Disinhibition 

Disinhibition is a behavioral change that can be seen after a brain injury, particularly after damage to the frontal lobe area. When this occurs, an individual is unable inhibit or control socially inappropriate thoughts, emotions, and behaviors. Their inability to filter themselves affects them emotionally and socially, making it challenging to follow social norms and established rules. Their actions as a result of their disinhibition have been described by others as being insensitive towards others, immature, and can pose as a challenge to maintain or form new relationships with others.

Disinhibition may look like either of the following signs: 

• Engaging in aggressive or risky behaviors 
• Being impulsive in their decisions  
• Laughing at inappropriate times 
• Being overly friendly towards others including strangers 
• Oversharing information with others 
• Speaking their mind before thinking 
• Being sexually inappropriate with others 
• Speaking from an egocentric perspective (e.g., selfishness, childishness, or arguing) 

Not only does this impact the brain injury survivor but can be distressing for families may not fully understand the causes of this new behavioral issue. The individual may feel isolated and disconnected from others, which can lead to depression or anxiety. Unfortunately, this can lead to a decrease in their life satisfaction, difficulties integrating back into their community, or experiencing possible legal problems. One study found that six and twelve months after experiencing a BI, individuals experienced suicidal ideations. Although it can become a serious problem, there is hope on recovering from their disinhibition. The following treatments and strategies are listed below: 

Strategies or Treatments: There are no known published treatment strategies specifically for disinhibition from TBI.

Practicing restraining their impulses, usually with the help of a professional – This repetition can help regain wanted behaviors through the brain’s ability to form new connections (neuroplasticity).  Surrounding yourself with a healthy support system that understands the condition and can help when engaging in appropriate behaviors  Modifying your environment is also a technique used. For example, if the individual has impulses to spend money, they can delete shopping apps, unsubscribe from emails, and block certain websites  Behavioral Therapy can be used to change behaviors when it is more difficult due to the individual’s inability to recognize their actions are inappropriate Applied Behavioral Analysis has been used for BI patients with disinhibition and has shown to be effective at addressing behavioral problems Cognitive Behavioral Therapy (CBT) is another form of therapy that can used if patients do not have severe cognitive deficits. Utilizing CBT can help the patient identify the thoughts behind their actions Insight-Oriented Psychotherapy addresses harmful beliefs rather than the triggers that CBT focuses on Referrals to see a neuropsychologist have also been recommended for disinhibition Medications might be prescribed if the patient’s behaviors are aggressive, harmful or dangerous. The medications prescribed are not specifically to treat disinhibition itself (e.g., antipsychotics, mood stabilizers, and anti-anxiety medications). For Family Members: Remember to keep in mind that these behaviors are not done maliciously, and the individual is not trying to hurt anyone through their actions. We all experiences thoughts or impulses that the typical person can easily filtered throughout their day. It is important to remain supportive throughout their recovery process and to be patient as they navigate through their injury.

References:

Osborne-Crowley, K., McDonald, S., & Francis, H. (2016). Development of an observational measure of social disinhibition after traumatic brain injury. Journal of Clinical & Experimental Neuropsychology, 38(3), 341–353. https://doi-org.westcoastuniversity.idm.oclc.org/10.1080/13803395.2015.1115824  

Osborne-Crowley, K., & McDonald, S. (2018). A review of social disinhibition after traumatic brain injury. Journal of Neuropsychology, 12(2), 176–199. https://doi-org.westcoastuniversity.idm.oclc.org/10.1111/jnp.12113 

FlintRehab. (2010). Disinhibition after brain injury: Causes, treatment, and management. FlintRehab. https://www.flintrehab.com/disinhibition-after-brain-injury/ 

Kim, E. (2002). Agitation, aggression, and disinhibition syndromes after traumatic brain injury. NeuroRehabilitation, 17(4), 297–310. https://doi-org.westcoastuniversity.idm.oclc.org/10.3233/nre-2002-17404