A brain injury can sometimes ‘rewire’ a person’s personality, causing their behaviour and emotional reactions to change. Exactly what is changed will depend upon which parts of a person’s brain are injured e.g. the frontal lobe controls our personality and our impulsivity.
If this area of the brain becomes damaged after injury, it is possible that the person has reduced self-control or restraint and may not be able to moderate their emotions, resulting in irrational behaviour.
The person may also go to the other extreme, and have what seems to be an emotionless personality.
This is known as “flat affect”. These types of symptoms are perhaps less obviously noticeable than physical problems, but also have a large impact.
It is often the case that the injured person does not realise that they are now acting differently compared to how they were before.
Examples of behavioural and emotional changes may include:
- Mood swings
- Lack of judgement, awareness and disinhibition
- Inflexibility / stubbornness
- Sexual problems
A brain injury can sometimes change a way that a person feels or expresses their emotions. Damage to the frontal lobes may mean that they lose the ability to regulate their emotions, and experience random mood swings that are unrelated to how they are actually feeling.
Unpredictable outbreaks of laughter or crying are common and they may feel like they are on an ‘emotional roller-coaster’. They may have a reduced tolerance for stress and frustration, so even something as minor as having the television volume too loud or losing a set of keys can lead to an extreme verbal or physical outburst.
e.g: seemingly random changes from one emotion to another
Lack of judgement, awareness and dis-inhibition
The ability to evaluate and adjust our personal behavior to the circumstances around us is a complex skill, largely controlled by the brain’s frontal lobes.
Damage to this area can affect self-awareness, insight into the consequences of one’s actions, and ability to show empathy or sensitivity. Those injured may also be unable to distinguish when they are being impolite or breaching social etiquette.
e.g: touching someone inappropriately, speaking your mind regardless of the circumstances, recklessness.
It is not uncommon for a recently injured person to be uncooperative due to disorientation, confusion and anxiety. They may do things like pull out their IV tubes or experience restlessness because the behaviour acts as a coping mechanism to relieve the stress of the situation.
An unusual level of agitation is most often a temporary symptom, going away with time as the person becomes less confused by their situation.
e.g: restlessness, fidgeting, pacing.
Damage to the frontal lobe can also cause a lack of motivation or spontaneity. This is because the person has reduced levels of emotion and forward planning, which makes activities appear extremely overwhelming.
e.g: staying in bed all day, a lack of interest in previous hobbies.
Once the rehabilitation process starts, it is very common for the person to experience depression. This is especially the case towards the later stages of rehabilitation, as they realise the full extent of the problems caused by their injury and any permanent damage that they will have to cope with.
It is worthwhile to note that depression is an important stage of mental recovery, because it means they are aware of the reality of their situation. Only then can the person begin to accept the situation and move forward.
e.g: wishing they had not survived the accident, believing life will never be good again.
It is normal for an injured person to suffer from anxiety, due to the loss of confidence they experience with situations and tasks that used to be commonplace but are now difficult, e.g. if the person has writing difficulties, they may be worried about signing documents.
It is important that these difficult situations are faced head on, with an attitude of independence in mind, because if these fears are left to fester then the more likely they are to become a long-term problem.
e.g: panic attacks, paranoia, poor quality sleep.
Inflexibility and obsessionality
The frontal lobe is where our ability to reason and make sense of things originates. If damaged, the person may be unable to do things differently, and stubbornly stick to a routine or habit.
This is because they have lost the ability to consider alternatives on their relative merit, and make a decision based on that analysis. Anxiety will make this worse because the injured person may think that sticking to a routine will make them feel better.
e.g: strange patterns of behaviour, unreasonable stubbornness, over-attachment to belongings.
A person’s sex drive can either increase or decrease. There are a great many physiological and psychological reasons for this, most of which are due to the hypothalamus (an important structure in the brain which controls hormone levels) being over or under-active.
e.g: increase or decrease in sex drive, misinterpretation of sexual advances