Emotional and behavioral difficulties following TBI can be a direct consequence of injury to the brain if regions involved in emotional processing are affected. They can also result from difficulties coping with problems experienced following the brain injury, and/or can be associated with pre-existing emotional difficulties (e.g., problems with depression/anxiety prior to the TBI).
Research suggests that more than 50% of individuals who have sustained a brain injury may experience depression or other emotional difficulties (e.g., anxiety). Treatment for these emotional and behavioral difficulties typically includes medications and psychotherapy.
Specific psychological consequences that are often associated with TBIs include:
Depression is a feeling of sadness, loss, despair or hopelessness that does not improve over time and is so overwhelming to the individual that the condition interferes with the individual’s daily life. When an individual feels depressed or is losing interest in usual activities at least several days per week and the symptoms last for more than two weeks, depression may be the root of the problem.
Symptoms of depression include:
- Feeling down, sad, blue or hopeless
- Loss of interest or pleasure in usual activities
- Feeling worthless, guilty, or that you are a failure
- Changes in sleep or appetite
- Difficulty concentrating
- Withdrawing from others
- Tiredness or lack of energy
- Moving or speaking more slowly, or feeling restless or fidgety
- Thoughts of death or suicide.
Sadness is a normal response to the losses and changes a person faces after TBI and will be experienced by the majority of individuals who suffer a TBI. However, prolonged feelings of sadness or not enjoying the things that one used to enjoy are often key signs of depression, especially if an individual is also suffering from some of the other symptoms listed above. Depression is a common problem after TBI, and roughly half of all individuals with TBI are affected by depression within the first year after injury. Even more (nearly two-thirds) are affected within seven years after injury. In the general population, depression affects fewer than one person in 10 over a one-year period. Over half of the individuals with TBI who experience depression also deal with significant anxiety.
Depression may occur while the individual struggles to adapt to temporary or lasting disability and loss, or to changes in the individual’s roles in the family and society caused by the brain injury. Depression may also arise if the injury has affected areas of the brain that control emotions. Both biochemical and physical changes in the brain can lead to depression.
Treatment of Depression
A vast number of treatment options and techniques are available to help individuals experiencing depression after suffering a TBI. If you have symptoms of depression, it is important to seek professional help as soon as possible with a health care provider who is familiar with TBI. Depression can be a medical problem, just like high blood pressure or diabetes.
An individual cannot overcome depression by wishing it away or using more willpower. Anti-depressant medications and counseling from a mental health professional who is familiar with TBI, or a combination of the two, can help most people who have depression. Aerobic exercise and structured activities during each day can sometimes help reduce depression. Seeking treatment early is the best course of action to prevent needless suffering and worsening symptoms.
Anxiety is a feeling of fear or nervousness that is out of proportion to a given situation. Individuals with TBI may feel anxious and not know the reason why or may worry and become anxious about making mistakes, failing at a given task, or about whether or not they will be subjected to criticism.
Situations that once presented no difficulty to an individual can be more difficult to handle after brain injury and cause anxiety, such as being in crowds, being rushed, or adjusting to sudden changes in plan. Some individuals may experience a sudden onset of anxiety that can be overwhelming which is commonly referred to as panic attacks. Since each form of anxiety calls for a different treatment, anxiety should always be diagnosed by a mental health professional or physician.
The onset of anxiety after suffering a TBI is often caused by a number of different factors. Difficulty reasoning and concentrating can make it hard for the person with TBI to solve problems. These situations can lead to an individual feeling overwhelmed, especially if he or she is being asked to make decisions. Anxiety often happens when there are too many demands on the injured person, such as returning to employment too soon after injury. Time pressure can also heighten anxiety. Situations that require a lot of attention and information-processing can make people with TBI anxious. Examples of such situations might be crowded environments, heavy traffic or noisy children.
Personality changes; anger; irritability or agitation; difficulty controlling emotions; emotional lability; and mood swings
A brain injury can change the way an individual feels or expresses emotions. An individual with TBI can have several types of emotional problems. Some individuals may experience emotions very quickly and intensely but with very little lasting effect. For example, individuals with TBI may anger easily but get over it quickly or they may seem to be on an emotional roller coaster in which the individual is happy one moment, sad the next and then angry. This cycle is referred to as emotional liability.Mood swings and emotional liability are often attributable to damage to the part of the brain that controls emotions and behavior. Often times there is no specific event that triggers an individual’s emotional response which can be confusing for family members who may think they accidently did something that upset the injured person.
In some cases the brain injury can cause sudden episodes of crying or laughing. These emotional expressions or outbursts may not have any relationship to the way the individual feels. In some instances the emotional expression may not match the situation (such as laughing at a sad story). Usually the individual is unable to control their expressions of emotion. Fortunately, this situation often improves in the first few months after injury, and individuals commonly return to a more normal emotional balance and expression. If an individual with TBI is having problems controlling emotions, it is important to talk to a physician or psychologist to find out the cause and get help with treatment.
Family members of individuals with TBI often describe the injured person as being irritable or having a quick temper. Temper outbursts after TBI are likely caused by several factors such as Injury to the parts of the brain that control emotional expression; Frustration and dissatisfaction with the changes in life brought on by the injury, such as loss of one’s job and independence; Feeling isolated, depressed or misunderstood; Difficulty concentrating, remembering, expressing oneself or following conversations, all of which can lead to frustration; experiencing fatigue or tiredness more frequently and easily; and the pain associated with TBI.
Apathy or fatigue
Fatigue is a feeling of exhaustion, tiredness, weariness or lack of energy. After TBI, an individual may experience physical fatigue, mental fatigue, or psychological fatigue. When experiencing fatigue, individuals are less equipped to think and express themselves clearly or to do physical activities. If overwhelmed by fatigue, individuals have less energy to care for themselves or do things they enjoy. Fatigue can negatively affect an individual’s mood, physical functioning, attention, concentration, memory, and communication skills. Fatigue can also interfere with the ability to work or enjoy leisure activities and can make activities such as driving dangerous.
Fatigue is one of the most common problems people have after a TBI. As many as 70% of survivors of TBI complain of mental fatigue. In individuals with TBI, fatigue routinely occurs more quickly and frequently than it does in the general population. The cause of fatigue after TBI is not clear but may be due to the extra effort and attention required of the individual to do simple daily living activities such as walking or talking clearly. Brain function may be less “efficient” than before the injury.
Other psychological consequences often associated with TBI include:
- Difficulty understanding social norms
- Behavioral disinhibition (i.e., saying the first thing that comes to mind or something inappropriate)
- Mania (mental illness marked by periods of great excitement, euphoria, delusions, and over activity)
- Rigidity, inflexibility, preservation (getting stuck on a topic)
- Psychosis, hallucinations, delusions