When cortical areas (frontal lobe or limbic system) responsible for emotion and self-regulation are damaged, hyper-emotionality, behavioral disinhibition, and a reduced emotional filter are common. It is most common in the early days following TBI, when patients are not fully aware of their surroundings and struggle to form new memories. Over time, most patients have some level of physical and cognitive recovery. As they become more aware of their surroundings and better able form new memories, they have fewer anger outburst.

Contributing factors to persistent anger and irritability

• Depression
• Chronic pain
• Difficulty adjusting to a rapid change in their level of independence and ability to engage in enjoyable activities
• Difficulty adjusting to alterations in their life role if they are no longer working or providing financially for their family
• Altered social support networks or an inability to socialize due to personality changes or altered abilities to engage in activities