Behavior Problems

A set of behaviors that is continuous or repetitive, despite negative consequences, could be indicative of a more complex problem. The diagnostic term for behavior problems that appear to be more than a series of bad choices, but rather to have a compulsive or out of control element is “behavioral disorders.”

The group of behavioral disorders accepted by mental health professionals as meeting clinical standards for inclusion in the Diagnostic and Statistical Manual of Mental Disorders is evolving as more is learned about the cognitive and emotional patterns associated with problematic behavior.

Because behavior is motivated by a variety of factors, some behavioral disorders are also listed as emotional disorders. Furthermore, some mental and emotional disorders can present as or result in behavior problems or behavioral disorders. In general, cycles of behavior or sets of repetitive actions that have a negative impact on daily life and personal relationships should be reviewed closely, as intervention may be necessary to preserve the safety and well-being of the individual, as well as that of the family and friends that care about the person.

Common Behavioral Disorders

Behavior problems of the sort that could be professionally assessed as behavioral disorders tend to fall into two very loose groups, organic and emotional. Organic refers to those behavioral disorders that are the result of a physical anomaly in the brain, such as a brain injury, deformity or defect. Those in the emotional category cannot be attributed to a specific physical cause. These groups are loose by necessity because there is a great deal of overlap between the two. Indeed, there are significant differences of opinion between experts, researchers, and in-the-trenches mental healthcare professionals on the classification of some common behavioral disorders.

In some cases, classification can change as more is learned about the particulars of a given disorder. Intermittent explosive disorder, classified within the category of impulse control disorders by Dr. Stephen Hucker, forensic psychiatrist and professor of psychiatry at the University of Toronto, offers a good example of this type of evolution in thought. According to Northern Kentucky University, impulse control disorders are considered behavioral disorders. Intermittent explosive disorder was once thought to be primarily an emotional, non-organic type of behavioral disorder. Indeed, as Hucker points out, there was a time when it was primarily viewed a criminal matter, rather than a mental health issue. However, research into this disorder has revealed that, in some cases, there can be an organic cause. As explained by the Mayo Clinic, organic causes of Intermittent Explosive Disorder can include higher testosterone levels and a malfunction in the production and utilization of serotonin in the brain.

According to the World Health Organization’s Classification

Classification of Mental and Behavioural Disorders Diagnostic Criteria For Research
There is a broad range of behavioral disorders; some of the more common behavioral disorders are:

Attention Deficit (Hyperactivity) Disorder

  • These disorders occur in adults as well as in children and adolescents. While the symptoms may be similar in each age group, the behavior that results may be of a different type, due to different levels of restriction and maturity in each group.

Eating Disorders

  • These disorders include anorexia nervosa and bulimia nervosa. However, it is important to note that these are not the only eating disorders, simply two of the best known.

Impulse Disorder

  • These disorders cover a broad range of potentially destructive disorders. Among these are compulsive gambling, trichotillomania (uncontrollable pulling out of hair), kleptomania, pyromania, intermittent explosive disorder, compulsive self-hurting such as cutting or burning, and some types of impulsive/obsessive sexual behavior.

Conduct Disorders

  • These disorders are often diagnosed as a matter of degree. Oppositional defiant disorder, for example, could be considered a less severe degree of the conduct disorder classification, because it typically does not involve the abuse or harm of animals, people or property, as do more severe forms.

Co-existing Conditions

Anxiety Behavioral ProblemsIt is very common for behavior disorders to be accompanied by other conditions, such as substance abuse or various types of mental illness. Indeed, it is not uncommon for a person suffering from a diagnosable behavioral disorder to have multiple co-existing conditions. Some of these are a direct result of inner conflicts relating to the compulsive behavior, such as from shame at not being able to control the behavior or guilt over harming others via their uncontrollable behavior. According to the National Alliance on Mental Illness, The American Academy of Child and Adolescent Psychiatry and the Massachusetts Executive Office of Health and Human Services, some common co-existing conditions include:

  • Anxiety: This can present in multiple forms, including post-traumatic stress disorder, panic disorders and obsessive-compulsive disorder. Hoarding is a disorder that can fall under the obsessive-compulsive disorder category, although it can also present on its own.
  • Depression: Depression occurs in varying degrees, and at its worst, can be life-threatening, due to suicidal thoughts and tendencies.
  • Mood Disorders: These come in a variety of forms, with one of the currently best known being bipolar disorder.
  • Substance abuse and addiction

Behavioral Disorder Treatment Therapies

Behavioral disorder treatment tends to encompass three approaches in varying degrees of balance, depending on the severity and type of the disorder. There may also be shifts in the balance of these approaches when used in conjunction with each other as symptoms make necessary.

The three primary means of treatment include medication, behavioral modification and cognitive therapies.

Some behavioral disorders are specifically organic in nature, having to do with, for example, differences in brain chemistry that can be normalized pharmaceutically. In some cases, non-organic behavioral disorders can result in temporary or even permanent disruptions in the chemical balance and operation of the brain. Sometimes, lifelong medication is necessary. Medication is frequently used in conjunction with behavior modification and cognitive therapies, and is reduced once coping strategies are in place and behavior triggers are brought under control. If, after a period of treatment, the behavioral disorder can be resolved by behavior modification and cognitive approaches, then medication is no longer necessary.

Behavior TherapyBehavior modification is about controlling behavior. Often in the beginning of the process, the control is external and fairly rigid; for example, a locked door rehab with a highly structured daily routine. During this process, however, there is also a focus on behavior modification that takes place more on an inner plane, resulting not from an external authority’s modification efforts but rather the individual’s desire to modify, control or change behavior. This inner process can take place on a continuum of sorts, naturally segueing into the cognitive therapy approach.

Cognitive therapy approaches, as the name suggests, deal with thought processes. Goals typically include understanding what thought patterns lead to problematic behavior, and to disrupt or replace those thought cycles with those that are healthier or more productive, thus changing behavior. A classic example of this is replacing negative inner dialogue, such as “I am fat” or “I am stupid,” with more positive messages. Learning strategies for thinking around certain problems or issues is another cognitive approach, such as teaching new ways to deal with or view stress, anger and other negative emotions. Instead of, for example, blotting anger out with substance abuse, use communication skills to resolve the matter more constructively. Another cognitive approach to behavior management is learning to self-analyze behavior, such as developing the habit of asking oneself if behavior is in fact in proportion with the situation. For example, assessing whether a specific incident truly merits screaming and cursing rage, and realigning behavior to meet what has been learned to be an appropriate standard of behavior or, failing that, to remove oneself from the situation before behavior gets out of control.

Cognitive therapy provides real tools for managing behavior and for coping with day-to-day living challenges.

Watch for Patterns of Behavior

If a behavioral disorder is suspected, based upon a set of behavioral problems, it is important to watch for patterns.

If, upon careful observation over a period of time, it seems as though there is an element of being unable to control a behavior or set of behaviors despite a desire to, or a compulsion toward such behaviors regardless of the negative consequences experienced, it may be time to consider intervention. Other things to consider are the degree to which people around the person with a behavior disorder enable that behavior, and what can be done to reduce the enabling that doesn’t allow a person to experience the full effect of negative consequences. For example, sometimes it may be necessary to allow an individual to face the full brunt of the legal repercussions of a behavioral disorder or co-existing condition, like alcoholism, in order to motivate a desire to change.

Speaking with an intervention specialist can help one to sort through these issues.

tactic-article