Understanding the Psychological Effects of Brain Injury: What They Are & How to Pursue Recovery

Various types of events including brain injury, can impact our psychology. Psychological effects of brain injury include cognitive and behavioral changes that can impact one’s personality or emotions. Many of these psychological effects can interfere with recovery making it more difficult for survivors to regain independence and return to living the life they want to live. 

For this reason, it’s important to learn what psychological effects may occur after brain injury and the most effective ways to cope with them. This article will discuss everything you need to know.

How a Brain Injury can Impact Psychology

Before learning about the psychological effects of brain injury, it first helps to understand how an injury can affect the brain.

Different areas of the brain are responsible for cognitive, emotional, and physical functioning. When the brain sustains an injury, it can alter these functions and result in secondary effects. These effects can be physical, such as muscle weakness or paralysis, or psychological, such as emotional or behavioral changes.

The frontal lobe, in particular, is responsible for cognitive function and it’s considered the home of personality (an individual’s unique combination of thoughts, feelings, and behaviors) and emotion. Damage to the frontal lobe can sometimes alter emotions and personality.

Depending on the severity and location, there are many different psychological effects of brain injury that can occur. Some examples include depression, paranoia, emotional lability, lack of insight, and executive dysfunction. It may be difficult for survivors to identify or separate symptoms of TBI versus other conditions. 

Because some of these conditions may not be immediately apparent, they are sometimes referred to as invisible illnesses, which can interfere with survivors’ daily living activities. Because these conditions are not apparent to the observer, it’s important to obtain an adequate assessment from a neuropsychiatrist to identify potential physical and psychological effects of brain injury.

Psychological Effects of Brain Injury

Psychological effects of brain injury can include cognitive, behavioral, and emotional effects that can make recovery more challenging or cause a shift in personality. Fortunately, there are a number of great resources for survivors to use to help them overcome these new challenges.

Here are some of the most common psychological effects of brain injury:

Anger and Aggression

After brain injury, survivors may display anger or aggressions towards others.  Aggressive behavior usually appears during the acute phase of brain injury, or the first couple weeks after the brain injury. This can be displayed in outbursts or unusual behavior such as foul language. While this effect should be taken seriously to protect everyone’s safety, studies show that agitation is a normal part of the recovery process.

Emotional Lability (Unexpected Mood Swings)

Another potential psychological effect of brain injury is emotional lability, or inappropriate mood swings. This can affect the way a survivor reacts to certain situations, which can not only affect them but their loved ones as well. Reacting differently to various situations is normal, but what characterizes emotional lability is the reaction is out of context. For example, some survivors may find themselves laughing during a sad movie or crying at inappropriate times.

Depression

Depression is another common psychological effect of brain injury. TBI survivors are two to five times more likely to develop depression than non-TBI survivors, but it may not be immediately apparent. Therefore it’s important to pay close attention to potential invisible illnesses like this before it gets in the way of recovery.

Alexithymia (Lack of Empathy)

After brain injury, survivors may experience lack of empathy, which is the inability to see and feel what another person is feeling. At times, individuals may seem uninterested or egocentric, or in other situations they may empathize with others but struggle to process their own emotions. This is a medical condition known as alexithymia. Alexithymia can cause difficulty identifying, describing, and processing emotions.

Perseveration (Repetitive Behaviors)

Perseveration refers to repetitive or continuous behavior or the tendency to stay focused on one task or topic of conversation. This can cause individuals to “get stuck” on a topic, idea, or certain thought patterns or activities thereby slowing progress in a therapy session. Perseveration can appear in many forms, such as writing the same word down or talking about a topic when the conversation has moved on to another. This type of behavior can be frustrating for both the survivor and anyone around, but it’s important to remember perseveration is often something survivors want to stop but they just don’t know how.

Flat Affect (Lack of Emotional Expressiveness)

Survivors may also experience what is known as flat affect, which is a lack of emotional expressiveness. This psychological effect of brain injury can also be caused by damage to the frontal lobe and other areas of the brain such as the hypothalamus, amygdala, and hippocampus. 

Like perseveration, this doesn’t mean a survivor does not feel emotion, they simply cannot express them through facial expressions or tone of voice. Some symptoms include monotone speaking, avoidance of eye contact, no change in facial expression, or neutral body language. 

Paranoia

Though rare, paranoia can be a psychological effect of brain injury due to damage to the frontal and temporal lobe. When an individual experiences paranoia, they may feel watched or persecuted in some way. High or extreme levels of paranoia can indicate a more serious condition. 

Studies show that the mean onset of paranoia happens within the first five years of the brain injury. This can cause individuals to have suspicious thoughts about people, even their loved ones. 

Paranoia can sometimes be confused with anxiety because they share similar symptoms. One distinguishing factor is that an individual with anxiety can possess a high level of insight or self-awareness, whereas an individual with paranoia usually does not.

Anosognosia (Lack of Insight)

Lack of insight, medically known as anosognosia, is another psychological effect that can occur after brain injury. Insight refers to the ability to identify, understand, and reflect on a situation or action. This skill mostly occurs within the frontal lobe, therefore damage to the frontal lobe usually impairs this skill.

Anosognosia in particular refers to the lack of self-awareness of one’s own condition, or the lack of ability to perceive the reality of one’s own condition. This can interfere with recovery because survivors may not recognize the need for help and won’t feel motivated to pursue or participate in rehabilitation.

Executive Dysfunction (Attention and Decision-Making Problems)

The frontal lobe plays an essential role in executive function, which refers to the cognitive skills necessary for planning, organizing, and multitasking, among many other things. It also includes high-level skills such as attention, decision making, self-awareness, and social cues. 

Damage to the frontal lobe can impair the ability to execute these functions, resulting in executive dysfunction. Some common symptoms include attention problems, lack of motivation or initiation, and impaired memory. Fortunately, many of these effects can be remedied through cognitive rehabilitation.

Disinhibition (Inappropriate Behavior)

Disinhibition refers to the loss of ones ability to inhibit oneself from doing or saying something.  Impulse control is largely a Frontal lobe task. The frontal lobe moderates our many ideas/impulses so that we have control over our emotions and behaviors.  Disinhibition can often cause poor decision making, risky behavior, impulsivity, and disregard for social subtleties. This can raise safety concerns for survivors and those around them.

Adynamia (Lack of Motivation)

Lack of motivation, or adynamia, is another potential psychological effect of brain injury. From the outside, this can appear as laziness or depression but that is not usually the case with adynamia. Instead, adynamia stems from the inability to execute the cognitive processes necessary for motivation.

Symptoms may include low activity, sleeping in late, loss of interest, or social isolation. Survivors experiencing adynamia may also struggle finishing self-care tasks. This can potentially interfere with rehabilitation because lack of motivation can cause a survivor to skip therapy appointments.

Confabulation

Confabulation involves the creation of false memories without the intent to deceive. Individuals with confabulation are not aware that their memories are false. One common cause of confabulation is having “gaps” in memory. When an individual tries to recall something, the brain then tries to fill in the “gaps” with information (confabulation). 

Confabulation is a psychological effect of brain injury that is not always easy to discuss with survivors, especially if they lack self-awareness or feel threatened by the idea that their memory is incorrect or false. It’s important to ask for help to improve memory and other psychological effects after brain injury.

Ways to Cope with the Psychological Effects of Brain Injury

While there is no one-size-fits-all treatment or coping mechanism for psychological effects of brain injury, there are many resources that can help survivors identify symptoms and find proper treatment. For instance, a Speech and Language Pathologist (SLP) can help your doctor to diagnose conditions and provide cognitive rehabilitation to address cognitive effects, especially executive dysfunction. 

Other professionals may also be able to provide guidance and help survivors embark on a recovery path most suitable to them. These can include clinical psychologists, clinical neuropsychologists, neurologists, neuropsychiatrists, occupational therapists, psychotherapists, and social workers.   Ask your doctor to refer you to these specialists for more help until you are satisfied with your results.

Psychotherapists in particular are great resources for the emotional effects of a brain injury. For example, a popular and effective method to help with the psychological effects of brain injury is cognitive-behavioral therapy (CBT). This has been used to treat a range of issues such as effects such as depression, anxiety, emotional lability, and other disorders or conditions. 

CBT focuses on helping survivors develop coping skills and learn to recognize and change problematic emotions, behavior, and thinking. The goal is to develop more effective ways to cope with psychological effects of brain injury.

Overcoming Psychological Effects of Brain Injury

Survivors may experience a variety of psychological effects after brain injury, especially if the frontal lobe has been affected. The frontal lobe is one of the main areas of the brain that contributes to cognitive processes and personality. When this area of the brain has sustained an injury, it can cause various psychological effects such as emotional lability and anosognosia, or lack of insight. 

Fortunately, there are ways to recover from these cognitive and psychological effects. Cognitive rehabilitation, for instance, can help survivors learn exercises and coping strategies but it’s imperative to work alongside a specialist such as an SLP or psychotherapist. With enough time and effort, many survivors can overcome psychological effects of brain injury and get back to their daily activities.