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Problem behaviour, overreaction and cathartic attacks

“Problem behaviour” is any behaviour that is socially unacceptable. People with dementia usually use their behaviour to communicate the way they are feeling or to express themselves. In time, you, as the carer, will be able to identify what the person is trying to tell you, and then learn how to deal with the behaviour.

When people with dementia show problem behaviour, we must always remember that they are still the same people that they were before the dementia. Their world has changed so much. They now live in an environment that they do not know and with people they do not recognise. They have no control over what happens and are trying to make some sense of it. What a frightening experience! To make matters worse, they try to tell people how they feel and what they want, but they’re not understood.

Unlike you, people with dementia are not in control of their behaviour, thoughts or actions as it is part of the illness, and confusion or a misunderstanding may cause their behaviour. Therefore, you may need to change the way you do things. You will need to control your anger, responses and expectations of the person. It is up to you to turn around and walk away when being verbally abused or attacked. The person is not trying to annoy or irritate you, but communicating a need or feeling.

Different types of “problem behaviour”:

  • Behaviour may be caused by people’s personality and history or by their present environment or people that they are with. There is no hard and fast rule to solving behaviour problems as what works for one may not work for another.
  • Be aware that some people may behave in a way that actually gives them comfort and keeps them busy. Sometimes we should allow people with dementia to carry out their “different” behaviours that will not affect anyone else but are important to them, and they might find comfort in them. Examples would be continually packing a suitcase, tidying a cupboard or hiding a handbag in the bed.
  • It is important to ask yourself, “Is the behaviour a problem and if so, to whom is it a problem?” You might find that it’s not really such a problem that it needs to be stopped. The behaviour may be more of a problem for you or others, than it is for the person with dementia.
  • All types of behaviour occur for a reason. They may be the result of feeling discomfort, confusion, fear, or loneliness. It is important to try to find out what the problem is. Maybe the person has an infection or pain, but cannot tell you. It is therefore better to let the doctor know.
  • It may sometimes happen that for no reason you can think of, the person you are caring for suddenly shouts, screams, hits out, swears, cries or laughs. Often, it looks like “having a tantrum”. This is known as “over-reaction” or a “catastrophic reaction” and happens when the person reacts to a remark or something that happens. Whatever caused the person to react this way is called the "trigger". Again, s/he is trying to tell you that something is wrong.

What to do if this behaviour occurs:

  • Never lose your temper. Turn around and walk away, as losing your temper will make things worse. Arguing will also make matters worse. Rather, go and do something to keep your mind off what happened. The person will probably forget about the incident quite quickly. Making something for both of you to drink could also help things return to normal. Should you ever feel that you might lose control of your temper, look for help from people who understand your situation, such as the doctor or support group.
  • Should the person become violent, get out of the way as quickly as possible, leaving the room if necessary, and return only once s/he has calmed down.
  • Arguing with the person who has dementia will only frustrate both of you as that person is not able to reason or understand why you are upset.
  • Do not try to reason with someone in this state. Concentrate on remaining calm and try to distract or reassure the person. If necessary, take the person away from the trigger.
  • Do not use punishment – s/he is not a child.
  • If the person laughs or cries, overreacting to a trigger, try to distract her/him, as the laughing and crying is not a show of emotion but hysteria, and can exhaust the person.

Steps to take to prevent the behaviour re-occurring:

  • If you can find out what the triggers are, you may be able to work out how to prevent them.
  • Try to keep both the environment and the activity calm. The environment could include the TV, radio, other, noisy residents or an unfamiliar place.
  • There may be a warning sign before the outburst. This warning sign depends on the person but may be increased agitation or restlessness. If this happens, try to distract or reassure by gently touching the person or putting your arm around her or him. Do not make it seem that you are trying to hold the person down or s/he will fight you.
  • Do not change familiar routines. Try, as much as possible, to keep to a routine and to familiar surroundings.
  • Perhaps the person has become frustrated about a task s/he can’t do or doesn’t want to do. Remember that people with dementia often have severe reactions to feelings of failing at a task. When you show or tell them what to do, give the instructions one at a time, with plenty of time between tasks for the person to carry them out. Don’t give too many choices, as this will confuse them. Ask, “Do you want to wear this dress?” (showing her the dress) rather than, “Which dress do you want to wear?”
  • You also have your needs and there will be times when you feel that you cannot face the day with the person, or you feel that you might shout or even hit out. If this happens, try to avoid letting the person see how you feel as people with dementia can be very sensitive to moods and will pick up yours quickly and react in the way that you feel. Take a walk on your own or sit in a quiet corner and try to relax.
  • Attend an Alzheimer's SA support group if there is one in your area, as the people there will understand your problems and will be able to give you support and advice.

Of course, sometimes you might become so angry that you overreact and are unkind. On these occasions it might be helpful to distinguish between being angry because of the person’s behaviour, and being angry with the person.