Can a head injury cause a personality change?

Can a head injury cause a personality change? FILE PHOTO | SHUTTERSTOCK

My brother was involved in a road accident five years ago and was unconscious in the ICU for a week. Now the doctors tell us the accident is responsible for the strange man he has become. He drinks too much, fights a lot, has uncontrollable fits of anger, and chases his wife away. Is it possible to link a head injury and this behaviour?

There are several possible ways to link the new behaviour with the accident. That said, it is impossible for me to comment on a patient I have not examined.

I will therefore describe in general what might be going on from the limited information you have given us.

At least three immediate explanations come to mind from the scenario you have described but remember there could well be others.

The first is the possibility that your brother developed PTSD (Post Traumatic Stress Disorder) after the accident. This condition is more common than many people realise.

It occurs in people under different circumstances including road accidents, observed in domestic violence. It also occurs in past traumas encountered at a social level including politically instigated violence.

One of the symptoms of this condition is a state of heightened arousal or alertness sometimes also called “hypervigilance”.

To contain the suffering due to this symptom, some people take alcohol to calm down their nerves and to help them sleep.

In addition to memories of the accident that might keep coming back to your brother, concurrent feelings of sadness and depression are also often treated by the unknowing patient using alcohol.

So, before you dismiss your brother as a grumpy alcoholic, let an expert find out if indeed the drinking is a complication of the accident, in this case, PTSD.

We see many patients who present with what on the surface is an alcohol problem, but deeper enquiry reveals that this is but a symptom of a deeper problem.

The other possibility that the doctor might have had in mind is regarding personality change. This is sometimes the consequence of damage to the frontal part of the brain in an accident.

If this part was the part that was damaged in the accident, you might, as you have implied, have noted a change in his behaviour resulting in the impairment of judgment, rational thinking, and in general impairment of the higher executive functions of the brain.

Damage to these higher centres of the brain could lead your brother into difficulties in managing the affairs of his family and might at least in part be the reason he is unable to keep his family together because he keeps making poor or irrational decisions, that might prove frustrating to a wife hitherto accustomed to a more rational manner of conflict resolution with her husband.

So, what you are seeing as him chasing his wife away, is evidence of a person with post-traumatic brain damage that has made it difficult for him to engage in what was previously a normal conflict resolution style.

In the same context, there are instances that the person who has had a severe head injury, as your brother seems to have had, changes in his behaviour in ways that make it impossible for him to relate well with a spouse or even an employer.

From a hardworking, loving and conscientious husband might emerge an angry quarrelsome lazy man who is always spoiling for a fight.

Such a personality change could be what you are witnessing in your brother and his family.

The third possibility that might be at play could be that your brother had damage to the brain, the consequence of which is now a condition we call Temporal Lobe Epilepsy (TLE).

This is due to the scar tissue in the brain that comes from the healing of any damaged parts.

In some variants of these conditions, the family will notice the occurrence of abrupt changes of behaviour, mostly unprovoked, which, as in the case of your brother, could be bouts of extreme rage.

Typically, and on close observation, there is often the presence of subtle signs called an aura, in which the patient might complain of sudden onset of tiredness, dizziness, confusion, headache, and slurred speech, followed, as sounds in your case, by an unexplained explosion of aggressive behaviour.

This surprising behaviour is sometimes followed by sleep and some people will have a partial or complete epileptic attack.

If this is what you have seen or suspected, then the doctor will do some tests and will be able to give your brother medication that will stabilise the activity of the brain to stop these abnormal brain discharges that are often responsible for the aggressive behaviour you have observed.

In conclusion, therefore, there is more than an even chance that what your brother is going through is a behaviour change directly attributable to the accident.

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