TBI Anger and Rage: What it is and what to do about it

Raw, Primal Protective Reflex
TBI anger is unlike any other kind of anger. It taps into our primal instinct to protect ourselves, like any wounded, cornered animal, with a burst of adrenaline. This is the source of the raw, primal strength, energy, focus, and coordination. Once it hits, it can not be stopped, only redirected in a safe direction.

Why does Primal Rage Happen in TBIers?
It’s a primal response we have to protect us from sabertooth tigers and other immediate physical threats. For most of us, those do not regularly exist in our world, but our biology interprets the onslaught of overwhelming input on our brain as an imminent threat. Our biological reaction kicks in, releasing adrenaline. But there is no immediate physical threat. So we often (and very wrongly) assume those around us must be the imminent threat. This is why some TBIers are verbally or even physically violent to those who love them. The truth is there is no threat. The “threat” is damaged neural connections inside our brain that make it so we can’t handle input from our own senses.

How to Handle TBI Anger
First, it’s important to know that typical anger management techniques do not work. They fail to recognize that the anger happens because of damage to the brain.

Second, trying to reason with someone in a TBI rage only makes it worse. Why? Because in their focused “fight or flight” state, you are standing against them and are thus mistaken for the immediate threat. Not accurate, but still what happens.

There is, however, hope.

First: Make sure everyone is safe
If the TBI anger bursts get physically directed at people, get immediate help until the survivor learns to direct their rage in a safe direction. If you feel like you are in danger, you are. Getting safe may just be the motivation your TBIer needs to learn how to address their rage

Second: Create a Sanctuary
A sanctuary is a room set up to minimize the stimulation on the survivor. Mine has a sound dampening door, increased sound proofing between me and the rest of our home, and is where I do most of my writing and other creating.

Sanctuary is where I go to recover when TBI rage hits.

Third: Learn to Direct your Anger Safely
This is challenging, but as we’ll see it cooperates with our natural biology

Pay attention to what it feels like immediately before an anger burst. When you feel it coming on, drop everything you are doing and get to your sanctuary as safely and quickly as you can. Do not engage the people or animals around you or who happen to be in your way. If you must hit something, hit a wall or slam a door. Doing these things gives your adrenaline somewhere to go. when you get to your sanctuary, crash and recover.

Why this works: This is your fight or flight response you’re experiencing. It either wants to fight the immediate danger, or flee to safety. Your sanctuary is safety, so its natural to direct your rage toward safety and away for harming others. Trying to stop the rage (you, or those around you) only makes it worse.

This is something you can learn to do fairly quickly. It is also the stepping stone toward learning the next step, which can take years to learn. In the meantime, whenever your rage hits, directing it’s purpose toward getting you to safety will keep you and those you love safe.

Forth: Learn to “Shut Down” rather than Rage
If the last step was hard, this one is even harder. The previous step at least had biology on it’s side

Once it starts, there is no stopping a TBI rage other then letting it run its course. I know. I tried for years. THe trick is to stop it BEFORE it starts.

We only get one shot at this with each anger burst. The window of opportunity to stop the rage is when I know it’s coming but before it arrives. Typically this is far less than a second.

Remember how step three above was a stepping stone to this step? Learning what it feels like immediately before the rage burst is key.

That feeling of impending rage is my “trigger” to shut down. Like a robot. whatever I’m doing, I simply slump to the floor and turn off. I do not move until help comes to help me to my sanctuary.

Doing this is a pure act of the will. Nothing in our biology tells us it’s good to shut down in the face of danger. But the benefits of doing so are numerous.

First I don’t verbally or physically threaten anyone when I’m shut down. I’m a completely non-threatening lump on the floor.

I’ve taken years to reach the point I can feel it and choose to “shut down” rather than let the rage hit. This takes a lot of work and effort to learn what it feels like immediately before the rage, and choose to make that a trigger that always, without question, causes me to shut down. If I think about it, it fails. And sometimes the rage is too fast for me. But for the most part I am able to now shut down.

Why is “shutting down” better than a rage? First, rage doesn’t benefit anyone. Second, the rage never happens. The adreniline is never released. I don’t have any burst of energy to deal with, no “crash” after the adreniline wears off, and no 2-3 days or more of recovery from the rage itself (let alone whatever overstimulation caused it). My muscles do not constrict, lmiting blood flow to my brain, causing more things to overcome to recover.

Shutting down is the right thing to strive for. It’s also amazing hard. It took me years to reach the point that it is my natural response to impending rage. As soon as I feel my brain getting overwhelmed, I shut down. I do not think about it because if I do, it’s too late, and I’m back to fleeing to my sanctuary in a rage. Hard as it is, shutting down is well worth learning.

What is your experience with TBI rage? How have you handled it? What have your found works for you or your survivor? Use the comments to share your experience and wisdom.


22 Responses to “TBI Anger and Rage: What it is and what to do about it”

  • Well said! I see a number of people who are court referred for anger management and one of my biggest frustrations and challenges has been trying (unsuccessfully) to get them to require some kind of screening so that people with co-morbid conditions (such as TBI, PTSD, Anti-Social PD, etc…) get treated for the true underlying condition. Its very difficult to give someone the proper treatment in a classroom setting over a period of 10 – 20 weeks.

  • Well said! I see a number of people who are court referred for anger management and one of my biggest frustrations and challenges has been trying (unsuccessfully) to get them to require some kind of screening so that people with co-morbid conditions (such as TBI, PTSD, Anti-Social PD, etc…) get treated for the true underlying condition. Its very difficult to give someone the proper treatment in a classroom setting over a period of 10 – 20 weeks.

  • Todd Gebow:

    As an individual with TBI I have experienced TBI Rage on occasion. Most recently my anger was triggered by a counselor who thought he knew best. He did NOT. That only increased my anger. He stated in front of a group of people that certain medications were not allowed. Yet, when I checked the medication a physician put me on, it stated precisely what he was saying was not allowed. This angered me further, heightening my rage. He had NO concept how to deal with an individual with TBI. Yet there he sits………….

    What can be done to avoid such situations? Obviously having contact with an individual with NO experience is the WRONG thing to do. (I only found this out after the fact. Luckily I was able to walk away before the situation became inflamed.)

    • Deacon Patrick:

      Hello, Todd. As one of the folks on my TBI email support group often says: “you can’t fix stupid.” Sardonic grin. What can be done to avoid such situations? I only see doctors for my TBI who I’ve vetted as much as possible by getting recommendations from folks whom I already know understand brain injury, that they understand brain injury also. Even so, I’ve had vetted docs berate me for “faking it” despite having just looked at my neuropsych test results and my SPECT scans.

      In those situations, I do what you did (and as you know, it can take a lot to do it) — walk out, run if need be, to escape and get to a sanctuary. After that, it becomes a matter of the heart and soul, of being able to let go, forgive, and move on. Otherwise we give control over how we are doing to the “small-minded people.” The best way I know to do that is prayer and striving to create whatever I’m working on.

  • Todd Gebow:

    Thank you Deacon…….. my ‘sanctuary’ is outside. Since I can’t operate a car I have to walk or ride the bus. I prefer to walk. I love being outside among nature. That is my sanctuary. I have a ver difficult time ‘sitting’ still. I was always a bit hyper. The TBI has made it more pronounced.

    Thank you for your reply.

    • Deacon Patrick:

      Have you tried exercising? I’m a strong advocate (as you’ve likely seen) of running to heal our brains. And now there’s starting to be some scientific evidence that supports this (I’m working on putting together that series, keep an eye on the tag “brain science”: http://www.mindyourheadcoop.org/blog/?tag=brain-science

      Getting as close as we can to running barefoot (even if that means minimalist shoes and walking, or more or less as need dictates), really does help us recover from hard days, and heal better over time. It would also be a great thing for being hyper. Grin.

  • Angela Bentley:

    My brother experienced aTBI 21 years ago when the car he was a passenger in wrecked. Since that time, my parents and I have been on an emotional roller coaster. My brother met a great woman 8 years ago and they were married. She understood his inability to work and she took on the role as the main bread winner. My brother was on a lot of medicine to help control shaking in his hands, anger, headaches, and depression. Almost two years ago, his doctor took him off all his medicine because he was having kidney stones on a regular basis. There wasn’t a link between the two, but my brother did not begin taking his medicine again. He has two young boys and for about six months his rage has been building. He refused to believe he needed his medicine again. On Thursday, he took his son to school and lost his temper. It was terrible. He made threats and the school went on lock-down. He left but there was an arrest warrant issued for him. My husband, father, and I bailed him out this morning. His charges were harassment and endangerment. His wife just couldn’t take anymore. She took their boys to her mother and came back to their home. My brother began choking her. He was enraged and she had to fight hard to get away. He left, the cops were called, and I helped her load her car. She wants a divorce. I don’t blame her. He has destroyed their home, and now the violence has erupted toward others. My parents make excuses for him- always have even before his wreck and TBI. My brother hit me while I was pregnant, and he pushed me down some steps. I called my dad that night for help. He said that it was between my brother and I and refused to come help. Now my mom and dad are blaming his recent problem on everyone but him. I understand he cannot stop his feelings, but I can’t make my parents understand that he needs to be in therapy under someone who understands TBI’s. He will be arrested again on Tuesday. He still says that he doesn’t need medicine. My parents said that they will just bail him out again. My problem is this: they are elderly. It is only my brother and I. What am I supposed to do after my parents die and he continues this behavior? He is my brother, but I cannot continue to bail him out of jail if he will not take his medicine? I just don’t know what to do. Can you give me any advice? We live in Alabama and I can’t find many resources that may help.
    Thank you,
    Angela

    • Deacon Patrick:

      Dear Angela,

      Please focus your initial efforts on ensuring that you, your parents, and your sister-in-law need to take steps to make sure you are safe. While your brother has less capacity due to his brain injury, that is no reason you and others need to be in danger, and it sounds like you are. Call 911 in any situation in which you are not comfortable. If need be, you and your sister in law may need to go to a battered women’s shelter for safety until this can be resolved. They may be able to help connect you with other local resources.

      Your parents sound like they are in deep denial about the effects of his brain injury on him and the threat it is to his (and their!) family, a pattern of excusing bad behavior that began long before his TBI. When sin isn’t named and confronted, it grows and takes over. This can be mindblowingly frustrating for others who see what is going on, but your parents may not have the capacity to change how they see the world, and thus their son. Your energies are better focused toward ensuring safety of everyone involved, and if possible, getting him the care he needs to begin making better choices again.

      Unfortunately for your brother, he may not have the capacity to make the choices he needs to make without help. Brain injury may well have taken away the capacity for self assessment, awareness, as well as anger control.

      The help he needs may or may not be able to reach him. While I am not a lawyer or familier with the laws of Alabama, this is one avenue that may be worth exploring: A 72 hour psychiatriac hold. Considering what has happened, he may qualify for a 72 hour psychiatric hold (worth requesting from the police), during which he will be evaluated and options explored for ongoing treatment. However, after that 72 hours, if no legal reason exists, he may be free to leave if he refuses treatment (including medication). It sounds like until he is on his meds again, no help is going to be able to reach him. That is a catch 22 that sometimes happens with TBI.

      Your brother and all of you are in my prayers, that Christ’s healing balm wrap you in peace beyond understanding.

  • Ken:

    WOW this is what i think every day since my accident. I used to be able to maintain my emotional state. Now I am a labile mess. I snap at anything or anyone any time. I cry for no reason. I am homicidal and suicidal all within min of each other. I have met with pain psychologist and another injury related specialist. They put me on amitryptiline. I hate taking drugs but perhaps they are necessary.I can’t see a psychiatrist cause i lost my job and therefore income/insurance. My PIP has ran out and I am still in a messed up state of mind. From what I read this could be the new me? I don’t think I like that idea. I look forward to a response, let me know if this is “normal” I know to call for help if I get to violent or suicidal don’t worry this is not my intent. I just want to know if other have or do feel this way.

    • Deacon Patrick:

      Dear Ken,

      Yes, TBI anger and rage are very common for us brain bludgeoned folks.

      When necessary, drugs can make a big difference. The trick with TBIers can be that our brains may be very sensitive to drugs, so even small doses can have a very large effect. Also, watch for the side effects — they sometimes outweigh the benifit of the drug if they kick in.

      Do you have a sanctuary set up, as described in the post? If you can learn what your triggers are just prior to the rage kicking in, you can then choose to go have time to recover in your sanctuary. For me, the big trigger is brain fatigue, which can happen from any number of things (light, sound, smell, etc.).

      You will be in my prayers, for God’s healing balm to embrace you and melt away your anger and heal you. May God startle you with joy!

  • Marie Rock:

    I have a 33 year old daughter with a TBI injury. She suffers with rages and I’ m the one who catches the worst of it. There is nothing I can do when she is screaming and cursing at me. Even understanding what causes the rage I sometimes become angry myself that she speaks to me this way. What I don’t understand is she can control it much of the time with other people people. She lives with me wih her children ages 5 and 6. It’s hard for them to understand what is happening when she gets like this. This sanctuary method sounds like a Godsend if she could learn to do this. It’s been 15 years and I’m exhausted. I’m 67 and living on a fixed income, getting no support for the kids and she’s not working. We have not been able to find a doctor that knows how to treat her because we cannot afford to see the doctors who treated her after her accident. She was in a Christian rehab for a short time and she seemed to come out a new person but the longer she is home she slowly slipping g back into the rages. Please if there is anything you can do to help, I would be forever grateful.

    • mary:

      I have a son who is 24 who has a TBI. The past 7 years has been hell. My two youngest boys were 8 when he was in his accident. We did everything to shelter them from the rages. Unfortunately one of the boys never accepted the accident and couldn’t deal with all the chaos. No one ever explained to us what to expect with a TBI. My son now is full of anger and has done some bad things and is now in a juivenile detention center. So please get your two grandchildren help and make sure that they know their mother is ill. She can’t help the way she is. We explained all that to our sons. The older he got the more he resented him. Then the more he got angry.

  • Me:

    I didn’t have a TBI but I do have a forebrain injury from septic emboli (basically an internal trauma to the brain). Mine was considered minor but, wow, it took a good 10 years to recover. I was 26 when it happened, female and extremely successful. I descended into anger, short term memory loss and also lost most of my friends.
    Anyway, I learned to “manage” my anger in the following ways (and still do so):
    – I compartmentalize or completely avoid the subject or person who triggers me until I have control. I have had experiences where individuals refuse to accept me putting them off and demand immediate answers, which would likely have them ending up in the ER or morgue. Or more likely, it would have resulted in the loss of our friendship. I just say I’m too upset to talk and extract myself. Or just extract myself by any means necessary.
    – I also have learned to “vent” my frustrations in other ways. Twitter is great for this because it can be anonymous and instant. I can say anything, or almost anything, I want. I can say things that are inappropriate or that I could never say to someone in person. I can write my thoughts and rid myself of the energy without hurting anyone. Most of the time, the exercise of writing things is good enough for me. I don’t even need to post most of my thoughts to the Internet.
    – Previously, before I developed Coping skills, I broke many a phone (to my own detriment), broke quite a few objects, and said many things I wish I could take back. I have probably done even worse but cannot recall. Fortunately, my brain has slowly healed. I’m never going to be the person I used to be but I don’t think anyone can go through major trauma and not expect to change.

    I owe my neuropsychologist a debt of gratitude. He warned me very early on that most people with brain injuries who have problems with impulse control Do get arrested within 3 years of their diagnosis. I decided I didn’t want to be one of them.

  • Patience.....please:

    My husband and I were in a wreck and both of us were in a coma. Since I woke up I have been busting my butt to protect him and get him better. The accident was in 2012 and so I know that everything is just starting, but his anger and aggrivation and lack of respect really gets to me sometimes. It is only he and I. The doctors just keep saying, “every tbi is a different tbi”. I know that everyone is different, but if you give 14 people a book on how to raise a 2 year old, well you are still going to have 14 different 2 year olds. I say this because everyone keeps telling me it’s like raising a child. We have no children and people have written numbers of books on raising them. I’m not a person who is into medications, but if there is something out there to mellow him out so that he will want to get better that would be great. Right now he is going through the agony of not being able to move his arm and leg correctly. I just wish he would get to the point where he is tired of trying to fight me and start fighting WITH me to get better. He doesn’t even smile any more (stopped 2 weeks ago). I know I must just be patient and be here for him as he goes through this, but for a world that has so many brain injuries there is nowhere for the caregiver to go. He was and is my best friend, we told each other everything, the other half of my smile………….now I am not allowed to talk to him, he stays in bed, he wants me to just leave him alone, and to say something nice to him I get a, “shut up” yelled back. I’m sorry if I sound like I’m complaining, but I’m just sooooooo lost. What can I do to help him? He starts seeing a shrink in a few days. Will they be able to help me??????? I hope so!

    • Deacon Patrick:

      Dear Patience,

      Och! I am so sorry this is happening to you both. I will help however I can.

      You’re exactly right: while every TBI is different, there are things that can help every TBI. I suggest you take a look at this post, Radically Reset Your Brain. The whole idea is to reset the foundations (nutrition, oxygen, posture, walking) needed to help his brain heal as much as possible so he can enter life as much as possible.

      If the shrink he and you will see is a Neuropsychologist, then s/he may understand brain injury and be able to help. If s/he is a psychologist, then they will likely fail to understand the difference between organic brain damage and psychological issues, and could very possibly make things worse.

      You may also find these posts on grieving loss due to TBI helpful.

      You and your hubbie will be in my prayers.

  • Mona:

    Wow is all I can say! I can really identify with everyone’s struggles with tbi’s. I sustained a tbi and stroke in 1979, in a car accident. It’s been so hard controlling my rage and thoughts of suicide, it haunts me all the time. I have sought out a doctor in L.A, CA, that’s treats the body/ hypothalamus with hormones. Dr Mark Gordon is a world renowned physician using bioidentical hormones to treat the brain. After extensive blood tests I was found to be lacking in the growth hormone, testorone, and progesterone. My levels were dangerously low, leading to depression and rage. He treats sports figures and veterans with phenomenal success. I just started my treatments and already I’m noticing my achey, sleep deprived and fatique feelings starting to reduce in intensity. I’m not saying everyone fits into this line of treatment but maybe some would benefit. I’m also used dbt therapy(dialectic behavior therapy) to help control the homicidal and suicidal thoughts. This involves attending dbt groups designed by Marsha Linehan for bipolar people. The plus in this treatment is that you call a dbt coach to help you cope during the rage event. I’ll keep you updated in my progress and hopefully help others.

  • Rita Richardson:

    My son has TBI from his war experience; he gets disability but incompetent treatment from the VA. This page is the best explanation of TBI rage I’ve ever read, wish I’d seen this 5 years ago.

    What, if any, meds work best here? He is hyper sensitive to anything they’ve given him. He’s living at home to finish school but has explosive episodes 2-3 times a week and it’s destroying our family.

  • Matt:

    March 22nd will measure a year since my accident. I was emotionally whacked for half or more of this time. After four months back to work, it’s uncontrollable exploding anger that is finally starting to surface. It was not an issue that I can recall th first seven pmonths of recovery.

    • Deacon Patrick:

      Dear Matt,

      I am so sorry your experiencing the anger rage of TBI. The trick is to 1) stop exposing yourself to the overstimulation triggers (something, or multiple somethings at work) so you can break the adrenaline cycle; and 2) recover from the adrenaline cycle that digs us into a pit that is very hard to recover from. I’m still recovering from a 30 minute attempted doctor visit 20 days ago. Here’s a post that may be helpful.

  • David W.:

    My wife had a TBI 30 years ago from a car accident. Over the years I’ve noticed it getting worse, she passes if off as menopause. Once in awhile she gets violent at me, spitting, kicking, slapping or punching. Most recently threatening divorce in front of our son. Not sure what to do accept keep her busy, calling her friends to have lunch with her, fill her time so she doesn’t watch TV all the time. I want to get her some therapy with someone who know TBI, but can’t afford it. I’ve endured 18 years of this and not sure where to go, and getting really tired of of her and her TBI. If someone was to ask me about marrying someone with a TBI, honestly, I’d say don’t do it. You’ll be in misery in your marriage.

  • Kayla:

    My live in boyfriend had a bad fall in Sept of 2013. He landed on his head and found unconcious. In this fall he reinjured his neck and back from a previous injury. This was his 7th concussion. He is depressed at times and lately has explosive rages directed at me. The next day its as if nothing happened. Its an onslaught of verbal abuse. He forgets things I have told him, leaving me as a target. It has gotten worse and to the point we might split up. At first I thought he may be bipolar until I read these stories. The workmans comp has not approved the shots to help his pain. I don’t know how to help him. We spoke of getting married and now the future looks bleak.

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Deacon Patrick’s Round the World Progress

Deacon Patrick's Round the World Progress