The effects on personality
Most people are aware of the physical effects that a stroke may have, however, there are many other effects of which people may not be aware. Although we cannot see feelings or thoughts, emotional changes can lead to behavioral changes that tell us all is not well. 34, 35
Emotional changes may be caused by physical damage to the brain. Different parts of the brain control different functions within the body – including how we feel. If the part of your brain that normally controls emotions is damaged by a stroke, the result can be changes to how the you think, feel or behave.
Stroke impacts individuals globally
Post-stroke depression is associated with poor rehabilitation results and ultimately poor outcome in 33% of stroke survivors. 36 Antidepressant drugs such as selective serotonin reuptake inhibitors (SSRIs) can improve mood during recovery. It is recommended that people who have had a stroke are monitored for signs of depression throughout their rehabilitation. 37
Anxiety is both a physical and psychological response to a worrying situation, resulting in feelings of fear or unease. At the same time, there is an increase in blood flow to the heart and muscles, preparing the body for action. This can be accompanied by sweating, rapid heart rate, shortness of breath, dizziness, and tremor. Anxiety can come on rapidly, or it may develop slowly over a long period of time.
Some of the most commonly reported worries to do with stroke are:
- Fear of having another stroke in public or while asleep
- Difficulties communicating in an emergency
- Being unable to drive or return to work
- Side effects of medication
- Feeling embarrassed in social situations
- Fear of falling
Some anxiety is normal and healthy, and may reduce with time. 38 However, if it persists for a long time or starts to become overwhelming, treatment should be sought.
Emotionalism often develops following a stroke, 39 with the affected person often becoming more emotional than usual or have trouble controlling their emotions.
People with emotionalism may suddenly have very intense reactions while talking to someone, watching TV, carrying out normal tasks or just from thinking. Although these reactions may reflect how the person is feeling, they will be expressed in a particularly strong way. 40
Other symptoms of emotionalism include outbursts of crying or laughing at inappropriate times. People can also rapidly switch between laughing and crying. These episodes will often seem out of place, and come and go rapidly.
Personality is a difficult concept to explain, but broadly speaking it is a combination of behaviours, thought patterns, and feelings. 41 People are normally consistent in their responses to things, however, a stroke can change a personality so much that they can seem like a completely different person.
Sometimes character traits can be reversed. For example, someone who was previously mild-mannered may become more aggressive, or a loud, outgoing person may become more passive. More often, however, personality traits simply become exaggerated, 42 and it is not unusual for the person who has had the stroke not to notice any change. 43
Anger is a normal, healthy emotion that we all feel and show from time to time, particularly during stressful situations.
After a stroke, people may experience anger much more frequently and have less control over their outbursts. Unfortunately, it is likely this anger will be directed towards family or carers.
Typical triggers for angry outbursts include:
- Struggling to do something normal, like getting dressed
- Needing other people to do things for them
- Not having enough time to respond during conversations
- Not being able to express themselves properly
- Other people making decisions for them
- Getting things wrong, or feeling embarrassed