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Disinhibition Following an Injury to the Brain

Disinhibition is the medical term for the lack of impulse control for social behaviour. We learn what is acceptable to others during our toddler years.

Think in terms of the ‘terrible twos’ – stamping feet and screaming – temper tantrums that the child uses to express frustration because they haven’t developed emotional intelligence. In other words, they don’t understand what their emotions are trying to tell them and don’t know what to call emotions because they are just beginning to develop social skills and language.

Disinhibition following any injury to the brain is really the inability to filter incoming environmental information both intellectually and psychologically because the mechanisms that linked these former learned behaviours have effectively been disconnected or interrupted.

Think of it as an uninhibited and spontaneous reaction where processing and consideration have not occurred. The links are no longer there. The end of the track for the runaway train no longer has any buffers.

brain diagram explaining reactionsThe impulsive firestorm is effectively the reptilian brain in survival mode. The brain is disengaged as if under threat or in danger. The autopilot takes over after an injury to the brain when there is a loss of functionality in the normal systems. 

Instinctive reactions inhibit the ability to be engaged and to notice emotions and how you feel. 

It is a firestorm that you have no way to shut off, manifests as outbursts that in no way represent who you are and are very out-of-character, and it feels like you are re-living your terrible twos.

You can’t suppress the response impulse to act or speak and you are unaware of it happening. People can’t use the social boundaries they learned as they were originally growing up – this is very scary.

Symptoms are explosive responses that are overly exaggerated and spiral – they go on and on and you can’t shut them off. However, often steam runs out quickly because the brain forgets what the response was about and leaves the person unaware that anything which would be deemed inappropriate has happened.

With a lack of impulse control, people feel a horrible sense of tension.  They never feel a sense of relief following an outburst and are left still feeling frustrated because they are actually no further forward in understanding. 

When people do ‘get it’ or later realise what happened, they feel regret, shame, and guilt.

brain with cord around and an electrical plugRecognising the impulsive firestorm starts with thinking about how you are physically feeling when this happens. It helps to look for the physical cues, learn what they are and how to recognise them. 

Connecting to who you are and what you are feeling by using mindfulness techniques helps you to notice reddening or heat in the face, a rising pulse, and asking yourself how you feel. For example, do I feel angry? Do I feel frustrated? Do I feel annoyed? Do I feel threatened because I feel ignored or misunderstood?

Learning to take time out for yourself and counting to ten, slowing your breathing and focusing on calm, all help you pause before responding to a situation or conversation. 

 It helps when friends and family learn about what is happening and are able to stay calm and non-reactionary themselves so they are prepared to offer feedback and support instead of becoming embroiled in the impulsive firestorm that really is not a reflection of the individual but a reflection of the damage within the brain. 

Cognitive behavioural therapy is excellent at helping people address disinhibition. 


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