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HD Reach
2409 Crabtree Blvd, Ste 107
Raleigh, NC 27604

Monday through Friday 9 AM - 5 PM

HD Reach
2409 Crabtree Blvd, Ste 107
Raleigh, NC 27604

Monday through Friday 9 AM - 5 PM

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 of 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 spontaneous 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 restaurant 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 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

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.

There is no arguing that choosing what to do about HD related aggression is a very hard task.  It’s emotionally difficult, socially complex, and involves risk. HD Reach social workers can help you step back and take a moment to ask yourself what you really want to change and accomplish. Once you are very clear about what needs to happen, choosing the appropriate interventions becomes less complicated. 

HD Reach social workers will help you choose interventions that are: 

  • Goal-directed:  Meeting the legitimate needs of the person with HD and the family or potential victim(s)
  • Reasonable: The least intrusive and controlling intervention possible.
  • Rational: Taking into consideration the progressive nature of HD and the many losses associated with having HD.
  • Effective:  Likely to achieve the goals of the intended intervention.
  • Timely:  So that no one has to suffer longer than is absolutely necessary.
  • Resourceful: Taking into consideration all the resources available to address the problem.

For more information about how to handle aggression, attend a Compassionate Care Workshop or speak with your social worker about developing a safety plan, and other strategies you can put in place to handle aggression. 


 

To learn more about the behavioral symptoms of HD and how to manage them, see the following: 

Understanding Behavior in Huntington’s disease, Paulsen and Johnson, 2016. This publication can be downloaded for free from the Huntington’s disease Society of America): 
http://hdsa.org/wp-content/uploads/2015/03/Understanding-Behavior.pdf 

When Someone You Love Has a Mental Disorder, Rebecca Woolis, MFT, 2013. This book can be purchased from amazon.com or other booksellers. Although not addressed to the HD population specifically, there are many tips about mental illness that apply to persons with HD. 
http://rebeccawoolis.com/When-Someone-You-Love-Has-a-Mental-Illness.php 

Law Enforcement Training Guide:  This publication can be downloaded for free from the Huntington’s disease Society of America at 
http://hdsa.org/wp-content/uploads/2015/05/HDSA-LET-Guide1.pdf 

Huntington’s disease Awareness for Law Enforcement:  This publication can be downloaded for free from Help4HD International at 
https://help4hd.org/wp-content/uploads/2016/04/LE-Brochure-Officer.pdf 

HD Reach
2409 Crabtree Blvd, Ste 107
Raleigh, NC 27604

Monday through Friday 9 AM - 5 PM

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