Take the Danger Out of TBI Caregiver Anger by Janet Cromer

Anger of a TBI caregiver is real but not talked about

A TBI caregiver can become exhausted.

A TBI caregiver can become exhausted.

Caregiver anger comes in every form and size. There’s the diffuse anger at the disease or injury that caused the brain injury. The anger towards family and friends who “don’t get it” and stop helping too soon. How about the anger towards the healthcare professionals who seem too rushed to care, and the easiest target of all—insurance companies who curtail benefits? Perhaps the hardest anger for a TBI caregiver to admit is anger towards the person you care for.

Specific consequences of brain injury can invoke a volatile mix of anger, sadness, and frustration for the TBI caregiver. This article addresses three problems TBI caregivers identify as interpersonal anger triggers:

  1. Changes related to cognition and memory.
  2. Changes in the relationship.
  3. Changes in the ability of the person with brain injury to process and express anger constructively.

Constant repetition of questions and lessons

diceEven the most well-intentioned TBI caregiver can get angry with the slow process of rebuilding skills. Sheila describes her husband Mark as a “bright, communicative engineer” before he sustained a traumatic brain injury (TBI) in a motorcycle accident. Sheila is a “get it done, no excuses” kind of person, and found herself getting angry when Mark asked the same question ten times or couldn’t follow a one-step command. Sheila says that when she couldn’t rally indefatigable patience, she would “blurt out the meanest thing that came to mind…and then feel horribly ashamed.” Many TBI caregivers describe this cycle of anger, guilt about feeling angry, then anger about feeling guilty.

Hazel had a pituitary tumor that was treated with surgery, radiation therapy to her brain, and hormonal supplements. The treatments took a toll on her executive functions and ability to express emotions. To complicate matters, she was later diagnosed with Hodgkin’s lymphoma. Her husband, Mike, says that a side effect of chemotherapy was the further dulling of cognitive functions known as “chemo brain.” Mike says, “My anger toward Hazel was so problematic that I couldn’t focus, and I felt that I could not address it with her. On one hand, Hazel’s flat affect made it hard to tell whether she was putting enough effort into engaging with me or her treatment.” He continues, “On the other hand, I didn’t know how capable of engaging she was, due to the nature of her illness.” Sometimes professionals can help clarify realistic expectations.

From intimacy to isolation for TBI caregiver

Personality changes, role readjustments, and ambiguous loss challenge every family’s dynamics and can be a source of anger for a TBI caregiver. Marsha’s husband, Terrence, suffered a brain injury on the job when an engine carrier hit him on the head. Marsha says that Terrence went from being a “charismatic, non-worrying sportsman to a sedentary man whose face is always pinched with a frown even when he’s not angry.” Married for 46 years, the couple “always goofed around and did everything together.” Marsha sighs as she says, “We were one. Now I feel very, very lonely.”

Mike says, “I was angry that the hard work Hazel and I had put into our relationship over many years did not result in the ‘golden years’ I felt we deserved. I was bitter about that, but did not express it to Hazel since she was blameless for her condition.”

“With TBI, you look at the person and initially you think he is the same because he looks essentially the same. It takes a long time for it to sink in that the person in front of you is only the outer shell of the person he was before the injury,” says Sheila. “He looks and smells like your husband, but he is a stranger in that body.”

The urge to fight back

When the person with the brain injury has trouble processing and expressing anger constructively, the TBI caregiver often becomes a target. When Terrence became overwhelmed and confused by multiple therapy appointments, he swore at Marsha. “He actually cussed at me for the first time in our lives!” she exclaimed. “His words hurt me like a whip.”

My husband, Alan, was prone to angry outbursts after his severe anoxic brain injury. When humiliated or frustrated by his losses, he screamed accusations at me. His memory was also impaired, so he forgot these incidents after a short nap. However, I resented the attacks, and distrusted Alan for awhile. Many times I longed to have a good argument like a “normal” couple, to clear the air, resolve the situation, apologize, and move forward. Alan’s cognitive limitations made that unrealistic, so we had to find less direct ways of restoring trust, control, and respect.

When your head’s ready to explode

Feeling overwhelmed by your anger?

Feeling overwhelmed by your anger?

The first step for a TBI caregiver in managing anger constructively is to recognize the feeling and the bodily sensations that go along with it, preferably before acting on the anger. Anger inflames and then depletes body, mind, spirit, and relationships. Marsha sums up the TBI caregiver’s perfect storm: “You feel fit to burst, like your head is going to explode, and your guts are hurting. You can take just so much, but you can’t take it out on the person.” Sound familiar?

Sheila found herself becoming an angry person overall. “I lashed out a lot at Mark, I got an ulcer, I quit doing the things I enjoyed,” she says. “And all that only made things worse.” Sometimes she would sit in the shower and cry and scream out. Sheila admits, “I didn’t want anyone to know I was coming undone.”

Take the danger out of anger

  1. Step back, take a few breaths and plan how to respond, not react, to the situation.

Respond with respect for both yourself and the survivor.

  1. Identify interactions when tensions tend to be highest.

    That’s the advice of Barry Jacobs, PsyD, in his book The Emotional Survival Guide for Caregivers, recommends identifying those interactions when tensions tend to be highest. Then define a specific plan to decrease those tensions or refrain from aggravating each other. Use a signal to stop before escalating.

Marsha and Terrence devised a red flag/green flag system that helps them. Marsha says, “When Terrence starts to get agitated and scolds me, I say ‘Red flag!’ and he stops to take a quiet break.” Terrence likes to tease his wife, and if she’s not getting the joke he says ‘Green flag!’ to signal that he’s kidding. The flags are direct, and a shared laugh can often defuse an argument.

  1. Find a psychotherapist who specializes in caregiver concerns.

Sheila processed her anger with a neuropsychologist who also validated her feelings. She says, “Therapy helped me put things into better perspective, forgive myself for not being perfect, which in turn, allowed me to forgive in all of the other areas of life in which I was angry.” Irritability and anger can also signal depression, so request screening. Alan and I benefited from couple’s counseling. Mike facilitated a support group, and in helping others, found comfort and relief.

  1. Practice patience with mind-body practices.

Mike practiced tai chi and meditation. He drew on the emotional self-knowledge developed in his spiritual community.

  1. Immerse yourself in physical and creative outlets.

Exercise, body work, gardening, hobbies, and sports can provide an outlet for angry energy.

  1. As you slowly adjust and put the “mosaic pieces” of a new life together, appreciate the unique strength, courage, and resilience of the family you are now.

Many thanks to the TBI  caregivers who honestly shared their experiences for this article. Pseudonyms were used to protect privacy.


Jacobs, B. (2006). The Emotional Survival Guide for Caregivers. New York: The Guilford Press.

Phillips, S. and Kane, D. (2009). Healing Together. Oakland, CA: New Harbinger Publications.

 About the author

Janet Cromer, RN, MA, LMHC is a psychiatric RN and the author of Professor Cromer Learns to Read: A Couple’s New Life after Brain Injury. Janet speaks nationally on family and professional caregiver issues including stress resilience, traumatic stress, compassion renewal, seasons of caregiving, and creativity and healing. See more at http://www.janetcromer.com.


Special Collection on Brain Injury Journey Vol 1

Special Collection on Brain Injury Journey Vol 1

This article is from Brain Injury Journey – Hope, Help, Healing, Vol 1, 2014.


One response to “Take the Danger Out of TBI Caregiver Anger by Janet Cromer”

  1. Samantha says:

    I needed to read this today. My husband is a little over a year from his the day of his accident when he fell off a work truck, March 14,2019. Several months before this accident I had my baby and was suffering from postpartum depression and anxiety. The day of his accident I had to put myself last and figure out a way to survive our new normal. It was hell honestly. His anger outbursts were so bad. He would destroy our place when he couldn’t find anything and say nasty things to me, and even threaten to divorce me. No one really knew what we were going through an I honestly was too exhausted to even reach out. I still don’t have friends but I work full-time. He is slowly getting better in some ways but we have our bad days still and I have my own bad days. We seem to run around in a circle. We will come up with a plan for when he gets angry and I do but not follow through on it. If I am able to, I will take the kids and walk away when he gets angry. But sometimes I am trapped and can’t go anywhere. I try to say things to stop him, calmly, but he will instigate me until I feel so angry I can’t control it. The one thing that I feel is important is acceptance. I have no accepted that the man I fell in love with is gone and I have to live with all these “triggers”. And it’s even more disappointing that I’m a behavioral specialist and I can’t even get a hold of myself or his behaviors. I feel I should. It could take a long time to get through this and I just hope we survive it together.

    Thank you for the article.

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