Emotional Mis-communication Changes Relationships after Brain Injury

Emotions alter Relationships after Brain Injury

By Dawn Neumann, Ph.D.

TBI changes communication in a marriage

The woman in my office was clearly a very successful woman, who for the most part, usually had it together.  But now it appeared she could fall apart at any second. She was there to talk to me about her husband who had a traumatic brain injury (TBI). She told me that since the accident, he had made terrific strides learning to walk again, improving his balance, and regaining most of his thinking skills. 

Despite these monumental improvements, there was still a terrific strain in their relationship.  She no longer felt “connected” with her husband. The wife was frustrated and perplexed. Prior to the injury, which was just months before they were married, he was an extremely compassionate person always in tune to her emotions. Now he was oblivious to her needs.  He never comforted her in times of sadness or worry. He was unresponsive to her frustrations.  He never participated in her joys, not even when their first child was born. Was this because he didn’t care?  Most people would assume so, but as you read on, you will see that this is because he just couldn’t tell how she was feeling.      

Brain injury can affect relationships with everyone

We all know relationships can be very challenging. This does not just refer to relationships with spouses, but relationships with family, friends, coworkers, and even acquaintances. Add a brain injury into the mix, and these relationships can become even more stressed. In fact, relationship problems are one of the most frequently reported long-term and devastating consequences after brain injury. They often cause families who have been touched by a brain injury to become fairly isolated and have dwindling support networks.  

In the last decade or so, researchers have slowly started to realize the impact of social challenges on an individual’s quality of life and well-being. Scientists are trying to understand the different sources of relationship problems after brain injury and figure out ways to address them.  

What changes after a brain injury?

Why does it become more difficult for many persons with brain injury to develop and maintain relationships? Well, a lot of things change, but an area that researchers are very interested in now is emotion. This is not simply referring to people who have trouble controlling their emotions, which often makes social interactions uncomfortable. It’s much more complicated than that.  

Reading and responding to needs and emotions of other people

What is the key to good relationships and social interactions? How well we interact depends a lot on being able to read and respond to other people’s needs and emotions, while effectively communicating our own. Let’s review why this is trickier than it sounds.  

For the most part, people don’t always tell us what they need or how they are feeling. Instead, this information is subtly expressed through facial expressions (for example, knitted eyebrows), tone of voice, or body language. Believe it or not, recent studies show that as many as fifty percent of people with a brain injury have a harder time correctly “reading” other people’s needs and emotions. They may not pick up on these subtle cues or inferences, and only pay attention to the words that the person actually says – which is only half the picture. 

Missing or mistaking emotions

Research has shown us that after a brain injury, people may tend to see no emotion when there is one, or mistake one emotion for another. Both errors have significant consequences. If a person sees no emotion when there actually is one, the person won’t respond to another person’s emotional need because it is not recognized. For example, if the person doesn’t realize that a spouse is sad or a boss is annoyed, there is no reason to offer comfort or to take action to solve the problem. If the person mistakes one emotion for another, such as assuming someone is angry when someone is actually sad, the interaction is more likely to be confrontational rather than supportive. This behavior would obviously be a problem.  

Expressing too much emotion

It’s not only important to be able to read the emotions of others, but it’s also important that we accurately and appropriately express our emotions to others. After brain injury, we often see exaggerated expressions of anger or sadness. The pitfall with expressing these emotions is that this might not be what a person is actually feeling. People who express a lot of anger are often feeling other emotions, such as fear or sadness. However, they may act angry because they are not aware of their other emotions, or because they don’t know how to express or deal with their sadness or fear. 

In cases where the person is feeling angry or sad, they may “take out” these emotions on people who were not responsible for causing these emotions. In instances when they are angry with the person they are interacting with, they may be verbally or physically aggressive because they may not be able to handle their emotions rationally and/or not know how to communicate these feelings in a calm way. 

Language and cognitive problems can present an even greater challenge. Nonetheless, inappropriate expressions of anger are likely to receive an undesirable response, such as pushing people away or inflicting anger, when what is really needed is support and understanding. 

Showing too little emotion

In contrast to those who are overly expressive with their emotions, there are people who show very little emotion after a brain injury. This will also be a problem for relationships and social interactions. When we talk with people, we try to get an idea of how they are feeling so that we know how to respond to them. If we can’t tell how they are feeling, it creates a lot of questions. Do they enjoy spending time with me? Does this person care about me or how I feel?  What do they think of me? When people are not emotionally expressive, social interactions can be confusing and unsatisfying.    

Sharing emotions builds relationships

The bottom line is that relationships are built on emotional exchanges that result in shared emotional experiences and the understanding of one another’s feelings. We must tune into the emotions of others and make sure we are kindly expressing our own. These are skills that often become more challenging for individuals after brain injury. The good news is that it appears to be a skill that can improve with treatment.


Radice-Neumann D, Zupan B, Babbage D, and Willer B (2007). Overview of impaired facial affect recognition in persons with traumatic brain injury.  Brain Injury: 21(8): 807–816.

Radice-Neumann D, Zupan B, Tomita M, Willer B (2009). Training emotional processing in persons with brain injury.  Journal of Head Trauma and Rehabilitation: 24(5):313–323.

About the author:

Dawn Neumann is a Postdoctoral Research Fellow at Carolinas Rehabilitation in Charlotte, NC.

Reading recommendations

OOPS! Social Skills after Brain Injury

By Harvey E. Jacobs, Ph.D.

Information on causes and consequences of changes in social skills in adults after acquired brain injury. Tips and strategies for family members and caregivers on improving social skills in survivors.


Procedure for Assessing Awareness and Adjustment Following Brain Injury

By Kit Malia and Anne Brannagan

Brain injury rehabilitation manual on assessing awareness and adjustment in adolescents and adults with brain injury in rehabilitation and community programs.



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13 Responses to “Emotional Mis-communication Changes Relationships after Brain Injury”

  1. kristine says:

    Very helpful..thank you

  2. Cheryl says:

    Over 15 years ago experienced a severe traumatic brain injury, relearned walking, talking, etc., met with a nueropsychiatrist for a couple years and thought 15 years later it would be easier, but it’s harder. My relationship of over 35 years with my partner is the only one that truely survives as she can look at my face and in an instant knows what I’m feeling. I cannot read her and often think she’s mad at me.

    In the last year have had multiple instances with family that I find I am expressing anger when what I am feeling is fear or sadness. I can say that at the time I am not aware of this and only in reflecting on the situation at least a day later do I realize this and still have not come up with a way to express that sadness or fear and am leaning to not interacting with people because they don’t deserve anger they aren’t willing to recognize as an emotional miscommunication from the TBI.

    There are days, after reflection even I do not like the person I am after the brain injury.

  3. jennifer chorn says:

    Reading this, it is all true. From the outside it doesn’t seem like that big of a deal, but living is totally different. My husband and I usually have a blow out 3 or 4 times a year. I try really hard to control my emotions, I get irritated at many little things because my energy is low. Leaving clothes on the floor, dishes in the sink, and he thinks I just bitch and complain and don’t appreciate all the extra things he does, like pay the bills, take the kids to school. Handle family issues with my husband and the kids etc. I do know and appreciate all he does.

    I wish I could still do all those things. When I get tired, he always asks if I am mad at him. I’m not, I’m just tired. It’s difficult to control your emotions when you have to use your brain and it’s damaged. If you don’t have a brain injury, it’s difficult to relate to. Your brain controls everything. It is not just a choice to get mad or upset, you have to be aware of it beforehand and scrutinize every reaction, gesture, etc. It bothers me and the other persons. It was all stuff you did before a brain injury without even thinking about it. I wish I had some easy answer…

  4. blue says:

    Yes, I got cut out becuase of his brain injury, he cannot cope with things, frustrated with things, emotions….I do feel sorry for him….as much as I would like to help, it seems all things I said is taken the opposite way; all wrong

  5. Thokozani says:

    Thank you for such information, my hubby got injured in July last year. He is recovering though I find it so hard to relate with him, this s a new thing to me, sometimes I would think he hates me, he is so emotional, sounds angry and he’s unappreciative, I don’t know if I am right or wrong , only its so difficult. However with God by my side I take it easy, when stressed I just go out to cool off, by myself.
    I also was to start a support group.
    Thank you

    Thokozani (South Africa)

  6. Kristen says:

    Thank you so much for the article! I have been interested in and spending a lot of time with a guy who had a major head injury in his mid 20′s. He is 42 now and has never been married. I love to spend time with him and he seems so into me when we are together but as soon as we are apart its as if he has forgotten about me. And I have been so patient but it seems he really isn’t interested. I saw him last night for the first tim in 7 weeks.. I have cried over trying to get over him.. let him know how much I liked him but he could never say the right thing or share any emotions or connection.. his best friend told me last night that he really likes me and I could see it in his eyes.. but here I am 24 hours later waiting for him to comment on a text I sent him saying how good it was to see him again.. I have cried some today and am really wrestling with being in a relationship where I initiate almost everything because he lost that skill in the accident. Is that ok since his lack of effort is not intentional? Can I accept his love for me just by his word but not by any follow up? Its really hard to walk away because he has so many great qualities and honestly it is his brokenness that I love so much and can relate to.. we have shared everything so openly.. like there were no filters or judgement..

  7. Jennifer Stokley says:

    Women, come to SSS (Semi-Support Sisterhood) and I may be able to help. I am a TBI Survivor, and it is all for women, by women, about women dealing with all this stuff. Been there, hope to one day have done that, lol

  8. Julia says:

    I find that i cry so much but realy do feel sad. I canot control the crying. of course, there is stress here at home and i have had the worst year of my life, losing my 34 year career, losing my good income, having a pregnant teen and losing my dad, all i the past 12 months. maybe i am normal and cring for true reasons. All i know is that i cry! maybe the tumor in the frontal lobe did it or maybe it is just life. who knows!

  9. Susan says:

    I am so glad I came across this story. I recently ended a relationship with someone who had suffered a brain injury in his childhood. During the relationship he would verbally express his love for me, but it was always hard to tell his true feelings because of his lack of emotion. He was not an expressive person and usually wore a serious look upon his face – often out of context with what was happening around him. As much as I truly cared for this man, it seemed he could not offer me the love and support I needed. I often felt unloved and out of touch with him. The human brain is so amazing and yet so complex. I have been searching for information relating to loss of emotions after an injury and found this story so helpful.

  10. Mr. kim kincaid says:

    In 2007, my right occipital lobe was removed due to an infection. I have estranged myself from the world, since.
    My former wife hates me. My 3 yr old son is being kept from me. I’ve just completed my autobiography. That project was a
    big help.

  11. Leslie says:

    Short term memory loss is very common after a head injury.
    It will affect your daily life as you will not remember people you meet or things you see. I would make sure that the person you have a relationship with knows all about the head injury and your short term memory problem. It would be good if you could keep daily notes about what you did, met, went saw, etc… Laughter can also help out, don’t take things to seriously, get someone you trust to help you with appointments, bills, etc. Good Luck

  12. Robert says:

    I was wondering about how lose memory effects relationships. I had two serious head injuries in my life. Now I have been dating for 10 months but it feels like a month. Do I keep forgetting the momements and feelings month by month? I still feel like we just met. Messed up huh?

  13. What a brilliant blog on emotions after brain injury and its affect on relationships !

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