Angry responses to emotional events: the role of impaired control and drive in people with severe traumatic brain injury.

Emotional and behavioral changes (e.g., irritability and anger or alternatively passivity and inertia) are common after traumatic brain injury (TBI). These changes have been conceptualized as reflecting a loss of regulation, specifically control (loss of inhibition) and/or drive (self-initiation). However, no empirical studies have examined the relationship between neuropsychological measures of these constructs and emotional responsivity in situ. In this study, 29 individuals with severe, chronic TBI and 32 matched control participants were shown emotionally evocative films selected to elicit anger and were asked to rate their emotions before and after. They were also given measures of executive function to assess inhibition and flexibility as indices of control and drive, respectively. Both groups had heightened anxiety after the films. An increase in anger and confusion correlated with impaired control (Haylings Test score, Trails B errors) in the TBI group but not in controls. No association was found between reduced emotional responsivity and drive (Controlled Oral Word Association Test, Matrix Reasoning Scaled Score, Trails A/B time difference). This study provides support for the use of formal measures of disinhibition on neuropsychological tests as a corollary for emotion disinhibition. As with previous work, operationalization of loss of drive was more difficult to achieve.