What a great forum this is- I thought it might be a good idea to try and post here to get some feedback on an issue I'm having, if possible.

I am dating someone who was wounded in combat, TBI five years ago. He is very transparent about his injury and how it occurred and states that he has very little in the way of deficits at this point. In short, the majority of his frontal lobe was removed. He seems to be a pretty "normal" guy, with the exception of being very... talkative.

I work in healthcare. When we first began dating, I did some very light research on TBI, as that is not my specialty and I wanted to at least be familiar with it. Apparently, I didn't "get it".

All has been well in our relationship, and we have a good time when we're together. Recently, we had a disagreement about something rather minor, and he began to shut down on me (our first real "disagreement"). My efforts to get him to smile and not continue the misunderstanding were met with resistance. I have always been one to attempt to resolve things rather than let them stew, and attempted to do so in this case. He became more and more angry and wouldn't even look at me, no matter what I said or did. The more I tried to make eye contact with him, the more frustrated he became.

Without going too far into details, the disagreement itself was silly and his side of the argument seemed a little less than rational to me. I knelt down in front of him, looked him in the eye and said, "Whether I'm right or wrong, can you at least appreciate where I'm coming from? Can you understand how you're making me feel?" In response, I got the most blank stare I've ever seen in my life, with a gruff "Yes", but he did not change his view or actions. Hurt and frustrated, I remained calm, and told him I'd see him later on, and I left.

I went home and read more about TBIs and frontal lobe injury, and then I read some more. Before I knew it, tears were falling and I felt awful. I was saddened to see that I broke just about every rule in the book when it comes to dealing with these folks. He looked so angry, and the only reason I gave up trying to talk it out was because I noticed he was beginning to shake. I think I waited way too long and cornered him too much. I was ashamed and frustrated with myself, and felt I should have known better. I went over to visit the next day, and let him know that I was sorry that I wasn't more supportive and that this is still a bit new to me. I apologized for cornering him and let him know that I appreciate the restraint that he showed. I got little in the way of a response. I gave him a kiss and left. I wished we could have made up "fully", but was glad to have at least communicated my thoughts and apologized.

What I want to know is-

Is he truly without empathy? Can he really not understand how his words and actions affect others? He said some awfully hurtful things, which I refused to engage.

Is lack of empathy something that can be improved upon with treatment?

Any advice for handling this type of situation in the future?

Note: If you are very familiar with TBI behavioral issues, please PM me, I have a couple of more questions that I would rather not put on a public forum.

Thank you all for your help and feedback in advance.

High and welcome! I'm a TBI survivor and not a medical expert but I'll do my best to craft a useful opinion based on my experience and what I do know about TBI.

While every brain injury is different (you will hear that over and over in this forum), the frontal lobes are where the emotions are sent for processing after they work their way through the amygdala and other parts of the limbic system. Emotional responses are thereby frequently altered by TBI, especially when the damage is to the frontal lobes. Since you stated your relationship has been going well up to the disagreement, my guess is (again, every TBI is different) he is capable of empathy; my guess is with the injury requiring the removal or part of the frontal lobe, he is slower to process emotional changes; his brain is likely still learning how to reprogram those pathways dealing with empathy and other emotional responses (what neuropsychologists refer to as plasticity). He probably also was not able to immediately process how his hurtful remarks affected you.

He may need more time to process these emotions, but the fact that he was able to relate to you to the point of “all has been well in our relationship” I think is encouraging. I believe your best short term option is to continue the communication from your side and see what the reciprocal response is. Again, this may require some patience on your part.

Best to both of you.

Lightrail, thank you- your feedback is encouraging. I'll be patient; it's the least I can do for him. I also noticed that he needs "space", far more than I do. I've told him we will meet in the middle...

For those of us with mTBI, once our brains get overstimulated or overstressed, they just begin to shut down on their own. It's difficult to think, concentrate, carry on a conversation, and manage our emotions. You may have discovered this already from your readings, but when this happens, the person with mTBI needs complete rest for awhile.

It may be surprising how little it takes to cause such overstimulation; even exposure to only mild visual and auditory stimulation can cause the brain to start shutting down if we don't take breaks. Also, any activity that requires a lot of concentration will quickly wear us out--especially if it is stressful.

I don't think I can offer much in response to your question about empathy. I haven't heard or read much about whether and to what extent a brain injury can affect this.

You'd have to ask him specifically about what he was going through. Every brain injury is different and he may not even be able to communicate what parts of his cognitive functioning don't seem to feel "normal" to him.

mTBI and TBI can cause emotional lability, and our emotional reactions can seem extreme, unfounded or even illogical in response to an event.

It can also cause rigidity in thinking. Stubbornness for no good reason, other than that's how I brains tend to "work".

It sounds to me like he just needs some time to figure stuff out and cool off.

I'm glad you read about how you can change your reactions when miscommunications occur to accommodate his needs. He may never be able to do the same.

In time, you guys might be able to work out a system. My boyfriend and I try to recognize when one of us is tired because that easily leads to a miscommunication and we prefer to head it off before it happens. But that takes the ability to be aware, analyze the situation and practice letting things go and talking about them another time. Luckily, I continue to heal and recover from the mTBI I sustained, so the issue is not as prominent between us as it once was - and even though it's still much worse than it was before the accident I was in, I'm hopeful it will continue to improve.

A brain that's been injured loves a routine - so if you guys have a routine of stopping the miscommunication/conversation before it gets "ugly" and picking it up later, he'll probably stick with that MO 9 times out of 10, if not more.


I hope that helps.

Oregon Trail,

Welcome to NeuroTalk. I will try to get inside his head for you. I have dealt with this problem for decades.

As others have said <But that takes the ability to be aware, analyze the situation and practice letting things go and talking about them another time. >

There are likely 2 issues here.

First is the explosive outburst. This can be over-stimulation or an emotion stimulation (disrespect, wining, crying, aggressive speech, confrontational speech) that causes a defensive or reactive response.

It can also be due to the rigid thinking common to TBI. This means the subject gets stuck in a thought and can not release the thought. They can combine and magnify the problem.

The root is an internal sense of mental confusion with a lashing out to create space. There is not likely a reasoning through this or way to moderate it. You said to him <"Whether I'm right or wrong, can you at least appreciate where I'm coming from? Can you understand how you're making me feel?" In response, I got the most blank stare I've ever seen in my life, with a gruff "Yes", but he did not change his view or actions. >

I think his 'yes' was just an escape mechanism. It did not change the thoughts stuck in his head. It was a way he chose to try to end at least your part of the conversation.

There are two parts to dealing with this, his and yours. You can only effect your behavior. Until he offers to let you help him with his behavior, your attempts will likely be met with resistance. In the short term, remember the 3 H's. Hush up, Hang around and Hugs. Let him deal with his need to pull his head back together without interference. When he sees you willing to just be there, you will have a better chance of him opening the door to your help.

I have more to say but you may be better off sending me an email. I can forward it to my wife to respond. She has lived with my issues for 32 years. She will have some good observations for you. Left click on my screen name and you should be able to send me an email or PM.

I can understand what you are going through because I now understand what my wife and three kids went through.

My best to you.

EsthersDoll- great suggestion. I've thought about this but the relationship is still fairly new and I don't want to pry or make him feel uncomfortable. However, at this point, it may be necessary. You bring up another excellent point: do TBI survivors realize that some behaviors are not normal, and just cannot control it, or do they believe the behavior is normal?

I guess this is where I went wrong. I didn't realize the situation had escalated until it was much too late. And by then, I was trying to fix it, which actually made things worse.