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Brain Injury and Behavioral Issues: How to Get Back In Control by Charles Watson


Posted on January 15, 2021

Each year in the United States, more than 2 million are hospitalized for traumatic brain injuries. According to the Centers for Disease Prevention, almost 140 people die every day in the U.S from TBI and those who do survive suffer from long-term disabilities, including memory and cognition problems, movement and sensation difficulties, and emotional and behavioral issues.

The behavior changes that follow a brain injury can lead to problems in your family and social life. It can even increase the risk of a repeat injury. There are a variety of ways in which behavior changes may manifest after TBI. 

Types of behavior changes after brain injury:

Impulsivity: this behavior manifests itself early during the recovery process when the patient is suffering from post-traumatic amnesia. Displaying inappropriate behavior, like sharing personal information freely and crude remarks, is common. With time, some people can regain some control, but they may still struggle with making rash decisions and saying hurtful things.  

Inflexibility and obsessive behavior:  some people, after a brain injury, can get fixated on certain thoughts and actions. They may get angry, confused, or scared when there is a change in their routine; they may also get stuck during a conversation and refuse to change the subject. They may also develop strange behaviors like keeping all the food on their plate separated.

Irritability and aggression:  the most common behavioral issue affecting 70% of the TBI survivor's struggle is anger and touchiness. Damage to the emotional center of the brain, increased sensitivity to pain and noise, and unable to accept the changed status can be some contributing factors. A lot of patience is required to deal with a TBI victim when outbursts occur. However, they need to understand that they should apologize for their misbehavior. 

Apathy: on the other hand, some brain injury victims may appear to be totally indifferent or unresponsive. This may be a form of executive dysfunction, which makes it difficult to initiate actions. Or it may be due to a condition that causes someone to lose emotions, called the ‘flat affect.’

Egocentricity: some people become self-centered and inconsiderate of others post TBI. This does not mean they are intentionally cruel or selfish; it is because some cognitive impairments make them oblivious to another’s feelings and point of view. 

Treatment options for behavioral issues after brain injury:

There are many treatment methods that can be used to treat a certain issue, and for others, you may need to use more than one approach to gain control over your actions.  

  1. Insight-Oriented Psychotherapy: this therapy is suitable for patients with mild cognitive issues but need control with their behavior. This therapy identifies underlying triggers leading to a particular action. Negative thoughts and emotions can be triggered by feelings of loneliness, fear, or even hunger. Once you know the triggers, the therapist will work with you to either avoid or cope with them.
  2. Cognitive- Behavioral therapy: this therapy focuses on your negative beliefs and how to overcome them. These may be your unconscious beliefs that shape how you see the world and thus affect your behavior. For, e.g., CBT therapists will help you discover that your hostile and unfriendly nature may be due to the fact that you believe that people don’t like because of your brain injury. So they will teach you to replace negative thoughts with positive ones. 
  3. Social Skills Training: to help TBI persons with interpersonal communication, this therapy helps you learn which behaviors are appropriate by different role-playing situations in a safe environment.