Understanding Behaviour Changes
In Huntington's Disease
Section
III General Approaches To
Solving Behaviour Problems in HD
Frustration, Irritability,
Anger,
Temper Outbursts
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Frustration, irritability, anger and temper outbursts are behaviours that most of
us experieince in our lives regardless of whether or not we have HD. These behaviours seem to increase when a person becomes
affected with HD because of the deterioration of the caudate
Aggressive behaviours can be particularily disturbing to the family because they
can be a source of fear and tension in the household or in the care facility.
Irritability can take different forms. Irritable responses can become exaggerated
in intensity and duration or punctuated by episodes of explosiveness.
Examples of Frustration, Irritability, Anger, Temper Outbursts
"When I have trouble understanding what he is saying he quickly becomes frustrated
and sometimes violent. I guess he feels his actions speak louder then words."
"She insists upon balancing her own cheque book even though she can no longer perform
this task successfully. When I try to help out she becomes angry with me."
"When I tried to introduce a new activity he became irritable and refused to make
an attempt to participate."
"I asked him to get dressed for the recreation centre. He said No, so I said Come
on, you need to get dressed and he slapped me."
"Ive always lefts my ice cream bowl in the family room when I fall asleep on the couch
at night. In the morning she typically finds it and is annoyed that I didnt take it to the kitchen and rinse out the bowl.
Now she totally loses it. She screams at me over this little sticky ice cream bowl. I cant believe it."
Possible Causes
- Feelings of frustration and anger and their subsequent reactions are usually triggered by real
and legitimate events in life, but the brain cannot control the intensity of the response.
- Frustration and irritability can arise from circumstances that emphasize a loss of ability to
function physically, cognitively, or emotionally. Underlying causes or triggers of this kind of behaviour include hunger,
pain, inability to communicate, frustration with failing capabilities, boredom, difficult interpersonal relationships and,
in particular, minor changes in routine.
- Usually, anger is an emotion that covers for another emotion. Typically when an individual experiences
anger the underlying feeling is disappointment, grief, hurt, frustration, or anxiety.
- Frustration, irritability, anger, and temper outbursts are expressed in response to a true feeling,
but with HD they become exaggerated due to a loss of control from the caudate.
Coping Strategies for Irritability:
- Restructure the persons interactions, expectations, and responsibilities. Such restructuring
may need to take place frequently as more activities become difficult.
- Family members and caregivers should learn to respond diplomatically, acknowledging the patients
irritability as a symptom. Confrontations and ultimatums should be avoided unless the issue is crucial. The environment should
be as calm and structured as possible.
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Coping Strategies for Frustration:
- An awareness of the persons capabilities is very important so that s/he is encouraged to be
as independent as possible and is allowed to take risks without constantly exposing him/ herself to failure.
- Consider a "happy medium" of responsibilities. A non-institutionalized adult should be responsible
for something. Choose tasks that are appropriate (a few plants, sweeping a small area) but not overwhelming (weed the garden,
clean the whole house).
- Close attention should be paid to the signals, verbal or nonverbal, that the patient is
upset or wanting something, so that s/he does not have to get to the stage of making a fuss before s/he receives attention.
- Knowledge of the person and sensitivity to his/her needs means that some situations can be anticipated
and potential frustration defused. It may be possible to identify situations that trigger frustration, and either avoid them
or provide diversional activities.
- Often an overachiever needs help to give up peripheral responsibilities. For example, one caregiver
encouraged his wife, "Let's ask Julie to take over the telephone chain for the women's auxiliary. Of course, you will still
try to go to as many meetings as possible."
Coping Strategies for Temper Outbursts
- Redirect the HD person away from the source of anger.
- Try to identify circumstances that trigger temper out-bursts and then avoid them.
- Assess your own expectations regarding the HD-affected individual. A family member may be unwilling
or unable to accept the patients new limitations.Therefore, there must be a restructuring of interactions, expectations and
responsibilities.
- Confrontations and ultimatums should be avoided. The environment should be as calm and structured
as possible. People with HD tend to become mentally inflexible and are typically comforted by stability. Establish daily routines
and break them as infrequently as possible.
- There are medications that can control irritability. It is important to see a physician who
has current knowledge of Huntington disease.
- HD in itself does not cause an individual to become dangerous, but a loss of normal regulation
of impulses can contribute to unsafe situations. Family members should be responsible for providing a safe environment so
that no person is ever in danger. Remove potential weapons from the house and have emergency numbers near the telephone.
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