Frustration, Anger, and Aggressiveness

After a TBI, some people can become frustrated more easily than before the injury. The service member or veteran may not be able to do things as easily as they once did. Sometimes, they may not know what others expect. This can understandably be frustrating for them.

Loss of independence, fatigue, overstimulation, or cognitive problems can also lead to feelings of frustration and irritability.

What might you see?

• Reaction to minor annoyances or sources of frustration is exaggerated
• General lack of patience (for example, when others don’t understand the changes resulting from the TBI)
• Low tolerance for change
• Unexpected outbursts of anger
• Increased irritability
• Verbal or physical demonstrations of anger
• Increased tendency toward frustration when tired, in new situations, and during high levels of stress
• Mood swings and/or emotional lability (exaggerated emotions disproportionate to an event or circumstance; for example, a person may cry excessively without feeling sad or unhappy)

How can you help?

• Develop a plan with the healthcare team to manage frustration or anger. Suggestions for how to manage the person’s anger or frustration could include taking a walk outside or going to another room and turning on some music. This can be a good signal to others that the service member or veteran needs to be alone for a while.
• Remain calm. Encourage the service member or veteran to recognize when they are becoming angry or frustrated. Help them learn to ask for a break or some space to calm down.
• Reinforce efforts to use effective anger management strategies.
• Prepare the service member or veteran for changing and challenging situations whenever possible.
• Simplify tasks and provide a consistent, structured environment.
• Try to avoid surprises and unanticipated changes in daily routines or activities whenever possible. People with a TBI do better when they are prepared and can anticipate a change in plans.
• A consistent response and approach to the service member or veteran with TBI will help management of difficult behaviors.
• Rehearsing and role-playing specific situations may decrease new situational anxiety.
• Approach challenges calmly, and allow yourself to take breaks.
• If the service member or veteran is often angry, the healthcare team can assist in developing a plan to address this behavior. Usually, the rehabilitation psychologist or neuropsychologist is the team member who will work on this plan, and they can help by teaching anger management techniques.

If angry behaviors occur, including verbal or physical attacks, contact the healthcare team as soon as possible. Behavior management and some medication approaches can assist in managing these behaviors.