Personality change
- Aoife Hickey, Senior Clinical Psychologist
- 10 minute read
- Last updated: December 2023
Some people experience behavioural and emotional changes after stroke. This can be very painful for the stroke survivor and those close to them.
What is 'personality change'?
"Personality change" is commonly used to refer to lots of different changes in your characteristic ways of behaving (how you act) and expressing emotion (how you feel) after a stroke. While the term "personality change" is often used, it’s not always useful. One reason for this is that it can blur together changes that are temporary or treatable and changes that are likely to persist into the longer term.
Changes to behaviour can happen because of damage to the brain and the pattern of physical, cognitive, emotional and social changes that follow, or psychological reactions to the stroke, or a combination of these.
"Personality change" can range from an exaggeration of your usual way of behaving or responding emotionally, to behaviour that is completely out of character. Some examples include irritability, carelessness, impulsivity and aggression. If the behaviour change is extreme it can put people at risk, create problems in social situations and lead to social isolation.
‘Personality change’ does not mean a complete loss of your personality before your stroke, though for some people there is a sense of disconnection in their experience of who they are now compared to before the stroke.
For families, glimpses of your loved one’s usual self can still appear, or it may be that they seem more their usual self with some people or in certain contexts over others. This is often what makes it so painful for families.
Types of behavioural and emotional changes
Behavioural and emotional changes depend on the location and size of the stroke, your personality and ways of coping before the stroke, and your understanding of your stroke and its effects.
Behavioural and emotional changes can include:
Acting without thinking or doing things that are unsafe.
Having less control or no control over behaviour, meaning that you act in ways that are not appropriate to the situation. This might include making tactless remarks, being over-familiar, laughing at inappropriate times, sexually inappropriate behaviour, or aggression.
Indifference or lack of initiative, drive or motivation. This means you may not want to do much or you need prompting or encouragement to do things.
Difficulty thinking about the needs, feelings or views of others, making you appear self-centred or insensitive to others. This is often linked to a stroke in the frontal part of the brain.
Being easily annoyed by things that might not have bothered you before the stroke. This includes being short-tempered or having difficulty managing anger, which can result in verbal or physical aggression.
Low mood and loss of interest or pleasure in activities.
Feeling nervous, on edge or fearful, or needing lots of reassurance.
Difficulty with expressing emotions, such as sudden uncontrolled crying which is out of proportion to how you actually feel.
Other information
Top tips for stroke survivours
Ask for help
Some emotional changes may respond to treatment. If depression or anxiety is a problem, speak to your GP (family doctor).
Aoife Hickey | Senior clinical psychologist |
Set up a routine
A routine can help make days predictable. It can be helpful to have a wall calendar, diary or whiteboard for upcoming appointments or events. Put this somewhere obvious at home, where everybody can see it. Try to include enjoyable activities too.
Aoife Hickey | Senior clinical psychologist |
Notice triggers and take breaks
Notice things that trigger strong emotions or situations where difficult behaviours tend to happen. Triggers will be different for everyone, but they might include feeling stressed or tired, or being in busy, crowded environments. Once you have identified triggers, it’s easier to plan around them. For example, you could go places at quieter times, or when you know you are likely to have energy and feel calm. You can also take breaks to help regain control of your emotions. Leave the situation for a little while, or do something different, and only return to the task when you feel calm. Relaxation and breathing exercises can help. Doing something physical can help calm your body too – for example, going for a walk or doing some housework or gardening.
Aoife Hickey | Senior clinical psychologist |
Top tips for family and carers
Look after yourself
Look after your own wellbeing. Eat well, get regular exercise, and get a good night’s sleep. Recognise the signs of stress. Keep up your usual social and leisure activities. This might involve asking others for help, or scheduling activities well in advance. While this can seem like a lot of effort, it’s important for wellbeing. Notice your thinking and whether this is helpful – for example, it may be natural to compare your loved one to what they were like before the stroke, but spending a lot of time thinking about this may not be helpful.
Let things go
Arguments can happen because you or your loved one feel tired or stressed. If something is unimportant, let it go. Try to "pick your battles" – focus on the behaviours you find most difficult, and let other behaviours go.
Aoife Hickey | Senior clinical psychologist |
"It’s brain injury"
Try to see behavioural changes as part of the brain injury, not something that your loved one is doing deliberately or that they can control.
Aoife Hickey | Senior clinical psychologist |
Anger
Notice what triggers your loved one’s anger (for example, noise, fatigue, being somewhere busy, engaging in a frustrating task, being under pressure). Once you’ve identified possible triggers, try to reduce these (for example, reduce background noise when having a conversation). Learn to spot early signs of irritability (for example, making a snappy comment, jaw-clenching), and try to distract your loved one before they lose their temper, or give them some space. Stay calm, and keep your tone of voice neutral. Avoid trying to reason with your loved one when they have lost their temper. Wait until you are both calm before trying to discuss things. If you feel unsafe, call 999 or 112.
Inappropriate behaviour
If your loved one does not understand why a behaviour is unacceptable, explain this to them, either at the time or shortly afterwards. It may also be important to explain positive ways of behaving (but note your loved one may struggle to remember in the moment). As a result of the stroke, it may not be clear to your loved one what they need to do and say to keep up relationships, and you may need to explain this to them. With their permission, it can be helpful to explain changes to extended family and friends. If inappropriate comments or actions don’t interfere too much with your day-to-day life, ignoring them can be a good approach.
Frequently asked questions
Emotional and behavioural consequences of stroke can and do improve over the course of recovery and rehabilitation. Some emotional changes can respond to treatment. These include depression and anxiety. Others can improve with time, such as emotionalism. Some changes may improve a little and then plateau. Stroke survivors and families often adjust to changes that remain. Where emotional or behavioural problems are severe or you are struggling to cope, discuss this with your doctor or public health nurse.
If your loved one’s behaviour is affecting your day-to-day life or there is a risk of harm to you or your loved one, you should speak to your GP (family doctor). They will be able to discuss treatment or support options with you, or link you in with a local service (or you can self-refer in some instances).
Think about what needs to be different to make the situation more manageable. Sometimes this can be something practical, like increased home supports, or having a break from the caring role. Making practical changes can require some time and effort but it’s worth prioritising this, as it can make the situation easier in the long run. Speak to your public health nurse at your local health centre to consider increased home supports or respite.
Sometimes a stroke survivor may need more care than can be managed at home. You should discuss this with your GP and/or public health nurse, who can carry out a care needs assessment to determine whether additional support can be facilitated at home, or whether long term care needs to be considered.
Stroke survivors and families often find their own ways of coping and adjusting with time. Some treatments can help behavioural and emotional changes after stroke, or help families cope with these changes. Some examples of treatments include:
Medication: antidepressants may be helpful if depression or anxiety is a problem.
Cognitive behavioural therapy (CBT): this helps you notice and change unhelpful thoughts and actions.
Behavioural intervention: this may be direct, with the stroke survivor, or indirect, with the family. Indirect treatment might aim to identify things that make particular behaviours more likely to happen, with a view to reducing the frequency of these behaviours.
Carer and family support: you can access practical support, such as home supports or respite care, through your GP or public health nurse.
For emotional support, it can be helpful to link in with carers' groups in the community or through the Irish Heart Foundation, Headway or Acquired Brain Injury Ireland. Programmes such as Stress Control and Living Well can help with managing stress.
Contacts
Family Carers Ireland provides supports to families, including young people.
Call: 1800 24 07 24
Website: www.familycarers.ie
1. Support from the HSE
Some areas have community brain injury teams.
Call: 1800 700 700
Website: www2.hse.ie/services/
2. The National Rehabilitation Hospital (NRH)
The National Rehabilitation Hospital(NRH) provides complex specialist rehabilitation.
Call: 01 235 5000
Website: www.nrh.ie/about-nrh/
3. Headway
Headway offer education, individual and group supports for family members over 18 years of age.
Call: 1800 400 478
Website: www.headway.ie
4. Acquired Brain Injury Ireland
Acquired Brain Injury Ireland offer support for people with brain injury aged 18-65 years.
Call: 01 2804164
Website: www.abiireland.ie
The Citizens Information Centre gives free independent information and advice on public and social services.
Call: 0818 07 4000 or visit your local CIC
Website: www.citizensinformation.ie/en/
