Brain injury can impact how you act (and react). This affects not just you, but also the people in your life. This can be a confusing part of life after brain injury, because you may:
- Not recognize that your behaviour has changed
- Recognize it, but not understand why it’s happening
Because your behaviour is so closely tied to our emotions, navigating these changes can be overwhelming. Learning about behaviour and brain injury can help with that.
On this page, we explore some behaviours that you might exhibit, how they might look, and tools to help navigate these behaviours.
Let’s talk about:
Before you keep reading
On this page, we use ‘you’ because we’re talking to all the people reading this page. You may not exhibit some of these behaviours - but other people will. So when we say something like “You may respond with aggressive behaviour”, we’re not speaking to your personal experience. If you have any worries about your behaviour or want some help going through this page, talk to a parent, guardian, or an adult you trust.
These three behaviours are grouped together because they have a lot of similarities. We’ll also talk about them on our emotional effects page.
Aggression
Aggression (like most behaviours/emotions) depends on the person. In general, aggression is when someone acts (or intends to act) in a way that might physically or mentally harm someone else [1]. Most people don’t mean to respond aggressively. They may be experiencing a challenging situation and not know how to work through their feelings about it.
Aggression can show itself in a variety of ways, including:
- Damaging or destroying objects
- Excessive swearing
- Threatening harm to others
- Inability to self-monitor
- Verbal, physical attacks
Episodes of aggression often come on very quickly and tend to pass within minutes. They also mostly happen when a person isn’t fully aware of the extent of their brain injury.
Displays of aggression can be upsetting for both you and your loved ones – not to mention a safety risk depending on the behaviour. While you may not think you’re being aggressive, you should still do everything you can to make sure you are taking the time you need to process a situation and work with the people in your life to navigate it. Some ways to do that include:
- Ask caregivers or health care workers to explain what they’re doing before they do it. Understanding what is happening can help reduce fear and confusion
- Identify and eliminate/reduce items or events that trigger aggression (when possible). For example, if the noise from the television is making you angry while you’re trying to do your homework, you could put in earplug, ask the person to watch their show later, or find a new place to work
- Work with your parent(s)/guardian(s) to set up the environment so you’re as comfortable as possible (i.e. dim the lights if they’re too bright)
- Redirect to calming activities you enjoy or go to a quiet place if you are feeling confused, angry, or scared
- Use calming tactics such as deep breathing or meditation
It can be hard to remember calming strategies in the heat of the moment. You and your loved ones can come up with a plan in case there starts to be a display of aggression. For example, maybe your parent could join you in some deep breathing exercises.
If you have more questions or concerns about aggressive behaviour, talk to your loved ones and to your doctor. They can refer you to someone who specializes in behaviour.
Anger
It’s common for people living with brain injury to get angry more often and/or more quickly. Plenty of things can make someone angry, including:
- Feeling confused
- Frustration with a task that is harder than it used to be
- Being tired
- Not understanding what another person is saying/doing
- People telling you what to do or pointing out mistakes
- Too much stimulation (e.g., light, noise, and movement)
- Feeling misunderstood or lonely
When you’re angry, you may want to:
- Shout
- Make loud noises (like slamming a door)
- Being mean to others through your words
- Keep quiet (this is often called the silent treatment)
- Expressing yourself physically by throwing things
As you may have seen, these are similar to aggressive behaviours. That’s why we’ve included them together. And while it’s okay to be angry, behaving in a way that could hurt yourself or others isn’t going to help.
One of the best things you can do to work through your anger is to ask to talk to your parent/guardian. Try not to put blame on anyone, but don’t be afraid to speak honestly (and respectfully) about your situation.
Here's an example:
“Mom, can I talk to you about something? I want to explain why I shouted at you and slammed my door. I was working on my homework, and the sounds from the kitchen were really distracting. I started getting upset about that, and then when you started asking me questions about my homework, I got really overwhelmed. That’s why I got mad. I’m sorry I yelled and slammed my door. Can we try a new system where no one talks to me during my homework time unless I ask for help?”
In this situation, all the noises and the interruptions were just too much. That happens sometimes. And it’s okay to feel angry. Talking it out might help navigate some of those feelings and minimize angry behaviour like yelling and door slamming. And your parent/guardian might not have understood why what they were doing was making you mad, and have solutions of their own. Using the example above, Mom might say:
“Thank you for telling me. We’ll do our absolute best to not interrupt your homework time unless it’s for supper. And maybe we can try getting you some noise-cancelling ear plugs to help with other noises.”
If it helps you, write down what you would like to say before going and talking to your parent/guardian.
Some other things you can do if you’re feeling angry include:
- Engaging in calming activities like listening to music, reading, or spending time in nature.
- Practicing deep breathing.
- Writing down why you’re angry in a notebook. Express yourself as freely as you want. Then you can either put it aside or rip up the paper (that can feel pretty good when you’re dealing with intense emotions).
- Removing yourself from the situation and go to a more calming location.
- Working with a doctor who is familiar with acquired brain injury on self-calming methods and communication strategies. Being able to communicate what you’re feeling to others can be extremely helpful when it comes to emotional situations.
- Working with a cognitive behaviour therapist. They can provide support and tools to help manage anger/aggression and understand why you have these reactions.
Frustration
It’s normal to feel frustration after a brain injury. Recovery is not a simple process and adjusting to the new challenges you’re experiencing isn’t easy.
There’s probably a lot of things that are going to make you feel frustrated. For example:
- Not being able to do something the way you used to do it
- Feeling slower at something you used to be really fast at
- People talking to you differently or telling you what you can/can’t do
- How you feel (i.e. you feel tired all the time, even if you sleep well)
This doesn’t include all the little things that can add up in a day to make you feel frustrated, like running out of ink in a pen or struggling with difficult homework.
When you’re frustrated, you may give up on tasks, avoid things because they are too hard, or have emotional outbursts. These behaviours won’t help make the situation better.
If you experience frustration, ways you can cope with it include:
- Celebrating your success, especially if you complete a task that used to frustrate you
- Doing challenging tasks for short periods at a time or with scheduled breaks
- Going to a quiet place when you’re frustrated
- Identifying what makes you frustrated. While you may not be able to entirely avoid being frustrated, understanding what causes you to feel that way is the first step in learning to cope with it
- Taking slow, deep breathes to help calm yourself
Have you heard the idiom “the straw that broke the camel’s back?” It describes that moment when a small thing happening causes a strong reaction because so many other small things have happened. We all have times when a lot of small bad things have happened that on their own wouldn’t seem so bad (like a pen running out of ink). But if your pen runs out of ink after you missed the bus, didn’t have a good physiotherapy session, and your phone died, it suddenly feels like a much bigger deal. This can happen a lot for people with brain injury, especially towards the start of their recovery journey. If you’re feeling like this, make sure to use the tips we mentioned, and talk to your loved ones about how you’re feeling.
Anxiety
Anxiety comes from a place of worry, fear, and/or stress. You may not even be aware that you’re feeling this way, but you might be exhibiting symptoms of anxiety.
It’s common for people with brain injury to experience anxiety, and unfortunately, there are a lot of things that could make you feel anxious. You may worry about:
- Recovery being too slow
- Getting back to school
- Missing out on activities with friends and teammates
- Changes in your relationships with family and friends
- Not being able to do the things you want to do
It’s normal to worry a little about stuff like that. But when anxiety gets in the way of you feeling good and moving forward, it creates more barriers that can impact your recovery. This can include:
- Avoiding places, people, or situations
- Re-checking things excessively
- Asking the same questions over and over again
- Saying no to things, even if you really want to say yes
- Feeling really unhappy and sad
Anxiety can also lead to panic attacks, which are sudden feelings of intense fear and physical sensations like your heart beating really fast, shallow breathing, and sweating. They can be brought on by:
- Overwhelming situations or emotions
- The way you’re thinking about a situation
- Upcoming events/appointments you’re dreading (like a homework
- deadline or a presentation)
We talk more about anxiety and panic attacks in our section on mental health.
While we recommend you read our page on anxiety in full, we also have some tips here on coping with anxious thoughts and behaviour.
- Develop routines. Having a plan will make you feel more in control
- Participate in counselling geared toward anxiety (e.g. cognitive behavioural therapy and mindfulness) if possible
- Practice slow, mindful breathing
- Redirect yourself to a familiar place or activity that makes you feel safe and calm
- Schedule “worry appointments” so you can contain your worries to a time and place of your choice (e.g., after breakfast) rather than having worries pop into your mind when you are trying to do other things
But I don’t know why I’m feeling anxious
If you don’t know what’s making you anxious, it’s hard to work through it. Sometimes all we need to do is take a few minutes to think about our day and how different parts of it made us feel. Grab something to take notes with and ask yourself:
“What did I do today and how did I feel about it?”
You can use this as a tool to support your mental health and provide more information to the health care professionals who are working with you.
For example, if your teacher reminded you about a book report due in two weeks and you felt anxious, due dates may be something you need some help with. If you are struggling to make this list, ask a parent, guardian, sibling or friend for help. They may notice things you don’t.
Treatment for anxiety from a mental health professional may be necessary if anxiety is impacting your daily activities, sleep, and relationships.
Most importantly, don’t punish yourself for feeling anxious. Anxiety is something almost everyone experiences, and brain injury can have a real impact on it. Remember to be patient and kind to yourself– you’re doing your best!
Denial
Denial is the act of thinking or saying something is not true when all the evidence points to it being true. Brain injury changes your life in a lot of ways, and many people go through a period of time where this is hard to face. Denial after brain injury can look different for everyone. Some people may not recognize how serious their injury is and how it’s impacting them. It’s not uncommon for phrases like “nothing has changed”, “there’s nothing wrong”, or “I’ll be fine” to be used. You might have said these yourself because you didn’t want to think about your brain injury. This kind of denial is often a coping mechanism and you will move through it as you learn more about brain injury and work with rehabilitation specialists.
You may also experience denial because of damage to the brain itself. This is covered in the “Cognitive Effects” section under judgement. You may not understand what has changed and you may not be aware that you’re experiencing denial.
Denial can also lead to some risky behaviour. You may become angry and frustrated in a situation, and as a result, engage in risky actions to ‘prove’ that you don’t have a brain injury. Or you may just not have the capacity right now to understand what’s safe and what isn’t.
You may also blame your challenges on someone else or the environment you’re in, because it’s often easier to blame someone else than accept something as life-changing and difficult as a brain injury.
It’s important to understand two things. First, denial is a normal part of the human experience, especially when facing a tough situation. Secondly, you probably won’t recognize that you’re in denial (at least not right away). It’ll probably be someone else who brings this up with you. And it might make you mad to talk about it. Remember to practice some deep breathing and engage in the conversation as respectfully as possible. The people who are talking to you about your behaviour are the ones who want to support you. If you have your own concerns, it may be helpful for you to speak with a parent/guardian or therapist. They can offer emotional support and practical advice on coping with the changes you are experiencing and how to move past denial into acceptance.
Depression
Depression is a complex health condition involving a person’s thoughts, emotions, and behaviour. It’s often linked to grief, mental health, and mental illness. Depression can be caused by many different things. This includes psychological factors (like stressful life events) or biological factors(like damage to your brain or changes in the way your brain is working).
Many people with depression may:
- Feel sad a lot of the time
- Lose interest in their usual activities
- Withdraw from others
- Have a negative outlook on life
- Experience changes in energy, sleep, and appetite
Depression can only be diagnosed by a mental health professional. We’ve included depression here because it does impact your behaviour. But it’s a really big topic, so we have a separate page for depression and mental health information.
Disinhibition/impulsivity
Disinhibition is your ability to act without thinking about consequences or being worried about rights/wrongs and how other people might think of you. On paper, this might not sound so bad. But our inhibitions keep us safe and help make sure we are acting in appropriate ways for the situation. For example, the way you behave at a sports game in the stands is not the same as you would behave in a classroom.
A brain injury can impact your inhibitions and your impulse control (which is your ability to think things through before speaking or acting). When you don’t have this control, it impacts how you behave. For example, you may:
- Be easily irritated
- Buy things you don’t need or can’t afford
- Do risky, dangerous things
- Have mood swings
- Ignore social and safety rules
- Make inappropriate remarks
- Say the first thing that comes into your head
Here's an example:
Your teacher asks you about whether you’ve started an assignment. You say no. They ask why not. Your first thought is this homework isn’t useful or interesting and you don’t want to do it. And you say “I don’t want to because it’s boring and pointless”. This isn’t something most people would say to their teachers because homework is something that is part of school and has to be done. It’s also not a very nice thing to say to a teacher who assigned the homework. This is an example of acting/speaking impulsively.
If you’re struggling with impulse control and disinhibition, two of the best things you can do are to develop a process for making decisions and asking for help.
Impulse control naturally means making decisions. We’re always making lots of little decisions without even thinking about it – like scratching an itch on our arm, turning the TV up when we can’t hear, and choosing to open up TikTok to scroll. With bigger decisions, we need to take a bit more time and mental effort to think about them.
Taking in all the information you need to make an informed decision can be challenging after a brain injury and as a result, you may do the first thing that comes to you (even if it might not be the right decision).
Here's an example:
It’s mid-morning and you see something you want in the vending machine. You have money, but you were supposed to save it to get a snack after school because you have practice. But you see something you want now, so you get it and eat it. Later on, you don’t have the money to get anything, and you get really hungry, which impacts your energy.
This is a pretty harmless example. But these kinds of impulses can affect all kinds of decisions, including more serious ones. Having a decision-making process can help prevent impulsive, risky behaviour and ensure that you consider all factors that go into the decision. This includes knowing:
- All your options
- How your decision could affect others
- How your decision could affect yourself
Your decision-making process will look different from someone else’s. You may want to:
- Write out the pros and cons of each option (you can do this in your head if you prefer)
- Ask for advice
- Share your decision with someone you trust before you act on it
You also don’t have to make every decision on your own. You can ask someone to listen to your thought process out loud. You can also ask for recommendations about how to act or respond to a situation (especially if it’s new to you).
Lack of initiation
For some people with brain injury, getting started on something (even if it’s something the love) can be really hard. The ability to start something is called initiation.
If you struggle to initiate activities, you might display the following behaviours:
- Apathy
- A general loss of interest in many things
- A flat attitude/not a lot of ability to show emotions
A researcher once referred to this as a “curious disassociation between knowing and doing” [2]. You might be able to know and tell someone what you want to do, but not actually be able to do the actions.
Unfortunately, someone looking in at the situation might mistake a lack of initiation as laziness or being difficult on purpose. In most cases, that’s not true.
If you have a hard time getting started, there are a few ideas you can try:
- Break down tasks into smaller, more manageable actions
- Use a routine to make things easier and more predictable
- Use reminders (verbally, written down, or on phones) to stay organized
- Celebrate your successes
Perseveration
Sometimes people with brain injury get stuck on single thought or action. Kind of like being stuck in a loop of doing or thinking the same thing without being able to stop. This is called perseveration. This tends to happen more in the early stages of recovery and fades away over time.
If you’re struggling with getting stuck (even if it might not be full perseveration), write down what you’re stuck on. Then separate yourself from it and do something totally different to give yourself a break.
You may want to talk to a cognitive-behavioural therapist or psychiatrist or psychologist for more specific assistance.
Sexually inappropriate behaviour
Sexually inappropriate behaviour is when someone acts in a way that is unwanted or not appropriate for the circumstances. This includes:
- Making inappropriate comments about themselves or someone else
- Inappropriate actions (such as touching)
- Exhibitionism, which is the act of displaying genitals in public places or to people without their consent. This behaviour can also include masturbation at inappropriate times or in inappropriate places
Sex is a topic you might not know a lot about yet, or it could be a newer part of your life. If you’re looking for more information, check out our page on sexual health and wellness.
Sometimes brain injury makes it hard to understand what’s appropriate and what’s not. This kind of behaviour can make a lot of people uncomfortable and create more problems if it isn’t addressed. Talks about sex, behaviour, and what’s appropriate should always be respectful. You might not feel comfortable talking to your parents or guardians about sex, but it’s important to find an adult you can speak with. If you have questions about sexual behaviour or sexual health, these should be shared with your doctor. It’s important to share your questions and have open, honest discussions about what you are feeling/experiencing, especially as you go through puberty.
Social dysfunction
Maintaining a social life is a high priority for most people and it’s also an important part of the human experience. Unfortunately, a brain injury can make socializing harder. For example, you may:
- Have trouble keeping up in group conversations
- Have a lack of awareness regarding how others feel emotionally
- Make inappropriate comments
- Misinterpret social cues such as facial expressions
- Mistake sarcasm for literal statements
- Show aggression and frustration
Trouble socializing can lead to isolation, anxiety, and depression. Socialization is incredibly important for mental health, so it’s important to understand what is involved in being social after a brain injury. We cover this more on our page about socializing.
You may experience some, all, none, or other behavioural effects not mentioned here and it may be for a short or long period of time. The most important takeaway is there are ways to work through unwanted behaviours. Your friends, family, and health care team are here to support you. Ask them what behaviours you should work on and strategies to redirect yourself. This may seem challenging at first and you may make mistakes, but with time and practice, you will get there! Don’t forget to celebrate your strengths and successes along the way.
