Aggressive Behavior After Stroke: Understanding & Coping with Anger

Aggressive behavior after stroke is frequently observed in acute stroke patients. It could be a temporary phase or a sign of damage to certain areas of the brain.

This gives rise to certain questions, like: How long does aggressive behavior last? What treatments are available? And what does “acute stroke” mean?

You’re about to find out.

Early Stages of Aggressive Behavior After Stroke

Acute stroke marks the early phase of stroke when the brain is still swollen.

The timeline of the acute phase varies, usually occurring during the first 24 hours, first few days, or first weeks after the onset of stroke.

During the acute stage, aggressive behavior after stroke has been found to occur frequently.

In a study of 202 acute stroke patients, anger was present in 35% of patients. Furthermore, 37% of angry stroke patients were severely angry.

Based on these findings, aggressive behavior after stroke is likely to occur during the first few days or weeks after the onset of stroke.

But what exactly causes the aggression?

The Frontal Lobe & Impulse Management

Jong S. Kim, MD, believes that aggressive behavior after stroke is more likely a symptom of brain injury rather than reactive behavior.

Understanding where the stroke occurred has implications for injury-caused aggression after stroke.

Kim explains that when stroke affects the frontal lobe, lenticulocapsular, or pontine base areas, emotional incontinence (inability to control emotion) is more likely to be a side effect.

The frontal lobe in particular plays a role in reasoning, problem solving, and controlling basic impulses like anger. When the frontal lobe is damaged, it can affect emotion regulation and lead to aggressive behavior after stroke.

That’s why it’s important to ask your neurologist about the location of your stroke. It has significant implications on the secondary effects you may experience.

While it’s unknown how long aggressive behavior after stroke may last, there is hope for recovery.

Overcoming Aggressive Behavior After Stroke

Many side effects experienced during the acute stage of stroke, like aggressive behavior, go away on their own – a phenomenon called spontaneous recovery.

More studies are needed to determine the likelihood of spontaneous recovery for aggressive behavior after stroke. However, there is hope.

During stroke recovery, the brain attempts to heal itself after the injury through the process of neuroplasticity. New areas of the brain can “pick up the slack” and take on lost functions.

It takes repetitive, dedicated effort, though. In order to regain the ability to control your emotions, you need to practice it. Working with a therapist or counselor can greatly help.

But what if your loved one has no desire for therapy or psychological care after stroke? Fortunately, there are other ways to treat aggressive behavior.

Drug Therapy for Aggressive Behavior After Stroke

Medication like selective serotonin reuptake inhibitors (SSRIs) can help treat aggressive behavior after stroke.

SSRIs are commonly prescribed antidepressants that work by increasing levels of serotonin in the brain. Serotonin is a neurotransmitter that carries signals between neurons (brain nerve cells).

Specifically, an SSRI called fluoxetine (Prozac) has been shown to help improve “post-stroke anger proneness” – even 3 months after discontinuation of treatment.

Interestingly, fluoxetine significantly improved post-stroke anger proneness and post-stroke emotional incontinence, but it did not help post-stroke depression in that study.

If your loved one suffers from aggressive behavior after stroke and depression, medication may not be as helpful. But if aggressive behavior is the primary issue, talk to your doctor about medication and be sure to discuss potential side effects.

Coping with Aggressive Behavior

Before treatment has begun, there are ways to cope with aggressive behavior. First, understanding the triggers can help.

According to synapse.org, common triggers for anger include:

• being confronted with a task the person is no longer capable of doing
• lack of structure or unexpected events
• perceived lack of control
• post-stroke fatigue or confusion
• confusion and overstimulation, e.g. crowds, lots of noise and activity
• other people’s behavior like insensitive comments
• unrealistic self-expectations
• barriers to goals or routines
• build-up of stress or frustration

Many of these triggers are common during the stroke recovery process, especially when patients are within the confines of medical establishments. By understanding the triggers, you can help buffer yourself or your loved one from angry outbursts.

A stroke often takes away independence and beloved hobbies. If you put yourself in your loved one’s shoes, you may find empathy and understanding for their anger.

Sometimes aggressive behavior exceeds levels of compassion, though. If aggressive behavior continues beyond the acute stage, seek counseling, for both yourself and your loved one.

In extreme cases, when aggressive behavior results in domestic violence, talk to someone as soon as possible. You must protect yourself. Call the domestic abuse hotline relevant to you. In the United States, it’s 1-800-799-7233.

Understanding Aggressive Behavior After Stroke

It’s understood that aggressive behavior is common during the acute stages of stroke, especially if the frontal lobe has been affected. This stroke effect may go away on its own.

Available treatments for aggressive behavior after stroke include psychotherapy and medication like the SSRI fluoxetine.

Talk to your doctor and neurologist about the location of the stroke and discuss possible treatments for aggressive behavior. Stay safe, and never lose hope.