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Ask the Mental Health Expert Archives 2001-2004

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Changed Personality

Q. A 65-year-old colleague returned to work after a 4-month long illness; she was in intensive care for almost 3 of those months. Prior to her illness she was complacent and timid. I would have liked to have seen her stand up for herself. She returned a different person.

Now, she is assertive, but too often she slips into aggressivity. It does not affect my work, but our mutual boss told me today that it is going to get her into trouble. I have cautioned her to avoid allowing out-of-control interpersonal problems; ones which are in fact NOT completely her fault, ones that have escalated out of control, to get worse by simply leaving the room. That has not worked. But that is not really addressing the issue anyway; the issue is that she is now aggressive.

Is my understanding of the matter, i.e., her personality changed during her illness, possible? If so, is there anything I can suggest for her to do to verify that it is so? Is there any hope that someone, whose personality has changed due to an organic illness, will be able to change his/her behavior?

A. This sounds like a difficult situation for all concerned. Of course, without knowing the nature of your colleague's 4-month illness; possible residual neurological effects of the illness; medications she may be taking; and psychological factors that may be affecting her behavior, it's hard for me to answer your questions with any precision.

It is certainly possible that an individual's personality can change as certain types of illness develop. This may relate to indirect or psychological aspects of the illness, to direct effects of the illness on the brain; or both. Let's take stroke as an example. A person who suffers a stroke may become morose, demoralized, or depressed because he or she is house-bound, isolated, or less able to get around. But the size and location of the stroke (left or right, front or back of the brain) may also determine the risk of post-stroke depression, and this may be independent of the degree of incapacity. This second type of effect is probably due to actual disruption of chemical pathways in the brain as a direct result of the stroke.

Another example is congestive heart failure. Some patients may become more withdrawn or subdued because they feel anxious or depressed over their condition; some may show personality changes as a direct result of decreased blood and oxygen being delivered to the brain--and some may experience both types of effects.

Aggressive behavior, of the sort your colleague is showing, might be the result of damage to the frontal regions of her brain, owing to whatever disease process she has experienced. On the other hand, it is possible that your colleague is more stressed out in the office because she finds it hard to meet the demands of the job, or because some aspect of her personal life is leaving her frustrated and irritable.

Probably the best help you can give your colleague is, first, a sympathetic ear, if she wants to talk about how things are going at work; and--more difficult but perhaps even more important--a recommendation to seek some professional counseling. This would need to be done in a respectful, supportive, non-accusatory manner, and most likely would need to come from your mutual boss.

Some companies have "employee assistance programs" (EAPs) on site, that provide psychological support or counseling to employees with emotional problems. There may be reason, in this case, for a psychiatrist to be involved, since aggressive behavior due to underlying brain dysfunction often responds to psychotropic medication. A thorough neuropsychiatric diagnosis is really the first step, and for this, a geriatric psychiatrist would probably be the best qualified professional to evaluate your colleague.

Depending on the nature of the problem, there certainly is hope that your colleague's aggressivity can be reduced.

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September 2002

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