The Emotional Effects of Traumatic Brain Injury (TBI)

Irritability
McKinlay et al. (1981) reported that 71% of a sample of TBI patients were described as irritable. Oddy et al. (1985) also found that irritability was the most common emotional change in patients who had sustained a TBI. Irritability has repeatedly been found to be a condition that occurs after a TBI in other studies as well (Hinkeldy & Corrigan, 1990; Dikman et al., 1989; Van Zomeren & van Den Berg, 1985).

Anhedonia and Depression
Anhedonia, or a loss of interest in activities that were once pleasurable, can be a reaction to a traumatic event such as a TBI, loss and/or failure, and can be an indication of depression (Prigatano et al., 1986; Hornung et al., 1981; Goldstein, 1952). Like batterers, a high frequency of depression has been reported among men who have sustained a TBI (Warnken & Rosenbaum, 1994). Brooks et al. (1987) found that 63% of a TBI population met criteria for depression within the first seven years after the injury occurred.

Perceived Helplessness and Depression
Patients who have sustained TBIs resulting in neuropsychological impairment may feel that they lack the skills and ability to exercise control over their lives. A negative attributional style, or a sense of a lack of control over life events may in turn, also lead to depression (Brown et al., 1988). Patients who are experiencing higher levels of depression and perceived helplessness, are often less active and discriminative in thinking tasks requiring action, initiation, and control (Kofta, 1993). This may potentiate even greater feelings of helplessness.
Research that has been conducted on helplessness has found that in uncontrollable situations people engage in intensive, yet unproductive cognitive problem-solving activities that do not yield positive results, despite their efforts. Sedek, Kofta, and Tyszka (1993) have hypothesized that prolonged exposure to such situations may lead to cognitive exhaustion, which can cause a generalized inhibition of the active processing of external stimuli. In such cases, there is tendency to oversimplify, or to rely on preconceived notions, which may cause impaired judgment and/or performance. Thus it would seem plausible that the decrease in abstract reasoning and concept formation, associated with the deficits in executive functioning seen in TBI patients may have an secondary environmental component that further exacerbates the biological injury.

Avoidance
Mikulincer (1989) observed that a tendency to turn inward increases the debilitating effects of unsolvable problems. Unsolvable problems have been found to be linked to the antecedent occurrence of “escape thoughts,” indicating an attempt on the part of the participant to distance themselves from the situation (Mikulincer, p. 133, 1989), a characteristic often noted in domestically violent men (Holtzworth-Monroe & Stuart, 1994; Waltz et al, 2000). Schontz (1975) and Klinger (1975) suggest that performance failure leads to task avoidance, which causes cognitive detachment that in turn impairs performance to an even greater extent. Over time this pattern may result in the development of cognitive helplessness, and a tendency to avoid discriminative reasoning (Sedek, 1993). It would appear that an avoidance of discriminate reasoning and greater cognitive detachment might lead toward a greater propensity of relying on physical force, as a means of problem-solving. This could result in an increase in marital aggression. It would appear that this could be especially true for TBI patients who have experienced performance failure as a result of their head injury.

Dependency Needs
The tendency of TBI victims to be more dependent on their spouses appears to be related to TBI victims’ higher levels of aggression post-injury. The head injured person’s increased dependency and likely feelings of increased helplessness may be a contributor to higher levels of aggression (Hamberger et al., 1996). Although West and Sheldon (1988) described compulsive care-seeking attachment within the context of battering, it appears likely that compulsive care-seeking attachment may also be a prominent feature in a person who has suffered impairment as the result of a head injury. Individuals who were once independent, often become limited in their ability to care for themselves after sustaining a TBI, and become more dependent –both physically and emotionally – on their partners and family members. Their increased dependency on others for care, along with feelings of increased vulnerability may result in a compulsive cake-seeking style of attachment which, as described earlier, can lead to violent behavior.

Self Esteem
Failure and a greater reliance on others may also threaten self-esteem, which increases both the likelihood of preoccupation with self-concerned thoughts and the person’s anxiety level (Snyder, Stephan, & Rosenfield, 1978). When a threat to self-esteem exists in such situations, there is a greater tendency to withdraw from active problem-solving and to assume a more defensive posture (Sedek et al., 1993). Patients who are unable to successfully complete problem-solving tasks have been observed to become anxious, depressed, irritable and apathetic on the basis of the psychosocial changes alone (Prigantano, Pepping, & Klonoff, 1986).