Irritability and Anger: After brain injury

Irritability and Anger: After brain injury

Samantha Backhaus, Ph.D

Anger and irritability are common challenges after brain injury. They can affect relationships with family, caregivers, friends, and coworkers. This tip card helps survivors, families and caregivers recognize the early signs of irritability and anger. It includes tips with strategies for preventing and managing changes in irritability and anger.

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Full Description

A survivor’s behavior can show early warning signs of growing irritability or anger after a brain injury. This tip card has strategies for survivors, families and caregivers to prevent, manage, and control irritability when a person feels overloaded by noise, lights, or activity in the environment. There are also tips for survivors to manage and control their anger, and avoid certain thinking traps. Tips for caregivers on managing the survivor’s anger are included in this tip card as well. Learning how to control irritability and anger can positively affect everyone, including the survivor, family and caregivers.
Pages 8
Year 2011


Samantha Backhaus, Ph.D

She is a Clinical Neuropsychologist at the Rehabilitation Hospital of Indiana’s comprehensive outpatient brain injury Neuro Rehab Center. Her primary focus is working with adults who have acquired brain injuries, both providing neuropsychological assessments and formulating appropriate interdisciplinary treatment plans to help individuals reintegrate back to the community. Her passion is working with families with the overall goal of helping the survivor achieve a positive long-term outcome following brain injury. Dr. Backhaus developed a 16-week treatment intervention, the Brain Injury Coping Skills Group (BICS) that won the 2009 McDowell Award for Best Presentation presented by the American Society for Neurorehabilitation. She has won one of the Healthcare Heroes of the Year in her community in 2001 for her work in neurorehabilitation. She is asked to teach this intervention to clinicians throughout the rehabilitation field, both nationally and internationally. She also developed a Peer Mentoring Program for brain injury survivors and family members, as well as chairs a support group called Bridging the Gap, specifically designed to meet the needs of families and caregivers in addition to survivors of BI.


The Brain Controls Anger and Irritability

Preventing Irritability

  • Tips for survivors to prevent irritability
  • Tips for caregivers to prevent irritability

Managing Irritability

  • Tips for survivors to manage irritability
  • Tips for caregivers on managing irritability


  • Tips for survivors on managing your anger
  • Avoid thinking traps
  • Tips for caregivers on managing the survivor's anger




Preventing Irritability

The goal is always to prevent it first, before it gets worse. Let's talk about prevention strategies first.

Tips for survivors to prevent irritability…

Control your environment or surroundings when possible.

  • Lower the volume of the television or stereo.
  • Space visits with people so you are not constantly entertaining or talking.
  • Avoid noisy areas when possible.

Be aware of your warning signs.

Pay attention to your behavioral early warning signs. For example, am I using sarcasm, gritting my teeth, fidgeting in my chair, sighing, etc.? By catching your early warning signs and letting someone know what is happening, you can prevent your behavior from escalating to anger or saying something negative.

Take an emotional temperature of your body.

Ask yourself the question, “How HOT am I feeling right now?” This will gauge your level of irritability. If you find yourself rising in temperature, say a 4-5 on the irritability scale of 1 (low) -10 (high), then it's time to look at your early warning signs and do something to prevent yourself from going to a 7 or 8. That's where you are more likely to make decisions you may not like

Prepare for family gatherings or holidays and try to prevent starting out feeling irritable by:

  • Snacking a little before the event (hunger can trigger irritability)
  • Sleeping well before (fatigue is a trigger)
  • Negotiating the actual time you need to stay
  • Using a key word for a signal to someone that, “It's time to go.”

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