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.

References:

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.

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

  1. Jamie says:

    Is it common for people who have experienced TBI to be completely emotionally unavailable? I have met the most amazing girl of my life around 1.5 years ago while working together. I transferred and she changed jobs so we drifted apart but stayed friends. Around 2 months ago we were talking to each other and found out that we had both been interested in one another for quite some time. We continued talking and decided to meet each other for our first date. So I flew to visit her and we met everything seemed the same at first but over the course of the weekend I noticed she is completely devoid of any type of affection, wouldn’t even let me hold her hand, open doors, anything. We were around each other quite a bit before and had several talks that lasted 5-6 hours so I’m not sure what to think and im really confused. I know that she suffered a TBI in the past and after it took her around a year to learn to read again. I really like this girl and can see myself with her for the rest of my life but I’m so confused now and not sure what to do or how to handle it. What I’ve wrote here doesn’t do justice to the lack of emotion/ affection that I observed. I don’t know how to put it but it was just like all the pieces were there but one.

  2. Dawn Neumann says:

    Hi Deb,
    Thank you for your post. I can’t begin to imagine the frustration that you are experiencing. I know your husband is not very convincing in his love for you, but I’m sure he loves you very much. From his comments that ‘he is broken’, it sounds as if he is hurting within and does not love himself very much right now – even it it doesn’t appear that way on the surface. Does he go to counseling to cope with the changes he’s experiencing? If not, he should. Maybe the two of you could go to counseling together if that’s feasible. If not, it’s hard to know what to recommend, as everyone’s situations are so unique. A couple ideas which may or may not work: 1) Talk with him and tell him how much you still love and want him. Tell him how much seeing him like this hurts you and you miss him. Leave him little affectionate notes to re-affirm your feelings for him; he needs to rebuild self-esteem – I think he feels unlovable. 2) Take it slow. Rather than snuggling or initiating sex, build intimacy through other small gestures – conversation, hand holding if he will; back rubs; doing something fun together- a date or a vacation. I wonder if he is experiencing any sensory problems at all – in such a way that he doesn’t feel sensory information the way he used to. It might not be a problem, but if it is, work slowly to build up his ability to process sensory information. 3) Try to initiate feelings in him by looking at old photos. 4) Tell him you want to work on strengthening your relationship and see if he will work with you to establish small goals (eg hand holding).

    Warm regards.
    Dawn

  3. deb says:

    It’s comforting to know that others are experiencing some of the same things as we are. You’re not the only one crying.

    My husband has had brain surgery and extensive radiation that has affected the hypothalamus as well as the frontal lobe. He had always been a very affectionate and playful person. After the radiation, he is non-emotional. He has NO desire for affection or intimacy and I have a real hard time with it. He says “I Love you” as if it’s a daily requirement like brushing his teeth. If I try to snuggle, I’ve been told that he needs to make a phone call or that if I want sex, he’s broken and why don’t I get a machine that could take care of my needs. Needless to say, I was devastated. He doesn’t always remember saying such things or he didn’t mean it that way. He thinks he’s broken for good and nothing will help. It’s my problem if I can’t accept him the way he is.

    We need help and the doctors don’t seem to have a clue or don’t want to deal with it. I’m at the end of my rope.

  4. Johne450 says:

    Hey very nice site!! Man .. Beautiful .. Amazing .. I will bookmark your blog and take the feeds. Also I am happy to find a lot of useful info here in the post, we need work out more techniques in this regard, thanks for sharing. . . . .

  5. Dawn Neumann says:

    In response to MYLYNN’s post:

    Thank you for sharing your story. I could only imagine that life was not always easy growing up in your house. BUT it does sound like you are a very strong family, and together you made it through. Everyone is affected differently by brain injury. It is possible that the situation impacted your brothers differently than you, but maybe not. There are so many variables that influence people’s relationships, so it is hard to really know what impact this had on your brothers and their marriages.

    You asked for resources regarding the effects on children that have been raised by parents with brain injury. I do not think much has been done in this line of research. However, I did come across a reputable resource (link below). I do not know if it will give you the answers to your questions, but it is a place to start. I wish you and your family the best.

    file:///C:/Users/dmneuman/Downloads/Parenting_Post-TBI.pdf

    Sincerely,
    Dawn

  6. Mylynn says:

    My dad had a frontal lobe injury when my mom was pregnant with me. I am 47. I hear about how laid back he was before his injury but this was not the man I grew up with. As a child, I learned to walk on eggshells and do my best not to upset my dad – he can be angry and unreasonable. As an adult and a parent myself, I know he loves me and that he does the best job he can given the life he was dealt. I will always wonder why long term psychological care or mood stabilizing medication was not a part of his life and how that might have changed the far reaching effects of his emotional instability. My parents are still married and raised me and my two older brothers. My dad returned to a professional career and has been a success in financially supporting his family. His ability to be an emotional support as a father and a husband is his greatest struggle. I feel defined by living with a dad that had a traumatic brain injury. I see the effects of this on my brothers and their relationships with spouses and children. I know it has to have a deep impact on me and don’t know that I fully understand that impact.

    I now have a daughter in college and she is in a serious relationship with a young man whose father suffered a temporal lobe head injury. My fear is that my daughter’s boyfriend will have difficulty being a loving and supportive spouse because of what I’ve seen my brothers go through in unsuccessful marriages and struggling relationships with their own children which are now grown. He is a decent young man but is not as patient with or as considerate of my daughter as I would like him to be which makes red flags go off in my head when my daughter brings up the possibility of marriage. I don’t want to unfairly judge this young man’s ability to be a good match for my daughter based on my past family experiences.

    I would welcome any thoughts or information or resources about understanding long term effects on children raised by parents with head injuries.

  7. Dawn Neumann says:

    To all who have commented on this blog, thank you so much for sharing. I learn so much from your experiences. Knowing what is important to survivors and their loved ones helps me to know where we need to continue focusing our efforts to best help people. My thoughts are with you all.

  8. Dear Angela,
    Thank you for sharing your story and your honesty in describing the challenges you face in your marriage and with your family. Few others can truly understand what this is like unless they are also caregivers.

  9. My husband had a brain tumor; he had three brain surgeries and it has been now 11 years. It continues to be a struggle for me because it affected him in so many ways. He lost most of his motor skills he had to learn how to eat and do basic things we take for granted on a daily basics. There has been little to no family support from either family. I feel like I have to carry this load by myself. I am now 50 yrs old now and I am so burnt out. We have a 17 year old son and he has been a god send; but it has taken it toll on him as well. He stated to me that it is harder now for him to see his father in this state. They have a close relationship.

    As for me I no longer feel I have a husband, I feel like I have a disabled room-mate. I cry , cry and pray. But I do feel that eventually I may have to leave the marriage because of the stress. It has caused me to shut down emotionally, spiritually, physically and there is NO sexual relationship at all. This is something I would not wish on any marriage. It takes all the LOVE and PATIENCE that you have and that only GOD can get you through.

    My prayers go out to all of you who are suffering with a brain injury and those of you who are supporters and caregivers to someone with a brain injury. God has blessed me to handle things this far, but how much can a person bear – even a dog gets tired. I am TIRED and STRESSED out. I also care for my disabled mother who recently suffered a STROKE in April. Seven siblings but no family support their either. My father is deceased. PRAY for Me!!!!Plus I work in mental health field which is stressful also!!!!!!I am not burn out!!I am burn Up11111

  10. Excelente Pagina de chicas. Estaba revisando constantemente este blog y estoy impresionado! la información es extremadamente útil . Yo estaba buscando esta información durante mucho tiempo. Gracias y buena suerte.

  11. Thank you for sharing your comments and experience. The support that you offer to others is important and only those who have walked in your shoes can truly understand. It takes courage to rebuild your life after a brain injury and to find new meaning after so many losses – I commend you for moving forward.

  12. Cecil says:

    I find comfort in reading about what others experience suffering with TBI but mostly seeing the compassion others show in their efforts dealing with a loved one with TBI. Sadly the understanding is just not there for many because the social difficulties we have are relentless. From previous friends, work associates, family members, children and future acquaintances will all be judgemental about how our injuries affect us. If they could feel like we do inside then and only then would they truly understand our misery. Daily meaningless tasks are at most times impossible to do. The variety of familiar symptoms can appear at any time but over time you recognize these symptoms as they have become a major part of your life. Part of my own personal healing process was accepting that all my meaningful relationships had vanished and being at peace in my heart knowing they will continue to elude me. I look normal. Websites like this one are the only way others will begin to understand those of us with TBI . I hope others keep writing on here to share their stories .

  13. kristine says:

    Very helpful..thank you

  14. 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.

  15. 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…

  16. 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

  17. 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)

  18. 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..

  19. 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

  20. 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!

  21. 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.

  22. 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.

  23. Leslie says:

    Robert,
    .
    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

  24. 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?

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

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