Quick Facts

  • Anger is a very common emotional response following a brain injury
  • This may be an exacerbation of the individual’s pre-injury personality, or a new change in personality and behaviour
  • Anger is an emotion triggered by an event, and may not always lead to aggression
  • Aggression or aggressive outbursts are what others can see, hear, or feel

What does it
look like?

  • Irritability
  • Having a very short fuse or trouble controlling temper
  • Verbal aggression, which may include: swearing, yelling, judgmental, and abusive comments
  • Physical aggression, which may include: hitting, pinching, kicking, pushing, or spitting
  • Physical symptoms such as rapid breathing and heart rate, tense muscles, sweating, and a flushed face
  • Physical self-harm
  • Threatening behaviours (e.g. raising voice, standing too close, staring, shaking their fist)
  • Characteristics of impulsive anger:
    • Anger begins with the injury or is much worse since injury
    • Feelings of anger come and go quite suddenly
    • Minor events trigger anger, threshold is lowered
    • Following the anger episode, the individual is surprised and embarrassed
    • Anger is made worse by physical stress such as fatigue, pain, or low blood sugar

Possible Causes and Complications

Possible causes:

  • Damage to the parts of the brain that normally control anger and behaviour
  • May have had an angry and irritable personality before the brain injury and these traits could be amplified following the brain injury injury
  • Environmental factors which may contribute to anger:
    • High level of noise, activity
    • Unexpected events, lack of structure
  • Medical factors that may contribute to anger:
    • Fatigue, pain, and low blood sugar
    • Medications, alcohol ,or drugs
  • Personal factors that may contribute to anger:
    • Frustration, fear, anxiety, irritability, and agitation
    • Feeling isolated, depressed, or misunderstood
    • Embarrassment, shame, or guilt
    • Discovery of their difficulties, lack of insight, or unrealistic expectations
    • Difficulty concentrating, remembering, and communicating
    • Grief

Possible complications:

  • Loss of friendships and damaged relationships
  • Withdrawal and isolation
  • Embarrassment, frustration, and sadness following an outburst

What can we do?

  • Keep a record of events, triggers, and levels of anger
  • Use positive ways to manage and respond to behaviour, such as gently redirecting their attention to something else
  • Try not to become angry yourself
  • If the anger is directed toward you, remove yourself from the situation
  • Do not take anger personally, recognize the impaired ability to control anger
  • Avoid the escalation of anger and aggression by developing behaviour intervention and management strategies, such as suggesting they take a time out to calm down, using breathing strategies, or listening to music
  • Support the development of self-control strategies (e.g. exercise or deep breathing)
  • Seek support from a health care provider to learn strategies for anger management (e.g. psychotherapist, speech language pathologist, psychologist, social worker)

Disclaimer: This information is not meant to replace advice from a medical doctor. Consult a health care provider regarding specific medical concerns or treatment.