Emotions and behavioural changes
The consequences of brain injury are different for everyone. It depends on the location of the damage in the brain and the severity of the damage.
Every injury is different!
N.B.! When an outsider makes a judgement about the emotional and / or behavioral changes of a person with brain injury, this can be very painful for this person. It may be experienced completely differently 'from the inside' by the person affected.
The consequences of brain damage in terms of behavior and emotion can be manifold and can be divided into psychiatric disorders (e.g. depression, hallucinations, delusions), behavioral problems (e.g. aggression), personality changes (e.g. more are self-centered or milder and gentler).
In many cases, the changed behavior does not arise from unwillingness but rather from inability.
Change on the emotional level
Anxiety can arise because life suddenly has changed in a negative sense. That brings uncertainty. Moreover, it may be that a person has experienced a life-threatening situation. This also brings uncertainty.
There may also be changes in emotions due to processing or acceptance of the brain injury.
There may be flattened or amplified more intense emotions. For example, one person may be angry more quickly or have depressive feelings, while another may no longer show or feel the emotion. Yet another seems to have excessive cheerfulness.
Emotions may be flattened, causing people to feel that they are no longer fully alive. "It's as if I'm living in a daze. My emotions no longer run so deep. Everything seems to have leveled off a bit, both sadness and joy. That is a great shame and is detrimental to social interactions." Another says: "Emotions don't come in as hard. While someone else is in tears from emotion or hearing bad news, nothing happens to me."
Some people are no longer able to cry due to brain damage. That can be a major obstacle in life. People may be able to feel the emotion, but the tears that can provide relief from this emotion do not flow. An experience expert puts it this way: "I am often 'full' and then think: what a relief it would be if I could cry now. But I can't do it anymore. It seems as if I have run out of tears."
On the other hand, emotions can also be more on the surface, causing tears to flow more quickly in the person with a brain injury. This does not always mean that he or she is sad or gloomy, but a mildly felt emotion such as compassion, emotion, frustration, tiredness, overstimulation can lead to tears in the eyes. Many people with brain damage call themselves 'emotionally incontinent'; the tears just roll out of the eyes.
When an emotional response is out of proportion to the situation, this is called emotional lability. Read more about crying and brain injury.
Having become friendlier or milder
There are also people with brain damage who have become more emotionally sensitive or more empathetic, friendlier or more vulnerable.
It is painful for these people to notice that emotional, character and behavioral changes caused by brain damage are usually spoken of in a negative sense.
The emotions are experienced more strongly due to the increased sensitivity, making life more intense and tiring.
Uncontrollable crying in fits of crying
When crying or laughing comes in attacks and occurs unconsciously and uncontrollably, this is called compulsive crying/compulsive laughter or Pseudobulbar effect (PBA).
It is important to distinguish and diagnose this properly because medication can provide relief. PBA resembles a depression, but the person does not have the sadness or enormous depression as with depression.
Overstimulation by emotions
Getting into tears can be caused by fatigue and by sensory, cognitive or even emotional overstimulation.
It is important that bystanders know that many people are ashamed of this, but cannot change it. Some people laugh it off.
Please ask these people what caused the tears. This creates clarity.
People with brain damage were once labeled as emotionally 'unstable'.
A person can be so intensely tired and overloaded due to the brain injury that she or he can do nothing but cry. Only if the crying by tiredness leads to falling asleep it can provide relief, otherwise not. Compare having a brain injury to an old battery that charges too slowly and runs out quickly. Emotions take so much energy.
NB! Crying due to overstimulation can coincide with crying due to fatigue.
Underlying neurodegenerative disease or neuropsychiatry
Crying can mask underlying degenerative suffering of MS, ALS, vascular dementia, Alzheimer's, Pseudo Bulbar affect
If the personality has changed enormously and all emotions seem magnified and/or inappropriate, you may consider calling in a neuropsychiatrist.
Less self-confidence and feeling like a burden
People with brain injuries may feel ashamed of who they have become as a result of the injury and may experience less self-confidence than before. They can feel like a burden.
Others seem to have reduced empathy, while others have greater empathy and are milder. No injury is the same.
Tension, emotions, many external stimuli. Something that was fun can suddenly become too much. This is related to fatigue.
'Mood swings' can suddenly occur. The brain can no longer put it all together. This can cause loss of overview and sometimes loss of self-control.
Hot weather can also cause someone to react differently and even become irritated. People with neurological disorders may respond physically and cognitively to summer temperatures. It is also known that stormy weather can affect people's functioning. Everything becomes more difficult, which can have an impact on behavior and mood.
No one is given a manual for brain injury.
Anything that is permanently damaged will have to be discovered through trial and error. Almost every person with a brain injury will try to fight back to the 'old and familiar level'. But every injury involves damage. What damage? The damage becomes recognizable over time or can be inventoried with, for example, a list of tests.
In the meantime, the person with a brain injury feels like walking on tiptoes when something no longer works properly.
Unnoticed, signals may be given to the environment, causing something to be interpreted as irritability, stress or self-focus.
Over time, the person with brain injury (or the partner/caregiver) may realize that he/she:
- no longer has a sense of time
- no longer has an overview
- can no longer plan well
- can no longer estimate speed
- is impulsive and cannot think through the consequences,
- can no longer estimate her- or himself
- has reduced orientation (where did I put this or where is that street?) while someone can still be completely intelligent
- has difficulty keeping his or her own head above water and therefore has less regard for others. That person needs all the concentration to stay upright. It may then seem that the person is less empathetic or egocentric and self-oriented
- The person with a brain injury appears to be a different person than before the injury. He or she is no longer the same. The basic mood may have changed
- After a brain injury, someone may have difficulty finding a balance between relaxation and effort
- It happens that one day everything goes well for the same person and the next day everything seems to go wrong and everything fails
- One person is more chaotic or has no inhibitions, keeps repeating and is stuck in an emotion (perseveration), while another no longer takes the initiative. There are different manifestations of disinhibition
- Behavior can change due to invisible consequences of brain damage
- When someone has reduced insight into her or his illness, this can lead to dangerous behavior or overestimation of self
- When someone cannot learn from experiences or generalize, this can also lead to overconfident behavior
- A person can underestimate him- of herself and no longer dare to do anything due to a lack of self-confidence. More insecure behavior may occur because everything becomes more difficult due to the brain injury
Unfortunately, the environment can also significantly underestimate or overestimate the person with brain injury. Get to know people!
Disturbed control over one's own behaviour
Due to the injury (for example, frontal injury) there may be disturbed control over one's own behavior:
- more easily irritated or aggressive,
- experiencing no boundaries,
- disinhibited behavior in, for example, heightened emotion, binge eating, spending money,
- experiencing no limits in doing good,
- lost self-reliance,
- taking less/no initiative, apathetic, more passive behavior,
- less empathetic,
- withdrawing, being more focused on oneself,
- difficult to get going at the beginning of the day.
Character traits can strengthen and people can change
About half of people with injuries appear to have some form of character change.
Character traits may be more present than before the injury, but people can also really change. Someone may exhibit 'socially maladaptive' or aggressive behavior. The injury may cause someone to swear a lot or have an altered sense of humor. Others may become softer, milder.
The majority of websites about brain injuries only mention the 'negative changes'. This is very stigmatizing. Only half of people with injuries have changes in character. Some of these people change for the better. It is important to also mention that the injury has made people gentler or friendlier. Negative character changes therefore seem to be more noticeable. This creates a disturbing and distorted picture of reality and gives a negative label to people with brain damage.
Right hemisphere behavioural changes and frontal damage
In general, damage in the right hemisphere and in the
forehead /(frontal syndrome) causes more behavioural changes and personality changes than damage in the left hemisphere. Injury to the left hemisphere, on the other hand, increases the risk of aphasia, which makes communication difficult and can be very frustrating. In left-handed people, the brain functions may be different.
Examples of behavioral change as a direct result of brain injury
- Behavior that occurs because the person with brain injury and those around him do not yet realize where the pitfalls of the injury are. For example, the person no longer has a sense of time. He or she has not yet realized this and will then be somewhat stressed about 'time'; rushing others under time pressure, being afraid of always being late, wanting to finish something regardless of fatigue. Over time, one must realize what is broken. This can cause considerable irritation among bystanders who observe the behavior but do not recognize or empathize with the cause.
- Behavior that causes someone to have motor restlessness or to be unable to sit still. Being verbally restless and talking too much or too loudly. Someone may be disinhibited when eating and drinking and therefore go on and on or may be sexually disinhibited,
- Behavior resulting in loss of initiative, apathy, inability to get going or indifference. This also includes the absence of emotional reactions,
- Socially inappropriate or indecent behavior,
- Depressed or sad mood,
- Not being able to stop emotions such as laughing or crying, compulsive laughing or compulsive crying,
- Self-focused, self-centered behavior that a person did not exhibit before the injury,
- Absence of empathy after traumatic brain injury. This is due to the injury itself and the location of the injury in the brain. It is not unwillingness. Here you can read about a therapy for it,
- Rapid and unpredictable mood swings; emotional lability,
- Claiming behavior. Often seen in combination with
- Changed behavior in intimacy or sexuality,
- Suspicion, for example, as a result of a disturbed memory function,
- Agitated behavior, for example, as a result of overstimulation as a result of mental fatigue (occurs more quickly with mental slowness). Overstimulation is an expression of inability, that there is no escape from the hustle and bustle or from the sickening stimuli,
- Being aggressive in words or actions or both,
- Physical aggression, for example, when verbal expressions of frustration are not possible due to aphasia,
- Absence of emotional responses, being unmotivated, lethargic (apathy),
- Disinhibited and impulsive behavior.
Examples of behavioral change as an indirect consequence of brain injury
- Behavior and emotions that can be explained as a tangible response to the brain injury that has happened to someone. The condition is that someone has insight into the consequences of the brain injury,
- Behavior that is characteristic of coping with loss of functions, skills and future prospects. It can involve emotions such as denial, anger, fear, depression, rebelliousness or indifference. These emotions often only occur at the end or after rehabilitation.