Impulsive & Disinhibition

Following a brain injury, a person may be left with issues of impulsivity and disinhibition. For example, they may speak without thinking through the consequences of their words, laugh at inappropriate moments, or engage in dangerous or costly activities without considering the negative impact of their actions. Impulsivity has long been linked to the neurotransmitter dopamine, which is involved in learning and reward, and recent research and modeling have helped illuminate the connection between the two.

A brain injury can have significant effects on behavior, impacting impulse control and self awareness. These effects stem from damage to areas of the brain that regulate emotions and include anger, impulsive behavior, self-centeredness, impaired awareness and even violence. The frontal lobe of the brain is responsible for executive functions, including controlling impulses. The prefrontal cortex with its sub-regions is the central structure responsible for executing these impulse control functions. Damage to the frontal lobes and reduced ability to control impulses can be caused by brain injuries, alcohol and other drugs, dementia, other types of brain disorders, and mood disorders.

Being able to focus on a complex task and inhibit unwanted actions or interfering information are essential human cognitive abilities. However, it remains unknown the extent to which brain injury may impact these critical functions. Inhibition may not be as dangerous to brain injury survivors, as impulse control would. For example, disinhibition can lead a previously shy person to become quite extroverted and talkative without boundaries. Impulsiveness on the other hand can lead a previously reserved person to make crude or sexually inappropriate comments to strangers as an example, and in some cases, can lead to unsafe decisions that impact their life and the lives of others.

Our experience

Before and after her brain injury, Sarah has modeled good behavior, with guarded and cautious impulse control. She has also been a competent student since grade school, with or without supervision. This was great, especially during her teen years, as it was one less thing for the parents to worry about, especially after her brain injury. After her brain injury, she had many struggles and slow-down periods, during which she tried harder to maintain. But, there was a price to pay, with the increased anxiety and increased seizure episodes. That has been my observation of Sarah’s impulsive changes, persistently and cautiously forging forward, but at a cost.

On the other hand, her inhibition changes are a different story. Sarah has always been an introvert since her early childhood. But after brain injury, that all changed. She started to become extraverted, with a witty and funny personality, which was fun to watch, and gave us some cheers, especially during these difficult times. In fact, I used to borrow some of her funny lines during my teaching years. Did the amazing and supporting people around her help this trajectory? Perhaps, or maybe that’s how she was wired, or how her brain decided to rewire after her brain injury. I am truly humbled and thankful that she did not suffer bad impulsive behavior and that her inhibition issues led in a good direction.

My inhibition story on the other hand was not significant, other than some minor bursts of frustration now and then, as well as the wrong choice of words here and there. However, my impulsive behavior and decision making was my main problem. To sum it up, before my brain injury, I was a straight A student, who played sports, and participated in family and friend activities. Like normal teens, my impulsive behavior and decision making was less than ideal at times. But, after my accident, my impulse control was affected greatly, my decision making was concerning at times, and I have some regrets to date. Some of those bad decisions brought me too close to danger, but I am thankful to have gained the experience, and skipped the danger.

My years of impulse issues and bad decision making felt to me like floating on a raft in the middle of the ocean, with the waves as my guide and luck as my friend. The only good thing to note is that somehow my impulse control and faulty decision making have mainly impacted myself, and that has helped ease my regrets. Looking back now, this was just a period of distractions, to make up for the internal struggle, as to what was happening inside my brain. Perhaps, things could have been much better had I known what brain injury is, received medical or psychological diagnosis and treatment, or been offered any sort of mentoring, support, etc.

Here we are, father and daughter with common genetics, but different impacts after brain injury. We are each unique, and each brain injury is different.

Remedies

When it comes to impulsive behavior and inhibition, it is important to recognize personality traits vs brain injury symptoms. This is not hard to do. First, we can simply look at behavior trends before and after brain injury. Second, we can look at the intention, meaning, was the inappropriate wording or timing intentional, or did the words just fall out of your mouth before you could catch them. Also, were these decisions intentional, meaning you had been meaning to break up with your significant other, or did you deeply regret this decision shortly after.

Here is the good news: things will get better, eventually, but you need to use some adaptive behavioral changes. This may include the ability to exert acts of control, ignore distraction, attend selectively, prevent an action from being executed prematurely, and to stop an action in progress. Here are some helpful remedies to consider.

Behavior therapy –

It is always a good idea to seek cognitive behavioral therapy (CBT), or social skills training. Also, mindfulness-based stress reduction approaches can be helpful, as they are used to treat emotional and behavioral changes related to brain injury.

Healthy company –

After sustaining a brain injury, you will shortly discover the need to restructure your relations and relationships. The obvious reason is how well those around you can cope with the new you. After brain injury, a healthy company of family, friends and a support network are what you need, as they will understand that your inhibition issues are not your fault, and they will help guide your impulses and bad decisions, if you let them.

Coping skills –

Having inhibition issues and impulse control after brain injury is common, and so developing coping skills can be helpful. For example, what should you do after the wrong words fell out of your mouth, or the timing of your spoken words was off? The best thing that you can do is simply think about it, apologize or correct if necessary, then move on.

Think twice –

This is no different than what most people do on a regular basis. Except, in the case of brain injury survivors, it is a promise to one’s self and to your caregivers that outside your intimate circle, you will compose and think about what you say twice, before you say it.

Sleep on it –

Again, this is no different than what most people do on a regular basis. Except, in the case of brain injury survivors, it is again a promise to run your important decisions by your caregiver, or at least sleep on it for a day or two, before executing such a decision.

Survivor ID –

Providing a brain injury survivor wallet ID card can be useful, in order to help avoid misunderstandings with others, including law enforcement and first responders. The wallet card should include contact information, an emergency contact, and your brain injury symptoms.