Personality, Mood and Behavior Changes

Prepared by: Cicilia Evi GradDiplSc., M. Psi

Introduction

• Personality changes can occur after any closed head injury, but it common in patients who have suffered severe or very severe head injuries

• Can happen as direct result of damage to the brain … but it is possible that some late-appearing personality changes reflect the person’s reaction to the problems and frustrations associated with handicaps caused by the head injury

Anger and Aggression• An event or circumstances which would be considered as

trivial or mildly irritating before the accident can trigger a major temper outburst difficult to regain self-control

• Rage as an epileptic activity in temporal lobe of the brain instead of convulsive muscle spasm or lose of consciousness

• Injury impaired emotion and behavior control• Rate of violence increase between 1-5 years after the

accident loss of abilities and change in lifestyle • Altered sense of humor

Anxiety and Nervousness

• Anxiety levels are greater in head-injured population 19% - 57% of the population

• What happen?– Feelings may feel tense, apprehensive, fearful or panic

stricken, irritable, tired– Physiological symptoms racing heart beat, headaches,

painful muscles (neck and shoulders), shakiness/trembling, hyperventilation, gastric problems and sweating

– Behaviors talk quickly, easily startled, lack concentration, signs of irritability and impatience, tired, insecure, overly dependent, avoid soc life

Contd.

• Causes of anxiety:– Damage to emotional centres of the brain (limbic

system)– As emotional reaction never recover, fear pr

failures, PTSD

Childishness

• About 60% of head-injured people reported by family showing childishness in average of 2.5 years after the injury but, dropped to 25% after 15 years of the injury

• Related to reduced behavioral and emotional control, tendency to see things from their own perspective and the insecurity from lack of confidence due to changed abilities

Dislike of Company

• Because they are very sensitive to noise and other stimulation and difficulty to cope with multiple inputs

• They need to limit the amount of time of spending their time with large social group and preceding the time with rest (Dr Muriel Lezak)

Depressions and Unhappiness

• Over 40% of the head-injured patients suffered a major episode of depression at some time during the first 12 months after the accidents mild to severely injured patients

• Can arise as direct consequences; or caused by the person’s reaction to the accident and its consequences

• Signs excessive crying, withdrawal, loss of pleasure and interest, low self-esteem, sleep and weight problems, marked lethargy and slowness

Contd.

• Depression can caused irritability, lack of initiative, a difficulty in making even simple decisions, poor memory and concentration, and a feeling that life is not worth living

• Fugue state appears awake and alert and their behaviors seem normal but later, they have no memory of the period during which they were in fugue state

• Depression can be serious, painful and even life-threatening illness need help and support

Impulsiveness

• Do not necessarily consider all the options available to them, or the likely consequences of their actions

• Some positive effects more relaxed approach to matters but they become reckless in every decision or action taken

Inflexibility and Stubbornness

• No matter how strong the opposition or how cogent the reasoning it’s very difficult to influence the inflexible brain-injured person once they have decided on a course of a action

• Rigid expectation can cause anger, conflicts, irritation and frustration

Jealousy and Possessiveness

• By making angry or disparaging remarks about the other person, by bullying or by studiously ignoring them objects of jealousy: other person’s good health, their personal relationships and the attention they receive or give to others

• Possessiveness not restricted to relationship matters, but also into objects

Laughter, Crying – Uncontrollable

• Suffer from frequent bouts of laughing or crying uncontrollably which are prompted neither by sad or amusing event nor by a happy or unhappy personal thought known as pathological laughter or pathological crying

• Their emotional behaviors do not reflect their actual feelings

Law-Breaking

• The head-injured people who is unable to control their temper, sexual responses or impulses to relieve others of their money or possessions may find themselves trouble with the law

• They have the knowledge of law, but they cant control their impulses to the extreme of taking others’ lives

Listlessness

• Adynamia having difficulty beginning or initiating an activity or a thought and tend to do and say very little unless encouraged or organized by someone else need to be prompted into action by someone else

• Being listlessly around the house, making no effort to occupy their time in a constructive or enjoyable fashion

• Not lazy but due to the damage to the region in the inner part of the frontal lobes which is responsible for initiating activities

Psychosis

• Quite serious psychiatric symptoms appear after a head injury their perception or interpretation of reality becomes grossly distorted delusions and hallucinations, paranoid

• Often begin during the period of post-traumatic amnesia, but can appear for the first time after the person is out of PTA

• They are usually temporary and disappear as the person recovers

Self-Centred Behaviors

• They view a situation entirely from their own point of view and according to how it affects them

• Derives from executive and reasoning limitation – Executive able to view from other’s perspective,

but don’t think to do so – Reasoning lost reasoning skills to view an event

from other point of view

Sexual Behavior – Changed, Inappropriate

• Ignore unwritten rules on how to approach opposite sex and in what circumstances it is appropriate to make suggestions of a sexual nature

• Unaware of the inappropriateness of their sexual comments, or maybe aware but unable to control their behaviors, preoccupied with sex and engage in excessive sexual activities masturbating or exposing themselves in public

• Some become disinterested in sex

Swearing and Verbal Abuse

• Head injury victims sometimes swear excessively and in a way which shocks and offends others

• Sometimes be assisted in special behavioral change techniques offered in rehabilitation programs

Positive Changes?

• Happier, more communicative, more sensitive, stopped drinking, manage to keep one’s job, talkative, extroverted

• Research by Dr Ranseen 120 patients over 2-year period 3.3% were judged to undergone a positive personality change by their relatives