After experiencing a severe medical trauma, such as a stroke, patients often experience emotional and behavioral changes. This is because a stroke affects the brain, thus triggering painful symptoms ranging from throbbing headaches to central post-stroke pain (CPSP). The extent of such changes varies from individual to individual. They can be as subtle as mild absentmindedness or as drastic as a violent outburst. For some patients, the post-stroke pain can become so severe that it could lead to personality changes. Personality changes after stroke can be upsetting to survivors, family members, friends, and even doctors. They can compromise a patient’s quality of life and even harm relationships. A few examples of personality changes include: being withdrawn, showing anger, becoming impatient, becoming aggressive, becoming impulsive, showing no interest in certain important aspects of life, or becoming self-conscious. However, not all personality changes are permanent. Some changes, such as depression, can be treated with medications, talk therapy, and support groups. In order to fully understand the different ways that stroke can affect personality, it is necessary to look at the three areas of personality change: thoughts, emotions, and behavior.
Often times, a stroke may affect the part of the brain that is responsible for thinking, memorizing, judging, and reasoning. That being said, a stroke survivor’s patterns of thought might change after experiencing a stroke. For instance, an individual who is calm and patient may develop characteristics such as impatience or aggressiveness over time. Other times, a stroke may affect the part of the brain that is responsible for emotion, thus triggering side effect known as emotionalism (or emotional lability). This side effect involves having uncontrollable emotions such as anxiety, anger, and more – all of which can lead to personality changes. Finally, a stroke can trigger behavioral changes. For instance, if an individual is affected by a neurological injury, it can have an enormous impact on the way they view life from that point on.
It is important to note that personality changes can be both positive and negative. Sometimes, some individuals tend to experience “wake up calls” after a severe trauma. It can force them to reevaluate their lives and lead them to new and positive ways of thinking and behaving. Other times, experiencing a stroke can push an individual into a state of apathy, making them lose interest in things that previously brought them joy. Either way, if you have a patient who is a stroke survivor and you feel that they are starting to pull away, it is crucial to enforce empathy and help them find the support they need during difficult times. Having empathy can help you to understand where their personality changes are coming from and determine how to properly help them cope with their individual situation.
As a doctor, there are several ways in which you can help your patients manage their conditions and cope with personality changes following stroke:
- Establish a doctor-patient relationship – although this is a given, it is important to recognize that the doctor-patient relationship is built on trust, respect, and honesty. By establishing a mutual bond, you will be able to recognize signs of body language and patients’ reactions to particular questions. This way, you will be able to anticipate their concerns and recognize the best approaches to their individual cases.
- Encourage open and honest communication – listen and encourage patients to talk about their thoughts and emotions. Understand where their emotional reactions are coming from. Most important, avoid using medical jargon and communicate with each patient on a “person to person” level, rather than “medical expert to victim”.
- Encourage therapy / support group – sometimes, the best approach to dealing with emotional and behavioral changes is to talk with a professional or join a support group. Encourage patients to seek support as a means of opening up about what they are feeling, why they are feeling this way, and how they have been affected by these changes. Participating in therapy or joining a support group can help your patients’ change the way they think or feel about particular things by getting to the root of their problems and establishing positive solutions.
- Utilize patient journals – encourage patients who have experienced medical traumas to keep a journal and write down their feelings. A journal is a great way for patients to channel their energy and get to the bottom of what they are feeling. Furthermore, a journal serves as a road map for doctors such as you because it allows you to see what exactly the patient has been going through and what factors triggered certain emotional or behavioral changes.
- Improve the patient knowledge base – most patient behavior is driven by fear of the unknown. Even when a patient comes into your office for a regular checkup, they may fear that they could receive disturbing news. For this reason, it is important to inform each patient the purpose of every test that will be performed on them, what it entails, what medications they will be prescribed, what are some of the potential side effects of the medications, and more. This does not have to be done in great detail but just informative enough so that the patient gets the overall picture. As they say, the best patient is a well-informed patient.
- Involve the caregiver – when it comes to dealing with personality changes, the role of the caregiver should not be underestimated. Depending on the patient’s condition, their resources, and the relationship itself, involving decisions and plans with a caregiver can greatly improve patient satisfaction. Moreover, there are several digital health tools available for caregivers, all with the aim to improve patients’ overall well-being and quality of life.
Where your patients are dealing with emotional, behavioral or personality changes, inform them of ways in which they can cope with stressful situations. They should:
- Talk about sensitive topics openly;
- Express their wants and needs clearly;
- Not allow themselves to feel embarrassed, frightened or overwhelmed;
- Contact other stroke survivors and share personal experiences with one another;
- Seek help from a psychologist or another type of specialist (consultant psychiatrist, clinical neuropsychologist, occupational therapist, social worker, etc);
- Get in touch with local support groups and explore online services;
- Build their daily routine around something that makes them feel happy;
- Take necessary medications to help them deal with stressful emotions, such as anxiety;
- Encourage other individuals to treat their emotionalism as a small distraction and not dwell on it;
- Seek out essential and necessary advice, health-related information, and support groups;
- Be aware of how their behavior is affecting other individuals around them;
- Look after their own well-being and safety;
- Reinforce positive behavior
Experiencing a stroke, or for that matter any medical trauma, can lead to a wide range of emotions – anger, sadness, denial, shock, grief, and guilt. All of these emotions are perfectly normal, although they can become overwhelming if they are not dealt with. One of the most common emotions that nearly all stroke survivors have to deal with is frustration. Frustration that builds up can cause irritability, thus leading to aggressive behavior and personality changes. Many personality changes resulting from stroke or other medical traumas may improve with time; however, there is no one or easy approach to dealing with them. An active role must be taken by the patient, caregiver, and the doctor. Each patient’s experience is different and requires a different approach. What works best for one patient might not necessary work as great for another. As a healthcare professional, it is your duty to cope and support your patients when they are faced with major life changes. Start by establishing a comfortable environment and encouraging open communication. By helping them to manage and improve their conditions, you can empower them to improve their behaviors and lead meaningful and fulfilled lives.