Destructive behavior following traumatic brain injury can occur during every phase of recovery. It is a symptom of many neuropsychiatric syndromes. To date, there have been few adequately controlled studies to guide clinicians in the neuropharmacologic management of this problem. However, there are emerging strategies that have been helpful for some patients. This article develops a syndromic approach to understanding these behavioral disorders and summarizes the available data and clinical experience in their management.