Managing impulsivity and disinhibition

Following a brain injury a person may be left with issues of impulsivity and disinhibition. For example, they may speak without thinking through the consequences of their words, laugh at inappropriate moments or engage in dangerous or costly activities without considering the negative impact of their actions.

Managing disinhibition or impulsivity can be a challenge because the spur-of-the-moment nature of the issue can make it hard to plan and develop coping mechanisms.

We asked our followers on social media whether they, or their loved one, experienced impulsivity following brain injury. We received an overwhelming response, showing that the issue is widespread and difficult to manage. From those responses we’ve put together some advice for coping with impulsivity and disinhibition after brain injury.

Surround yourself with people who understand

Saying inappropriate or offensive things or laughing at the wrong moment can lead to embarrassment for both the brain injury survivor and others.

Surrounding yourself with friends and family who understand your situation may help when inappropriate moments strike.

AJ Johnston said: “I swear a lot now, even in front of my parents which I would never have done before my brain injury. I also say some very insensitive things to people because I’m so direct and I don’t often know until it’s pointed out to me.

"For people that knew me before my accident, they know I don’t mean to be offensive, but I guess new people must just think I’m rude. It does help having friends and family that understand."

Daniel MacEachern said:

I can't help it, by the time I've thought about the comment I've already said it and the damage is done.

“Generally I'm fortunate enough to have the understanding of my peers and loved ones in these situations, but it's awful none-the-less to know the pain I can cause with my words and my actions.”

Develop coping strategies

While some aspects of impulsivity and disinhibition are hard to predict and manage, there are ways to reduce the impact this has on everyday life.

It might be possible to use techniques to help increase awareness and thought before acting. This is something you should speak with your doctor about as they might be able to refer you to someone who can help, such as a cognitive behavioural therapist or neuropsychologist.

Daniel MacEachern advises trying to take some time to think things over before you speak:

Step back, walk away and think it over in your head. Am I being reasonable? Do I really, truly feel this way and is that a socially acceptable way to feel? If you answer no, you have to keep it to yourself. This is the hardest thing you'll do.

If you’re the friend or family member of a brain injury survivor you might be able to help them to identify when they’re acting impulsively.

Emily Draper said: “My husband was affected in this way with impulsiveness but has calmed down a bit as time has gone on. Now we talk about the practicalities of things first, things that he may not have thought about, I have to be the realist which isn’t always great.”

Make it harder to act impulsively

While it might be difficult to stop yourself from acting in the moment, it might be possible to take steps to make it harder to act impulsively when the urge strikes.

For example, if you have a problem with impulsively spending money on things you don’t need online, consider unsubscribing from promotional emails, blocking access to your favourite sites and deleting shopping apps from your mobile phone.

Ask your friends and family to help you manage your impulsive behaviour.

I definitely bought too much online and was very impulsive and spent far too much money on clothes and shoes.

"My husband imposed a rule that all purchases had to be checked with him in advance and this worked well," said Claire Freeman.

If you are a family member or carer of someone with a brain injury it might be necessary to take steps to manage and control your loved one’s behaviour. However, doing so might lead to conflict if the person doesn’t appreciate your positive intentions.

Jane Silbert talks about managing her brother’s obsessive hoarding: “My brother hoards books and CDs. Every few months his son and I clear him out and take a trip to the charity shop. He buys them back again over the weeks and it starts again but at least it’s manageable.”

Apologise and move on

Damage caused to the brain might make it harder to process and filter information. This can lead to people saying what’s on their mind without considering whether it might cause offence.

Anthony Potter said: “I’d blurt out things that I thought were really funny in the spur of the moment and then realised it was inappropriate as I saw everyone’s face drop to the floor. I’ve learnt to just not try to join in with banter unless it’s my closest mates.”

Elly Maynard recounted the awkward moment when she and husband went to watch a school concert shortly after his accident: “A school walked on stage with recorders and my husband said very loudly ‘I hate recorders’,” she said.

Sometimes it might be necessary to accept that you made a mistake and apologise. You may find it helpful to show your Brain Injury Identity Card to explain your symptoms.

I carry the Headway ID card and explain when necessary that I’ve frontal lobe damage.

- Mike Palmer

Keeping safe

If you or your loved one’s impulsivity leads to behaving in a dangerous way then it might be necessary to take steps to mitigate any danger, for example, accompanying a loved one when out in public. For people more severely affected by their brain injury, this is likely to form part of any care plan that might be in place.

Speak with your doctor or contact our Helpline if you need advice on keeping yourself or a loved one safe.