Dating with a brain injury

The dark side of personality change is at the top of the list. In my recent post, After Brain Injury: Learning to Love a Strange r, I shared my experience of building a new relationship and marriage with my husband Alan. Alan suffered a severe anoxic brain injury following a massive heart attack and cardiac arrest. Most of the time, Alan displayed his engaging pre-injury personality marked by kindness, love, curiosity, and humor.

However, post-injury personality changes also meant that we dealt with bouts of intense anger , confusion, and unpredictable behavior. Sometimes his moods shifted so suddenly that I called it " Jekyll and Hyde syndrome. One was rational and easy-going, but the other was frightening and even dangerous at times. Why brain injury affects emotions First, some background. Brain injury sometimes causes subtle or pronounced changes in personality.

Damage to specific areas of the brain, including the frontal and temporal lobes, amygdala, and hippocampus might leave the survivor vulnerable to agitation, volatile emotions, memory impairment, verbal attacks, physical aggression, and impaired impulse control. Physical vulnerability combines with emotional responses to life changes to cause problems. These problems might occur only occasionally, or be a repeated challenge to daily functioning and relationships.

Alan had damage to the areas above, and that meant his executive functions were impaired. Executive functions refer to the complex group of skills we use to plan, make decisions, problem solve, self-monitor, make sound judgments, and get along with others. He also had both short and long term memory impairmen t. The combination, not uncommon in severe brain injury, was the "perfect storm" for behavioral outbursts.

The angry outbursts could be triggered by his awareness of losses, wanting more control over his life, or not understanding the reasons behind safety measures such as no longer being able to drive his car.

I understood that they were an attempt to communicate distress and handle the situation as he saw it. We worked hard to prevent and minimize the outbursts, and to use strategies to improve communication and self-control. Psychiatric issues after brain injury Brain injury can also contribute to psychiatric issues including depression , severe anxiety, substance abuse, or obsessive compulsive disorder. Some survivors experience post-traumatic stress disorder PTSD as a consequence of the circumstances and medical events that caused the brain injury.

We quickly learned that anxiety or depression made Alan more susceptible to angry outbursts or threatening behavior. He often responded well to the judicious use of medications to modulate depression, anxiety, and agitation for years after the injury. We never used medications in place of attention, communication, behavioral strategies and keeping environmental stimulation within his comfort zone. However, I came to appreciate their value.

So, how did personality change impact us? Personal integrity—When Alan remembered what he had said or done, he often felt ashamed, guilty , and "Like some other guy is living inside me, not myself. Emotional pain—On many occasions, Alan yelled at me, and then took a nap to calm down.

Biting my tongue and suggesting a proven technique to calm down was more fruitful. And yet, I yearned to have the kind of argument couples have to clear the air and resolve a problem. Decreased intimacy —There were several times when Alan said hurtful things and threw his clothes around in an agitated outburst. He quickly forgot the incident and suggested that we make love. I withdrew, since it took me days to guardedly trust in his predictability again.

Risk of injury—Alan never struck me, but he did hit his home health aide and threaten to hit others. When angry, he rallied his limited strength and could be dangerous. Families need training in how to prevent or deal with such incidents. Even health care professionals are unaware of how common verbal and physical aggression are at home. Please continue to Part 2 of this article for information on anger management strategies. In my memoir, Professor Cromer Learns to Read:

NeuroInternational provides supported living programs for traumatic brain injury (TBI) and spinal cord injury patients in Florida and Michigan. Drugs for behavior disorders after traumatic brain injury: Systematic review and expert consensus leading to French recommendations for good practice.

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