Personality Influences Psychological Adjustment And Recovery From Stroke

Some stroke survivors are highly susceptible to emotional changes from the brain injury and psychological reactions to that injury. How they cope with the changes – and how well they recover – is based on the individual’s unique pre-stroke persona, according to new research.

“In some cases, two people with the exact same stroke-related deficits can have very different results,” says Lynn M. Grattan, Ph.D., lead author and associate professor of neurology at the University of Maryland School of Medicine in Baltimore. “One person might return to work and social and leisure activities, while the other may end up on permanent disability. Our research is the first to demonstrate that in many cases, personality has a greater influence than the brain injury itself.”

Grattan says healthcare providers should act promptly to identify an individual’s pre-existing personality features including previous methods of coping, problem-solving and emotional styles and sensitivities.

“By harnessing and mobilizing their strengths early on, you can help reduce the disappointment, confusion and pain brought on by the stroke and engage them immediately in the rehabilitation process,” says Grattan.

She suggests that this can easily be done with a brief neuropsychological examination of the patient within the first few days of a stroke.

The psychological reaction to having a stroke can cause feelings of frustration, anxiety, apathy, anger or depression. Depression can seriously hinder an individual’s willingness and ability to participate in rehabilitation, as well as their ability to avoid another stroke.

In this study, researchers hoped to identify which elements of an individual’s baseline personality changed and determine which personality types are vulnerable to depression after a stroke. Investigators studied the personalities of 35 stroke survivors – 20 female, 15 male with an average age of 57. They administered standard psychological tests to the close relatives (spouse, child or sibling) of the individuals who had a stroke. They were asked questions about the patients’ interpersonal style, degree of extroversion or introversion, openness to new experiences and how they coped with stress. The test was given a few days after the stroke and again one year later.

Researchers found that people whose families described them as highly self-conscious or as “deep thinkers” were most vulnerable to post-stroke depression.

“After the stroke, these people became more self-conscious, moody, withdrawn and socially isolated,” says Grattan. “Their subsequent depression made it very difficult for them to participate in and benefit from rehabilitation as they lacked the energy or interest to succeed.”

In contrast, people described as more energetic, outgoing, flexible and self-confident before a stroke can often successfully dedicate themselves to a rigorous post-stroke rehabilitation routine and get themselves back to a higher level of recovery, she says.

Much of stroke care has focused on medically stabilizing patients and sending them home, she says. “While this is clearly crucial for recovery, more attention should be placed on working with patients and their families soon after hospital admission to understand the changes a stroke can cause so that they can all better deal with the stroke-related deficits and subsequent disability.

“Pre-existing personality is exceedingly important to how an individual faces the painful aspects of stroke recovery, how they approach the challenge of rehabilitation and maximize recovery,” she says.

Ultimately, the researchers hope to develop counseling and medical regimes that will optimize psychosocial outcomes following stroke. Grattan’s research was supported by a grant from the National Institutes of Health/National Institute of Neurological Disorders and Stroke.

Co-authors are Marjan Ghahramanlou, M.A.; Jodi Aronoff, M.A.; Marcella A. Wozniak, M.D., Ph.D.; Stephen J. Kittner, M.D.; and Thomas R. Price, M.D.