Some people have significant behavior changes following a stroke. For many people, behavior changes may be long lasting, but for others, they may be temporary. Treatment options may help.

If you’ve recently had a stroke, you may be dealing with emotions and behaviors that are unfamiliar to you. One minute, you may feel like yourself. The next, you may feel like an entirely different person. While this situation can be upsetting, take comfort in knowing you aren’t alone in what you’re experiencing.

Here’s what you need to know about behavior changes after a stroke, what causes them, and what treatments and therapies may help.

A stroke is a major health event. As a result, people may experience different behavior due to both physical and psychological reasons.

  • Physical causes: Physical causes for changes in behavior following a stroke have to do with brain injury and other chemical changes that happen in the brain after a stroke.
  • Psychological causes: Psychological causes for changes in behavior after stroke are related to mood disorders like depression.
  • Other causes: Other causes for behavior changes after stroke may be related to the frustration, fear, or wide range of emotions you’re dealing with because of the aftereffects and complications of your stroke.

No two survivors are the same regarding their experience after a stroke. Some people may have no noticeable behavioral changes. Others may seem like entirely different people. And others will fall somewhere between these two extremes.

Some of the changes in behavior may include:

Pseudobulbar affect (PBA)

Pseudobulbar affect (PBA) is a condition caused by a specific pattern of brain damage. PBA is common after a stroke, after a brain injury, in dementia, and in other neurological diseases. Shifts in mood that don’t match the context of an event or situation may occur with PBA, but this phenomenon is uncommon when someone doesn’t have PBA.

Shifts in mood

Not all unpredictable emotions and shifts in mood following a stroke are PBA.

Extremes and shifts in mood are common after a stroke. “Emotional lability” is the term used to describe experiencing particularly intense or unpredictable emotions. For example, you may be very happy one minute and crying for no particular reason the next.

Your emotions may not match the context of a situation, or they may not seem characteristic of emotions you would’ve had before your stroke. The shifts may last a couple of seconds or a few minutes.

Depression, anger, anxiety, and fear are all usual after a stroke, and it’s common to have more than one of these emotions.

Apathy

You may feel like you don’t care about things as you once did. You may not have the same motivation you once had to go about your day’s tasks. You may even feel somewhat numb when confronted with extremes, like joy or sadness.

Another word for this feeling is “apathy.” It may arise if you have serious physical or cognitive issues after your stroke. Apathy may also be a feature of depression.

Anger

Other times, you may feel like you have a short fuse. Maybe you respond to others in an aggressive manner. Anger can be a feeling you experience inside your body, or it can be something that you act out by yelling, tossing things, or upsetting the people around you.

Anger is yet another symptom that can be associated with depression, particularly in people assigned male at birth.

Self-centeredness

Many stroke survivors may turn inward and give the highest importance to their own activities or emotions. They may not seem to care about the feelings or celebrate the accomplishments of others, or they may seem to be impolite or lack empathy.

However, this behavior is often associated with a frontal lobe stroke. Individuals with this type of stroke aren’t self-aware and often need a high level of caregiving.

Anxiety

Feeling nervous or anxious is also common after having a stroke. In fact, experts share that anxiety impacts around 1 in 4 people after stroke and is related to poorer outcomes.

You may not even be able to pinpoint exactly what’s making you feel uneasy. This type of anxiety is called generalized anxiety. Alternatively, you may fixate on certain issues or situations and develop irrational fear. This type of anxiety is called a phobia.

Some behavior changes, like depression, may respond to treatment. Other changes, like anger and anxiety, may get better with time.

Patience with yourself, or the person who has had the stroke, is key in these cases. It may not happen overnight, but through medication and therapy, you can get through feelings of depression, anger, and anxiety.

Some behavior changes may be permanent. Ultimately, there’s no way to know how long different behaviors will last.

It depends on the person, the effect the stroke had on the brain, and a number of other individual factors, including things like access to medical help, your support system, and your general health.

Speak with a doctor if you’re experiencing changes in your behavior after a stroke. It may take some time to feel like yourself again, but a healthcare professional can refer you to more specialized care to address specific issues.

  • Cognitive behavioral therapy (CBT): CBT is a psychological treatment that helps people identify unwanted thought patterns or behaviors and find ways to modify them or problem solve.
  • Other types of therapy: Anger management and other behavioral management training may also be helpful for more specific behavior issues.
  • Medications: Antidepressants can be another useful tool to address depression after stroke. If you’re already taking antidepressants and they aren’t helping, you may ask a doctor to evaluate what you’re taking and suggest alternatives.

It’s important to note that PBA can’t be cured. However, it can be managed with medications such as dextromethorphan, quinidine, or antidepressants.

Finding help for behavior change after a stroke

Ask a doctor for more information about support groups in your local area. You can find them through state agencies, hospital systems, churches, and even online.

For example:

  • Pacific Stroke Association’s Stroke Support Groups
  • The Stroke Network’s Online Support Groups
  • John Muir Health’s Stroke Support Group
  • Stroke Support Groups in Michigan
  • Facebook Stroke Survivor Support Group
  • Facebook Stroke Caregiver Support Group

You may also search the national database on the American Stroke Association’s website — Stroke Support Group Finder — or call 1-888-4-STROKE.

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It can be difficult to adjust to behavior changes whether you had a stroke or your friend or family member has had a stroke. Here are tips to help you or your loved one face post-stroke behavioral changes.

Coping with behavior changes if you’ve had a stroke

Along with medical treatment, there are some things you can do to cope with your behavior changes after a stroke.

  • Lose the guilt: Try to avoid labeling your emotions as “good” or “bad” or in other ways that make you feel guilty or negative.
  • Surround yourself with support: If the people in your life aren’t lifting you up, find people who do, or ask a doctor about support groups in your community.
  • Move your body: Getting exercise and engaging in other activities will keep your body and mind active and less inclined to dwell on behavior changes.
  • Celebrate the small stuff: If you make progress through therapy or otherwise, take time to recognize your efforts, however big or small.
  • Get plenty of rest: Your brain is working hard. Be sure to get enough nighttime sleep and rest throughout the day as needed.

Coping with behavior changes if a loved one has had a stroke

Not all people who have had a stroke may realize their behavior is different. Not only that, but stroke survivors also tend to show their biggest behavior changes to the people closest to them or to their caregivers. Understand that you’re not alone despite how isolated you may feel in your situation.

Some tips:

  • Resist the urge to compare the behavior you’re experiencing to the behaviors of the person before their stroke.
  • Don’t take behaviors personally. Remember that they’re a part of the aftermath of the stroke and that there are treatments to help.
  • Surround yourself with your own network of friends and family. You need your own support system, too!
  • Try your best to take care of yourself — exercising, eating well, and sleeping regularly — so you can avoid burnout. Take a break or divide up caregiving duties if possible.
  • Seek out additional support through local or online caregiver support groups.

What causes PBA?

PBA happens when there’s damage between the frontal lobe of the brain, the cerebellum, and the brainstem. The frontal lobe is responsible for controlling emotions, while the brainstem controls reflexes. When these areas don’t work together, your emotions can seem erratic even without triggers.

How can I tell if what I’m experiencing is depression or another behavior change?

Symptoms can overlap between depression and other common post-stroke behavior changes. A doctor can help you identify if your changes are due to psychological or biological factors. That said, it’s possible to experience both, so creating a custom treatment plan with a doctor can help.

Does the area of brain damage from stroke correlate with certain behavior changes?

It may. For example, people who experience damage to the right side of the brain may feel overly confident doing things (driving, walking, etc.) that they may still need help with after their stroke.

This overconfidence may seem careless, impulsive, or even dangerous. They may also have trouble reading the emotional cues of others.

If you’ve experienced behavior changes, be gentle with yourself. While it may sound unsettling, you may not always return to your old self after a stroke. You’ve gone through something significant and life altering.

Not all change is bad. It may be more helpful to reframe your thinking so you can accept some changes (that aren’t harmful to yourself or others) as a “new normal.”

If you’re a caregiver to someone who has recently had a stroke, reach out if you’re feeling stressed. Visit the American Stroke Association to find a support group near you.