Our Frontal Lobes help us make fairly rational decisions even when we feel strong emotions. For example, if we are angry and have the impulse to hit someone, our Frontal Lobes tell us: ‘No – don’t! You might hurt them!’.

Several things can work together to cause difficulties with managing mood swings, irritability or anger after a brain injury. The three most common are:

1. 1. 1. Direct damage to the brain
         If there is damage to parts of the brain such as the Frontal Lobes or other linked brain structures, they may not be performing their job managing your emotions as well as before. A brain injury may also exaggerate any personality traits or problems you had previously.
      2. Your psychological reactions to changes following your injury.
         Coping with life after a brain injury can be challenging. Understandably, you may be going through a range of emotions such as disbelief, anger, regret, guilt or grief. You may be trying to come to terms with changes such as fatigue, disability, having to give up work or perhaps having less control over your life. All of this can cause a lot of emotional upheaval and unwanted stress.
      3. Your environment
         Your emotional reactions are influenced by where you are (your physical environment) and who you are with (your social environment). Currently your social environment may include, for example, rehabilitation staff, family, friends, neighbours or perhaps colleagues.
         If you are in an environment that is busy or unfamiliar or where you feel your needs are not being met, this may make your stress levels go up. This can affect how you feel and act.

After a brain injury, many people find they become irritated over small things that would not have previously bothered them, for example, being kept waiting for an appointment.

Many things can set off emotional responses like irritation. We call these triggers. These triggers will vary from person to person but there are some common ones that affect many people.

• Avoid trying to reason with someone when they are at their angriest. Give them space and time to regain control of their emotions.
• Acknowledge their feelings and try to help them to sort out whatever is causing the anger.
• If they are too upset to sort out the problem, directing their attention away from what caused the anger may be effective – for example suggest doing something else or getting some air outside, if possible.
• If there doesn’t seem to be any obvious reason why they were angry, ask them how they were feeling before the anger outburst. This may help them to pinpoint if some other feeling lead to their anger – for example, frustration, embarrassment or feeling under pressure.

Emotional lability

Some people who experience mood swings after their brain injury have what is known as Emotional lability. Emotional lability means a loss of emotional control or reduced control. It can cause unpredictable outbursts of laughing, crying or anger, for example. The emotions often come on very quickly and intensely but pass with little lasting effect.

If you are affected by emotional lability, you may find yourself laughing one moment and crying the next. This can be upsetting and embarrassing for you and people around you. However, understanding what is happening and learning to avoid things that trigger it, may help.

• Ask friends and family to help you pinpoint what situations or events trigger your outbursts of emotion. Try to avoid these triggers as much as possible.
• Explaining to other people that your strong emotional reactions are directly due to your brain injury, may help them to accept what is happening and make allowances for you when you have an outburst. There are tips for what they can do below.
• Explaining simply to friends and family exactly how your brain injury affects you may help – for example: ‘Since I had my brain injury I cry a lot even when I’m not sad. Don’t worry, I will be fine in a few minutes.’.
• Some medications can help with the control of emotions. Talk to your GP about this.
• If your emotional outbursts are anger outbursts, read back over ‘Common causes and triggers for anger and irritability’ above and try to pinpoint any triggers for your anger. Try out the tips for managing anger above.

If, after their brain injury, someone you know is affected by emotional lability, their outbursts of laughing, anger or crying, can take a bit of getting used to. This is usually directly due to their brain injury and often there is nothing specific that triggers the outbursts.

Some things that may help are:

• Try to stay calm yourself. People who are prone to emotional outbursts find it harder to control themselves when other people become emotional.
• It is important to ask them what they want. If they want to be left alone for a while, respect their wishes.
• If you were talking about something that brought on the outburst, try changing the subject.
• Suggest they take some slow, full breaths.
• If you know the person well, a hug or a touch on the arm may be reassuring. This will naturally depend on your relationship with them and what they want.
• If anger outbursts are the issue, see ‘What other people can do about your anger’ above for specific tips on what you can do.

In some situations, professional support may be useful to help you manage anger or mood swings following your brain injury.

• Contact your GP for advice.
• If pain or headaches are affecting your ability to manage your emotions, your GP can give advice on treatment options. They may offer treatment themselves and/or refer you for Physiotherapy, Occupational Therapy or to a specialist for management of your pain or headaches.
• Seeing a Psychologist experienced in the treatment of brain injury may also be helpful. They may suggest doing an assessment of your cognition (thinking and reasoning) and behaviour, and recommend strategies that can help with managing your emotions.
• If you have significant difficulty with emotional outbursts, your GP may suggest referring you to a Psychiatrist. The Psychiatrist may recommend medication to help manage your emotions.
• See Help and Information below for ways to contact the various professionals mentioned here.

• Many people have trouble managing emotions, including irritability and anger, after a brain injury.
• Several things can cause difficulties, including direct damage to your brain, your environment and your reactions to changes in your life.
• General tips such as taking plenty of exercise, not getting too tired or hungry and getting relief from pain or discomfort, may help reduce irritability and anger.
• People prone to emotional outbursts may have things which set them off or ‘trigger’ them. Getting to know your triggers is one of the key steps in managing these difficulties.
• However, if you have emotional lability (a loss of emotional control or poor control), there may be nothing specific that triggers an outburst.
• If you have difficulties managing anger, try to learn to spot the early signs of anger building up in your body. Then, practice steps to prevent the anger getting out of control.
• Getting professional advice may be helpful. Speak to your GP or other professionals involved in your care.