Anger after stroke can occur for many reasons. Some stem from the biological impact of the stroke while others stem from unwanted lifestyle changes, such as losing a job due to stroke-related disabilities.

It’s important to address anger issues after stroke because it can cause distress for both survivors and their loved ones. In this article, you will learn the different causes of anger after stroke and what you can do to cope.

Causes of Anger After Stroke

After a stroke, changes in emotion such as anger can result from one or multiple sources. Factors that may cause anger after stroke include:

• Cognitive impairments. Sometimes a stroke causes changes in the brain that alter a person’s ability to process information and understand others. Some of these changes, such as lack of empathy or increased impulsiveness, can result in feeling angry more frequently.
• Physical effects. Difficulty with movement is one of the most common secondary effects of a stroke, which can make it more difficult to engage in one’s typical daily activities. When an individual begins to struggle with everyday tasks that were once easy, it can cause frustration and anger. When motor difficulties prevent survivors from engaging in hobbies or activities that they once enjoyed, it can also cause negative feelings including anger.
• Emotional disorders. When a stroke affects the emotion center of the brain, it can cause a condition called pseudobulbar affect. This involves involuntary, inappropriate, and uncontrollable outbursts of emotion such as laughter, crying, or anger, particularly when a situation does not call for such emotion.

When anger after stroke becomes extreme, it can result in aggressive behavior after stroke, which should be taken seriously. If you or a loved one are a victim of domestic violence, it is critical to take action to protect yourself by calling the domestic abuse hotline in your area. In the United States, that number is 1-800-799-7233.

Now that you understand the biological causes of anger after stroke, let’s discuss the environmental triggers that also cause contribute to this issue.

Common Triggers of Anger After Stroke

To learn how to regulate anger after stroke, it is critical to understand the factors that may trigger the emotion. Some common triggers for anger include:

• Perceived lack of control. The road to recovery is full of challenges, such as navigating institutions like therapy, insurance, and government-funded disability programs. When these institutions prevent a person from engaging in the activities they want and need, such as adequate access to therapy, it can cause the person to feel like their life is out of their control, which can lead to anger.
• Being confronted with a task you can no longer perform. With motor difficulties being a common post-stroke effect, survivors are often confronted with tasks they struggle to perform, which can be upsetting.
• Fatigue or confusion. Post-stroke fatigue and cognitive difficulties can heighten emotional reactions like anger.
• Other peoples’ behavior. Individuals with disabilities are often faced with insensitive comments and other challenges that can trigger anger due to other peoples’ behavior.
• Anxiety and overstimulation. When the brain is recovering from a stroke, it can heighten anxiety and/or result in one becoming easily overwhelmed due to overstimulation in situations with large crowds, excess noise, or excess activity. Some survivors struggle with grocery stores, for example, due to crowded aisles that they must navigate. This can heighten anxiety and be overwhelming, which can trigger anger.
• Barriers to goals or routines. Stroke recovery can be a slow process, and even if the survivor is making progress, it can be upsetting when disabilities block you from reaching your goals or participating in daily routines.

Individuals without disabilities may feel confronted by one of these triggers at any given time. However, individuals recovering from a stroke are often confronted by multiple triggers at once, which can heighten angry outbursts and reactions.

Hopefully, by understanding and avoiding the triggers, you may reduce the frequency of angry outbursts. Up next we will explore specific steps for this.

Managing Anger After Stroke

In many cases, episodes of post-stroke anger and aggressive behavior decline in frequency and intensity as time passes. As the brain heals and survivors adjust to new situations, they may naturally regain control over their emotions.

It works best to take a proactive approach to managing emotions, however, instead of waiting for things to improve on their own. Here are some steps you can take to help reduce angry feelings after a stroke:

1. Understand your behavior

Recognizing the situations that trigger your anger after a stroke may help you manage your mood. As you’ve learned, stroke survivors are often confronted by multiple triggers at once, making it important to be aware of potential triggers so that you can reduce or avoid them.

For example, if you know that large crowds and fatigue tend to trigger angry reactions, take steps to avoid these situations as much as possible. Take naps when you feel fatigued and ask loved ones for help avoiding crowds.

Talking with a psychotherapist may also help you to better understand what situations trigger your anger and how to modify your reactions.

2. Take a Break

Many triggers involve pushing yourself too hard. If you grow frustrated from not being able to complete a task or feeling confused by something, you can take a step back and give yourself a break.

Stroke recovery is a challenging process, and survivors should practice self-compassion to make an already-difficult process more manageable.

Other helpful coping mechanisms include:

• Deep breathing
• Listening to relaxing music
• Meditation and prayer
• Physical exercise
• Closing your eyes
• Expressing emotions through journaling or artwork

If you struggle with unwinding and stepping back from difficult tasks, consider using relaxing tasks to distract you and allow your anger to ease.

3. Talk to your doctor about medication

If anger is getting in the way of your quality of life or damaging relationships with loved ones, you can ask your doctor if antidepressants are appropriate for you.

Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) may help reduce anger after a stroke. Specifically, an SSRI called fluoxetine (Prozac) has been shown to help improve “post-stroke anger proneness” – even 3 months after discontinuation of treatment.

Be aware that, as with all medication, there are side effects that may negate the benefits. For example, some side effects of fluoxetine include anxiety, confusion, and difficulty falling asleep. This can increase some triggers for anger such as fatigue and overstimulation, so exercise caution and work closely with your doctor to monitor your health.

It often works best to use medication in conjunction with other anger management techniques like the ones previously discussed in this article.

Strategies for Caregivers to Prevent Anger Proneness

Immediately after a stroke, a person may have lowered self-control. Therefore, it may fall on family members and caregivers to avoid triggering the person’s anger and frustration level. The following tips can help you accomplish this.

Empathy and self-care

First and foremost, it can help to remind yourself that a stroke survivor’s anger is often not directed at you but rather at their limitations. Even if the person is reacting in a way that is hurtful to you, try your best to practice empathy for the survivor and also practice compassion for yourself, too.

Being a caregiver for a survivor can be difficult, and angry outbursts add more stress to the situation. Take care of yourself by practicing self-care routines like attending support groups, seeing a therapist, and maintaining healthy boundaries.

As we mentioned earlier, if anger turns into violent or aggressive behavior after stroke, you must protect yourself by calling the domestic abuse hotline in your country.

Help fill in the gap

If your loved one has difficulty with memory problems, this may make them feel disoriented and confused. Frequently remind them where they are, what they are doing, and why. This may prevent agitation and overstimulation after a stroke.

Validate feelings when appropriate

As you’ve learned, many triggers for anger after a stroke involve frustration with upsetting circumstances, like physical limitations or insensitive comments from others. You can help ease your loved one’s anger by validating that it’s understandable to feel hurt and upset by these things.

Understanding Anger After Stroke

Empathy is often the most helpful strategy for coping with anger after stroke. It helps to understand that the trigger can be the biological impact of the stroke itself and it’s often not personal. It also helps to understand that survivors are often faced with multiple triggers at once, versus only facing them one at a time before stroke.

You can help ease their upset by reducing triggers that are in your control, such as avoiding crowded areas, encouraging naps to reduce fatigue, and cheerleading their recovery. Remind your loved one of how far they have come and that there is always hope for recovery.

Finally, take care of yourself too. You cannot pour from an empty cup, and it’s important to focus on your own mental health while helping others with theirs.