One of the most difficult areas when dealing with traumatic brain injury is the effect it has on the individual's personality and emotions. After a head injury, in addition to pain, headaches, dizziness and cognitive problems, there can also be changes in personality and emotions that can be temporary or permanent.

Diagnosis of personality changes by medical clinicians can be difficult as they may not have great familiarity with the individuals personality before the accident. Family members must be relied on as they know best what the person was like before when compared to after the traumatic brain injury.

Damage to certain parts of the brain can cause changes in personality and emotions. Some of the specific areas of the brain that can cause this are the frontal lobe, temporal lobe and areas inside the temporal lobe that contain the amygdale and the hippocampus. These are parts of the brain that control executive function, behavioral control, higher intelligence, personality, orientation, speech, integration of sensory inputs and language comprehension. Damage to these areas caused by direct impact, penetration, severe force (axonal shearing and coup-contrecoup) and oxygen deprivation can cause minor or severe personality changes.

Some of the personality changes and emotional difficulties that can occur are as follows:

• Lack of emotion - A person may lack emotional responses such as smiling, laughing, crying, anger or enthusiasm, or they may have inappropriate responses.
• Emotional lability - In some cases, neurological damage after a head injury may cause emotional volatility including intense mood swings or extreme reactions to everyday situations.
• Aggressive behavior - Severe anger and aggressive outbursts.
• Self centered attitude - A lack of empathy, thoughtlessness, hurtful remarks.
• Poor concentration - A lack of understanding
• Lack of awareness of deficits - Not recognizing problems and being in denial.
• Inappropriate sexual behavior - After a head injury a person can experience either increased or decreased interest in sex.
• Anxiety - A feeling of fear or nervousness that is out of proportion to the situation.
• Depression - Psychiatric disorders can occur resulting from the traumatic brain injury including depression - feelings of sadness, frustration and loss.

All of these personality changes can result in the destruction of family relationships and relationships with loved ones.

Coping with behavioral problems after a traumatic brain injury requires identification and acknowledgment of the impaired individuals deficits. A comprehensive neuropsychological assessment is recommended to help both the injured victim and all family members and loved ones. Thereafter, psychological counseling can be arranged and in some cases psychiatric treatment with medication.