Irritability and irritable aggression are common symptoms of Huntington’s disease (HD). Fortunately, irritable aggression related to Huntington's disease is treatable with medications and environmental interventions. Some facts you should know:
- About 22% of patients with HD who live at home experience aggression.
- As many as 60% of people with HD living in long term care facilities become aggressive.
- Episodes may occur years before onset of motor symptoms or worsen as the disease advances.
- If left untreated, aggression may cause significant disruption of interpersonal relationships, affect work performance, risk placement in a long-term care facility, or prompt intervention by emergency responders.
Help is available! HD Reach takes an evidence-based approach to helping patients and HD families manage HD related aggression, whether fear of aggression is the main concern or care is required after an aggressive episode has already occurred. Every person with HD can benefit from healthcare interventions, compassionate care, and support. If you want to learn more, see the topics below:
- How we describe behavior matters.
- Why do people with HD become irritable or aggressive?
- The Spectrum of Irritability.
- Being Safe
- Where do I start?
- Choosing the Right Interventions.
- Where can I get help
How we describe behavior matters.
The following language has been used to describe HD related behavior. It’s helpful to understand which of these terms best describe the person you know with Huntington disease.
Anger is an emotion that motivates and energizes us to act. It is a natural response when personal rights have been violated, or a person has been wronged. It can be a healthy and reasonable response, with positive consequences.
Irritability is a prolonged emotional state or mood in which a person can be short-tempered or easily annoyed. Often, it results from periods of fatigue, excessive stress, or pushing ourselves beyond our limits. It rarely results in positive consequences.
Aggression is a behavior motivated by an intent to cause harm to another person who wishes to avoid harm. In other words, an altercation between two people only one of whom wants to cause the other harm is more than a fight, it’s aggression. Aggression can be defensive or offensive. It is often a form of communication but is never constructive.
Violence is an extreme subtype of aggression, a physical behavior with the intent to seriously injure or kill another person. It can be impulsive or premeditated, based in disordered thought processes or cool-headed planning.
Agitation is a state of psychological and physical restlessness, manifested by pacing, hand-wringing, gesturing, hostility, excitement or distress. It can be associated with disease states, such as delirium or dementia, or related to distressing psychological factors. Understanding the difference between aggression and agitation in people with HD requires that the observer understand the circumstances around the behavior, taking into consideration the demands of the environment and the stressors that could potentially precipitate the behavior.
There are reports in the medical literature and in case law that describe individuals with HD who demonstrate the broad range of these behaviors. It’s important to note that sensational descriptions of HD related behavior make good news and garner intense social media attention. It doesn’t mean, however, that aggression will inevitably happen in your family, especially with knowledgeable medical care, good preparations and planning for change, stressors, and disease progression.
Why do people with HD become irritable or aggressive?
Irritable aggression in HD is related to uninhibited anger or frustration. The abnormal HD protein directly damages the part of the brain responsible for control over impulses and activation of behavior. Normally, there is a “gate” in the brain that allows an impulse to become a behavior, opening when it’s appropriate to act and closing when it’s not in your best interest to act. For the person with HD, it’s like the gate is constantly open (disinhibition), constantly closed (apathy), or very inconsistent (unpredictable).
Many cognitive disabilities in HD are due to a problem with awareness. Before the individual became ill, these same cognitive abilities were also unconscious. It’s hard to imagine how frustrating HD related cognitive impairments can be when you can’t even explain to yourself or others what is wrong.
The combination of frustration and disinhibition results in irritability. Continued lack of understanding by all involved results in escalation. Only when symptoms are improved with understanding, appropriate medication and reducing environmental demands can the person with HD recognize what skills they were missing.
What can HD Reach do for you?