16 Jul 2020

Marital distress and breakdown: exploring the relational impact of brain injuries

patient being diagnosed

The Olympic rower James Cracknell has provided a powerful and very personal narrative on the relational impact of a brain injury. James was cycling across America in 2010 when he was hit by a fuel truck travelling at 70mph. He suffered a contrecoup injury to the frontal lobe of his brain.

Soon after the original injury, James and his wife Beverley spoke of the stark warning a neuropsychologist gave them: three out of four marriages end after a brain injury, due to the multiple, devastating effects upon relationships. The couple vowed to beat the odds but by 2019, announced their separation.

Speaking with deep honesty, James has suggested his brain injury meant Beverley had a ‘different husband’ before and after the accident and despite their best efforts, the effects of the injury overwhelmed their relationship.

The relational impact of a brain injury is widely recognised but is difficult to measure. The original evidence for high divorce rates comes from several European studies which suggest post injury divorce rates range from 48 per cent to as high as 78 per cent.

More recently, work in Virginia suggested a different picture, with a study showing of 977 people from different backgrounds finding 85 per cent remained married for at least two years post injury (2008, Virginia Commonwealth University TBI Model Systems researchers).

Further work (Kreutzer, J., et al) has shown after a brain injury, there are relatively high levels of marital dissatisfaction (50 per cent and above) but marital stability nonetheless (72 per cent).

Despite variations in reported divorce rates, brain injuries clearly present a significant additional pressure on relationships. This may be in terms of behaviour changes which can be mapped quite precisely to the original injury. Equally, there are often challenges in the wider relational pattern established before the injury: for example, the caregiving spouse or partner may need to take on new roles and obligations which were previously the domain of the injured partner.

The injured partner may not be able to return to their pre-injury employment and families often find themselves facing severe financial pressures. Tasks such as caring for young children or living with teenagers may become particularly challenging after a brain injury.

James Cracknell described becoming ‘more of himself’ after his brain injury; meaning, characteristics such as being stubborn and single-minded which served him well as an elite sportsman, were amplified by his brain injury. He observes these amplified characteristics were not as helpful in married family life.

Trying to map these kinds of individual observations into a broader map of psychological change after brain injury is an interesting task. In one mapping exercise, researchers measure four key factors widely recognised as brain injury effects: behavioural regulation, affective regulation (the ability, for example, to lift yourself from a negative mood), engagement and restlessness. They found between 64% and 82% participants reported moderate or severe changes in at least one of each of these factors after a brain injury (Obonsawin et al, 2007).

Another study, which also shows there is a significant personality change after a brain injury, suggests there may be a link between the location of injury and the type of personality change. An injury to the frontotemporal part of the brain seems to be associated with an increase in neuroticism (Norep and Mortensen, 2015).

There does seem to be agreement on one positively mitigating factor: family and professional support. A study of 279 siblings of individuals with traumatic injury to explore their perspective on their siblings’ quality of life after a brain injury (Degeneffe & Lee, 2010) found among those assessing quality of life as positive, the most commonly cited reason for this was family and professional support. Education about the multiple impacts of a brain injury and rehabilitation needs to be provided to the whole family in a holistic way in order to be as effective and supportive as possible.

While the work is still ongoing to better understand the long term emotional and behavioural impacts of brain injuries, it is clear that for relationships, there will be very significant challenges. The presenting behaviours can be really hard for partners and family members; in the heat of the moment, it is not always possible to ‘unpick’ the way difficulties are a result of the original injury. However, recognising the many ways brain injuries affect relationships is key to negotiating the new relational context in which couples find themselves.


Cracknell, J. Touching Distance

Degeneffe, C., Lee, G,. Quality of Life After Traumatic Brain Injury: Perspectives of Adult Siblings, Journal of Rehabilitation (2010)

Kreutzer, J., Sima, A., Marwitz, J., & Lukow, H. (2016). Marital instability after brain injury: An exploratory analysis. NeuroRehabilitation, 38

Norep, A. and Mortensen, E. Prevalence and Predictors of Personality Change After Severe Brain Injury, Archives of Physical Medicine and Rehabilitation

Obonsawin, M. A model of personality change after traumatic brain injury and the development of the Brain Injury Personality Scales, Journal of Neurology, Neurosurgery and Psychiatry

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