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Understanding the emotional impact of brain injury

In the wake of a brain injury, emotional changes are common. About 31% of stroke survivors, and about 50% of people recovering from a moderate to severe TBI experience episodes of depression. Rates are even higher for people with post-stroke aphasia at about 68%. These emotional changes can be a result of physical brain damage caused by the injury, or can be related to the life-changing impact that these injuries often have on the survivor and their loved ones.

It’s important to note that everyone is different, and emotional experiences after brain injury may vary in severity. The intent of this article is to normalize the emotional side effects of brain injury, and bring awareness to this aspect of the recovery journey. Hopefully, when the emotional waves present themselves, you or your loved one will feel better equipped to face them.  

How brain injury can cause emotional difficulties 

Physical damage to the brain can result from a traumatic injury like from blunt force to the head, or an acquired injury like a stroke. These kinds of injuries cause physical damage to the brain tissue, which affects a wide range of functions, namely speech, language and cognitive skills, but emotional challenges can arise as well. 

Location of physical damage

  • Depending on the region of the brain that is affected, emotional functions can be impacted. For example, when there is damage to the frontal lobe (the front part of your brain), personality and emotional changes can occur. As a brain injury survivor, you may experience mood-swings, or have a difficult time regulating your emotional responses to your environment (think being pushed to tears more easily). This dysregulation and lack of emotional control can often feel alarming, and can trigger feelings of frustration, overwhelm, or even anxiety. 

Impact on daily functions

  • Similarly, when an injury impacts a survivor’s daily function and activities, it can trigger a cascade of heavy emotions. For people with Broca’s aphasia, the conscious effort it takes to get the right word out can be incredibly frustrating. For brain injury survivors, sensory overload from things like lights, background noise, or lots of movement can easily occur. In both these examples, a heightened stress response is typical. A recovering brain is hypersensitive to strain or overwhelm. So be gentle. Try to relate to these emotional reactions as signals to take a break.

There can be profound feelings of fear and helplessness at the beginning of rehabilitation. These feelings are normal and fully warranted. 

Survivors can also experience “incomplete mourning” 

Survivors can often feel, especially in the beginning stages of recovery, that they are no longer themselves. The contrast of pre and post-injury life can bring up feelings of loss. In embracing a new reality post-injury, a grieving process may be necessary. A difficult aspect of recovery is the feeling of what’s called “incomplete mourning”, where some aspects of  a survivor’s life are very much the same, and some things are completely different. The change and ambiguity is difficult to process, but this emotional reckoning is a common, even foundational, part of any rehabilitation journey. 

The end goal is acceptance 

The last step in any grief process is acceptance. Acceptance means no longer resisting the reality of the situation, and no longer trying to make it different. Sadness, uncertainty, fear — all these emotions can still be present, but in a state of acceptance, feelings of loss are more manageable. Acceptance might not come immediately, but it is a great emotional goal to aim for. 

Even with these changes it’s critical to remember that as a survivor, you are still you!

Though there are a lot of changes that come in the wake of a brain injury. A critical thing to remember is that pre and post injury, you are still you. Your recovery journey is a trajectory that will offer new challenges and triumphs. And though there will be moments where emotion runs high, remember, there is agency in this process! As a survivor, you get to choose what your new goals are, the kind of  life you want to lead, what kind of care you want to receive, and who your support system includes. You are still at the helm of your life.

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  1. Dean G Morris

    This is the best article on recovery that I have read in a long time. The most important sentence in the entire article is the last.

    • Constant Therapy

      We’re so happy to hear that this article felt useful to you, Dean. Thank you for the kind words.

  2. Michael J Greig

    I was hit by a car while riding a bicycle in March of 2019. I was in a coma for 21 days and 18 of those day was on life support. I have many screws and rods in my spine as well. I am fortunate to walk again. I was diagnosed with Frontal Lobe Brain Damage as a result from this incident. I still have a very difficult time when someone or something either causes stress or pressure on me. I always either completely shut down and hide in my room from everyone or if I cant get away from the situation or the people I will start to panic and end up not understanding things and can not clearly grasp the situation and over-react. Is this normal for my condition? Also I was involved in a very toxic relationship at the time with a narcissistic woman who I dearly loved even though I knew I should not be with. It was at times s very loving relationship as well. The relationship ended in February of 2020 when she committed suicide laying next to me while I was asleep. That has been something that has become nearly impossible for me to have closure and I wonder if it has anything to do with my brain injury. My sister has done so much for me trying to help me have a normal life snd I am so grateful and I have tried counseling services but it seems nothing is really helping. Do you have any thoughts or recommendations of what I can do is r that my sister can look into for me ?

    • Lisa Gundlach

      This all sounds like a lot to handle! Know that you are not alone – it can be very common to struggle with mental health following a serious accident like yours, and sometimes finding the right counselor or mental health provider can be a process – definitely continue to reach out to your support systems like your primary care physician to ask for recommendations for any other counseling services! Telehealth could be an option to explore, too, to make sure you find a therapist that is the right fit for you.

  3. Sue

    I was told last week by a HCP that I am not the same person that I was a year ago. I don’t believe that. I am the same person just need to make a few adjustments. Reading the words here that ‘you are still you’ means a great deal. Thank you

  4. Donna Gee

    Great article! Wondering if any patients began to have seizures after their stroke? And how they handled the fear of having another and getting hurt?
    My daughter started having seizures after stoke and now she is having 3,4 7 5 at a time that has been sending her to the hospital. The dr ordered her a nasal spray but, we haven’t been able to find any. There seems to be a shortage of it.

    • Constant Therapy

      Hi Donna, thank you for your question. We are so sorry to hear your daughter is struggling with both physical and emotional issues as a result of her seizures. When it comes to understanding seizure risk post-stroke, we would recommend talking with a healthcare provider. For handling fear and anxiety about having seizures and associated risks, talking with a mental health professional could be helpful. Here is another BrainWire article about traumatic brain injuries and mental health that provide context and additional resources. Best of luck to you and your daughter!


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