TBI and Impulsivity

A traumatic brain injury (TBI) is a multifaceted injury with a broad spectrum of symptoms and disabilities. If you know someone with a TBI, you may notice changes in their behavior. An injury to the brain (usually an injury to the frontal lobe) often causes changes in emotion, which leads to modifications in behavior.

In the early stages of recovery, people often struggle with their ability to judge situations, which can include socially inappropriate and personal remarks, being over-familiar with strangers, using abusive and crude language, or generally behaving in an unpredictable way. This behavior could be troubling for families and friends as well as potentially hazardous for the individual. It can be difficult to control because they lack their usual level of awareness and might demand immediate gratification.

Common features of impulsivity include:

• Saying whatever comes to mind without thinking about how it might affect the person, him/herself or someone else
• Acting without thinking about potential consequences
• Inappropriate comments to or about others
• Sharing personal details inappropriately or asking personal questions of others despite their discomfort
• Inability to save money or regulate finances
• Irritability or temper outbursts
• Yelling out answers before questions have been completed
• Intruding in on or interrupting conversations or games
• Unable to wait patiently for their turn

For individuals with a TBI, “Stop and think” is a good mantra to help a person make up for various cognitive changes. It allows the person to slow down, pause, and take the needed time to think about something before acting upon it. They can also try to discuss an upcoming interaction aloud and try to talk through the plan of action. The more discussion that takes place, the less need there will be for improvising – as it’s improvising that brings out the highest level of impulsivity. Emotional overload can produce a massive tendency to act impulsively, so if you notice that state, you should consider the following methods:

• Use redirection (suggest a different activity or topic of conversation)
• Develop a “stop and think” signal that you can use to alert your family member when he/she is doing or saying something inappropriate (raising your finger, saying a special word)
• Suggest that your family member stop and think, slow down, and consider options
• Praise and reward desired behaviors; discuss consequences in private, after the fact
• Avoid comparing past and present behaviors

When other people do not understand the reasons for this behavior it often leads to rejection and criticism. Impulsivity can, therefore, lead to social isolation as the person alienates existing friendships and cannot make new ones.

Feinberg Consulting is extremely well-versed in the arena of TBI. A Case Manager can be instrumental in providing families and individuals with concrete steps in combating a TBI. There are thousands of individuals who have shown marked improvement under professional direction and coaching.