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Helping a loved one readjust after brain injury

After Brain Injury: The Dark Side of Personality Change Part I

In the brain injury world, there are taboo subjects that family caregivers can't wait to talk about among ourselves. The dark side of personality change is at the top of the list. Read More

uncanny correlation

First, let me say that my heart goes out to you and others whose spouse suffers the kind of brain injury and subsequent personality changes you describe; it must indeed feel at times very surreal, as though a stranger who only looks like your spouse has replaced him or her. And the tbi sufferer who is even partially aware that they are no longer the person he or she used to be, has to be a devastatingly difficult reality to accept.

As I read your article, I was struck with astonishment that the behaviors you described fit my own mother with uncanny accuracy, but she never had a brain injury that we know of; she had borderline personality disorder.

It truly makes me wonder about the cause or causes of personality disorder. The behaviors are SO nearly identical to the brain injury behaviors you describe (eerily so) I can't help but speculate: did my mother at some point in her early life have an unrecognized and untreated tbi? My mother (now deceased) had distorted, negatively skewed perceptions about her own family of origin from childhood on (and about her husband/my dad and us kids throughout my life) so, perhaps she had a tbi in childhood?

Mother had most of the diagnostic traits of borderline pd but was high-functioning; she would scream and rage at my Sister and me and at our dad in private, was frequently physically violent with us, and yet she had the ability to appear absolutely charming and normal in public and could maintain jobs and friendships.

Can you imagine your husband, in his post-brain-injured state, being left alone virtually 24/7 to care for small children? The frightening, hair-trigger raging and violent behaviors you describe in your husband are what my Sister and I grew up with, inflicted on us by our mother. I have some symptoms of c-ptsd and depersonalization as a result, and my younger sister had extensive childhood amnesia. My memories are mostly intact, but I lost the ability to feel my emotions.

I wish fervently that research studies would be done comparing borderline pd patients with brain injury patients: comparing the known cause (brain injury) of these very negative personality traits with the unknown cause (life-long personality disorder) to see how the symptoms correlate, and possibly through parallel research discover ways to improve treatment of both those with physical brain injuries and those with borderline pd.

Thanks.

Here is a study involving

Here is a study involving Brain Injury and Borderline Personality Disorder. I included the link and the abstract.

http://www.ncbi.nlm.nih.gov/pubmed/7561819

Prior head injury in male veterans with borderline personality disorder.
Streeter CC, Van Reekum R, Shorr RI, Bachman DL.
Source

VA Medical Center, Tufts University, Boston, Massachusetts, USA.
Abstract

This study evaluated the relationship between traumatic brain injury (TBI) and borderline personality disorder (BPD). Forty-three males with BPD were compared with 49 age- and sex-matched controls with other psychiatric diagnoses. The occurrence of TBI was identified by chart review. Head injury was identified in 42% of patients meeting criteria for BPD but in only 4% of controls (p < .001). All patients but one had sustained a TBI prior to the diagnosis of BPD. The prevalence of TBI is higher in subjects with BPD than in controls. Since TBI occurred prior to the full expression of the BPD clinical syndrome, TBI appears to be a cause rather than the result of BPD.

This is fascinating, thanks for the link

I think all these little puzzle pieces falling into place will eventually begin to form a more comprehensive picture of how and why borderline pd happens.
(Its got to be the equivalent of a million-piece puzzle and we only have 10% of the puzzle pieces in place, now.) The fact that the behaviors are so similar RE tbi and borderline pd can't JUST be a remarkable and uncanny coincidence, so I'm going to read this article on the study RE tbi preceeding borderline pd, with great interest.

Uncanny correlation

Hi Annie,
Thank you for your comment. I've been a psychiatric RN for many years, so I understand what you're saying about borderline personality disorder. I'm so sorry that you and your sister had to endure so much. In recent years there has been a lot of research into the physical changes in the brain that trauma actually causes. Those changes often influence behavior and processing emotions. I think the mental health field is delving into biochemical/structural/cellular reasons for many psychiatric illnesses. I also agree with you that it's quite possible that an early, undetected brain injury could contribute to a person later having mental health issues. I hope you have received assistance to make a satisfying life for yourself.

Thank you

Yes, from what I've read RE the NIMH decision to start from scratch and create a new "DSM", it sounds very hopeful to me, and it sounds very much like they want to include a complete physiological/neurological workup a complete medical workup, background history research, real-life observation of the patient and interviews with those who know, work with and live with the patient, in order to more accurately diagnose an individual.

Plus, the newest, cutting-edge tools for observing a living brain in real-time, as a 3-D image, as it processes information under various test conditions, surely can help with learning exactly what is going on in dysfunctional brains aka mental disorders and help provide more targeted and more accurate diagnoses, and treatment.

My younger Sister had access to very affordable therapy through her employer and is doing much better now in most areas of her life.

I function very well in my working life, particularly now that I work for myself, at home. (Ahhhh! The delightful solitude!) But I'm pretty limited / not functioning as well socially.

Maybe when "Obamacare" kicks in, I'll be able to afford some therapy too.

sad parents

I grew up with the most "war" traumatized parents ever..I guess. they taught me "SUCK IT UP!!!" No wonder I love comedy, Marijuana, and animals

So sorry to read your quick

So sorry to read your quick note about being taught to "SUCK IT UP!!!" You don't have to. Obviously you are hurting. There are many groups that I am a part of now. Please let me know if I can do anything to help you. We all need eachother. Please send me an email if you would like a friend.

TBI Surviour

I am a TBI surviour and I try to tell my family about the personality changes but they choose to believe that I am crazy an reject me-disown me i am a retird RN and have written how I lost myself and I call going south in my emotions do you know someone who would publish it Thanks

The brain

I also survived a severe TBI that occured in 1997. This has been one of the most devastating things that has ever happened in my life. My frontal lobe was also the area that was damaged primarily. Now that it is 15 years later, I was just diagnosed with Hashimoto's disease which is an autoimmune disease that attacks the thyroid. Just when I thought things could not get any worse, they did. Brain injury education has become my passion, but I can't even organize all the thoughts in my head. Everything stems from the brain whether it is physical damage or some sort of chemical imbalance...no matter what, the brain should be the first place the medical world looks. They don't yet, but some day they won't have any thing else to blame it on.

TBI

I am close to tears as I read your blog, After Brain Injury: The Dark Side of Personality Change Part I. This is my life. My husbabnd survived a car accident. It left his body broken and TBI that has changed our lives so much that it's almost impossible to put into words. Since my husband was already on SS Disability due to heart problems and other health issues, when we were dismassed and sent to a rehab., we were basically being checked out before being checked in. I was handed a book, told to read it and my husband was put into a "tent bed" for his safety. I was told later that was a "crack bed", what ever it was it wasn't right. By the way his accident happened in Nov. 2009, not much info out there at the time about brain injuries, well, nothing that I found. The rehab we were at had no real help for Randy(my husband) or me. We came home 21 days after being admitted to rehab. I brought home a 280 pound very angry man home. He was in a wheel chair due to the broken leg, with a feeding tube still in place even though it wasn't being used, I had to clean it a couple times a day. I could go on and on. Here we are 3 and 1/2 yrs later and life is what I call cartoon land. I've laughed when I wantedd to cry, screamed when I shouldn't, cried more than I wanted. As I sit here this morning I wonder what today will bring. We just got back from a trip thats was suppose to be fun. It started that way, it always does, then WHAM, wrong word. Funs over. I've learned alot about how to deal with this man that used to love me, who used to be my best friend on my own. I'm constantly worried about what I say, have learned to pick my battles and yes I miss things being the way they were prior to Nov.09. Thank you for putting this out here for people to read.

Hello Trish, believe me there

Hello Trish,
believe me there is always some one else who feels your pain, because i do. my husband was allergic to medicine, and it cause his brain to swell. He has a brain injury, and its been 3 years. 3 of the worse f'n years of my life. Albeit i had two babies during this time, and supported the family on my own. I have so much resentment to the brain injury. I have dr jekyll and mr hyde. Now he has started having affairs.

I had a man before this, very cool calm collected. Now I have a 30 year old mommas boy who cannot so much as wipe his behind without her in tow. Now don't give me wrong. They did nothing while the injury was going on, or me needing help with him and the two babies.

But now mother dearest is here for her "boy". He has serious personality issues, up down, in out, happy sad, mean depressed. Today took the cake.

We are separated for one week, and have been arguing fighting for almost 3 years, today he had the kids.

Oh his mother was hahahahahhahahah so loud in the background when i called to check on my boys 1 and 3, it was 7pm so I told him I was coming to get them. I get there and mother dearest issooo happy, we get into it, and she tells her boy to come on, come on, and he follows her in the house.

I mean so much has been lost. The ability to think for self, make on decisions, maturity, all of it are gone, and I'm left with a immature , boyish shell of a man I loved.

I read often, and one lady said, if you mate has tbi, my advice to you is to leave now, later you'd wish you had. Unfornatley, i get it.

For the caregiver, there is really nothing. Your spouse, died.
Whats left, is somebody new, who may not even like you.

I prayed to God, and on Monday I am filing a divorce. Our 2 year anniversary is March 19.
I have nothing but hell to show.
I focusing on my children, and letting this man have his own life.

My 72 year old father

My father, aged 72yrs, had a fall in August 2013. He got checked over in hospital and was released after being told he was fine. Then in December, he fell on black ice 2 days in a row. Shortly after I started to notice a massive difference in him. Within a week he went downhill very fast.

To cut a long story short my husband and I took him to his doctors who sent us to hospital. They did tests and discovered he had a large blood clot on the front of his brain. He got operated on, then 5 days later he got rushed to theatre to remove another one. He was on a HD ward for 17 days. My father had no idea what he had been through. His behaviour changed dramaticaly. He was put on a rehabilitation ward for a few weeks, but because his behaviour didnt improve and he was confused with what was happening to him and not being helped he got put in a mental institution.

He has since been removed and put in an home for the elderly, with talk of him being moved back to the MI as he is too much work for the home. I feel helpless. I'm thinking of bringing him home but don't know if i could cope.

Truly a heartbreaking situation

My advice RE the idea of bringing your father home to care for him, is that if he is currently too difficult/dangerous for the staff of an elder care home to handle and THEY wish to transfer him back to a MI, then unfortunately your father is too difficult to be cared for just by you in a private residence.

Its just NOT a one-person job, truly.

It takes a whole staff of trained professionals to properly and safely care for dementia patients and/or patients who have become agitated or unpredictably violent or self-harming due to traumatic brain injury. It takes skill and training to be able to give meds/injections to an agitated, uncooperative patient without hurting either them or yourself.

My advice is to consult with your father's doctor about his functioning and prognosis.

If your father's doctor believes that your father needs the level of care and supervision (24/7 by trained professionals) that the MI provides, then, transferring him to the MI is in your father's best interest, and yours.

If you go there often to visit him and spend time with him, that will show him that you love him and care about his feelings and his comfort.

Best of luck to you.

-Annie

Really it is true; I have

Really it is true; I have seen many example of such incident in my life. Among all injury brain injury is the most serious. Many times it is not recover in their whole life. Doctors are also admiring it that the brain injury is the most serious injury. Wearing of helmet at the time of driving become compulsory according to our constitution.
personal injury

Subdural Hematoma & Personality Change

I found your article, and this forum, while searching for info on how to deal with my partner's radical personality change after he sustained a severe concussion and chronic subdural hematoma, after hitting his head.

He is 51 and in excellent physical health otherwise, I am 42, and we have been dating for 3 1/2 years. We are both divorced with kids from our previous marriages. Our relationship was great, we had fun, got along well and laughed a lot. We had plans for our future... when and where we were going to retire, where to live when all the kids were grown & gone.. etc.

Then, he hit his head and started having excruciating, debilitating headaches. He couldn't even get out of bed or go to work. It took me 3 months to convince him to see a Dr. By then, he had a tennis ball sized SDH on his frontal lobe. He now suffers memory loss, is short tempered, impulsive, irrational, and apathetic. None of these things are 'normal' for him.

Further, and perhaps worst of all, after the diagnosis, he suddenly decided we no longer had anything in common, led completely different lifestyles, and had no future together! He cut off all communication with me literally overnight! (we still maintained separate households).

The neurologists first course of action was to observe the SDH for a month and see if it would start to reabsorb on its own. For the full 6 weeks between CT's, he refused to communicate with me in any way. To me, it was as if he had suddenly died... he was just simply gone...

Instead, he turned to his ex-wife for support and help. Someone he could barely say a civil word to on a good day, prior to the TBI. My logical brain understands that it is the brain injury, not the person, but I'm so hurt and resentful.

He finally called me when he had his follow up CT and the neurosurgeon decided that the SDH has to be drained. We have had a few limited visits, and he still insists that we no longer have a future together, but he will at least speak with me now, and talk to me about his injury and upcoming surgery. We are still waiting for a date for the surgery.

Will this get better? Will his personality revert back at all after the SDH is relieved? Or is this now the person that he is? I've read that most healing and recovery happens within the first 6 months, but there is still very little detailed information about what happens wrt the personality changes.

Is the person I planned to spend my future with coming back or do I finish grieving him now, and move on? This really is Hell on the partner/family and although he is the one with the physical injury, a TBI is something that happens to the whole family, not in isolation to the patient.

my wife

The article and much of what people have shared sounds familiar. My wife received a so-called "mild" TBI in a car wreck in 2007. She was 47. It took months to get a correct diagnosis. Even the excellent neurologists she has seen don't seem to know how to help. Two or three years ago she began having debilitating migraines. She has fallen several times in the past couple of years and struck her head again.

My wife went from a high-functioning well educated person to being unable to read a newspaper headline after her accident. Much has been recovered in her intellectual abilities but from day to day I don't know if she will even be able to get out of bed. Pain and depression are constant companions. Her memory is not improving. Her mannerisms often remind me of her mother when she was diagnosed with Alzheimers.

Her personality changes are the most difficult for me to deal with. She is sometimes paranoid. I am blamed because she had to surrender her driver's license. I had to cancel her debit card because she was spending money on things she did not remember buying. Even though she still has a checkbook she resents the loss of plastic. We are on different planets when it comes to decisions about our three college age kids. I now have four kids instead of a wife and three kids.

This is very disturbing. It

This is very disturbing. It takes a strong, resilient person to stay with someone with a TBI. You have my respect.

This all ties into the current NFL-concussion crisis. This week, one NFL player was banned for knocking his wife unconscious and another for beating his child with a switch. Violence seems to be par for the course with these athletes, and you have to wonder what role head injury plays. Getting hit in the head repeatedly for a living cannot be healthy. Many go on to commit suicide in bizarre ways and are found to have CTE upon autopsy.

Perhaps these violent outbursts are a sort of precursor to full-blown CTE?

Neurotruth, You bring up a

Neurotruth,
You bring up a very interesting question in this controversy that has a lot of merit. Violence, increased anger and loss of control over outbursts are something I have personally seen with TBI. Since these players careers depend on being healthy and able to play, I wonder how many hits to the head that should be followed up are actually hid by the player and 'walked off'. ?
I'm happy to see however, that with the next generation of players whether football, hockey, etc. there is a great deal of emphasis placed on concussion prevention and education for both coaches and the young players.

lost

My bf had an accident a couple of months b4 we met 3 years ago. I have slowly watched the person I first met, drift away from me and from himself. He was diagnosed with OCD depression and anxiety but my research has lead me to believe it was BPD and now TBI. Is it possible that he has something in/on his brain that is making his symptoms increasinly worse? Or may the anger outbursts that include head butting walls worsening his brain injury? I just don't know and GP dismissed my queries and requests totally. I've stuck by him through this nightmare and no-one understands how I have remained so loyal. I don't know how I have remained this way but I'm sure as heck not going to lose him without a fight x

Lost....Anonymous

Dear Anonymous,

I just read what you wrote and please don't give up on this man. The GP dismissed you, so you need to find someone else. There isn't much know about TBI's, so most doctors tend to disregard any complaints that someone is making....especially if it isn't the patient themselves. You are acting as an advocate for this man and he has no idea how fortunate he is. From what you describe, it sounds as though he definitely has a TBI, but I have no details, so it is difficult to elaborate on it. Depending on what area of his brain was damaged, this can affect his behavior. I'm not sure that BPD (I am assuming this means Bipolar Disorder) is an accurate assessment. Brain injuries cause major mood swings and you never know when they will occur. I have to commend you on the fact that you are not giving up on him. Most individuals would have already been gone, so kudos to you for that. I'm not sure if you are on facebook, but there are many groups on there. I am on one called Traumatic Brain Injury Healing and Recovery Support Group. This is a closed group, but I could get you in if you sent me a message to my email address. There are many things that could be going on with your bf....he definitely needs a neurology doctor. Also, there are much better tests out now then there were when I was hurt. I could guide you, but I will end here. Please just know that you might be the only one that truly cares for this man and that he needs more help. Good luck and I pray that you find the answers you are looking for....God Bless....Kerry

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Janet Cromer, R.N., L.M.H.C., is a nurse, psychotherapist, and adviser on brain injury caregiving.

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