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Relationship problems after a brain injury

Information Services

Carers & family members

Relationship problems after a brain injury

Families are usually ecstatic when a loved one returns from hospital but over time the effects of a brain injury can place a great strain on relationships. 

A formerly easygoing wife now has a short fuse and a fiery temper. A husband who used to help around the house has to be constantly reminded to do the simplest tasks. A son who was always concerned about others now acts in a selfish manner.


Common problems include:

  • short temper and emotional ups and downs
  • inability to start tasks and/or see them through
  • low tolerance for stress and anxiety
  • egocentric behaviour
  • apparent lack of gratitude
  • saying and doing inappropriate things
  • impulsive risk-taking behaviour
  • lack of awareness how behaviour is affecting others
  • difficulty understanding or accepting different points of view
  • frustration if needs are met quickly.


It is easy to understand how a person may be labeled as lazy, self-centred, arrogant, rude, thoughtless, argumentative, irresponsible and aggressive after a traumatic brain injury (TBI) or other type of brain disorder.  This can lead to a lot of conflict with relationships and families. 


Lack of self-awareness

Many of these problems stem from injury to the frontal lobes of the brain. Unfortunately a common problem associated with this is lack of self-awareness - if a person has lost the ability to analyze and monitor their own behaviour then it becomes extremely difficult to encourage more appropriate behaviour. In these cases it is important to discuss behavioural issues with the rehabilitation team and form coping strategies. If rehabilitation is finished, contact your Brain Injury Association to find out about behaviour specialists in your area. 


Understanding is the first step

Learn as much as possible about the brain injury, regardless of whether it is a traumatic brain injury or other type of brain disorder. It will be easier to cope, and respond effectively, when you understand it is the brain injury affecting the person's behaviour, emotions, personality and difficulty seeing the world through other people's eyes - it is not a wilful decision to annoy you. There can be a natural grieving process when a family feels as though they have 'lost' the person they remember - it will be easier to understand and accept the 'new' person when you understand more about brain injuries. 


Provide feedback

When the person still has some self-awareness, it is important to provide immediate, direct and clear feedback regarding behaviour. It's common to not understand non-verbal communication after a brain injury, so you may look and sound very annoyed but this can be completely missed. An example of clear feedback is "I feel frustrated when you walk in and change the TV channel without asking me first."


Useful tips for feedback are: 

  • Provide the feedback in a calm non-judgmental manner
  • Describe the behaviour as clearly as possible
  • Ask if the person has understood what you've said
  • Repeat the feedback regularly if needed due to memory problems. 


Look for the message behind a behaviour

Before taking a challenging behaviour personally, look for the message. This could be:

  • "It's so frustrating trying to handle my volatile emotions nowadays"
  • "This is an unfamiliar environment/activity and it's disturbing me"
  • "I've got sensory overload from too much noise/light/overcrowding"


"I" statements

A powerful technique to remember in conflict situations is using "I" statements instead of "you" statements. Instead criticizing the other person, you are letting them know how you see and feel about the situation. Examples of both statements are:

  • "I find it unpleasant when you yell at me loudly and stand so close"
  • "You are a horrible person and treat me as if I'm nothing to you". 


Setting limits

Setting limits is essential: it helps when the person knows exactly what is expected of them in any given situation, and prevents them from having unclear or unrealistic expectations. Set limits as early as possible with the person, and set them often. Limits can concern roles, tasks, activities, or about specific behaviours that are appropriate or inappropriate. Don't set limits you can't keep to e.g. don't threaten to leave if the behaviour continues and then stay in the situation.


Develop strategies to handle conflict

It can be very difficult for families to calmly respond in a consistent way to challenging behaviours but this is easier when a positive behaviour plan is developed. See your Brain Injury Association about behaviour specialists, and read our detailed fact sheets on challenging behaviours. 


Be involved in rehabilitation

Even when the official rehabilitation is finished, in a sense it never finishes - people regularly report improvements for many years after a brain injury because they keep learning strategies to compensate for lost communication skills, emotional control, stress management, poor attention and low motivation. This process works much better when the family is involved too, and will reduce the amount of conflict over time. 


Give positive feedback & encouragement

When there is a lot of conflict it can be hard to provide the person with positive feedback, but where possible you should aim to provide much more positive than negative feedback. People with a brain injury often say they feel as if trying to recover from a brain injury is the hardest thing they have ever done in their lives, and often feel their partners or family don't understand just how difficult it is.


Examples of positive feedback include:

"I like to see how you are helping others"

"You are doing so well with. . ."

"You put a lot of effort into that task."


Safety plans

If angry outbursts are common, have a safety plan in place. When anger has got to a certain point it's best 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. Maintain a safe environment if needed e.g. remove potential weapons or dangerous objects that could be thrown or used to damage property. Violence is never acceptable. 



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