A stroke can lead to changes in your behaviour. This can be due to the damage to your brain, or it might be linked to emotional problems. 

On this page we explain how these changes happen and what you can do about them.

The information on this page can be accessed in the following formats: 

Why am I behaving differently?

The way we behave often depends on the way we feel. A stroke is sudden and shocking, and there are many emotions to deal with when you have one. It’s normal for this to affect your behaviour.

But it’s not just about the way we feel. We’re constantly receiving information from the world around us, which our brain has to understand, organise and keep. This is called cognition.

Our brain uses this information to adjust the way we think and react. If the parts of your brain that do this are damaged by a stroke, this can change the way you behave.

Other effects of stroke will also affect your behaviour. Pain can make you irritable, for example. Frustration at not being able to do things for yourself can build up and make you angry or even aggressive towards others. Fatigue (tiredness that doesn’t improve with rest) is common after a stroke. Fatigue can make someone avoid social situations, or become irritable more easily. 

What kinds of problems can this cause?


Apathy

Apathy is when you lack motivation. You may lose interest in life and not want to take part in everyday activities. Things that you’d usually respond to, like good news or seeing someone upset, may not make you feel anything at all.

Apathy is fairly common after a stroke, although it’s more likely to affect you if you have severe physical or cognitive problems after your stroke. It can be a sign of depression, but it can also happen on its own.

Anger and aggression

Many people find themselves getting frustrated and angry after their stroke. You may lose your temper for no reason or get angry about things that never would have made you feel that way before. If your anger turns into aggression, you may shout, throw things, threaten people or try to hurt them.

Inappropriate behaviour

People usually think that behaviour is inappropriate when it ‘breaks the rules’ and makes other people feel uncomfortable. This can happen after a stroke for a number of reasons.

  • If you lose the ability to read social situations you won’t know what’s expected of you, so you may stand too close to other people, interrupt them when they’re talking or not respond to their body language.
  • You may not be able to think decisions through properly, so you may make tactless remarks, act impulsively or spend money unwisely. 
  • You may also lose some of your inhibitions. If this happens you may seem more self-centred and refuse to do anything you don’t want to. This can also affect your sexual behaviour, so you may crave more physical intimacy or make inappropriate comments to other people. 

Will it get better?

It’s normal for your behaviour to change in some way after a stroke. This is likely to get better as you recover and begin to understand what’s happened.

Some changes can be long-term, but this isn’t always a problem. Some people think that if you’re behaving differently to how you did before your stroke, then this needs to be ‘fixed’. But it depends entirely on the way your behaviour has changed. You may just need to give the people around you some time to get used to it.

If you’re behaving aggressively or inappropriately, however, you do need to do something about it. The information below might help. 

What can I do about my behaviour?


1. Listen to others

It’s very difficult to see changes in our own behaviour. So if you’re acting differently your friends and family are probably going to be the ones to notice. That’s why it’s important to listen to them if they bring it up.

People often talk about their loved one’s ‘personality’ changing after a stroke or claim that they’ve ‘become a different person’. It can be upsetting if your family or friends say this about you. However, what they’re really noticing are changes to your behaviour, not who you are as a person – a stroke can’t change who you are.

2. Give it time

Some change to your behaviour is to be expected, and although it may be difficult to live with at times, it’s likely to improve. Many people find that they have to learn what’s ‘normal’ for them again after they’ve had a stroke. This will take time, for you and the people around you.

3. Talk to someone

Talking about the way you’re feeling with someone who understands can really help. You may want to do this with a professional, such as a counsellor or therapist. Or it could be a family member or friend – whoever you feel most comfortable talking to.

Many people also find support groups helpful, because you can talk about your problems with people who are going through the same thing. Stroke clubs and groups are a good way to meet other stroke survivors and get advice and support.

If the change to your behaviour is extreme, or you start to behave in ways that may hurt or offend other people, you need to speak to your GP to get some help with it.

4. How your GP can help

The way you’re behaving may be a sign of emotional problems, such as depression or anxiety. So your GP will be able to look into other possible causes and talk to you about the best way to treat them.

They may also be able to refer you to a clinical neuropsychologist. This is someone who specialises in the way the brain works. They can carry out a detailed assessment to see if there are any cognitive problems that may be causing you to behave differently.

Your GP should be able to tell you about other sources of support, especially if you’re becoming aggressive or behaving inappropriately.

They may recommend talking therapy to you, for example. Talking therapy gives you time and space to talk about difficult feelings with a trained therapist and think about how your feelings may be affecting your behaviour. 

What can I do if I’m becoming aggressive?


1. Learn your triggers

Talk to your friends and family to work out what makes you angry and how you can avoid it. If you have fatigue and your behaviour changes when you are tired, try telling those you are close to so they can understand how you feel. To avoid anger developing, you can try to make sure you get more rest or do things earlier in the day when you have more energy. Or if it happens when you’re bored, try to keep busy and plan activities ahead so you don’t end up with days when there’s nothing to do. 

2. Develop a strategy

Agree a word, phrase or sign that your family and friends can use to let you know that you are acting aggressively. Or agree that they walk away and leave you on your own for 15 minutes. 

What can I do if I’m behaving inappropriately?


1. Don’t ignore it

The way you behave will seem entirely normal to you, even if it seems inappropriate to everyone else. So it’s important to listen to the people around you. It may not mean that the way you’re behaving is wrong, but it may mean you need to try to manage it a little better and help your family and friends adjust to it.

2. Try talking therapy

Cognitive behavioural therapy (CBT) is a type of talking therapy that focuses on your thinking and behaviour and how they are connected. CBT may help you to learn how to think through your actions and understand the effect they can have on other people.

A therapist could also work with your family members, to help them adjust to your change of behaviour and help you all find a way to be comfortable with it. 

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