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Feeling emotional, aggressive, anxious, and, most of all, frustration is some of the most common problems after TBI. If you have TBI or know someone who does, you might have noticed that these outbursts are mostly spontaneous and hard to control. The best you can do as a family member is to understand this and respond calmly instead of getting emotional yourself.

What causes feelings of aggression and agitation after TBI?

Case studies on people involved with minor accidents and concussions show swelling, brain tissue compression, and cranial deformations. It can also develop in diffuse brain injury caused due to micro-damage to the neuro-axonal structure like the cerebral white area, corpus callosum, and the brainstem. Immediately after injury, the synapses, where neurons connect, are damaged hence diagnosed as mild TBI (mTBI). 

Symptoms include difficulty in focusing, blurry vision, dizziness, loss of consciousness, headaches, insomnia, irritability, and depression. Some mTBI patients are also diagnosed with PTSD, and in case of complications, chronic traumatic encephalopathy (CTE) can occur.

On the other hand, cases of severe TBI or focal brain injury caused by repetitive brain trauma and ruptured skull and cranium need intensive care. The brain can shift to one side of the head, and beside excessive blood loss, it also disconnects the synaptic clefts and postsynaptic densities (PSDs), temporarily interrupting the neural circuit.

However, due to the initial loss of synapses in the cortex, the efficiency of neurotransmission from one synaptic terminal to the other is reduced. That results in short term memory loss, feeling lost, and inability to function correctly.

Symptoms for severe TBI include slurred speech, vomiting regularly, terrible headaches, seizures, sleep-wake disorders, loss of mind-body coordination, etc.

If your aggressive and impulsive behavior worsens, then medication can also be taken by your doctor's guidance. Even though there is no specific drug/ medicine for TBI related anger issues, anti-depressants, painkillers, and mood stabilizers can be taken. Only to be used in case of emergency; few to list are:

• Propranolol – can help with aggression  (B grade)
• Carbamazepine 
• Valproate
• Prozac

Dealing with impulsive temper and frustration after TBI

First and foremost, observe how you feel and how your body language transforms during these episodes. Note physical and verbal signs like:

• Balling of fists
• Sweating profusely
• Fidgeting/restlessness
• Throwing/slamming things
• Shouting
• Use of abusive language

These signs may help you and your caretaker foresee an outburst. Moreover, avoid things that can trigger aggressive behavior. For instance, most people can get triggered by noise, bright light, headaches caused by fatigue or alcohol, stress, and even high intake of sweets/chocolates.

If you have someone in your family or support group that you comfortable with, then make sure to confide in them. If not, professional help like a behavioral therapist can be an excellent outlet to express any bottled up things that are causing stress.

Any other way to get hold of sudden episodes and violent behavior is exercise because it relaxes the muscles and improves mental health. Instead of vigorous exercise, try doing yoga or meditation for a change. It will help you with concentration and self-awareness.

Nonetheless, don't miss regular checkups with your doctor, and in your free time, try researching on your condition to help understand it even more. Join a support group or contact an expert for moral and emotional support.