Personality Changes After Head Injury: Why They Happen & How to Cope

Personality changes after head injury are some of the hardest TBI symptoms to deal with, for both the patient and their loved ones.  A brain injury can make patients suddenly angry and aggressive, or even cause them to feel nothing at all.

As a result, personality changes after a brain injury may change the way patients relate to the people they love the most.

In this article, we’ll discuss the causes of personality changes after head injury and explain some helpful ways to cope.

What Causes Personality Changes After Head Injury?

Personality refers to a person’s unique combination of thoughts, feelings, and behaviors. When a head injury or concussion causes changes to a person’s emotions and behavior, it can, therefore, cause them to have an apparent change in their personality.

The location of the brain injury can especially change how the person behaves. For example, the orbitofrontal cortex helps control impulsive behavior and plays a role in a person’s empathy. If this area becomes damaged, the person may struggle to empathize with others and might engage in more reckless behavior. To their loved ones, they may seem to have a different personality altogether.

In addition, a head injury often affects a patient’s mood and emotions. This can make them seem more depressed, angry, or irritable than usual, causing others to believe that the person has had a personality change.

However, it’s important to remember that your loved one’s personality is still intact, it is just hidden under these effects from the direct injury to the brain. Therefore, treating the emotional and behavioral effects of brain injury can often help the person return to their old self again.

In the sections below, we’ll look at some specific emotional and behavioral effects that can lead to apparent personality changes after head injury.

Emotional and Behavioral Changes After Head Injury

Head injury can lead to a variety of emotional and behavioral effects that influence personality. These effects can cause the patient to seem like a different person to their loved ones.

Below you’ll discover different types of emotional and behavioral changes that can affect personality after a head injury.

1. Emotional Lability (Severe Mood Swings)

A head injury can cause a person to lose control over their emotional expressions. This condition, also known as emotional lability, changes the way the patient reacts to certain situations, which plays a large role in apparent personality changes.

While everybody experiences emotional highs and lows, what separates emotional lability from normal mood swings is the extremeness of the emotions and how fast the changes occur. For example, a person might alternate between laughing one moment to crying almost immediately after.

Other symptoms of emotional lability include:

• Mixed emotional outbursts, such as crying that turns into laughing, or vice versa
• Short outbursts that only last a few minutes
• Laughing or crying at situations that are not funny or sad (emotions often out of proportion or out of context to the situation or environment)

It’s important to note that these outbursts might not reflect how the person actually feels. In fact, many TBI patients say that they often start crying even though they do not feel sad.

2. Flat Affect

Family members of TBI patients often report that their loved one seems less engaged or less interested in the rest of the family and in the activities they once enjoyed. This change in personality may be caused by a condition known as flat affect.

Flat affect refers to reduced emotional expressiveness (both verbally and visually) after a brain injury. For example, this could appear as a person not saying anything in response to an emotional stimuli, and/or could present as the lack of ability to show emotion through facial expressions. This can make the person appear apathetic or indifferent to others.

However, while brain injury can cause apathy, most patients with flat affect do still care about their loved ones. They have simply lost the ability to express their feelings.

3. Aggressive Behavior

Perhaps the most common personality change after a head injury is increased aggression. Studies have shown that around 30% of traumatic brain injury patients report struggles with anger and aggressive behavior.

For family members and friends, it can sometimes be a frightening experience to witness these outbursts. The person might yell, use foul language, throw objects, and slam their fists into the wall.

Outbursts like these are caused by several factors, such as damage to the brain’s impulse control center and fatigue.

In addition, the brain is much more susceptible to overstimulation after a head injury. Things like bright lights, crowded rooms, and loud noises, or cognitive activities such as reading, can easily overwhelm the brain. As a result, the person might react angrily when they become overstimulated.

Therefore, it’s important to stay patient and try to remember that your loved one’s anger is likely not personal towards you. They are just dealing with the effects of their injury.

4. Inflexibility and Obsessive Behavior

Some people with a brain injury can get fixated on certain thoughts or actions. This is known as perseveration.

For example, they might get scared, angry, or confused when their routine changes. They also might get stuck on a topic during conversation and refuse to change the subject.

These issues are caused by reduced cognitive flexibility. Cognitive flexibility allows people to move between different tasks smoothly, change their ways of thinking, and apply concepts from one context to solve problems in another context.

Without cognitive flexibility, TBI patients can get stuck on certain thought patterns or activities. They are usually unaware of their inflexibility and cannot control it.

5. Egocentric Behavior

Finally, many brain injury patients seem to develop a more self-centered personality after their head injury. This is caused by damage to the frontal lobe.

Multiple areas of the frontal lobe contribute to a person’s ability to empathize. For example, the right supramarginal gyrus helps people overcome egocentric bias (self-centeredness) when making decisions.

The orbitofrontal cortex is another area of the brain that helps someone react to another person’s feelings. Therefore, if any of these brain regions become damaged after brain injury, a lack of empathy can occur.

Dealing with Personality Changes After Head Injury

These drastic changes can be frightening for family and loved ones to witness. For many, it sometimes feels like the person they once knew no longer exists.   

It’s important not to deny these feelings and let them fester. Instead, brain injury patients and their families should try to stay open with each other and work together to cope with their new normal.

The following are a few tips to help you do that:

• Acknowledge the loss. Traumatic brain injuries change people; they change both the person with the brain damage and the people closest to them. Neither you nor your loved ones will ever be the same people you were before the injury. And that’s ok. All you can do is decide your response to your injury by taking the necessary steps to begin your recovery.
• Identify triggers. Most personality changes occur because the person has lost their ability to problem-solve effectively. Therefore, when they encounter a problem, they get easily frustrated and act out. To reduce frustration then, you must determine the root cause of a person’s behavior. Once you do that, you can work on removing the triggers entirely.
• Learn behavioral strategies. If it’s not possible to remove the trigger, the next best thing is to retrain your brain to use strategies that will help you cope. You can do this through cognitive-behavioral therapy techniques for TBI patients. A CBT therapist can also teach you how to relearn empathy and critical nonverbal cues such as tone of voice and body language.

Finally, don’t forget to be patient with yourself. Remember that you are more than your emotions. While there will be bad days, that does not make you a bad person.

With enough work, you will notice improvements and you might start to feel like your old self again.

Personality Changes After Head Injury: Conclusion

Personality changes after a head injury or concussion are distressing. But while you may never be the exact same person you were before your injury, this shouldn’t cause you to lose hope.

But thanks to the brain’s remarkable ability to heal and rewire itself, you can still learn effective ways to deal with unruly emotions and relearn how to connect with others.

In fact, you may even find, after learning new coping methods, that you are a stronger and more resilient person than you ever thought possible.