Emotional distress, especially anxiety, frustration and depression are common problems after stroke and other chronic, disabling illnesses. Other common difficulties include over-dependence on others, inflexible or rigid thinking, impatience, irritability, impulsiveness, denial, lack of awareness of problems, insensitivity to others, and poor social perception.
The emotional reaction to the physical changes of stroke is complicated and compounded by cognitive deficits in language, memory, visual perception, planning and judgment. These cognitive problems can contribute to emotional problems in a number of ways. For example, a stroke survivor may jump to conclusions after considering only part of the relevant data. This can lead to misinterpretation of emotions of others and erroneous conclusions.
Depression is a common emotional problem following stroke. Stroke survivors at first may not be depressed because of limited awareness of their deficits, but as they become more aware of the losses caused by the stroke – loss of mobility, energy, occupation, hobbies and cognitive abilities that accompany their disability – they become anxious and depressed.
Many question their self-worth as people tend to value themselves through their activities.
Anxiety after stroke is common and frequently is associated with periods when the person is left alone, leading to greater dependence and loss of freedom for caregivers.
Irritability and inability to control anger often lead to temper outbursts. Such outbursts are usually verbal rather than physical and are sometimes viewed with remorse by the patient.
A stroke survivor may not be aware of the disability caused by the stroke. In some cases, the survivor will deny the existence of the paralyzed arm or leg. In a later stage of rehabilitation, he or she may acknowledge the disability but not realize the full implications of it.
It is sometimes hard to assess the emotional problems of the stroke survivor because of language deficits, denial or unawareness of the disability. Medications may also affect emotional responses. In some cases, common symptoms of the stroke – lack of appetite, fatigue, decrease in sexual relations – may be misinterpreted as depression.
The greater the changes in the survivor’s cognitive and emotional behavior, the greater the suffering experienced by the family. The stroke survivor may be demanding, depressed, irritable and unable to initiate affection or to empathize with others. Family members may react with depression, anger or guilt.
Family members often hope for complete recovery and are disappointed when it does not occur. The spouse may be left without a partner who can participate meaningfully in the activities of life.
Stroke survivors and their families need time to adjust to the changes caused by the stroke. Stroke support groups can be helpful during this period of adjustment. Learning from others who have “been there” is extremely valuable.
However, in some cases, professional therapy may be needed to help the stroke survivor and/or family deal with the emotional problems related to the stroke.
Sexual concerns at first may be limited or of no importance to most stroke survivors. But sex becomes increasingly more important as the survivor resumes daily living activities.
Sexual behavior is a function of physical and psychological variables. Medications may affect sexual relations. One common worry is that another stroke could be caused by sexual excitement. Another concern is that the stroke survivor feels unattractive and undesirable because of the physical changes after the stroke. Stroke survivors can still achieve satisfaction and intimacy, especially if these feelings existed before the stroke.
Right vs. Left Brain Damage
Emotional problems vary depending on the location and extent of the brain damage. Neglect, indifference and impulsiveness are more common with right-brain damage, as well as anger and frustration. Communication problems, tears and bursts of anger are often observed with left-brain damage. Family problems are more often associated with right-brain damage because of the inability of the survivor to express emotions and solve problems. The expectations for full recovery are often greater because the survivor is also able to communicate; consequently, the potential for disappointment and frustration is also greater.