survivors-families

Explosive Behavior

Excerpts from Handbook for Professionals, published by Frazier Rehabilitation Center, Louisville, KY

"Explosiveness" or behavioral agitation is a very common result of brain injury. Angry, agitated outbursts occurs in approximately 50% of brain injury cases. This type of behavior, which can range from mild outbursts to more extreme long-term aggressive behavior, can have many different causes. The severity of the brain injury, the individuals’ environment, the degree of cognitive impairment, and the individuals’ personality can all influence explosive behavior.

Why Does Brain Injury Cause Agitation?

It is important to realize that a normally functioning brain coordinates our actions and helps to eliminate socially unacceptable behaviors. When the brain is damaged, this built in control system can fail to eliminate some inappropriate behaviors. More severe brain injuries can, in turn, lead to a greater number of behaviorally explosive outbursts.

The nature of the environment is another factor which can lead to explosive behaviors. Each individual person has the ability to tolerate various levels of environmental activities. For an individual with a brain injury, situations that are noisy, busy or crowded can lead to increased feelings of discomfort. Without the ability to restrain behavioral responses, the individuals response to unusually noisy, busy or crowded situations can be explosive in nature.

In injuries where the individual’s cognitive abilities are impaired, there is typically a decreased ability to observe, understand, and respond to the environment. Hence the individual can become frustrated and agitated in situations where they do not recall the appropriate ways to respond to what is going on around them. The individual is unable to cognitively formulate a plan of action in unfamiliar situations and this confusion can lead to explosive behaviors.

Another factor which influences the degree and frequency of explosive behaviors is the individual’s personality. If an individual had been easily angered prior to their brain injury, it is likely that they will be more inclined to become angry following the injury. The same is true for behavioral problems. If the individual had a history of acting out behaviorally before their injury, it is likely that their behavior will become more severe following the brain injury.

In order to minimize, if not prevent, the occurrence of behaviorally explosive behavior, families and friends of the individual can make use of the following strategies:

In injuries where the individual’s cognitive abilities are impaired, there is typically a decreased ability to observe, understand, and respond to the environment. Hence the individual can become frustrated and agitated in situations where they do not recall the appropriate ways to respond to what is going on around them. The individual is unable to cognitively formulate a plan of action in unfamiliar situations and this confusion can lead to explosive behaviors.

  • Provide a consistent, structured daily routine.
  • Reinforce the individual’s knowledge of their location, time, date, schedule, etc.
  • Provide visible environmental cues (e.g., clock, calendar)
  • Provide memory aids or a daily activity schedule.
  • Recognize the need for frequent breaks or rest periods.
  • Minimize the individual’s exposure to overly stimulating environments.
  • Allow the individual to make simple choices about any activity in which they are involved.
  • Talk to the individual about familiar past events, interests or friends.
  • Speak in short simple sentences.
  • Explain all activities to the individual in order to help them become aware of what is going to happen.

It is important to remember that agitation is a very normal phase of recovery from brain injury. Although the agitated patient may seem angry at caretakers and family, the agitated behavior is only a reflection of internal confusion. Generally, the agitated behavior will subside as the brain injured person begins to understand this.

Address information

Brain Injury Alliance of Kentucky 7321 New LaGrange Road, Suite 100 Louisville, Kentucky 40222