09/10/2025
IS A TBI SURVIVOR FEELING ANGRY?
Aggression is one of the most common consequences of traumatic brain injury. Approximately 34% of TBI survivors will exhibit physical or verbally abusive behavior. Physical and extreme verbal aggression are hazardous behaviors that require immediate professional attention. Often, family members are afraid to address the issue. Other times, their efforts, including seeking outside help, are not successful. It can lead to involvement by law enforcement, mental health, or other emergency systems. In extreme cases, a person may be hospitalized or jailed for a brief period to address the immediate event, but this rarely solves the problem.
It is essential to understand that such steps constitute crisis management rather than treatment. The goal of such efforts is to eliminate the immediate danger. The good news is that there is always a trigger for aggressive behavior: frustration, fatigue, hunger, pain, overstimulation, disorganization, unexpected events, fear, communication impairments, medications, alcohol or drugs, illness, or embarrassment. Watch for warning signs. Few people automatically become explosive. Often, there are predictable signs of impending danger. Some symptoms may be subtle, facial grimaces, posturing, or withdrawing from situations. Other signs may be more obvious, such as changes in the person’s tone, increasing complaints, threats, warnings, tears, or crying. Address the problem at this point, when the person can still be engaged in conversation or has enough composure to try and calm down. The discussion should be supportive, not judgmental. All parties involved should remain calm and composed. Try and help them identify the trigger for the anger. Talk to them about advocating for their needs in a socially acceptable manner.
Should a situation escalate to aggressive behavior, withdraw yourself and others from the area, if possible, and do not engage with the survivor until they have calmed down. If the survivor causes harm, call the police. The treatment of chronic aggression in TBI survivors involves a combination of environmental modifications and therapy, which consists of assessing the antecedents to the behavior, the behavior itself, and the consequences of the behavior. Therapists who specialize in working with TBI survivors are the most qualified and will create a plan for caregivers to implement.