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In some cases survivors of a brain injury can appear to become very self centred and display the egocentricity more normally associated with a young child.


They lose the ability to see the world from another person's perspective and have little or no self awareness about how their behaviour is impacting on others.


"Gavin used to be a thoughtful considerate husband and father. We've made so many sacrifices since his hospital discharge but he says we have not been supportive. No matter what I'm doing he expects me to drop everything to do the smallest tasks and responds with outbursts the moment he doesn't get his way."


"Before her stroke Belinda was a great listener. But now she never takes an interest in my life any more, and gets frustrated when the kids want her attention."


"I gave up my job to look after Andrew full time. This has been so exhausting that I've arranged respite one night a fortnight to have coffee with friends for an afternoon. Every time he sulks and complains that I don't really care about him."


This inability to see another's point of view can be very destructive as the family often cannot understand how a previously caring person now lives completely for themselves and has no insight into how they are affecting the family.


Why does it happen?

Although we take it for granted, the ability to view the world from someone else's point of view is a very complex cognitive skill. This is just one of many sophisticated mental skills that occur in the frontal lobes of the brain. Unfortunately this is a very common area to be affected in a traumatic brain injury (TBI) and other brain disorders.


This is why self centredness frequently goes hand in hand with lack of self awareness, anger, depression, fatigue and reduced social skills. It is no wonder that families are often brought to the breaking point in the months after the injury.


Impact on the family

Families are usually overjoyed when their loved one survives the initial trauma of acquiring a brain injury. After discharge, a relieved family will go to great lengths to help with the continuing rehabilitation process, usually making many sacrifices in time, money and effort on the road to recovery.


As the months and years go by, families understandably become frustrated if none of their sacrifices are acknowledged, in fact often they will be criticised for not being supportive enough. Friends will be even less likely to tolerate self centredness meaning the family is usually left as the only social network available.


In some cases the person may be able to portray a cheerful caring seemingly unchanged personality around their old friends but immediately revert to their self centred behaviour when only the family is around. This is particularly difficult as these friends may not believe the family when they talk about the difficulties of the new personality they are facing.


What the family can do

Often the hardest part for a family is accepting that the self centredness is unlikely to go away. Some say that understanding that the traumatic brain injury has caused the self centredness eventually brings them to a point where they can accept the changes and enact strategies to manage the situations that arise.

Sometimes the family unwittingly contributes to the problem. In the early days after the injury families may spoil the patient and do everything for them. If the family member is self centred they will obviously lap up the attention, become dependent and expect to be the centre of everyone's world even more. Families need to be very firm in setting boundaries, and realise that they must look after their own needs as well as their loved one's needs.

Understand that your loved one will no longer be concerned about your rights and needs. Instead of feeling hurt try to be assertive about your rights and needs.


In some cases a person will not only be self centred but very skilled at manipulating their family emotionally. If their demands aren't met they try various strategies to get what they want such as threats, pleading, criticising the lack of compassion or sullen silences. Family members are often surprised that their loved one's skills in manipulation are so effective when their overall social skills have dropped significantly. In these cases it is vital for the family to have agreed on boundaries for acceptable behaviour, not be drawn into arguments and always be assertive.

If there is a support group for survivors of brain injury it may help if they can go along. Sometimes seeing similar behaviours and attitudes in others can bring about some level of self awareness.

Another possible way to increase a person's awareness of their self centredness can be through therapeutic sessions with a neuropsychologist. If an assessment indicates the person could benefit from therapy, the neuropsychologist will gradually gain the person's trust and begin exploring and challenging their beliefs and behaviours. With time this can gradually increase a person's awareness and insight into how their behaviour impacts on others.


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