Chapter 21.Behavioral Dyscontrol

Behavioral dyscontrol, including both aggressive and disinhibited behavior, frequently complicates the care and management of individuals with traumatic brain injury (TBI), particularly moderate or severe TBI. Aggression and disinhibition represent sequelae that are clinically challenging, frequently interfere with rehabilitation efforts, disrupt social support networks, and compromise optimal recovery. Aggressive behavior poses crucial safety issues, especially when it puts patients and their care providers in harm’s way. Importantly, aggression may be directed outwardly, manifesting as aggressive behaviors toward persons or objects in the surrounding environment, or directed inwardly, resulting in self-directed violent behavior (the latter is addressed in Chapter 23, “Suicide”). Furthermore, when aggression yields violence, negative social and legal consequences may occur, further complicating the patient’s recovery and potentially compromising access to care (Wortzel and Arciniegas 2013). Caregivers and families have identified posttraumatic behavioral disturbances as among the most challenging aspects of meeting the needs of individuals recovering from TBI.