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Emotional and behavioural effects of brain injury

Everyone who has had a brain injury can be left with some changes in emotional reaction and behaviour. 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.

Our range of publications give much more detailed information on the effects of brain injury. They are available to buy from our online shop. Use the links on the right to go to the online shop homepage, or straight to relevant publications.

Headway's network of local groups & branches are an excellent source of advice and support for the person with a brain injury and members of the family. Go to the 'In your area' section to find your local service.

This subject is very large, and not everybody will experience all of the problems below. The severity of the problems will also vary.

Emotional and behavioural effects can be divided into 11 different areas:

Agitation

For example, restlessness, pacing and pulling at intravenous tubes.

This can be as a result of direct neurological damage, and frequently occurs at a very early stage after the accident. It can be a coping mechanism for the patient, who may be disorientated and very confused. It is a stage through which a person passes, rather than a permanent change.

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Explosive Anger and Irritability

For example, exaggerated angry reaction to apparently minor annoyances.

Direct damage to the frontal lobes, which is the part of the brain which controls emotional behaviour and tolerance of frustration, can create emotional lability. This means emotions can swing to extremes. The stress of coping with even minor crises, such as misplaced shoes or a noisy vacuum cleaner, can be too much and trigger an angry outburst. If these stresses can be identified, they may be able to be reduced.

Our booklet 'Managing Anger after brain injury' contains practical advice for coping.

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Lack of Awareness and Insight

The mental ability to monitor personal behaviour and adjust it accordingly is a sophisticated skill contained in the frontal lobes of the brain. Damage to this area affects the ability to be self-aware, have insight into the effects of personal actions, show sensitivity or feel empathy. It also means that a person may not fully appreciate or understand the effect that the accident is having on their life, health or family.

Involvement in a brain injury support group, such as one of Headway's local groups & branches, can be very useful for meeting people at various stages of recovery who can help a person recognise difficulties they may also be experiencing.

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Impulsivity and Disinhibition

For example, speaking your mind no matter what the circumstances, touching people inappropriately, and not considering the consequences of any action.

This is the lack of ability to control either actions or speech, and is due to neurological damage to the frontal lobes. This problem often goes hand in hand with lack of awareness, and the person may not be aware of breaching any social rules or etiquette.

A behavioural management system devised with the help of a neuro-psychologist can help improve the situation, and prevent a person developing unacceptable behaviour through habit.

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Emotional Lability

This describes a person's tendency to laugh and cry very easily and to move from one emotional state to another very quickly.

Loss of control over emotions means the person has lost the ability to discriminate about when and how to express their feelings. This can be very tiring and embarrassing for family members to deal with, but in time a person can begin to re-learn emotional control.

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Self-Centredness

For example, not showing any interest in family matters, and only being concerned with personal needs.

This can be partly due to direct brain injury affecting a person's ability to judge how another person is feeling, and may be partly due to a person becoming accustomed to the huge amount of attention focused on a head injury survivor while they were in hospital.

The result can be very hard to cope with. It needs to be handled firmly to avoid a family feeling their effort and love are not appreciated.

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Apathy and Poor Motivation

For example, no interest in hobbies enjoyed previously, or not being bothered to get out of a chair all day.

Lack of motivation or spontaneity, or apathy, is a direct result of brain injury to frontal lobe structures that concern emotion, motivation or forward planning. Over time, lack of motivation can lead to social isolation and lack of pleasure. To help, activities can be broken down into small steps to avoid overwhelming the person.

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Depression

For example, feeling there is no point in having survived the accident, or thinking that everything has changed for the worse.

Depression is a very common emotional reaction which comes on in the later stages of rehabilitation, often when a person realises the full extent of the problems caused by the accident. This can be seen as a good sign, that a person is aware of the reality of the situation, and is coming to terms with the emotional consequences. 'Healthy' depression can be worked through in time, as adjustments are made.

If a person feels emotionally blocked and unable to move on, professional counselling from someone who understands head injury may be helpful.

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Anxiety

For example, panic attacks, nightmares, and feelings of insecurity.

It is natural for people involved in a traumatic experience to feel anxious afterwards. Loss of confidence when faced with situations and tasks which are difficult to cope with is also a pretty normal reaction. However, long standing problems can occur if difficult situations are continually avoided, or if carers encourage dependence rather than independence.

Talking about fears and worries is very helpful, and adopting methods of staying calm under stress can reduce the effect of anxiety on everyday life.

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Inflexibility and Obsessionality

For example, unreasonable stubbornness, obsessive patterns of behaviour such as washing or checking things, or fear of possessions being stolen.

The ability to reason must not be taken for granted. The roots of this type of rigid behaviour are in cognitive difficulties resulting from damage to the frontal lobes. The person can lose the ability to jump from one idea to another, and becomes 'stuck' on one particular thought.

This type of behaviour is often made worse by anxiety or insecurity, so reassurance is helpful, as is trying to redirect attention to more constructive ideas and behaviour. This type of behaviour can be very irritating to family and friends, and often leads to social isolation.

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Sexual Problems

For example, increased sex drive, promiscuity, or misinterpreting other people's behaviour as a 'come on'.

The sexuality of a person who has experienced a head injury can be either increased or decreased as a result of the physical damage for a variety of psychological reasons.

Damage to the hypothalamus, a small nerve centre in the middle of the brain, affects sex drive and the release of testosterone.

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