Traumatic brain injury, often referred to as TBI, is most often an acute event similar to other injuries. That is where the similarity between traumatic brain injury and other injuries ends. One moment the person is normal and the next moment life has abruptly changed.
In most other aspects, a traumatic brain injury is very different. Since our brain defines who we are, the consequences of a brain injury can affect all aspects of our lives, including our personality. A brain injury is different from a broken limb or punctured lung. An injury in these areas limit the use of a specific part of your body, but your personality and mental abilities remain unchanged. Most often, these body structures heal and regain their previous function.
Brain injuries do not heal like other injuries. Recovery is a functional recovery, based on mechanisms that remain uncertain. No two brain injuries are alike and the consequence of two similar injuries may be very different. Symptoms may appear right away or may not be present for days or weeks after the injury.
One of the consequences of brain injury is that the person often does not realize that a brain injury has occurred.
A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems.
Some people may experience emotions very quickly and intensely but with very little lasting effect. For example, they may get angry easily but get over it quickly. Or they may seem to be “on an emotional roller coaster” in which they are happy one moment, sad the next and then angry. This is called emotional lability.
Anxiety is a feeling of fear or nervousness that is out of proportion to the situation. People with brain injury may feel anxious without exactly knowing why. Or they may worry and become anxious about making too many mistakes, or “failing” at a task, or if they feel they are being criticized. Many situations can be harder to handle after brain injury and cause anxiety, such as being in crowds, being rushed, or adjusting to sudden changes in plan.
Some people may have sudden onset of anxiety that can be overwhelming (“panic attacks”). Anxiety may be related to a very stressful situation— sometimes the situation that caused the injury—that gets “replayed” in the person’s mind over and over and interferes with sleep (“post traumatic stress disorder”). Since each form of anxiety calls for a different treatment, anxiety should always be diagnosed by a mental health professional or physician.
Feeling sad is a normal response to the losses and changes a person faces after TBI. Feelings of sadness, frustration and loss are common after brain injury. These feelings often appear during the later stages of recovery, after the individual has become more aware of the long-term situation. If these feelings become overwhelming or interfere with recovery, the person may be suffering from depression.
Symptoms of depression include feeling sad or worthless, changes in sleep or appetite, difficulty concentrating, withdrawing from others, loss of interest or pleasure in life, lethargy (feeling tired and sluggish), or thoughts of death or suicide.
Because signs of depression are also symptoms of a brain injury itself, having these symptoms doesn’t necessarily mean the injured person is depressed. The problems are more likely to mean depression if they show up a few months after the injury rather than soon after it.
Family members of individuals with TBI often describe the injured person as having a “short fuse,” “flying off the handle” easily, being irritable or having a quick temper. Studies show that up to 71% of people with TBI are frequently irritable. The injured person may yell, use bad language, throw objects, slam fists into things, slam doors, or threaten or hurt family members or others.