4.1 Explain the impact of changes in personality on an individual with acquired brain injury and others

This guide will help you answer 4.1 Explain the impact of changes in personality on an individual with acquired brain injury and others.

Acquired brain injury (ABI) happens when the brain is damaged after birth. This damage may result from accidents, strokes, infections, or other medical events. Often, people focus on the physical effects, such as issues with speech, memory, or movement. But personality changes can be just as significant.

Personality means the combination of characteristics and behaviours that make each person unique. When someone experiences ABI, these traits may shift. They might seem like a different person to themselves, family, and friends.

Types of Personality Changes

Changes in personality after ABI vary from person to person. The changes depend on factors such as where the injury is in the brain, how severe it is, and the person’s previous personality.

Common personality changes include:

• Loss of inhibition: The person may say or do things without thinking. They might act out, swear, or behave in ways they would not have before.
• Low motivation and apathy: Interest in hobbies, work, or relationships can fade.
• Impulsiveness: The person may make decisions quickly without considering the result, leading to risky actions.
• Emotional bluntness: There may be a lack of empathy or difficulty showing emotions.
• Mood swings: Sudden or frequent changes in mood can occur. The person may be happy one moment, then angry or sad the next.
• Irritability and aggression: They might become short-tempered, snap at people, or get frustrated easily.
• Anxiety and depression: Feelings of fear, sadness, worry, or hopelessness might develop.
• Self-centredness: The person may focus more on their own needs and struggles to consider how others feel.

Some people also develop obsessive behaviours or find it hard to adapt to changes.

How Personality Changes Affect the Individual

Changes in personality can have a big effect on the person who has acquired brain injury. Life may feel confusing or disturbing. Suddenly, things that were easy before—like keeping calm or thinking before acting—become a struggle.

Self-awareness is often reduced. Some do not notice their behaviour has changed. Others know, but cannot control it. This can be very upsetting and make them feel a loss of identity.

The person may:

• Feel isolated or misunderstood by others
• Lose confidence and have low self-esteem
• Withdraw from social activities
• Feel frustrated or angry at their situation

Previous coping strategies may no longer work. Everyday tasks, such as managing money or relationships, may become harder. Some fear they have lost who they are. This emotional pain can be as serious as any physical condition.

The Impact on Family and Friends

Family and friends often feel the effects of personality changes, too. Relationships change, sometimes overnight. A once-caring partner might be short-tempered. A friend who was fun and outgoing may withdraw.

Family members might feel:

• Shock at the change in behaviour
• Grief for the “old” person they remember
• Guilt if they get frustrated or angry
• Stress at dealing with unpredictable moods

Spouses may feel alone or unloved. Children may be confused or scared by angry outbursts. Brothers and sisters could feel their relationship is broken or lost.

Over time, people may:

• Lose patience and avoid contact
• Take on roles they did not have before (such as being a main carer)
• Struggle to balance their needs with those of the injured person

Arguments may become more common. Some relationships recover and adapt, while others break down.

Impact on Social Life and Wider Community

Outside the family, personality changes can affect friendships and community life. Old friends may not understand what has happened. Invitations to social events might stop. The person with ABI could find it hard to recognise social cues or keep to social rules. This leads to awkward situations, embarrassment, or rejection.

The person may:

• Have fewer friends due to changes in behaviour
• Lose their job or role in organisations or clubs
• Stop taking part in favourite hobbies, especially group activities
• Struggle to make new friends

Isolation often increases. People might feel “different” or left out.

Impact in Health and Social Care Settings

Personality changes can affect care arrangements. Staff must be aware of how new behaviours affect daily routines.

Impacts include:

• Increased need for monitoring and support if a person is impulsive or aggressive
• Staff stress from dealing with challenging behaviour
• Difficulty planning care due to unpredictable actions
• Conflicts with other residents (in shared living environments)

Care workers may need to change support plans, give extra supervision, or adapt communication styles. Training and teamwork become more important.

Managing and Supporting Personality Changes

Supporting people after ABI takes patience and skill. Strategies depend on the person’s needs.

Ways to support people include:

• Developing routines for predictability
• Encouraging independence, but giving support as needed
• Teaching techniques for managing anger or impulse control
• Giving regular feedback (in a kind way) to help the person build awareness
• Setting clear rules and boundaries to reduce confusion

Communication is key. Care workers may need to use simple language, repeat information, and listen with empathy. Involving the person in their care plan, where possible, supports choice and wellbeing.

Families often need guidance and support. This may be through counselling, support groups, or information about ABI. Helping the family understand that personality changes are a direct effect of brain injury—not just “bad behaviour”—can ease blame and tension.

Clear, honest communication between care teams and families helps everyone know what to expect and how to cope together.

Changes in Risk

Shifts in personality can increase risks for the person and others, such as:

• Financial problems from impulsive spending
• Exploitation due to poor judgement
• Physical harm to self or others if aggressive behaviour is present
• Accidents through risky actions or lack of awareness

Staff must assess changing risks and take steps to keep everyone safe. This includes updating risk assessments and working closely with the individual and their support network.

Common Myths and Stigma

There are many myths about personality changes after ABI. Some people think the person “should just try harder”, or “snap out of it”. Others wrongly believe the individual has always had this personality.

Such views create judgement and make the person feel blamed. Stigma stops people seeking help. Being aware of these issues helps staff break down barriers and offer better support.

Practical Examples

Here are some real-life examples to show the impact of personality changes:

• Loss of inhibition: Sarah was quiet before her brain injury. Afterwards, she started making rude jokes at family meals. Her children felt embarrassed and stopped inviting friends over. Sarah did not notice her family’s discomfort.
• Mood swings: Peter had a road accident, leaving him with a brain injury. He now gets angry very quickly, sometimes shouting at his wife. She struggles to cope and feels she cannot talk to friends about it.
• Emotional bluntness: Joe became distant and cold after his stroke. His wife said he no longer cared about her feelings, although he did not mean to hurt her. Their marriage grew tense.
• Impulsiveness: After his injury, David started spending large sums of money on things he did not need. He put his family’s home at risk. His wife had to take over managing their finances to keep them safe.

Supporting Carers and Families

Support for family and carers is just as important as support for the person with ABI. Some steps include:

• Giving clear information about personality changes and what to expect
• Providing access to counselling or support groups
• Teaching practical strategies for handling challenging behaviour
• Creating a plan for breaks and respite care

Good support helps families stay strong, manage stress, and continue providing care.

Emotional Impact on Others

The emotional impact on friends, family, and carers should not be ignored. People may feel anger, guilt, sadness, or helplessness. Some feel like they have lost their loved one.

Carers often face exhaustion, anxiety, and depression. Support in the form of listening, acknowledgement, and practical help can make a big difference.

Adjusting to the “New Normal”

For many, learning to live with personality changes is a long process. It takes time to understand what has changed and to adapt. Some relationships improve, while others may not recover.

Staff and families can help by:

• Recognising successes, even small steps
• Finding new activities or interests that suit the person’s current abilities
• Creating new routines that support stability

Patience, flexibility, and kindness help everyone adapt.

Final Thoughts

Personality changes after acquired brain injury are often the most challenging effects for the individual and those around them. These changes touch all parts of life—from home to work, friendships, and community. They can bring new risks, create stress in relationships, and leave both the person and their support network feeling lost.

Understanding that these personality changes are a direct result of brain injury can bring some comfort. Support, patience, and clear information are key. With encouragement and the right help, individuals and their families can adjust to new ways of living and find meaning in their changed circumstances. The aim is not to go back to the past, but to find strength and value in the present.

Adjustments are hard and emotions run high, but progress is possible. As a health and social care worker, your role in recognising, understanding, and supporting people through these changes will have a profound effect on their quality of life. By showing empathy and adapting your approach, you help people with acquired brain injuries and their families feel heard, respected, and supported as they build their new future.