Relationships after brain injury

Relationships with others are incredibly important to our overall health and happiness. After a brain injury, it can be challenging to maintain or build relationships. This is because of stress for all parties involved, changes to responsibilities and roles, and communication issues. It can also happen because of the behavioural, physical and cognitive changes you experience. Brain injury can cause many changes, and you may have different thoughts and behaviours now. It will take time for you to adjust to your new self, and it will take time for the people in relationships with you to adjust as well.

While many of these changes are now outside of your control, there are steps you can take to make sure that your partner, family, and friend relationships are nurtured after your injury.

Intimate & partner relationships

Relationships between romantic partners can be drastically altered after a brain injury. You may be experiencing emotional, behavioural, and cognitive changes that make relating to your partner more challenging. You will also be experiencing complicated emotions related to your injury, which can spill over and affect how you treat your partner. All of these factors will affect your relationship; they can be incredibly stressful, and without the proper interventions, can cause the relationship to break down.

Topics in this section include:


Communication

Communication between partners is made up of conversation, gestures, and body language used to share thoughts and feelings. After a brain injury, you may experience trouble with communication. You may be coping with changes to your cognitive abilities that make conversing, paying attention, or understanding others challenging. This is incredibly frustrating for both people, especially when you’re used to being on the same page.

Another reason communication suffers is because couples may feel they can’t share their thoughts and feelings with each other anymore. It can be hard to put into words the thoughts and feelings you’re having about your brain injury – and you may not want to ‘burden’ your partner. They are probably feeling the same way. They may be feeling strong emotions related to your brain injury, to their new roles, and the changing dynamics in your relationship. This could change the way they communicate with you – they may change the amount they talk, the amount of physical interaction, or have stronger emotional reactions.

Without communication, relationships can quickly run into obstacles – and without communication, those obstacles will be impossible to overcome. It’s important to be as honest and forthcoming as possible with your partner and be mindful of how you’re communicating with them.

I could no longer… remember family or friends & experiences shared with them.

Tips for communicating with your partner

Commit to working on communication
Acknowledging that communication between you and your partner has changed is the first step in making improvements. Set aside time each day or each week to discuss how you would like to communicate and what you both could be doing. When you do get feedback on how you communicate, commit to putting the feedback into practice.
Focus on respect, even when disagreeing
Disagreements are a guarantee in relationships, and after a brain injury you may find yourself disagreeing about different things. But do your best not to let anger, sadness, or hurt feelings interfere with being respectful to your partner. They’re struggling with their feelings too, and while you may not agree with them, you can always tell them that you respect and value them.
Listen actively to your partner
When you and your partner are having a conversation – no matter the seriousness of the subject – you should be actively listening to what they have to say. If you need them to speak more slowly, break down the conversation into smaller sections, or even record what they’re saying, tell them that is what you need in order to be an effective listener. It’s easy to become preoccupied with your own topics and opinions – but don’t forget how important it is for your partner to be heard.
Practice constructive communication
Practicing what you want to say is a great way to organize your thoughts. It also gives you time to write down/record your points, so you don’t forget them. Keep a journal handy or record talking points You can also record things that make you frustrated and angry and wait until you are both calm to discuss.
Remove distractions
Distractions such as the television, bright lights, other conversations, or additional stimuli make it difficult for you to fully engage in a conversation with your partner. These distractions should be removed (or you should move to a quiet, distraction-free zone) so you can focus.
Respect the other person’s space
Everyone needs space to be alone, process their thoughts and feelings, or just to do things they want to do. It’s important to respect that need for space, and make sure the other person in the relationship knows it’s okay to take the time they need.
Work with a therapist
Communication is challenging for many couples, and this can increase after a brain injury. A psychologist or psychiatrist with a specialization in relationships and brain injuries will be able to address communication challenges individually or as a couple. Therapy is a long-term process, so results won’t happen overnight – but if you are committed, you will see progress.

Intimacy/sexuality

Intimate/sexual relationships can change after a brain injury. It can be difficult for you to feel comfortable being close to your partner, or attention and memory problems can cause relationship problems. Changes in sexual relationships can be caused by changes in hormone levels, medication, mobility issues, emotional and cognitive changes, sexual roles and sexual interest, and sexual function. Some people have decreased sexual drive, while others may have an increased sexual drive. There can also be changes to reproductive functions, including menstruation [1].

Tips for improving intimate relationships

Create a positive environment
Both of you will feel more open and comfortable if you are in an environment that makes you feel that way.
Find activities you can do together
You may not have as much in common with your partner as you did before the injury. Finding new activities you both enjoy and can do together can help nurture new intimacy.
Focus on empathizing with your partner
Intimacy requires you to be in tune to what your partner feels/needs. Try to take some time each day to think about how they may be feeling and what they may need, and start conversations with your partner about their feelings.
Try to be as open as possible with your partner
A lot of times intimacy struggles because of mental and emotional blocks. You don’t feel your best, and you may not want to be intimate. Communicate that to your partner, and talk about what you need.
Work with a therapist
A psychologist or a psychiatrist are able to help both you and your partner explore the challenges you’re facing and work through issues. It won’t happen right away, but over time you will notice improvements.

You can also try to find support groups through your local brain injury association or through doctor recommendations.

Tips for coping with sexual challenges

  • Find positions that make you comfortable, particularly if you have mobility challenges
  • Plan sexual activities with your partner for when you have the most energy. Fatigue is a big obstacle for people with brain injuries, and sexual intimacy requires lots of energy. By planning out intimate moments beforehand, you are able to capitalize on it
  • Remove distractions that would take your focus away from your partner
  • Talk to doctors about your sexual concerns. You may feel a little uncomfortable talking about your personal life, but there’s no need to feel embarrassed. The only way to find solutions is to seek out the answers
  • Work with a psychologist or psychiatrist or sex therapist. A therapist can help both you and your partner communicate more openly about your sexual relationship and provide advice on developing that aspect.

Responsibilities

Before a brain injury, you may have had a lot of responsibility in the relationship. For example, you may have been responsible for cooking dinners, picking up kids, cleaning, or doing the errands. You may also have been more spontaneous with romantic gestures or initiated more communication about your relationship.

After a brain injury, you may not be able to have the same responsibilities. Your partner may need to take on more of the daily tasks, as well as additional ones involving your care. They may also become the main financial support for the household if you are unable to work or have to take a job with a lower salary. This change of responsibilities and independence for both of you is going to be challenging. It will trigger a lot of emotions. You both may feel pressure as recovery progresses and time passes.

Tips for managing changes in responsibility

Be patient with each other
Adjusting to change takes a lot of time and patience. You may be experiencing some trouble using patience, or you may be focused on your own responsibilities and not those of your partner. Try to remember that they are feeling stress too, and they may need extra time or extra support.
Say please and thank you
Your partner is doing a lot, and the simple act of saying please and thank you is a tremendous kindness. It’s an easy way to show appreciation and demonstrate that your partner is valued.
Take breaks
Responsibilities are important, but so is personal time. Giving someone a break from their responsibilities – whether it’s an afternoon, an evening, or a weekend – will allow you all to rest and reset.
Work with a psychiatrist or psychologist
Changes in responsibilities can lead to a lot of emotions, all of which can impact a relationship. A therapist can help you and your partner navigate these emotions and relationship changes. This is a long-term process that requires your commitment and participation.

Divorce/separations

Sometimes after a brain injury, people may be worried about separating or divorcing. It’s not good to focus on this immediately after the injury – instead, focus on all the ways you can work on your relationship with your partner . It is normal after a major life event – such as brain injury – to feel a sense of instability. You might feel hesitant, unsure, or even loneliness within the relationship. The important thing to remember is that a relationship doesn’t have to be all or nothing. You and your partner may have to adjust your expectations and your communication in order to figure out how to navigate this new situation. This is something you may have to continue doing for the duration of the relationship.

In some cases, a relationship cannot continue after a brain injury. This decision is not always reached immediately, but months or years in the future. There are many reasons for this, and some of those reasons may be related to the brain injury. This is a highly personal decision. These kinds of decisions will need to be made together, and with the help of therapists and counsellors. If you have children, you will need to work with the other parent (or their lawyer) to make sure you reach an agreed-upon custody arrangement. You will also need to talk with your children about the family changes that are happening.

Learn more about:


See sources

Tips for exploring the new normal

Self-identity after a brain injury is fluid. While things have changed and that’s hard, with time, patience and support you have the opportunity to explore your new identity and shape your new normal.

Ask for positive reinforcement

Positive reinforcement from others is helpful – everyone needs encouragement, especially during recovery. You can also give yourself positive reinforcement by writing down encouraging statements or recording the positive parts of your day on an audio device (like a smartphone).

Attend therapy

Therapy is an excellent way to explore your feelings and your self-identity after brain injury. A psychologist or psychiatrist will help you work through what you’re feeling, focus on positive progress, and adjust to your new normal.

Be patient with yourself and others

Finding a new normal and re-forming a self-identity doesn’t happen overnight. You’re going to have a lot of ups and downs. Reflect on what can you do now that you couldn’t do a month or year ago, rather than always compare your current self to your pre-injury self. It’s difficult but being patient with yourself is one of the most important things you can do for your mental/emotional health and well-being.

It’s also important to be patient with others, especially families and caregivers. Everyone is adjusting to the changes in relationships and responsibilities. It’s normal to feel frustrated with others – you’re going through a lot. But try to remember that their whole world has changed as well, and they need your support and love too.

Celebrate your wins

It’s important to recognize your accomplishments, even the smaller ones: they are worth recognizing. For example, can you sometimes remember things without looking at your notes? Or control a strong emotion? Or feel a little more stable on your feet? Celebrating your wins will not only improve your mood, but it will reinforce how far you have come.

Find the familiar

While you shouldn’t compare where you are now to where you were before the injury, it’s okay to take comfort in the aspects of yourself you recognize or are familiar after your brain injury. It’s reassuring, and it’s helpful when building your new normal.

Try new things

Part of living in the new normal is trying new things and learning what works for you and what doesn’t. This can be done through rehabilitation or simply getting out there through community classes, social groups, or trying new hobbies. Recovery does not have to mean get your old life back as much as possible. It can also mean bringing new valued activities into your life.

Adjusting to the new normal

After a brain injury, things may never go back to the way they were. It will take some time to cope with that fact and adjust to what many people call the ‘new normal’. The new normal may include your routines and abilities.

The term ‘new normal’ may not be the one you want to use. Brain injury recovery is challenging and full of ups and downs: normal may not be the word you would use to describe new routines or realities. We are using the term ‘new normal’ because it is widely used by healthcare professionals, caregivers, and individuals living with brain injury. 

Factors impacting the new normal

Recovery is different for everyone – that’s also something that doesn’t have a sense of normal. Recovery and establishing the new normal will be impacted by several factors, including:

  • Habits from before you were injured. Our habits – good or bad – are the building blocks of our daily life. Habits that you carry forward into your recovery or that you pick up after your injury will mold your day-to-day routines
  • Location and severity of injury. The location and severity of the brain injury will play a large part in determining what routines will become a part of your new normal
  • Rehabilitation. Rehabilitation is an important part of brain injury recovery and can have an impact on your new normal depending on the kinds of rehabilitation you’re doing, how much rehabilitation you’re doing, and your commitment to putting rehabilitation techniques into practice outside of appointments

It took a long time to figure out what I needed…

The new normal will not happen right away

When you first sustain your injury, you may feel like you’re getting too much attention from your healthcare team, family, and friends. But eventually you won’t have as many tests or appointments, and you might feel a little invisible. Many people feel stuck in place and become more physically and socially isolated. But socialization and interacting with others is not only important to your mental health, but in establishing your new routines and finding out how your life looks moving forward.

The new normal isn’t something that will happen when you leave the hospital or rehabilitation centre. Chances are your new normal will change several times, and that’s okay. It’s a long process often lasting years that involves rehabilitation, support from family and friends, and coping with the changes you’re experiencing. It’s important to be patient with yourself and the people involved in your recovery as you all discover it together.

I was told things would get better over time

If you’re having some trouble coping with recovery and the changes you’re experiencing, you may want to consider finding support groups or a therapist. Support groups and local brain injury associations are an incredible resource. Other people who have gone through similar experiences can share what they’ve learned and offer advice. Therapists can offer the same kind of support. The important thing to remember is that there is no right or wrong way to move through recovery and establish new routines. Everything you’re feeling is valid, and you only need to focus on doing what works for you.

Disclaimer: There is no shortage of web-based online medical diagnostic tools, self-help or support groups, or sites that make unsubstantiated claims around diagnosis, treatment and recovery. Please note these sources may not be evidence-based, regulated or moderated properly and it is encouraged individuals seek advice and recommendations regarding diagnosis, treatment and symptom management from a regulated healthcare professional such as a physician or nurse practitioner. Individuals should be cautioned about sites that make any of the following statements or claims that:

  • The product or service promises a quick fix
  • Sound too good to be true
  • Are dramatic or sweeping and are not supported by reputable medical and scientific organizations.
  • Use of terminology such as “research is currently underway” or “preliminary research results” which indicate there is no current research.
  • The results or recommendations of product or treatment are based on a single or small number of case studies and has not been peer-reviewed by external experts
  • Use of testimonials from celebrities or previous clients/patients that are anecdotal and not evidence-based 

Always proceed with caution and with the advice of your medical team. 

How family & friends are impacted

Brain injury impacts a family and community, not just the injured person. This includes their routines and their emotions.

Shock
Brain injury is unexpected for everyone, including family members. They may experience a period of shock when they find out about the injury. They may also be shocked when they see the impact to your behaviours, emotions, and abilities. Shock may make it hard for them to see how significantly the brain injury has affected you. Friends and family members are trying to understand what’s happened, may have trouble processing their thoughts, and could even feel physical fatigue. But shock is temporary: it will vary for different people, but it will go away. Make sure to talk with your family about what’s happening – it’s good for all of you to be open and communicate about brain injury.
Frustration
Frustration often is in a cycle with guilt, hope, and helplessness. Friends and family may experience frustration with themselves, with the situation, or even with you. It’s important to remember not to take this frustration personally; they are doing their best to be patient and to adapt, but nobody’s perfect.

If either you or a friend/family member are experiencing frustration, take a few deep breaths and try to share why there’s frustration. Talking about and understanding the cause of frustration is a great step towards diffusing it.

Grief
A brain injury is life-altering, and it is normal for both you and your friends/family to experience grief surrounding the changes in your abilities and your identity. Not everyone will experience all the common stages of grief, and they may not experience them in order.

Guilt
A family member or a friend will most likely feel a lot of guilt connected to your brain injury. It’s a stressful and sometimes confusing emotion that goes hand in hand with frustration and helplessness. They may feel guilt that they get frustrated with you, that they feel they don’t spend enough time with you, even that the injury happened to you and not them. Grappling with guilt is complicated, and it may benefit all of you to speak with a professional therapist.
Helplessness
Family and friends often want to help, but don’t know how. This leads to them feeling helpless. Those feelings of helplessness can become hopelessness quickly. After a brain injury, chances are you will need some help – so let your friends and family members know what you need. Not only will you be supported, but you’ll show friends and family how best to support you.
Hope
As you move through recovery, it’s important to focus on the positives. Your friends and family members will feel hopeful when they see your progress. While celebrating progress is fantastic and well-deserved, it’s important that you all understand that things may not go back to the way they were before the injury. Instead of comparing the then and now, focus on how you’re doing in the moment.
Role reversal & changes in responsibilities
After a brain injury, your partner, children, or other family members may have to take on more responsibilities around the house and for your continuing care. This may be a huge change for both you and your family members. You will be coping with changes in your independence, and your family will most likely feel stress as you all adjust. It’s confusing for everyone, but with time and thoughtful, positive communication, you will all adjust to this new relationship dynamic.

Withdrawal of social network
After a brain injury, you may notice that friends or distant family you saw often at the beginning of your recovery don’t visit as much as time goes on. Some may disappear entirely. This can be due to the changes in your relationship with them, coping challenges, lack of understanding of brain injury, and even stigma. Sometimes people stay away because they don’t know what to say or how they “should” interact with you, even though they would like to connect with you. While this is hard to face, it’s important to be patient with your social network and communicate how you are feeling to them. Talk to them about the changes in your relationship and what you need from them. In turn, listen to what they need and be patient: they’re also coping with changes.

You may also avoid people you know because you are tired of answering the “how are you?” question. Or you may put off seeing people until you are “better.” Or you may not feel like being around others, even if you can recognize that time with family and friends may be good for you. Losing interest in socializing may be a sign of depression.

Behavioural effects

Brain injury can have a profound impact on how you feel (emotions) and act (behaviour). It helps to understand how your behaviours may have changed and how to manage those changes.

Topics in this section include:


Aggression, anger & frustration

Aggression
In the acute stage of recovery after a brain injury, a person may display uncharacteristic aggressive behaviour if they are scared, frustrated, or confused. This usually happens when the injured person is not yet consistently aware of their situation (the injury and its consequences) and surroundings (where they are, what day or month it is, etc.). Aggression can show itself in a variety of ways, including:

  • Damaging or destroying objects
  • Excessive swearing
  • Threatening harm to others
  • Inability to self-monitor
  • Verbal, physical attacks

Episodes of aggression often come on very quickly and tend to pass within minutes. Aggression is upsetting for both the person exhibiting it and the caregivers or family members who witness it. Some aggressive behaviours can be risky to a person’s safety. That’s why it’s important to take steps to manage it.

  • Ask caregivers or healthcare workers to explain what they are doing before they do it
  • Identify and eliminate/reduce aggression triggers (when possible)
  • Keep the amount of stimulation in the room (e.g., light and noise) low
  • Redirect to calming activities or go to a quiet place if you are feeling confused, angry or scared
  • Use calming tactics such as deep breathing or meditation

If you are the person experiencing the aggression, you may have a limited ability to calm down, so help from others is necessary to prevent and de-escalate aggression. If your episodes of aggression continue or cause others to feel unsafe, you should consult a behavioural therapist.

Anger
It is common for people living with brain injury to get frustrated, angry or irritated more often or more quickly. This can lead to yelling, cursing, threats, destruction of property and physical outbursts.

These episodes of anger or an increase in irritability can be triggered by:

  • Confusion
  • Frustration with a task that is harder than it used to be
  • Fatigue
  • Misunderstanding another person’s intentions
  • People telling you what to do or pointing out mistakes
  • Too much stimulation (e.g., light, noise, and movement)

If you’re experiencing periods of anger or irritability, try some of the following coping methods.

  • Engage in calming activities – listening to music or reading are some examples
  • Practice deep breathing
  • Remove yourself from the situation and go to a more calming location
  • Work with a doctor who is familiar with acquired brain injury and emotions on some self-calming methods and communication strategies – being able to communicate what you’re feeling to others can be extremely helpful when it comes to emotional situations. Cognitive behaviour therapy can provide support and tools to help manage anger/aggression and understand why you have these reactions.
Frustration
It’s normal to feel frustration after a brain injury, and that frustration will come and go throughout recovery. Frustration will be caused by different things for different people. For example, it can come from not being able to complete a task or being annoyed with other people or self-criticizing. When someone is frustrated, they may give up on tasks, avoid things because they are too hard, or have emotional outbursts.

If you experience frustration, ways you can cope with it include:

  • Celebrate your success, especially if you complete a task that used to frustrate you
  • Do challenging tasks for only short periods at a time or with scheduled breaks.
  • Have a quiet place to go when you’re feeling frustrated.
  • Identifying what makes you frustrated. While you may not be able to entirely avoid being frustrated, understanding what causes you to feel that way is the first step in learning to cope with it
  • Take slow, deep breathes to help calm yourself

Anxiety

Anxiety stems from feelings of worry and fear. After a brain injury, people commonly worry about recovery being too slow, getting back to school or work, not having enough money, and relationship difficulties. Anxiety may lead to unhelpful behaviours, such as avoiding places or situations, re-checking things excessively, and asking the same questions over and over. Anxiety can also lead to panic attacks. Panic attacks (sudden, intense fear and physical sensations like rapid heart rate, shallow breathing, and sweating) – can be brought on by overwhelming situations or emotions, a person’s thought process, or by upcoming events/appointments. Some ways to cope with anxiety include:

  • Developing routines that are clear and able to be used repeatedly
  • Medications
  • Participate in counselling geared toward anxiety (e.g. cognitive behavioural therapy and mindfulness)
  • Practice slow, mindful breathing
  • Redirect yourself to a familiar place or activity that makes you feel safe and calm
  • Schedule “worry appointments” so that you can contain your worry to a time and place of your choice (e.g., after breakfast) rather than having worries pop into your mind when you are trying to do other things

It’s important to be patient and kind to yourself. Anxiety is deeply personal and emotional.

Some worry after brain injury is normal. When it becomes difficult to control and interferes with your sleep and daily activities or relationships, mental health treatment (e.g., cognitive-behavioural therapy) may be necessary.

Denial

Brain injury comes with a wide variety of changes and people often can’t do the things they would normally do. This can be incredibly difficult to cope with: as a result, people begin experiencing denial. They don’t recognize how serious their injury was and how it continues to impact them. A brain injury can also impair a person’s ability to monitor and judge their own performance. They may become angry or frustrated, place their blame for their challenges on someone else, or engage in risky actions to ‘prove’ that they haven’t been affected.

You probably won’t recognize denial in yourself – at least right away. It may be helpful for you to speak with a caregiver or therapist about your current feelings and concerns. They can offer emotional support and practical advice on coping with the changes you are experiencing and how to move past denial into acceptance.

Depression

Depression is a complex health condition involving a person’s thinking, emotions, and behaviour. Depression is linked to grief. Many people with depression may feel sad much of the time, lose interest in usual activities, withdraw from others, have a negative outlook on life, and experience changes in energy, sleep, and appetite. It’s important to understand the impact of depression, and how to cope with it. Depression may not only be psychological – brain injury can alter the brain’s structure, so depression can also be biological. The challenge of dealing with emotional and behavioural changes like depression require as much commitment in recovery as working on cognitive and motor skills.

When symptoms of depression continue for weeks or longer, mental health treatment may be necessary.

Disinhibition/impulsivity

Impulse control/inhibition is the ability to think through actions and speech. When someone is experiencing disinhibition or impulsivity after a brain injury, they may:

  • Be easily irritated
  • Buy things they don’t need or can’t afford
  • Do risky, dangerous things
  • Have mood swings
  • Ignore social and safety rules
  • Make inappropriate remarks
  • Not be able to think things through
  • Speak impulsively

If you’re struggling with impulse control and disinhibition, there are ways to cope with these challenges.

Ask someone for assistance
Impulse control includes elements of decision-making, and you don’t have to make every decision on your own. You can ask someone to listen to your thought process out loud. You can also ask for recommendations about how to act or respond to a situation.
Develop a process for decision-making
Having a decision-making process can help prevent impulsive, risky behaviour and ensure that you consider all factors that go into the decision. This includes:

  • Your decision options
  • How your decision could affect others
  • How your decision could affect yourself
  • Write out the pros and cons of each option
  • Ask for advice
  • Share your decision with someone you trust before you act on it
Practice before social interactions
If you have plans with other people and are worried about social interactions, practicing with a caregiver or family member beforehand is a great way to build your confidence, identify possible areas to make improvements, and revisit your decision-making process.
Use verbal and visual cues
Caregivers, friends, or family members can help you identify when you need to check in with yourself and self-moderate your behaviour using verbal and visual cues.

Grief

Grief is an emotion that has a direct impact on how a person behaves. Someone experiencing grief after a brain injury may engage in risky behaviours or have angry/aggressive/emotional outbursts either alone or directed at others.

It’s normal to experience grief after a brain injury, but it’s important to understand how grief works and how to manage it so that your behaviours don’t put you or your loved ones at risk.

Obsessiveness

Obsessiveness is when someone becomes ultra-focused on an object, a task, or even something someone said. They can’t think about anything else, may become incredibly stubborn, or do something over and over again. This can be made worse by anxiety or by injury to the parts of the brain that enables a person to shift the focus of attention. It can make it harder to solve problems and maintain relationships.

Obsessiveness can be caused by a variety of things and can be managed with the right supports.

  • Identify what causes the obsessive behaviour, and eliminate the cause if possible
  • Ask for help in identifying when you’re being obsessive
  • Give yourself a break – it’s normal to experience these challenges
  • Speak with a therapist

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental health disorder that occurs in people who have suffered a traumatic event. It’s common in individuals that have experienced assault, accident survivors, and people in the military. Behavioural symptoms of post-traumatic stress disorder include:

  • Anxiety
  • Increase in negative thoughts, feelings, and beliefs stemming from the trauma
  • Disassociation – losing touch with the present and feeling like you are experiencing the trauma again
  • Avoidance of certain situations that may recall (trigger) the trauma
  • Feeling on guard all the time
  • Sleep problems

Not every person who suffers a traumatic brain injury will have post-traumatic stress disorder. Additionally, not everyone with post-traumatic stress disorder will have had a brain injury. Only a licensed professional like a psychologist or psychiatrist can diagnose post-traumatic stress disorder.

Self-image loss

Brain injuries not only change a person’s abilities; they affect identity (e.g., “Who am I now?”) and self-image because of the physical, cognitive, emotional and mental impacts. Someone with a brain injury may only focus on their limitations and fail to see their positive qualities. The emotions related to these changes can lead to behaviours such as withdrawal, avoidance or choosing not to take actions, and a lack of motivation to do anything – including work on rehabilitation and recovery.

It can be difficult to recognize that you’re experiencing self-image loss. You may recognize it but find it difficult to break the cycle of focusing on what you have lost. But it’s important to work towards acceptance of your new  normal. It can be helpful to ask a caregiver to work with you to provide positive reinforcement. You can also:

  • Celebrate your successes
  • Figure out how you can get back to doing activities that were important to you, in a different way if necessary
  • Give yourself a break. It’s normal to feel loss, and it’s important to let yourself process it
  • Identify the ways that you have NOT changed
  • Keep a positivity journal: at the end of the day (or as they happen), write down the good things that happened to you

Sexually inappropriate behaviour

An uncommon behavioural effect of brain injury can be sexually inappropriate behaviour. This includes making inappropriate comments about themselves or someone else, inappropriate actions (such as touching), and exhibitionism, which is the act of displaying genitals in public places or to people without their consent. This behaviour can also include masturbation at inappropriate times or in inappropriate places.

It’s difficult for people with a brain injury to recognize that they are being sexually inappropriate. They may think their behaviour is normal. It’s important to work with a healthcare professional or a caregiver to identify what is appropriate. Examples include:

  • Writing down what’s appropriate to say or do in social situations
  • Setting clear boundaries of where masturbation is acceptable (in the bedroom, with the door closed)

If you have questions about sexual behaviour or sexual health, these should be shared with a caregiver or healthcare professional. It’s important to share your questions and have open, honest discussions about what you’re feeling/experiencing.

Social dysfunction

Socializing after a brain injury can be difficult due to several factors, including how the person with a brain injury behaves. It’s common for people living with acquired brain injury to:

  • Have trouble keeping up in group conversations
  • Lack awareness regarding how others feel emotionally
  • Make inappropriate comments
  • Misinterpret social cues such as facial expressions
  • Mistake sarcasm for literal statements
  • Show aggression and frustration

Trouble socializing can lead to social isolation, anxiety and depression. Socialization is incredibly important for mental health, so it’s important to understand what is involved in being social after a brain injury.


See sources