TBI and Domestic Violence

The healing process of a Traumatic Brain Injury (TBI) is difficult in the best of times. One of the aspects of the injury can be aggressive behaviors that the patient brings on to their family.
Trauma to the brain can lead to repeated incidents of violent behavior in individuals without a previous history of aggression prior to the injury

Patients will TBI tend to be more dependent on their spouses. That tendency also appears to be related to higher levels of aggression towards spouses post-injury. Because of several factors patients often lash out at the one who is caring for them, in many cases this is the spouse.

Because patients can forget day to day incidents they can feel that they are being lied to. The frustration and anger from this process can be taken out on their family members when they are reminded of an event as this reporter has experienced.

In 1981 McKinley found that there was a a 70% incidence of post traumatic irritability of which 20% was defined as violent behavior that could persist for at least 5 years after injury. Furthermore that following head trauma aggression is often poorly directed, unrelated to any specific trigger, and can occur with minimal or no provocation. Because there has been damage to the orbital and ventro-medial structures behavioral self-control is damaged. This can also cause problems in rehabilitation and community reintegration.

Rodger L. Wood, Ph.D. and Christina Liossi, D.Psych. authored a study (Neuropsychological and Neurobehavioral Correlates of Aggression Following Traumatic Brain Injury ) that took place over a seven year period from March 1997 until June 2004 studying 287 severely head-injured patients referred for neuropsychological examination and rehabilitation advice were selected from 361 consecutive referrals.

The patients in the study had exclusion criteria of a) a previous history of head injury, neurological or psychiatric disorder; b) alcohol or drug abuse; c) neurological or neuropsychological disability, such as speech, motor or perceptual deficit, likely to interfere with neuropsychological assessment; and d) a pre-accident history of aggressive behavior.

These of the exclusion criteria 29 cases were dropped from the study. Patients were seen between one and three years post-injury. All patients in the study were living in the community but were having persisting employment and relationship difficulties as a result of the cognitive and behavioral legacies of their head injuries.

The authors assessed the study subjects through semi-structured clinical interview about the incidence and nature of aggressive behavior. Reports from family members and patients were corroborated by case records.

The authors found 134 cases of post-accident histories of verbally abusive and threatening behavior, or actual physical violence. Most of the violence had not involved the police. The majority of partners found that their relationship with their spouse with TBI had become extremely fragile as a result of impulsive aggression or unpredictable and volatile changes in mood and temperament after the brain injury occurred.

The researchers found that there was a relationship between low IQ, socioeconomic status, male sex, and aggression.

Domestic violence is in some ways different when dealing with a person with TBI. Because of the damage to the frontal lobe during a TBI a patient will often lose their social judgment capabilities. This can cause the person to not be able to reason the appropriateness of either their own behavior or the behavior they expect from others.

In the case of the family, the patient does not often understand the amount of patience the family has to have in dealing with him or her. The person with TBI also often may have little insight into their impact on the family.

While it is very difficult to do Brian Injury Org. reminds family members not to take the abuse personally. Each incident needs to be treated as an isolated one, even though it can be difficult.

Do not allow yourself to live in a reign of terror. If problems persist, you may need to consider professional support with a programme geared at behavioural management. Your local Brain Injury Association should be able to refer you to specialists in this area.

If at anytime the abusive behavior becomes physical do not stay. Your life can depend upon this.


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