Changes to behaviour

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 why your behaviour may change and we look at some of the things that can help you and the people around you cope with it.

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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. Our brain has to understand, organise and store this information. 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 can also affect your behaviour. Pain can make you irritable, for example. Frustration at not being able to do things can make you angry or even aggressive towards others. Fatigue (tiredness that doesn’t improve with rest) is common after a stroke. Fatigue can make you avoid social situations, or become irritable more easily.

What kinds of problems can this cause?

Apathy

Apathy is when you lack motivation to do things. You may lose interest in life and not want to take part in everyday activities. Things that you would 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.

Having a structure to the day can sometimes help people with apathy. Get family members or friends to support you with practical help. They can encourage you to start and finish tasks. Sticking to a regular routine might be helpful.

Anger and aggression

Many people find themselves getting frustrated or 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.

Aggressive behaviour puts you and other people at risk. So it’s essential that you learn how to manage it. If you need support, contact your GP who may refer you for expert help.

Inappropriate behaviour

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

If you lose the ability to read social situations, you will not know what’s expected of you. You may not realise you are behaving inappropriately. You may stand too close to other people. You may interrupt them when they’re talking, or not respond to their body language.

You may not be able to think decisions through properly. You may make tactless remarks, act impulsively or spend money unwisely.

You may also lose some of your inhibitions. If this happens, you may be more impulsive. You could seem more self-centred and refuse to do anything if it does not give immediate results. This can also affect your sexual behaviour. You may crave more physical intimacy or make inappropriate comments to other people.

Will I go back to how I was?

It’s common for behaviour to change in some way after a stroke. As you begin to recover, you might feel that your behaviour changes or improves. You may start feeling better physically and emotionally. But some changes can be long-term. You are still the same person, but a stroke may change the way you respond to things.

It’s not always possible to go back to the way you were before a stroke, but you can get help and support to make the best recovery possible for you.

It can be hard for the people around you if they feel you’ve changed. They may also need some support to help them understand what’s happened to you.

However, if you or people around you notice that you’re behaving aggressively or inappropriately, it’s vital to do something about it. The information on this page could help you understand what to do.

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 will probably be the ones to notice. That’s why it’s important to listen to them if they mention your behaviour.

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 cannot change who you are.

2. Give it time

Some change to your behaviour is to be expected. 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 you could talk to a family member or friend. Find who 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, contact your GP surgeryto ask for help.

Getting help

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

Talking therapy can help with emotional problems. You can talk about difficult feelings with a trained therapist and think about how your feelings may be affecting your behaviour.

You may need more checks to see if there are any cognitive problems (changes to your memory and thinking) that may be causing you to behave differently. Cognitive problems can affect things like your ability to plan and complete everyday tasks. Your GP may refer you to a specialist such as a clinical neuropsychologist.

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 loved ones so they can understand how you feel. Try to 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, so you do not 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. Do not 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 changed behaviour and help you all find a way to be comfortable with it. To find talking therapies in your area, visit the NHS website or contact your GP surgery.

Tips for family and friends

It can be difficult when someone close to you starts to behave differently, especially if they’re being aggressive or behaving inappropriately. Here are some tips to help you.

Talk about it in the right way

If your friend or family member is behaving in a way that upsets you, you have a right to tell them. But be careful not to make them feel that they are the problem. Keep your focus on their behaviour and how it makes you feel. Say “it upsets me when you shout” rather than “you’re always upsetting me”.

Don’t do it all on your own

Get as much support as you can. Contact your GP surgeryto find out about services in your area that can offer support. Talking to a therapist or counsellor may help you come to terms with the changes.

Dealing with apathy

Be patient

Apathy can be very difficult to deal with. It can feel as if your friend or family member has completely changed. But remember, they are still the same person and it’s likely to get better with time. Having a regular routine can help. You could try encouraging them to plan their days and start and finish activities.

Dealing with anger or aggression

Listen

Sometimes, people can become angry because they feel ignored or not in control. Make sure you listen to your friend or family member and involve them in decisions. For example, even if they can’t make their own lunch, they may still want to choose what they have to eat.

Don’t put yourself at risk

It’s essential that you look after your own safety, so don’t feel bad about walking away if you need to. Just because someone has had a stroke, it doesn’t give them the right to hurt you.

If your friend or family member becomes verbally or physically aggressive, try not to raise your voice - it won’t help if you become angry too. Leave them alone until they’ve calmed down. If you are in danger, call 999.

Dealing with inappropriate behaviour

Explain what’s acceptable and what’s not

If your friend or family member is acting inappropriately, make it clear that their behaviour is not acceptable. Be firm but not rude – remember they will not be doing it deliberately. Praise them when they do act in the right way.

Get everyone on board

Being consistent is important. Talk to other friends, family members and carers to ensure that they deal with inappropriate behaviour in the same way. It will help to get the message across if everyone says the same thing.

Be willing to compromise

Just because your friend or family member’s behaviour has changed, it doesn’t automatically make it wrong. It may just be a matter of adjusting to it. Talk honestly about it with them and find a compromise that you’re both comfortable with.