
Strokes can cause a wide range of emotional and behavioural changes, including anger, irritability, impulsivity, and aggression. These changes can be temporary or long-lasting and are often related to damage in specific areas of the brain, particularly the frontal lobe. This is because the frontal lobe plays a crucial role in reasoning, problem-solving, and controlling basic impulses like anger. When the frontal lobe is damaged, it can lead to emotional dysregulation and aggressive behaviour. Additionally, strokes can cause neurochemical changes, such as disruptions in the brain's serotonin system, which can also contribute to angry or aggressive behaviour.
While not everyone will experience behavioural changes after a stroke, it is common for stroke survivors to exhibit signs of apathy, depression, anxiety, and pseudobulbar affect (PBA). PBA is characterised by a mismatch or exaggeration of feelings and expressions, such as laughing at a funeral or crying at a joke. These emotional and behavioural changes can significantly impact a stroke survivor's quality of life and can be challenging for both the survivor and their caregivers to navigate.
Characteristics | Values |
---|---|
Prevalence of anger after a stroke | 11-35% of stroke survivors experience anger or aggressive behaviours during the acute stage of stroke, while 19-32% experience anger during the first 3-12 months following a stroke |
Symptoms of post-stroke anger | Aggressive behaviours, such as hitting; difficulty getting along with family members |
Causes of anger after a stroke | Changes in brain chemistry; difficulty adjusting to new neurological deficits; genetic predisposition; cognitive changes; physical effects; emotional disorders |
Triggers of anger after a stroke | Perceived lack of control; difficulty performing tasks; fatigue or confusion; other people's behaviour; anxiety and overstimulation; barriers to goals or routines |
Management of anger after a stroke | Recognising triggers; taking breaks; self-compassion; listening to relaxing music; meditation and prayer; expressing emotions through journaling or artwork; medications (e.g. selective serotonin reuptake inhibitors) |
What You'll Learn
Anger and aggression
Physical Causes
Physical causes of anger and aggression after a stroke are related to brain injury and other chemical changes in the brain. For example, strokes affecting the frontal lobe, lenticulocapsular, or pontine base areas can lead to emotional incontinence, which is the inability to control emotions. This can result in aggressive or combative behaviour.
Psychological Causes
Psychological causes of anger and aggression after a stroke are related to mood disorders, such as depression, anxiety, and frustration. The frustration may be associated with neurological deficits, unfavourable environments, or the aftereffects and complications of the stroke.
Treatment
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Apathy
If you or someone you know is experiencing apathy after a stroke, it is important to seek help. A structured daily routine can be beneficial, with support from friends and family to encourage the completion of tasks. Medication may also be an option, with selective serotonin reuptake inhibitors (SSRIs) often being considered as a first-line treatment.
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Emotional instability
These emotional shifts can be caused by physical changes in the brain, such as brain injury and chemical changes, as well as psychological factors such as mood disorders like depression. Frustration, fear, and other emotions related to the after-effects and complications of a stroke can also contribute to emotional instability.
The physical effects of a stroke, such as motor impairments and pain, can make it difficult for survivors to engage in daily tasks, leading to feelings of frustration and anger. Cognitive changes can also occur after a stroke, such as a lack of empathy or increased impulsivity, which can result in frequent feelings of anger.
Additionally, strokes can affect the emotion centre of the brain, causing a condition called pseudobulbar affect (PBA). PBA involves involuntary, inappropriate, and uncontrollable outbursts of emotion, such as laughter, crying, or anger, that don't match the context of a situation.
It's important to address concerns about emotional instability after a stroke, as it can cause distress for both survivors and their loved ones. Treatment options such as cognitive behavioural therapy, anger management training, and medication can help manage these emotional changes.
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Lack of empathy
A stroke can cause a lack of empathy in survivors, which can be extremely upsetting for friends and loved ones. This is often caused by damage to the frontal lobe, which helps us to react to another person's feelings. The right supramarginal gyrus, which helps people overcome egocentric bias when making decisions, can also play a role.
The result of this brain damage can be that stroke survivors appear more self-centred and may be less able to identify with the emotions of others. They may also suffer from alexithymia, which makes it difficult to identify, describe, and process emotions, both their own and those of others. This can lead to stroke survivors seeming insensitive or non-empathetic, when in fact they are simply unsure of how to react.
It is important to remember that this change in behaviour is not premeditated or intended to be insulting. It is also not necessarily permanent. As with other emotional changes after a stroke, a lack of empathy can sometimes go away on its own as the brain heals. Even if it does not, it may be possible to relearn empathy through therapy and practice.
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Socially inappropriate behaviour
A stroke can cause physical and psychological changes that may lead to socially inappropriate behaviour. This can be due to damage to the brain, emotional problems, or a combination of both.
Loss of Social Awareness
Damage to the brain can result in the loss of social awareness, causing the person to behave inappropriately without realising it. They may stand too close to others, interrupt them while speaking, or fail to respond to body language cues. This can be due to an inability to read social situations and understand what is expected of them.
Aggressive Behaviour
Post-stroke anger is a common occurrence, with studies showing that between 11-35% of stroke survivors exhibit anger or aggressive behaviours during the acute stage, and 19-32% in the first 3-12 months following a stroke. This anger can manifest as irritability, impulsivity, hostility, and physical aggression, such as hitting or hurting others. It can be directed at family members or caregivers and can cause distress for both the survivor and their loved ones.
Emotional Disorders
A stroke can affect the emotion centre of the brain, leading to a condition called pseudobulbar affect (PBA). PBA involves involuntary, inappropriate, and uncontrollable outbursts of emotion, including anger, that are disproportionate to the situation.
Cognitive Changes
Cognitive changes following a stroke can alter a person's ability to process information and understand others. This can lead to a lack of empathy, increased impulsivity, and frequent feelings of anger.
Physical Effects
Motor impairments and pain are common after a stroke and can make it difficult to perform daily tasks. The resulting frustration and anger can lead to socially inappropriate behaviour.
Management Strategies
Managing post-stroke anger and aggressive behaviour is important for both the survivor and their loved ones. Recognising and avoiding triggers, practising self-compassion, and engaging in relaxation techniques can help reduce angry feelings. Medication, such as selective serotonin reuptake inhibitors (SSRIs), may also be beneficial in reducing anger and improving quality of life.
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