Traumatic Brain Injury (TBI) And The Psychiatric After-Effects
If you have ever known anyone that has suffered brain injury, whether from an accident, stroke or other medical complication, or, from aggressive, long term engagement in sports (ie. Football, Hockey), no doubt, you have seen them develop significant behavioral changes after the injury.
Brain injury can contribute to psychiatric issues such as anxiety, depression, substance abuse, obsessive compulsive disorder, or other addictions. Some survivors will experience post-traumatic stress disorder (PTSD) as a consequence of the circumstances and medical events that caused the brain injury. The most common change however that is reported, is the altered state of the individual’s mood. It is often reported by loved ones of the person, that they went from being incredibly kind, calm, and even tempered, to down right-angry and unpredictable (Psychology Today, 2012).
The following, are the most common difficulties that TBI survivors and their loved ones face:
1. Trust Issues: The unpredictability of the TBI survivor’s angry eruptions or accusations make it harder to maintain the trust so essential for any relationship. It is commonly reported, that the loved one feels as though, they are ‘walking on eggshells all the time’.
2. Integrity Issues: After an anger outburst, the TBI survivor feels guilty, shameful, and regretful, but also feels that they had no control over the outburst to begin with.
3. Emotional Pain Inflicted on loved one of TBI survivor: This goes without saying. Usually the one closest to the TBI survivor gets the anger outbursts the worst, and later on, the TBI survivor does not remember what they did. They will use justification tactics a great deal of the time too. Ex.: ‘You made me yell at you. You are always trying to control me’.
4. Troubles with conflict resolution: Loved ones of a TBI survivor often report, that arguing with them, is like arguing with a brick wall. It is futile.
5. Decreased intimacy: Loved ones of the TBI survivor state that due to the unpredictability of emotions and anger outbursts, the motivation to be intimate with that person is significantly decreased.
6. Risk of injury: With the increase in anger outbursts and issues, comes the threat that the TBI survivor can in fact become physically violent.
How To Cope With A TBI Survivor’s Behaviors
The following are tactics and techniques specifically for caregivers/loved ones that are dealing with a TBI survivor’s unpredictable behaviors and angry and aggressive attitude:
1. Try to remain as calm as you can. Ignore the behavior, and remember that the behavior is NOT the person.
2. As difficult as this may be to do, try to simply agree with the person when they are being unreasonable and unrealistic. This will likely diffuse a potential intense argument.
3. Validate the TBI survivor’s feelings. Know that, they are frustrated themselves with the loss of their functional and cognitive abilities.
4. Do not confront the person on the fact that they are wrong about something. Use negotiating skills instead. For example, if they do not like the plans that are being made for the upcoming weekend, ask them to choose the plans instead.
5. Present anger management options to them. Great ideas are hitting a punching bag, yelling in the backyard (especially if they have a big piece of property behind), and writing down all the things that they are angry about.
6. Caregivers and loved ones of a TBI survivor need support themselves. Seek out professional help from a therapist such as myself, and/or support groups that are available for TBI survivors and their families.
7. Finally, remember that, safety comes first! If the TBI survivor is escalating to the point where they are a threat to themselves or others, law enforcement needs to be contacted, as well as having a safety/escape plan in place-and ready to be utilized if needed.