Unintentional vs. Intentional Brain Injury: Helping People Cope with the Cause of their Brain Injury
Most of us are familiar with the common causes of brain injury as being related to “accidents” – due to falls, motor vehicle crashes, sports or recreation injuries – which would be considered “unintentional” brain injury. This falls under the general category of “stuff happens” to people, and while we can try to minimize risk and be safe, accidents will still happen. More awareness is now being focused on “intentional” brain injury, where there was actual intent by one person to harm another, or to harm oneself. Estimates are that between 15 and 20 percent of all brain injuries fall under this “intentional” brain injury category.1
Intentional brain injury would certainly include interpersonal violence, such as occurs with child abuse, domestic violence, and in cases of criminal activity. Intentional brain injury therefore includes someone intentionally trying to harm another person, resulting in assault to the head, gunshot wound to the head, or blow to the body of sufficient force to cause shaking of the brain inside the skull. It would certainly include the newly framed category of abusive head trauma (formerly shaken baby syndrome).
Intentional brain injury would also include brain injury as a result of an attempt to take one’s own life by attempted hanging, deliberate drug overdose, gunshot to the head, insulin induced coma (although the latter could also be unintentional), etc. In Ireland, it has been found that many people receiving brain injury services are there as a result of an attempt to take their own life. Twenty percent of residential clients currently served by ABI Ireland have received their brain injury in this manner.2
A study by Wagner and colleagues3 found that intentional brain injury was more highly associated with minority status and substance abuse. Intentional brain injury was also more predictive of mortality, and to the severity of anatomic injury to the head. They also looked at penetrating intentional TBI and found it to be predictive of injury severity. Other factors, such as unemployment, lower educational and income levels, and being unmarried, have been shown to be highly associated with intentional brain injury due to interpersonal violence.
Maybe you are asking yourself what difference it makes whether the cause of the brain injury was intentional or unintentional? A study by Hart and colleagues4 examining interpersonal violence and attribution of blame for injuries found that those patients who had sustained intentional brain injury blamed others, compared with those who had sustained unintentional brain injury, who tended to blame themselves more. While self-blame was not itself a significant factor predictive of depression or life satisfaction, it was found that over time if impairments from the injury do not resolve, concern over the cause of the injury can be associated with higher levels of emotional distress. Therefore, it may be useful for clinicians to be aware of attribution factors, and to help people to cope with blame-related issues in order to improve their adjustment to disability, which could affect their overall life satisfaction.
- Esselman, P., Dikmen, S., Bell, K., and Temkin, N., (2004). Access to inpatient rehabilitation after violence-related traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 85, 1445-1449.
- Personal Communication, Barbara O’Connell, Chief Executive, ABI Ireland, November 30, 2017.
- Wagner, A., Sasser, H., Hammond, F., Wiercisiewski, D., Alexander, J. (2002) Intentional traumatic brain injury: Epidemiology, Risk Factors, and Associations with Injury Severity and Mortality. Journal of Trauma and Acute Care Surgery, 49(3), 505-410.
- Hart, T., Hanks, R., Bogner, J., Millis, S., Esselman, P. (2007) Blame attribution in intentional and unintentional brain injury: Longitudinal changes and impact on subjective well-being. Rehabilitation Psychology, 52(2), 152-161.
This article was contributed by Drew Nagele, Psy.D., CBIST, CESP, Beechwood NeuroRehab.