A New Understanding of TBI and Mental Health

By P. Casey Arrillaga, LCSW, LCDC

NOTE: This is the second post in our series on TBI. The first post was on “TBI and Addiction”, released on 3/3/25.

Traumatic Brain Injury [TBI] used to be considered as either as life-threatening condition when it was moderate or severe, or it was largely considered benign when it was mild. In recent years, it has become more and more apparent that TBI can have profound and long-lasting effects on mental health conditions that have not been previously recognized. This post explores what we know so far and what we can do to help.

What We Know So Far

Traumatic Brain Injury (TBI) is a serious medical condition that occurs when an external force injures the brain, such as in a car accident, a bad fall, high-impact sports, or military combat trauma. The severity of TBI can range from mild concussions to severe brain damage. One of the most significant yet often overlooked consequences of TBI is its impact on mental health. When the brain sustains an injury, it can struggle to regulate emotions, thoughts, and behaviors the way it used to. The person with TBI may or may not notice the changes, but those closest to them often see differences in personality, such as increased impulsivity or anger.

One of the most concerning mental health impacts of TBI is an increased risk of suicidal thoughts and behaviors. The combination of cognitive impairments, depression, social isolation, and loss of independence can create feelings of hopelessness.

Related to this is that individuals who suffer from TBI are at a significantly higher risk of developing depression. This may be due to any combination of changes in brain chemistry, damage to areas controlling mood regulation, or the psychological distress caused by life-altering impairments. One such life change is that many people with TBI see themselves as lacking enough social support due to changes in functioning and personality, leading to more loneliness, and then depression. Symptoms of depression, such as persistent sadness, fatigue, and loss of interest in activities, can in turn make recovery from TBI even more challenging, creating a negative cycle.

Anxiety disorders are another danger from TBI. Those who have been hurt may develop generalized anxiety, panic attacks, or PTSD, particularly if the injury was caused by a traumatic event such as an accident or combat exposure. The fear of re-injury, difficulty coping with changes or struggles in thinking, and uncertainty about the future can all contribute to heightened anxiety. This can lead to avoidance behaviors, social withdrawal, and increased stress, further complicating recovery.

Additionally, TBI can lead to mood swings and emotional instability. People with TBI may experience sudden outbursts of anger, frustration, or crying for reasons they can’t explain or understand. This can occur because the parts of our brain responsible for emotional control, such as the frontal lobe, may be damaged. This can puts further strain on personal relationships, making it difficult for individuals to maintain social connections and support networks, which are crucial for mental well-being.

How Do We Use This Knowledge to Help People?

At Windmill, we not only screen every client for TBI as part of our thorough assessments, every client is also given an EEG shortly after arrival, which allows us to directly see if there are effects of concussion and TBI. Through this process, our clients, team, and family members can then move forward armed with objectively accurate information. When we find evidence that someone has had TBI, we have cutting-edge tools including validated psychometric tools and individualized Transcranial Magnetic Stimulation [TMS], as well as some of the best trauma therapy available to help people not only manage their lives, but also directly reduce the effects of TBI, thus giving them a much greater chance of recovery from both the TBI and any mental health struggles.

Given the social challenges that many people with TBI experience, we use as social approach in working with each client to make sure they have the resources to continue building their network and their understanding of the support available to them. This includes our strong alumni program for both clients and their families.

In addition, we offer specialized services for active-duty military, military veterans, and first responders. We have what it takes to overcome combat trauma, other military trauma, and first-responder trauma, both physical and psychological, including any TBI effects.

The Bottom Line

Traumatic Brain Injury (TBI) can result from accidents, falls, sports, or combat, and its effects range from mild concussions to severe brain damage, often impacting mental health by altering emotions, thoughts, and behaviors. TBI significantly increases the risk of depression, anxiety, mood swings, and even suicidal thoughts due to cognitive impairments, social isolation, and personality changes. At Windmill, every client undergoes thorough TBI screening and gets the help they need. If you or anyone you love has been affected by TBI and/or mental health struggles, reach out for help now.

About The Author

P. Casey Arrillaga is the Team Leader for Education at Windmill Wellness Ranch, and he is the author of books including “Realistic Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”.