In the neuropsychology community, some disagreement exists over the degree to which behavioral and emotional disorders following a traumatic brain injury (”TBI”) are caused by the injury itself or by the stress of coping with the resulting disabilities. The consensus seems to be “a little of both.”
The following describes the emotional problems the TBI survivor can experience and some of the reasons they can be expected.
Imagine having difficulty with memory tasks or concentration and being fatigued because you can’t sleep through the night. Imagine being unable to add two numbers in your head or looking in your refrigerator and being unable to make sense of its contents. Things that used to be easy are now incomprehensibly difficult. Do you think you would be irritable?
TBI survivors deal with such frustrations on a continual basis, but recent research has associated heightened irritability immediately after an injury with lesions on the brain’s left cortex. Those whose irritability appears some time after the injury are more likely suffering an emotional response to their diminished abilities.
Anxiety and Depression
Anxiety is unreasonable fear and apprehension that can lead to sleeplessness, restlessness, irritability, fatigue, and difficulty concentrating. Given that each of these by-products of anxiety is also a frequent brain injury symptom, it can make an accurate diagnosis of anxiety difficult. For someone coming to grips with what may be life-long disabilities, a certain amount of fear and apprehension about the future is probably not unreasonable.
When a person’s life and future have changed so dramatically, it seems predictable that the individual would become depressed. But depression can be so severe for many TBI victims that it leads to suicidal thoughts and actions.
Many discussions of emotional problems following a TBI list anxiety and depression together because it is not uncommon for the survivor to suffer both. But one small study found that a group of TBI sufferers with both anxiety and depression had lesions on one side of the brain, while another group experiencing clinical depression without anxiety had lesions on the opposite side. What does it mean? Researchers aren’t yet sure, but future data may reveal an organic basis contributing to both disorders.
Also called “involuntary emotional expression disorder,” mood swings can have the patient literally laughing hysterically one moment and crying inconsolably the next. Angry outbursts over seemingly inconsequential matters may also be part of the package. The patient’s loss of control over emotional responses can strain the family and make social interaction difficult, causing the patient to withdraw and adding fuel to feelings of depression and anxiety.
Most experts agree this condition is a direct result of a brain malfunction because it also occurs frequently in association with Lou Gehrig’s disease, pseudobulbar palsy, stroke, and neurodegenerative diseases. This type of mood swing disorder is associated with frontal lobe injury.
Lack of Emotion
Lack of emotion is also described as apathy, lack of interest, lack of motivation, emotional numbness, or “flat personality effect.” The patient may have no interest in activities and have little response to sad or humorous situations. This condition is also associated with injury to the frontal lobe, which controls emotions and personality.
Some rehabilitation experts make a slight distinction between emotional problems and behavioral problems; possibly because emotional issues affect the patient more severely while behavioral problems tend to have greater impact on people around the patient. Despite this difference in classification, the root causes can also be a mixture of organic injury and stress response.
Typical behavioral problems experienced by traumatic brain injury survivors include:
- Inappropriate sexual behavior
- Extreme temper
- Manipulative behavior
Treatment for Emotional Problems
Treatment for emotional problems typically involves psychotherapy, behavioral therapy or rehabilitation, and/or medication. Each case is unique, and the patient’s physicians must develop an individualized treatment plan suited to the patient’s specific injury, symptoms, and tolerances.
- Overview of the Traumatic Brain Injury Recovery Process
- Cognitive-Behavioral Brain Injury Rehabilitation
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