury survivor may struggle with social problem-solving.

These issues are also likely to alter a person’s personality and this may have an impact on existing or future relationships. Families, partners and friends may feel like the person is no longer who they once were and question whether they will ever be the same again.

Executive dysfunction may be particularly problematic at work. Relationships with colleagues or one’s employer might therefore become strained if, for instance, the survivor is falling behind with their workload because they are struggling to multi-task or prioritise.

Insight and awareness issues

A brain injury survivor may no longer be able to observe and reflect on their own thoughts and actions, being unaware of the impact of their injury or seemingly denying issues when others point them out. This can cause frustration and distress in the survivor, as they may struggle to understand why people are restricting them from doing certain things, which can impact on their relationships.

Role changes

The effects of brain injury can change the role that a brain injury survivor may have held in their family, at work or within wider society. For instance, within the family they may have been 'the breadwinner', or held certain household responsibilities that they are now no longer able to do. These changes in role may affect the survivor's relationship with others.

Carers of brain injury survivors also experience changes in their role when they take up caring responsibilities. Partners, parents or adult children who take up such caring duties may feel more like a 'carer' than a relative, especially if they need to help with activities such as personal care. This may affect their feelings towards the relationship.

Types of relationships and how they are affected after brain injury

Different types of relationships will be affected in different ways after brain injury. We have therefore produced specific guidance for others in the survivor's life, including guidance for partners, friends, employers and colleagues, as well specific guidance on supporting children. Visit Relationships for more information. 

Family's reaction to brain injury

No family is ever prepared and ready for a brain injury; most families already have a full agenda of problems to cope with before clearing the decks to cope with the impact of brain injury. Research into the effects of severe brain injury on the other family members gives some indication of the extent of their difficulties. The following points are worth noting:

• Close family members are likely to experience high levels of anxiety and depression during the years following a brain injury. As time elapses, there is often a decrease in relatives' capacity for coping, particularly with emotional and behavioural problems.

• Spouses often feel isolated and trapped with a marriage where their emotional needs are not being met. Some describe this as being neither married nor single.

• Children often experience emotional problems as, alongside coping with the initial trauma and the subsequent difficult behaviour of a parent with a brain injury, their own needs are often neglected and this can impair their performance at school.

Families need attention, education, guidance and support if they are to survive, regroup and rebuild their lives. Some families cope better than others, but all have difficulties. There is no 'normal' way of responding to a brain injury. The saying that 'people act abnormally in abnormal situations' is undoubtedly appropriate.

The people in families and relationships who seem to cope best are those who have two qualities:

1. They have the ability to be flexible, not being rigidly tied to how things ought to be but being able to embrace change and view it as a challenge.

2. They have the ability to communicate openly and honestly, directly expressing emotions both positive and negative and recognising the needs of themselves and others within the family.

If a family has these characteristics of flexibility and open communication, then it is possible that, out of the crisis of brain injury, a family can grow in strength through its way of dealing with it.

The fragility of life can give a whole new perspective and intensity to the love that existed prior to the brain injury. Having a person with disability in the family often brings a new sensitivity and awareness to other members of the family. It is often said that the experience of head injury tends to make strong marriages and relationships stronger and troubled relationships more troubled.

Impact of changed relationships

The relationships described in the previous section are affected by brain injury in different ways. However, when any type of relationship is negatively impacted, this can commonly cause feelings of sadness, confusion, hurt and loneliness among everyone involved.

Brain injury survivors may feel a sense of loss of their social network, causing them to be at risk of becoming further withdrawn and socially isolated. It might become more difficult for them to seek support.

Such experiences can commonly cause feelings of loneliness due to the reduced socialising opportunities they cause. However, sometimes loneliness can be experienced even when surrounded by others. Brain injury survivors who have maintained relationships with friends, partners and other relatives, may still be at risk of experiencing loneliness if they feel that others in their life do not understand their brain injury and or if they are unable to effectively communicate their needs.

Some brain injury survivors may feel that their loved ones do not understand how they are feeling, which can cause them to become frustrated and distant. Conversely, families and friends of a brain injury survivor may also feel frustrated and helpless if they are unable to understand how the survivor is feeling and how they can help.

Both brain injury survivors and their partners, relatives and friends can be affected by a change in the relationship, and it’s important that both feel able to access support accordingly.

New relationships

People continue to develop new relationships across their lifetime. Brain injury survivors may feel that they have fewer opportunities of forming new relationships with people, especially in regards to finding romantic partners.

They might also question whether or not they should tell new people in their life about their injury.

Many people do go onto forming new, strong relationships after brain injury. New people in the brain injury survivor’s life will not know what they were like before their injury and will therefore not compare them to their ’old self’, which can be helpful.

Experiencing a brain injury can make many people re-evaluate what is most important to them in life and they may seek new opportunities based on things that matter most to them, such as volunteering or fundraising for a cause they are passionate about, or learning a new skill that they have always wanted to try but never had a chance to do. This might offer the survivor opportunities to socialise with people who share their interests and values, which is a good starting point for relationships to develop.

Some tips for forming new relationships are offered below…

• Consider attending your local Headway to meet others affected by, and therefore understanding of brain injury, or consider getting support through our online communities.
  

• Join local groups with activities of your interests or hobbies. Look online or check through local newsletters or magazines.
  

• It is up to you how much you choose to tell someone new about your brain injury, but you should always be careful about telling new people personal information about yourself. Never reveal personal details about yourself to strangers online.
  

• Take time with getting to know people and allow relationships to develop naturally.
  

• Consider dating services if you are looking to meet someone romantically, but get support from someone you trust with this process in order to keep yourself safe.
  

• Ask existing friends to introduce you to new people, for example at parties or social outings.
  

• If the effects of brain injury are making it difficult for you to socialise and meet new people, consider seeking professional support.
  

• Consider showing new people you meet your Headway Brain Injury Identity Card so that they understand you have a brain injury and how it might affect you/ your interaction with them. This might help to prevent any misunderstandings from the start of forming a new relationship.
  

• Above all, don’t lose hope! People can and do continue to form new relationships after brain injury.

Getting support

In some cases, it might be helpful or necessary to get support for difficulties in a relationship.

Support can come in different forms, depending on the level of input required. Having mutual friends, other relatives or colleagues involved in discussions can sometimes help to address issues, as it can be helpful to hear things from another perspective.

In some cases it may be helpful to get support from professional services such as relationship counselling or family therapy. Before arranging for such support, research find out how much experience the therapist has in supporting clients with brain injury so that they are able to factor this into support sessions. To find a suitable therapist, contact local mental health services, your GP or Relate, or find a therapist in private practise from the College of Sexual and Relationship Therapists' Find a Therapist directory. 

Professionals called clinical neuropsychologists specialise in the emotional, behavioural and cognitive effects of brain injury, and may be particularly suited to support brain injury survivors with relationship issues related to these problems.

Some clinical neuropsychologists specialise in relationships, and may welcome both the survivor and the person (or people) with whom they are having relationship issues with. Speak to your GP about getting a referral to a clinical neuropsychologist, or alternatively look for private clinical neuropsychologists in your area, for example from the British Psychological Society's Specialist Register of Clinical Neuropsychologists. 

The organisations listed on this page are provided for information purposes only. Their inclusion does not imply endorsement, recommendation, or approval by Headway. Users should make their own assessment of any organisation or service before engaging with them.

The information on this page was written with expert support from Dr Giles Yeates, Clinical Neuropsychologist and Couples Therapist and Laura Thorpe, Safeguarding Adults Manager at Ann Craft Trust.

This information was last reviewed in 2023.