4.5 Sources of misunderstanding

Identify how the behaviour of a person with impaired cognitive functions might be misunderstood or misinterpreted by other people

Changes in personality and behaviour can be extremely disruptive, affecting how an individual manages interactions, with people who are not well known, right through to their ability to maintain an established relationship.

After a traumatic brain injury a person may present with one or more personality and behaviour changes that are caused by their brain injury. Others can misunderstand these changes as the person being deliberately difficult, which in turn can make it challenging and frustrating to spend time with them. Due to their reduced insight into their condition, people with TBI often have limited awareness of how they may contribute to a situation.


Personality/behaviour change due to TBI

Misinterpreted by others as being deliberately:

Disinhibition, impulsiveness and poor self control Rude, immature, intimidating, angry
Egocentricity and self absorption  Insensitive, selfish, obsessive
Apathy – lack of interest or feeling  Insensitive
Emotional lability  Over reactive, superficial
Inertia – lowered drive, poor motivation, poor initiation  Lazy
Restlessness and increase in energy  Agitated
Reduced social skills  Difficult, inappropriate


Personality and behaviour changes are likely to occur in combination with cognitive deficits with considerable overlap between many of the different deficits.

A person with TBI may also find themselves in a situation where their social network has been depleted or disappeared, they have lost independence, and they may also have financial, accommodation, and family concerns. They could be quite stressed, anxious, or depressed, which could also impact upon their cognitive functioning. Their cognitive difficulties may make it difficult for them to express their needs and their concerns, which might be why they present as a frustrated or over reactive person.