How a Stroke Can Change Your Personality

Couple standing by window together
kupicoo/Getty Images

A stroke can produce significant personality changes in addition to the obvious physical effects. If you are a stroke survivor, your post-stroke behavioral changes can hit you and your loved ones by surprise if you suddenly do not act like "yourself" anymore.

A stroke can produce major life-altering changes, such as impaired vision and diminished physical strength and coordination. And recognizing that personality changes can begin to emerge after a stroke can give you a sense of reassurance, knowing that there is an explanation for why you or your loved one might be acting a little bit different. Acknowledging personality changes can be a huge step in modifying unwanted behavior as you work towards getting back some of the personality traits that make you feel more like "you."

Depression

Depression is the most common personality change after a stroke. In fact, as many as 60 percent of stroke survivors report prolonged depression, which is depression that is more severe and long lasting than routine sadness.

Causes of Post-Stroke Depression

Post-stroke depression results from a combination of biological and situational factors.

  • Physical limitations: The limitations caused by a stroke, such as weakness, vision loss, and coordination problems may make you feel disempowered or handicapped.
  • Health worries: After a stroke, you might worry about your health or experience anxiety about your own mortality. The resulting feelings of helplessness or hopelessness can contribute to post-stroke depression.
  • Brain changes: And stroke-induced damage to the brain can produce changes in how the brain functions, resulting in altered biological activity that leads to depression.
  • Delays in treatment: Many people are reluctant to seek treatment for depression. Some stroke survivors hesitate to take on the label of depression due to the associated stigma or out of concern that it can be a self-fulfilling prophecy. Others may not believe that treatment can help.

Treatment

If you or your loved one has lingering feelings of sadness or hopelessness, you can get effective help for this problem. The recognition that your depression is not your fault and is not a sign of weakness is an empowering step towards getting the right medical treatment.

Despite all of the elements that contribute to the development of post-stroke depression, it is usually treatable with a combination approach that includes prescription anti-depressant medication and counseling.

Social Avoidance

After a stroke, isolation can occur if you are no longer able to do the same things you used to do. If you have to leave your job after a stroke, or if it becomes difficult for you to participate in your regular social life, this can lead to a sense of loneliness and social isolation.

Some stroke survivors have severe disabilities that make it difficult to drive, leave the house or even get out of bed. Extreme disability may necessitate moving into a new living environment to obtain assistance with daily living. All of these factors can lead to avoidance of social situations, which makes the loneliness even worse, creating a cycle that is difficult to escape without a deliberate plan of action.

Loss of Cognitive Skills

The loss of cognitive skills after a stroke can happen after a stroke in almost any region of the brain, but occurs most often with strokes that affect the frontal lobe, the parietal lobe or the temporal lobe.

Changes in cognitive skills include trouble with language, problem solving, reading, and simple mathematical calculations. Some stroke survivors become forgetful, forgetting names, losing things, or neglecting important tasks. Cognitive deficits can also cause confusion or may make it difficult to understand concepts that a stroke survivor would have previously been able to understand.

The loss of cognitive skills can be distressing, and many stroke survivors may make excuses for frequent mistakes, or even lie about errors to avoid embarrassment.

Building up cognitive skills is a challenge, but just as physical disability can sometimes improve with physical therapy, cognitive disabilities can improve with dedicated cognitive therapy.

Emotional Instability

Many stroke survivors find themselves becoming unusually emotional or inappropriately crying or laughing. Some stroke survivors experience a condition called pseudobulbar affect, which is characterized by mood changes and uncontrollable expressions of emotion.

There are medications that you can use to control this problem, and cognitive therapy, as well as social support, can help you cope.

Lack of Motivation 

A stroke can lead to a lack of motivation, which is described as apathy. Apathy occurs after most types of brain injury. There are several reasons for post-stroke apathy.

  • The decline in cognitive abilities after a stroke can make many tasks seem too challenging and unsolvable. 
  • Additionally, the development of post-stroke depression, having less responsibility to deal with after the stroke, and sometimes the feeling that "nobody will notice" what you do, can all lead to apathy. 
  • Lastly, apathy may also occur due to changes in the structure and function of the brain secondary to the stroke itself. 

Aggression 

Some stroke survivors become unexpectedly hostile and angry, behaving in ways that are mean or physically aggressive. Aggression, like the other behavioral and personality-related stroke changes, is often a result of both the emotional feelings about the stroke and the stroke-induced brain injury.

Aggression is particularly noticeable in stroke survivors who have has a large stroke or who have a stroke pattern that produces vascular dementia. Vascular dementia occurs when many small strokes happen over time, leading to a buildup of injuries throughout the brain, and resulting in a distinctive type of dementia. Vascular dementia is characterized by a decline in memory and thinking skills, confusion, trouble finding things, trouble with directions, and changes in behavior.

Denial of a Stroke: Anosognosia 

Anosognosia describes a stroke survivor's inability to recognize that he or she has had a stroke. Anosognosia is manifest by overconfidence and unawareness that there is anything wrong after a stroke. In fact, a person who has anosognosia may express surprise and bewilderment at the fact that there is any medical care being administered at all.

Stroke survivors who have anosognosia present a challenging problem for loved ones and caregivers who try to offer assistance and care - which is often met with no cooperation. Sometimes stroke survivors who have anosognosia treat those who are trying to help them with dismissal or rejection.

Lack of Empathy

The lack of empathy after a stroke is caused by brain damage that affects regions of the right side of the brain. A lack of empathy is usually upsetting for friends and loved ones, but is typically unnoticed by the stroke survivor.

It is not easy to predict whether a lack of empathy will improve after a stroke, as some stroke survivors can show improvement, while others do not.

Loss of Sense of Humor 

A sense of humor requires insight and the quick thinking. Humor is often based on the recognition that dissimilar ideas that do not belong together are funny and amusing when placed together.

Many types of strokes can diminish a stroke survivor’s sense of humor. A stroke survivor who was previously funny might not be able to construct jokes, and a stroke survivor who would have been able to recognize and laugh at jokes might not be able to do so anymore.

A loss of sense of humor can be difficult to recover from, because this stroke effect is caused by a loss of cognitive skills. However, understanding that the lack of humor is the result of a stroke and not a personal rejection can help in preventing hurt feelings and misunderstandings when a stroke survivor does not respond to lighthearted joking as expected.

Loss of Social Inhibitions

Some stroke survivors may behave in ways that are considered socially inappropriate. This is most commonly associated with a stroke of the frontal lobe. Behaviors such as taking food from a stranger's plate, insulting people out loud, or even undressing or urinating in public may pose challenges for the caregivers and family members who take responsibility for the safety and care of a stroke survivor.

Generally, a stroke survivor who displays socially unacceptable behavior does not have the insight to understand that the actions are not acceptable, and is unlikely to apologize or try to correct the behavior.

The language or insults of a stroke survivor who has suffered from a frontal lobe stroke are not necessarily consistent with a person’s ‘normal’ pre-stroke personality or beliefs. And it is very important to be aware that mean statements are not reflective of what a stroke survivor ‘really feels, deep down inside", but are more likely to be phrases that he or she heard in a completely unrelated setting, such as on a television show.

The loss of social inhibition can be somewhat better controlled when the stroke survivor is comfortable, in a familiar environment, and under as little stress as possible.

Jealousy 

A rare type of stroke causes a syndrome called Othello Syndrome, which is characterized by irrational and illogical jealousy, particularly in the context of romantic relationships. This syndrome can affect stroke survivors as a result of brain injury affecting areas of the right cerebral cortex.

A Word From Verywell

A stroke can cause major personality changes that can make you feel as if you have lost yourself or that you've lost the loved one you used to know so well. Personality changes after a stroke can be emotionally draining for everyone involved.

However, if a stroke survivor and loved ones understand that the source of the behavior comes from stroke-induced brain damage, it can reassure everyone in knowing that the unpleasant behavior is not premeditated or intended to be personally insulting. High functioning stroke survivors who learn about the typical post-stroke behavioral changes can gain enough insight to be able to make some changes, which can result in more satisfying interpersonal relationships.

Was this page helpful?

Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.