1. Identity and Relationships After Stroke
Personality Change
This presenation focuses on personality change. A common factor following stroke and one that creates a great deal of distress for loved ones and carers. Dependent upon the personality changes it can also be difficult to find suitable care facilities and staff.
Identity and Relationships After Stroke

2. What is Personality?
Personality refers to our individual way of thinking, feeling and behaving.
Generally when someone is talking about an individual’s personality, they will talk about their behaviour, mannerisms, characteristics, feelings, beliefs, opinions and everything else that makes somebody the person they are.
Psychologists have spent years trying to define personality, and trying to label the different facets and aspects (or traits) that make up personality, but there is still no agreement about what exactly personality is made up of.
There are various tests of personality available. Some of these test certain traits (e.g. agreeableness, extraversion) whereas others may test for a “type” of personality.
Highly strung type A personality are those seen as ambitious, organised, sensitive, impatient, status conscious, proactive, take on more than they can handle. Often high achieving workaholics.
Easy going type B personalities work steadily, enjoy achievements but not overly stressed if don’t achieve something/miss a deadline, not competitive, creative, enjoy exploring ideas, reflective, poor time keeper. Remember your patient had a history prior to their stroke. They have a personality type. What is it. Find out about them as an indivdual.
What is personality?
Personality refers to our individual way of thinking, feeling and behaving.
Generally when someone is talking about an individual’s personality, they will talk about their behaviour, mannerisms, characteristics, feelings, beliefs, opinions and everything else that makes somebody the person they are.
Psychologists have spent years trying to define personality, and trying to label the different facets and aspects (or traits) that make up personality, but there is still no agreement about what exactly personality is made up of.
There are various tests of personality available. Some of these test certain traits (e.g. agreeableness, extraversion) whereas others may test for a “type” of personality.

3. Common Personality Changes after Stroke
Becoming short tempered
An increase in aggression/anger
Increased anxiety and worry
Low mood and/or apathy
Increase in frequency of shouting/swearing
Reduced patience, or less easy going nature
Uncaring, unsympathetic attitude
Making inappropriate comments
Increased impulsiveness
Dissatisfied easily
Personality isn’t static, as we grow up and have different experiences, our personalities are gradually moulded.
However, after stroke, family and friends of the patient sometimes report that they have noticed an abrupt change in their loved one’s personality. The patient themselves may not be aware of it, but sometimes family and friends will go as far as to say that they aren’t the same person – almost as though there is a “before stroke” personality, and an “after stroke” personality.
Of course sometimes, this may just be a normal reaction to having a stroke – for example, someone may appear to be more impatient/angry because they are frustrated by what has happened to them, or by physical limitations they might face.
Becoming short tempered
An increase in aggression/anger
Increased anxiety and worry
Low mood and/or apathy
Increase in frequency of shouting/swearing
Reduced patience, or less easy going nature
Uncaring, unsympathetic attitude
Making inappropriate comments
Increased impulsiveness
Dissatisfied easily

4. Personality Feeling angry Aggressive behaviour
There is a very thin and blurry line between emotions, behaviour and personality. 1
Feeling angry 2
Aggressive behaviour 3
Seen as an “angry person”
So someone may be experiencing the emotion of anger, and may then display aggressive behaviour (for example they may punch a wall, or push something over). An observer of this behaviour may assume that that individual is an “angry person” or has an aggressive personality.

5. Personality Physical Changes after stroke
Personality change
Physical Changes after stroke
Emotional changes after stroke
Personality changes are often caused by damage to different areas of the brain. For example, part of the frontal lobe is responsible for inhibiting certain behaviours which may be considered inappropriate. Damage to this area may result in people seeming to act ruder than they normally would.
Personality changes can also occur due to emotional changes after stroke, there is no doubt that if a patient is experiencing depression, their personality and/or behaviour may seem very different than it did before stroke.

6. Phineas Gage
One of the most famous cases of brain injury causing personality changes is that of Phineas Gage.
He became impatient
Had little restraint, acted on his desires
He used swear words regularly
He became erratic, impulsive and indecisive
Lacked respect and seriousness
Became very stubborn, likely to disagree with others
“Previous to his injury…he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was "no longer Gage".
One of the most famous records of personality change is the story of Phineas P. Gage was an American railroad construction foreman now remembered for his improbable survival of an accident in which a large iron rod was driven completely through his head, destroying much of his brain's left frontal lobe, and for that injury's reported effects on his personality and behavior—effects so profound that friends saw him as "no longer Gage".
Doctors, family and friends of Gage reported that after his accident, his personality and behaviour changed considerably:
Phineas Gage.
He became impatient
Had little restraint, acted on his desires
He used swear words regularly
He became erratic, impulsive and indecisive
Lacked respect and seriousness
Became very stubborn, likely to disagree with others
“Previous to his injury…he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was "no longer Gage".

7. Personality Change
It can be extremely difficult to provide care and unconditional love/attention for someone who often seems ungrateful and/or treats their caregiver with little respect.
Changes may only be noted by primary caregivers or family.
Personality change after stroke is not something that remains static – as with physical differences, there can be improvements/changes over time.
Changes may only be noted by primary caregivers or family – which can make things harder for these individuals as other friends/relatives may not see the changes/understand where they are coming from.
It can be extremely difficult to provide care and unconditional love/attention for someone who often seems ungrateful and/or treats their caregiver with little respect.
Changes may only be noted by primary caregivers or family.
Personality change after stroke is not something that remains static – as with physical differences, there can be improvements/changes over time.

8. What Can You Do?
If a patient or relative is reporting personality changes, one of the first things you should do is try to identify the reason behind the changes.
Rule out sleep problems – Most of us have at some time experienced sleep problems – whether due to internal causes such as an illness, or external causes such as a new baby. After a poor night’s sleep, or multiple poor night’s sleep – we are often at our most irritable/impatient.
Rule out emotional disorders – Depression or low mood can cause any number of changes in behaviour, and often these are mistaken for a change in personality.
At one time or another, most of us will have experienced difficulties with sleeping. Whether due to internal causes or external causes (such as a new baby), you will know how grouchy you feel after several nights of poor sleep. Generally when we are tired, we are at our most irritable and may find the tiniest little thing frustrating or annoying. A lack of sleep can also make you feel more impatient than normal, often resulting in short temperedness which you can take out on your loved ones.
If a patient or relative is reporting personality changes, one of the first things you should do is try to identify the reason behind the changes.
Rule out sleep problems
Rule out emotional disorders . We know that depression or low mood can cause any number of changes in behaviour, and often these are mistaken for a change in personality.

9. What Can You Do?
Are they receiving enough support? - Without the correct support, people can quickly become frustrated and impatient with both themselves and those around them.
Talk to the stroke survivor – With personality change, the stroke survivor may genuinely not realise that they are any different. If family and friends skirt around the issue and don’t mention it for fear of upsetting the person affected, they may never realise that there is a problem.
Communicate and provide information - sit down with friends and relatives and explain a little about personality change after stroke, ensuring they realise that it is a common issue and that it will often not be immediately obvious to those who don’t spend day in and day out with the stroke survivor.
Being unable to do things that at one time came easily to you can be incredibly frustrating. Having the correct support in place can greatly ease this frustration however, and make things that little bit easier. If someone is struggling physically, or has been left with a cognitive impairment that they are finding hard to cope with, ensure that they have the appropriate support in place.
Without the correct support, people can quickly become frustrated and impatient with both themselves and those around them. Imagine if one day you woke up and it took you three or four times as long to do everything that you would normally do in a day – you too would probably feel frustrated. Having the right support in place can make things that little bit better, easing frustration and pressure and making life that little bit more like “normal”.
What can you do?
Are they receiving enough support? - Without the correct support, people can quickly become frustrated and impatient with both themselves and those around them.
Talk to the stroke survivor – With personality change, the stroke survivor may genuinely not realise that they are any different. If family and friends skirt around the issue and don’t mention it for fear of upsetting the person affected, they may never realise that there is a problem.
Communicate and provide information - sit down with friends and relatives and explain a little about personality change after stroke, ensuring they realise that it is a common issue and that it will often not be immediately obvious to those who don’t spend day in and day out with the stroke survivor.

10. What Can You Do?
Educate - – If a stroke survivor, or relative is reporting personality changes, they should be provided with information about personality change after stroke, including how and why it occurs. They will then understand not to take any negative changes personally and realise that the stroke survivor is not necessarily able to control their actions or behaviour in some instances.
Use recording – With permission from the stroke survivor, video or sound recordings can be a good way of illustrating how personality/behaviour has changed if they are unable to recognise the changes themselves.
Education is important. If a stroke survivor, or relative is reporting personality changes, they should be provided with information about personality change after stroke, including how and why it occurs. They will then be able to make sense of perceive negative changes personally and realise that the stroke survivor is not necessarily able to control their actions or behaviour in some instances.
Use recording – With permission from the stroke survivor, video or sound recordings can be a good way of illustrating how personality/behaviour has changed if they are unable to recognise the changes themselves. This should of coursee be carried out with sensitivity but also at a time that is appropriate for that indivdual as this realisation, if possible, could be catastrophic if not prepared.

11. Summary
Personality and/or behaviour changes can occur for a number of reasons after an individual has had a stroke.
Often, it is not the stroke survivor themselves that reports the problem, but family and friends who can sometimes be on the receiving end of uncharacteristic behaviour.
Relatives will need education to understand personality change, and support to help them to care for their loved one, and be patient with them, in what can be very challenging circumstances.
Sometimes, helping the patient to see the issues will allow them to take control of the problem and work towards change.
In summary
Personality and/or behaviour changes can occur for a number of reasons after an individual has had a stroke.
Often, it is not the stroke survivor themselves that reports the problem, but family and friends who can sometimes be on the receiving end of uncharacteristic behaviour.
Relatives will need education to understand personality change, and support to help them to care for their loved one, and be patient with them, in what can be very challenging circumstances.
Sometimes, helping the patient to see the issues will allow them to take control of the problem and work towards change.