Anger

A brain injury can damage areas of the brain involved in the control and regulation of emotions, particularly the frontal lobe and limbic system. Other effects of a brain injury can lead to irritability, agitation, lowered tolerance and impulsivity, which also increase the likelihood of angry outbursts. Anger issues are commonly associated with a traumatic brain injury (TBI) but occur with other types of brain injury as well.

There is usually an ‘on-off’ quality to the anger – an explosive angry outburst one minute, but calm again shortly after. This can be very difficult for family members and partners to cope with. In some cases, a brain injury can impact self-awareness. The person may not acknowledge they have trouble with anger, and may blame others for provoking them. It may take carefully phrased feedback and plenty of time for the person to gradually realise that anger management is an issue.

When a person has sufficient self-awareness to realise that they need to manage their anger, the first step is to recognise the triggers.

Common triggers for anger include:

• lack of structure or unexpected events
• perceived lack of control
• being confronted with a task the person is no longer capable of doing
• fatigue or confusion
• impulsivity
• confusion and overstimulation, e.g. crowds, lots of noise and activity
• other people’s behaviour, e.g. insensitive comments
• unrealistic self-expectations
• barriers to goals or routines, e.g. queues
• build-up of stress or frustration.

Recognising these triggers is an important step. The person can then avoid those situations, or prepare for them mentally and begin to use their anger management strategies.

It is important to become aware of personal thoughts, behaviours and physical states associated with anger. These can include an increased heart rate, sweating, muscles tightness or raised voice. After a brain injury, it can be difficult to recognise these signs and avoid unpleasant situations or prepare for them.