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Does An Old Brain Injury Contribute To Anger Management Problems?

Question:

I was in a serious head on car accident when I was about two years old, over 50 years ago. I don’t know exactly how serious the brain injury was, but I am told I was till black and blue in the face months later. My head hit the radio and pushed it onto the dash at least a couple of inches. I have been struggling to control my angry reactions for all of my life. I’ve never physically hurt someone because I was angry, but I do react with verbal shouting and door slamming. Usually my anger subsides pretty quickly, especially if I take a break, but I still can’t catch myself quick enough to prevent saying mean things or slamming something. My partner believes it’s a matter of "just not doing what I do" but it’s not that easy. Is she right? Or do after effects of the old injury make it harder or impossible to just not get angry?

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Answer:

This is an excellent question, but one that is going to resist a simple explanation. Here’s why:

Head injury (or Traumatic Brain Injury: TBI) can affect all manner of cognitive and emotional functioning, including emotional expression, language, judgment, concentration and attention, motor functioning, you name it. If a person can do it behaviorally, a head injury can affect it. In this context, you are quite correct in thinking that a brain injury can affect a person’s personality and more specifically, how that person’s temper (angry outbursts) will manifest. However, not just any head injury will have this effect; only injuries that specifically damage particular areas of the brain (for instance, in this case, probably the frontal brain which is the seat of "executive functioning" (e.g., emotional control, impulsiveness/attentiveness and judgment). It is going to be very difficult to know what areas of your brain may have been altered by the accident you sustained as a child. Since the accident happened at a time when your brain was still actively developing it will be hard to know if any damage you sustained was lasting or whether it might have been worked around. Further complicated the problem is that we don’t know how your brain (and thus your temperament – your innate personality tendencies) was to begin with. You might have been prone to angry outbursts from birth, for instance. All in all, it is impossible from this far distance in time to say with precision whether your accident has caused this anger problem you have. It couldn’t have helped things; that much is safe to say, but it is not easy to say whether it caused or contributed to the problem.

Though it will not be possible for you to know with precision whether this injury is the cause of your woes, it is possible for you to learn how your impulsive anger problems and other aspects of your cognitive-emotional functioning compare to other adults, those with and without brain damage. I suggest that you call a board-certified Neuropsychologist in your area and set up an appointment for an in-depth neuropsych testing session. This testing is not inexpensive, but there is no substitute for it, given the questions you are looking to get answered. The Neuropsychologist will administer a battery of tests designed to measure brain-behavior functional relationships. The IQ test (e.g., the WAIS) will likely be one of these, but there will be others as well, measuring various aspects of attention, concentration, perception, problem solving ability, judgment, etc. All of these tests have been given to populations of people with known specific problems. The pattern of your scores on the tests will likely allow the Neuropsychologist to make a very educated guess about what sort of brain problems your pattern of scores resembles (if there is a problem detected at all), and how severe it appears to be. Neuropsychological testing of this sort are actually a more sensitive detector of brain problems than even the best brain scans available today. This is because brain scans can detect only physical brain damage, and then only relatively gross damage, whereas the psychological tests detect functional damage – e.g., how the damage manifests in terms of your behavior. So very subtle amounts of damage that nevertheless influence your behavior can be detected, even when they cannot be visualized in an MRI.

If functional brain damage is detected by the neuropsych evaluation, next steps might be to consult with a neurologist to see if medication might help you, and/or to consult with a psychotherapist (preferably one who has experience working with anger management, and/or impulse control disorders) to see if a program targeting your symptoms is in order. Participating in an anger management program would probably be in order even if you do not have any functional brain damage, since either way you are aware of yourself having anger management problems that are affecting your relationships.

Before closing, I want to address the matter of how you and your partner are viewing this anger problem of yours differently. I believe you are hoping to make the argument that you can’t control this problem (at least not entirely) because it is being caused by brain damage and therefore you are helpless in the face of that damage and your partner should just accept that sometimes you will get inappropriately angry just like you can’t control the color of your skin or whether you have hair or are balding. She is making the opposite argument, that you have control over the problem and that your argument of helplessness based on brain damage is but a rationalization designed to let you get away with behavior you don’t deserve to get away with. You can’t both be correct. More to the point, even if you find a doctor or Neuropsychologist willing to say that you have brain damage which has contributed to your anger problem, that still doesn’t excuse inappropriate behavior. It just would provide an explanation for why you were more prone to act inappropriate. My point is that the behavior is always going to be inappropriate, even if you have an excuse for why you have more difficulty not acting that way than someone else.

Perhaps a compromise position of mutual acceptance is in order. Everyone here might consider reevaluating the hand of cards they have got, keeping in mind that there is no such thing as a perfect hand of cards. You seem to have more trouble controlling your outbursts than some other people do. Why you are that way is in some sense irrelevant. It still comes down to it being your own responsibility to doing all you can to avoid alienating the people you care about. If you fail to do this, your partner may ultimately leave you, emotionally or literally, or both. It is a similar analysis from your partner’s perspective. She has gotten herself into a relationship with a man who has some anger problems. It may help her to feel compassion for you if there is a reason for your behavior beyond "you just act that way", but even if there is a reason, she still has a right to protect herself from inappropriate harm. She should give you the benefit of the doubt, I think, but that doesn’t mean she should excuse your behavior when it is inappropriate. It comes down to everyone understanding that no relationship is perfect and being willing to accept some negatives in a partner, because the positives outweigh the negatives. It sounds like you both have some work to do in this relationship, and I hope that you can, out of mutual love and affection, find a way to do that work together in the spirit of mutual acceptance and support, rather than as part of an adversarial process.

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