Carers & family members
Relationship changes after a brain injury
The impact of a brain
injury has often been likened to throwing a pebble in a pond - the
influences reach out to partners, friends, family, carers, work
colleagues and the wider community.
The issues vary according to the stages of the recovery process,
and each stage will bring its own joys, challenges, hopes and
needs. Old coping methods may remain helpful for some but others
will find new methods need to be developed.
Resentment, anger, despair, grief and numbness may be emotions
encountered. Your task in the process of recovery is to sort out
what you are feeling, and seek out help and support for
The hospital & rehabilitation
If the brain injury is life-threatening then no one wants to
leave the hospital - everyone's focus is on the patient. Your own
needs right now hardly seem to matter. Your friends want to help;
this is the time to let them by taking care of the house, children,
car pooling, shopping, and so forth.
Beyond attending to day-to-day tasks, some may want to offer
emotional support as well. You may have conflicting feelings about
this. Your good friends will understand and be there for your
needs, whatever they are. You might find it helpful to name one or
two of them as coordinators. They can return phone calls for you,
offer apologies and thanks to others, and do whatever else needs to
During the rehabilitation stage, the patient is medically safe and
has been moved to a rehabilitation centre. At this point, you can
relax a bit and start to put order back into your world. You may
feel exhausted and out-of-sorts - this is part of the natural
letdown of the initial trauma.
You may not feel like talking to, or being with, your friends
right now. You may be pre-occupied by your own concerns. This is a
perfectly natural reaction even if it feels disconcerting to you.
Ask your friends for their patience and grant yourself the same.
You may find more comfort being with other families in the
rehabilitation unit who are going through what you are, than being
with your old friends.
The return back home
The person with a brain injury moves back into family life and
begins to renegotiate his or her social world. You, as care giver,
begin to redefine your world as well. Your friendship needs
will change again. Depending on the severity of the injury, you
will find it difficult to leave your loved one and go out. You may
want a friend or two to visit, but even that may feel like it is
too much because of the extra work that now goes on in your
Some friends may be comfortable with what has happened, and with
the difference they observe in your loved one - and perhaps in you.
One of the first ways to address their fears or discomforts may be
to educate these friends about the injury. With information, they
can become more comfortable with the situation.
You may feel isolated, and even jealous of your friends'
happiness. You might want to find support groups and other carers,
who are dealing with the same issues. You do need to go out, take
time for yourself and start making your life a priority.
The family: one of the common issues that
families face is their son or daughter with an injury returning to
the family home despite having lived away from home prior to the
injury. For the person with the injury this can represent a huge
loss of independence and self-reliance. Everyone's lives can change
Future plans may be put on hold, there may be dramatic
personality and behavioural changes after the brain injury such
aggression, rapid changes in mood, self-centredness, impulsivity,
sexual and social disinhibition, poor motivation and lack of
empathy. Friends of the family often distance themselves over time
when there are behavioural issues.
Partners: the rate of marital and relationship
breakdown is very high following a brain injury. The pressures can
be immense: running of the house, becoming the sole wage earner,
making most of the decisions, and providing support to the person
with the injury. Finances may become a major concern due to medical
bills and loss of income. A change in the sexual relationship of a
couple can also be a very distressing and sensitive issue e.g.
either a decrease or increase in sexual drive.
Children: a child may have to come to terms with
why their parent has changed so dramatically after coming home from
hospital - why their parent needs care, walks or talks strangely,
never remembers anything, gets upset so easily, and why they no
longer want to play with them.
Children may display increased acting-out behaviours, emotional
problems, or relationship difficulties. Negative parenting
performance such as yelling, ignoring or being impatient by both
injured and uninjured parents is reported in most families. Many
families report substantial breakdowns in relationships between
children and their injured parent when it is the father who is
injured. Most non-injured parents report substantial depression,
which correlated significantly with negative behaviour in
Friends: a very common statement made by people
with a brain injury is 'you find out who your real friends are'
after the accident. Unfortunately, friends can disappear at the
time when the person most needs their support. It is also common
for people who have spent a long time in hospital to feel that they
have missed out on a lot of experiences with their friends and that
they now have trouble relating to their friends and sharing their
Supportive friends learn to adjust their expectations of the
person with the injury and seek new activities for spending time
together e.g. watching a game of sport instead of going to a
nightclub. Alternatively, the person may wish to meet other people
with a brain injury by joining a specialized group rehabilitation
program or a less structured brain injury social group.
Major issues for
Both men and women with brain injuries find the loss of autonomy
and independence is their biggest problem, and say personality
changes and memory deficits are significant. Among married couples,
wives identify their personality changes and cognitive deficits in
their husband with a brain injury as primary problems. Husbands, by
contrast, place loss of autonomy and mood swings in wives with a
brain injury at the top of their lists.
Families in which husbands had sustained brain injuries place
higher importance on job loss and income change than do families in
which wives were injured. Women with brain injuries and
non-disabled wives value support groups and other emotional support
methods as coping strategies, whereas the men stressed
problem-focused and goal-orientated strategies. Individuals with a
brain injury who experience higher ratings of cognitive and social
dysfunction are more likely to be depressed and anxious.
Non-injured spouses also show increased anxiety and depression,
with wives more affected than husbands.