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Safety in HD

Dealing with Irritability & Aggression


A common behavioral symptom of HD is irritability. Frequently, this trait is noticeable years before motor symptoms are evident and the episodes don’t necessarily have an obvious goal or desired outcome. Sometimes, it’s easy to spot an episode of irritability before it occurs. Some identifiers include:

  • Deliberately moving into your space.
  • Increased volume of speech (or an increased rate).
  • Intense eye contact.
  • Repetitive questions or comments.
  • Restlessness.

Common triggers that go hand-in-hand with irritability include fatigue, pain, hunger, dehydration, change in routine, medication issues, recent losses, holidays or other special events, or the change in the lives of important family members.

Irritability in HD patients is different than anger or aggression.  It's a specific behavior characterized by:

  • Brief outbursts of rage followed by a long period of calm.
  • Irritability is frequently spontanious and not premeditated.
  • Outward irritability is in reaction to a modest or seemingly meaningless trigger.

There are several things you can say to someone who is irritable in addition to nonverbal cues you can use to help deescalate the situation.  Try some of the following:

  • Don't fight back or argue.
  • Give positive reassurance.
  • Give the person space and don't touch him or her.
  • Let the irritable person do most of the talking while you listen.
  • Make the environment as calm and safe as possible - slowing down or stopping the car, taking kids to another room, or leaving a resturant are some examples of environmental control.
  • Manage your emotions and stay calm.
  • Repeat what you hear the person say so you're sure you understand the concern or problem.
  • Use "I" messages and statements instead of "you" messages and statements.
  • Use a soft tone of voice and don't argue.
  • Use a specific cue to distract the person - call the person's name sharply, make a loud noise, clap your hands - this distraction is to be used each time to send the person a cue it's time to calm down.
  • Use non-threatening body language (relaxed stance, arms at your side instead of crossed, etc.).

The person with HD who is experiencing irritability is typically upset or embarrassed after the outburst.  Untreated irritability can evolve into aggression.  Luckily, irritability is one of the easiest symptoms to treat.  Start by consulting a doctor - if you're more comfortable, you can speak with a doctor alone and request confidentiality.


Aggression can be commonly mistaken for irritability and vice versa. It’s important to note aggression is a more extreme and escalated behavior where property damage or physical damage (to one’s self or to others) can be minor or major. Verbal threats of violence or hitting are surefire signs of aggression. Children who witness aggression are much more likely to become aggressive as adults. Have a plan in place to deescalate the situation or get in touch with your doctor and know what to do in case of an emergency.

For more information about how to handle aggression, how to develop a safety plan, and to learn about strategies you can put in place to handle aggression, reference our tips on behavior management.

Click here for more information on how to deal with Aggression and Irritability in HD.