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At one point, Lee became so enraged over an empty cereal box that he wrenched the cupboard door off its hinges.Lee’s wife reported, “The children are terrified of him now.” Because of these aggressive episodes, it has been hard for Lee to get into a day program whose goal is to help him transition back to work.With regard to treatment, aggression in the acute stage (which often stems from delirium) requires careful medical evaluation.The treating doctor will make a determination on whether or not to use medication.Indeed, people with TBI usually regret their outburst.Aggression soon after the TBI, in the context of confusion and disorientation, is usually due to delirium.

The professional may create a plan—in a rehabilitation setting, for example—and it is up to caregivers to implement the plan when the person with TBI returns home.

In the chronic period (3 months or more after the TBI), aggression can be associated with clinical depression, post-traumatic stress disorder (PTSD), alcohol or illicit drug use and/or chronic pain.

Other social factors, such as trouble adjusting to a new level of functioning or becoming dependent on family, can also be associated with irritability and agitation.

After Lee returned home, he had emotional outbursts over trivial matters.

For example, a minor disagreement at the dinner table with his family escalated into a shouting match, and Lee stormed off, punching holes in walls.

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