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Challenging & complex behaviours - anger

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Challenging & complex behaviours - anger

Anger is a common emotional response after a brain injury and can be directly related to impairments caused by the injury.

A brain injury can damage areas of the brain involved in 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 but occur with other types of brain injury as well.


Anger & self-awareness

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 realize that anger management is an issue. 


Triggers for anger 

When there is sufficient self-awareness for the person to realize they need to manage their anger, the first step is recognizing the triggers for their anger.


Common triggers for anger include:

  • Lack of structure or unexpected events
  • Perceived lack of control
  • Being confronted with task the person is no longer capable of doing
  • Fatigue or confusion
  • Impulsivity
  • Confusion & 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
  • Buildup of stress or frustration.


Recognizing these triggers is an important step, as the person can either avoid those situations, or prepare for them mentally and use various strategies to manage their anger. 


Recognize the signs of anger

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


Coping strategies

Coping strategies for managing anger are a skill learned over many years as we grow up. A brain injury can mean needing to relearn these skills. Depending on an individual's level of self-awareness, learning ability and cognitive skill, assistance from family members or a carer may be needed.

Keep a record of events, triggers and associated levels of anger. This can assist with finding coping strategies that suit.

The back off, calm down and try again technique is a technique from the Brain Injury Association of Washington. It involves:

  • leave the situation when early warning signs of anger appear
  • move to a safe place and calm down
  • review the situation and prepare for return
  • If needed, talk through the situation with others upon your return. 


The Stop - Think technique is similar. When you feel anger rising, Stop and think before reacting to the situation, this may require someone to assist you with creating a cue to signal when you are becoming frustrated. Consider the options for how to respond to your frustration; do you need to walk away, find a better way to communicate or take some time out.


Extra trips that many people find useful after a brain injury include:

  • Distracted yourself from a stressful situations e.g. carry a magazine
  • Explain to another person how they can be of help to solve the problem
  • Leave the situation if possible if you feel you are losing your temper 
  • Phone a friend or a crisis centre to talk about the situation
  • Make changes to routines  e.g. avoid peak hour traffic
  • Speak with a doctor, psychologist or rehab specialists for advice.


Recommended strategies for family and carers

It is important family and carers do not take anger personally and recognize the individual has an impaired ability to control anger. Below are some tips for coping with anger.

Validation and understanding - try and understand why the individual is angry, listen to them and validate/acknowledge their feelings and try and find a way to assist the person with finding a solution to the problem.

Maintain structure -  changes in structure or surprises in routine can result in agitation and frustration. Make sure the person had advance notice on changes to routines, is clear on what is happening and why the changes are occurring.


Distraction involves changing the discussion topic, activity or setting. Once the person has been distracted it can help to change the activity to one that is calming and enjoyable.

Self-removal & safety
If anger has escalated you may need to remove yourself from the situation if it safe to do so. Tell the person what you are doing e.g. "You're getting upset, we are leaving for a few minutes so you can calm down". Tell them you will return when their anger under control. If the person is being verbally abusive ignore the behaviour by reducing eye contact and verbal interaction.


Maintain a safe environment e.g. remove potential weapons or dangerous objects that could be thrown or used to damage property.



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