Emotional Lability, Anger, and Impulsiveness

A TBI can change the way you feel or express emotions. Often you may experience emotional lability, mood swings or strong feelings like anger.

Emotional Lability is rapid exaggerated changes in mood. You may find yourself finding very strong emotions and feelings. 

Emotional lability often occurs after a TBI especially if there is damage to the area of your brain that controls your emotions and behaviors. Often there is no specific event that triggers a sudden emotional response. In some cases, you can experience sudden episodes of laughing or crying. This may be confusing for friends and family who think they accidentally did something that upset you. These emotional expressions may not have any connection to the way the person ACTUALLY feels (for example you can cry without feeling sad or laugh without feeling happy). In some cases, the emotions may not match the situation - such as laughing at a sad story. 

It’s important for you, and your support system, to know that often you cannot control these expressions of emotion and you may feel like you are an emotional rollercoaster.

Let’s talk about triggers. A trigger is something that sets off a reaction in you. Triggers can be internal (something that comes from a thought or an emotion you create) or external (something in the outside world that causes you to react). The most common trigger for those who have experienced a TBI is overstimulation and/or sensory overload. 

Common triggers of emotional lability: 

  • Overstimulation 
  • Excessive fatigue or tiredness 
  • Stress, worry, or anxiety 
  • Strong emotions or demands from others 
  • Very sad or funny situations, such as jokes, movies, books 
  • Discussing certain topics, such as driving, loss of job, relationships, death of family member 

Strategies for coping with emotional lability 

  • Become aware of triggers and try to avoid them. Consider keeping a mood log to help track your emotions and pinpoint your triggers. 
  • Take a break from the situation or person so you can regain control of your emotions 
  • Try to ignore the behavior and suggest your support system does the same. By focusing on the lability and giving it too much attention it could increase the problem. 
  • Change the topic or task to something less stressful or triggering. 
  • Plan ahead and know your limits. Make sure you’re well-rested and avoid putting yourself in a situation with high stress, high demands, and overstimulation. 
  • Deep breathing and/or relaxation techniques to reduce stress and reset yourself

Be aware of your emotional triggers 

As mentioned above, a mood log can help you pinpoint and identify your triggers. Here are some things to add to your mood log or mood journal. 

  • What happened just before the behavior started? 
  • Were there other people involved when the behavior occurred? 
  • Where did it occur? 
  • What is happening in your living space? 
  • Is this a new behavior? 
  • Are there certain actions that make it worse? 
  • Are you trying to communicate a need or desire? 
  • Are there any patterns you can see? For example, is there a time of day, events such as shift changes, a particular caregiver or visitor, substances like drugs or alcohol, sugar or caffeine, or medications that can be a trigger?

When you are experiencing a trigger, ask yourself. . . 

  • What type of situation are you in? Are you safe? 
  • What is happening around you? 
  • What kind of emotions are you feeling? 
  • What thoughts are you having? 
  • What does your body feel like?

Remember that emotional lability is a common challenge after a traumatic brain injury. You may be experiencing a loss of work, ability to drive, independence, changes in your relationships or finances - and there are a lot of emotions that come along with these losses and changes. Feelings of sadness, grief, anger, frustration, disappointment, or depression after a TBI are common. Seek help from a counselor, psychologist, social worker, trusted friend, or family member to help you navigate and manage these feelings. 

MANAGING ANGER 

Excessive anger is often a symptom present after a traumatic brain injury. The brain is made up of a lot of different parts, which control different emotions and behavior. When the parts of the brain that help us control and process emotions become injured, it becomes more difficult to control emotions such as anger. It may also become more difficult to recognize when anger is getting out of control.

Depending on the situation, anger can be either a positive or negative emotion. Anger is often negative when it’s uncontrolled and when it leads to aggressive behaviors. Anger is usually an attempt to communicate - even though it often does the opposite and can shut down communication in a situation. 

Reasons for why you might feel angry 

After a TBI you might find yourself angry for some of these reasons: 

  • Angry about the cause of the injury. You might be angry at the cause or circumstances surrounding your injury. Maybe it was a drunk driver, a distracted driver, an assailant, or another reason. If you are experiencing this type of anger, it’s often recommended that you seek help from a trusted friend, family member or therapist to help you navigate and channel this anger. 
  • Grief reaction. It is human nature to grieve when we lose someone, something, or when we suffer an injury or illness. We often try to find reasons for our losses. One part of a grief reaction is being angry at what we think caused it. This anger can often be displaced onto any convenient target. People can often work through a grief reaction by talking it out with a trusted friend, family member or therapist. It’s important to remember that grief after a traumatic brain injury can be further complicated by poor memory, judgment or emotional or personality changes associated with your injury. 
  • Frustration. When frustration contributes to angry reactions, it can often be helped by trying easier things. You can mentally prepare yourself for situations when you know you’ll likely get frustrated doing difficult tasks. For example, “Now it’s time to go shopping. I know shopping is sometimes frustrating - how will I know if I’m starting to get frustrated and what will I do about it?” 
  • Impaired judgment. It’s common for a TBI to cause impaired judgment which can contribute to anger problems. Cognitive rehabilitation, or checking judgments with people you trust, can help. Alcohol and drug use (or not taking prescribed medications) can contribute to anger problems. 
  • Normal, legitimate anger. Sometimes there are legitimate reasons to get angry. If legitimate anger is discounted, ignored, or treated, you will likely find yourself getting angrier. If anger is expressed inappropriately, your original complaint or issue may be overshadowed by your expression of anger. 

It’s important to remember that a traumatic brain injury can affect how fast you get angry AND it can also affect how intense your anger feels to you. You may find yourself feeling hopeless or overwhelmed by these emotional changes - but there are strategies and techniques you can use to cope with your anger. 

Strategies for coping with anger 

Everyone who experiences anger after a TBI is going to experience it differently. There is not “one right way” to cope with anger - every person is different. The best thing you can do is listen to your body, identify, and acknowledge your triggers, and find coping strategies that work for you. 

Early intervention strategies for coping with anger 

There are things you can practice proactively ahead of time - those are called early intervention strategies.  

  • Learn your anger warning signs, such as - louder talking, making fists, faster heart rate and breathing, sweating, tense muscles, negative thinking, threatening, breaking things, throwing things, hitting, kicking, etc. By knowing your anger warning signs and understanding how you react, you can be better prepared when they arise. 
  • Prevention by finding ways you can PREVENT yourself from getting into vulnerable situations. For example, prevent yourself from throwing objects or breaking objects by removing items from your environment that you’d be most likely to throw. Make plans to avoid temperamental situations. 
  • Do not use drugs or alcohol especially if you know they make you feel irritable. 
  • Regulate your stimulation by knowing your limits and plan accordingly. For some people overstimulation is a trigger for anger, while others prefer to keep busy and distracted to avoid feelings of anger. Know what your body needs and make intentional choices to prevent the earliest triggers. 

Self-control strategies for coping with anger 

When you find yourself starting to feel angry, you’ll want to use real-time strategies, also called self-control strategies

  • Recognize you have the power to control your emotions. Controlling emotions is a skill - the more you practice, the better you get. 
  • Remember that ups and downs are a normal part of life. 
  • Breathe slowly and deeply. 
  • Explain yourself calmly. 
  • Always be looking for constructive ways to deal with anger. If you find something that works - do it regularly. Don’t be afraid to try something new! 
  • Give yourself credit when you do control your anger! It’s not easy but with regular practice you can get better at it. 
  • Celebrate when you successfully dissipate your anger. Pay attention to what works - and use it in the future! 

IMPULSIVITY 

Being impulsive means, you are acting rash, quick or hasty. An impulsive decision is one made very quickly, with little time given to consider the possible outcomes of that decision. An impulsive decision is generally, any decision made “in the heat of the moment” without stopping and thinking about the potential consequences.

After a TBI you may struggle with being impulsive. A TBI can make it more difficult for you to resist giving into impulsive thoughts and urges - especially if an injury occurred to parts of your brain (primarily the frontal lobe) responsible for controlling impulses. Brain injuries can often change your personality - you may have been generally cautious before your injury but find yourself impulsive.

Executive functions are a set of mental skills that help get things done. These skills are controlled by the frontal lobe portion of your brain. Executive function helps you manage time, pay attention, control behavior, and use humor.

Having experienced a TBI does not make you exempt from making well-thought-out, responsible decisions. A brain that has been injured can be retrained, and with practice, you will be better able to control your impulses. The better you learn to control your impulses the more likely you are to avoid unwanted personal and legal consequences in the future.

What does impulsivity look like? 

  • Faulty or poor judgment - rushing to a decision without thinking 
  • Reacting without thinking - jumping to conclusions, saying things or doing things without thinking them through. 
  • Moving onto another task before completing what is already started 
  • Rushing into activities without planning first and making a lot of mistakes 
  • Interrupting conversations and talking over others 
  • Sharing personal or sensitive information about yourself or others without thinking it through. 
  • Making hurtful comments 
  • Having trouble taking turns or waiting in line 
  • Seeking instant gratification - wanting things now, not able to wait 
  • Buying things on impulse, even when not affordable 

Consequences 

Reacting with anger or impulsivity often results in negative consequences. Those consequences can be small (such as being reprimanded) or can be much more serious (such as being arrested). 

When you react with anger or impulsivity you can potentially affect or hurt people you care about. For example, if you act impulsively and punch a friend in the face, you could possibly… 

  • Hurt the friend physically, hurt your friends’ feelings or make them scared of you 
  • Be arrested and go to court 
  • Be found guilty and pay fines or go to jail or prison 
  • Receive a restraining order 
  • Lose a friend 

This is an extreme example - but it’s important to note that ALL actions have consequences (good or bad). Ultimately, when you react with an angry outburst, it’s likely that your reaction and actions become the focus - not the root of the issue that made you angry in the first place!

If experiencing any, or all, of these symptoms and would like additional resources and Get Support