Sharon McClellan Thomason
Understanding Irrational Behavior in Huntington’s Disease
It happens out of the blue. There you are, going along with what appears to be a somewhat normal moment in time, when suddenly the irrational behavior rears its ugly head! It isn’t that you have never seen this before. It’s that even though you have seen it, you are still caught off guard. One second, your loved who has Huntington’s disease seems rational, and then suddenly, he or she is anything but. How does one cope with irrational behavior?
First, let’s talk about the why. Knowing the why won’t change the behaviors you see, but it may help you to wrap your head around what is going on. The brain of the person with HD is being attacked. We could go into all kinds of medical and scientific descriptions about that, but rather than do that, let’s understand it in simple terms. The brain is being attacked, injured, damaged, and brain cells are being murdered. When that happens in the frontal lobe of the brain, it impacts behaviors.
Some factors that trigger irrational behaviors are:
Frontal lobe damage erodes impulse control. At times, we may all have some irrational thoughts, but our impulse control allows us to get rational again and to get control of any irrational thoughts. That is an impossibility for people with Huntington’s disease who are experiencing irrational thoughts or irrational understanding. The brain has taken off on its own direction of thought, and what the brain believes to be true is true to that person. To someone with HD, every one of those thoughts is real and true. And they behave accordingly.
People with Huntington’s disease can feel very anxious when their brains aren’t working for them like they realize they should be. Their ability to cope is undermined, they feel a loss of control, and their anxiety begins to rise. This isn’t the basic anxiety that a person without Huntington’s disease faces. This is an intense, all-consuming anxiety that begins to overwhelm them completely.
With so many emotions swirling around all at once, it is confusing and extremely overwhelming. There is no way for people with Huntington’s disease to sort through all of those extreme emotions. It becomes so overpowering that it removes rational thought from them. Just coping with those emotions is more than they can do; forget adding rational thought to that. Even if the processing of the brain allowed rational thought at that point, this extreme mixture of emotions would hijack it.
Confusion of thoughts and emotions
There’s a part of the person with HD that will fight to find what is true, what is going on, and even what is rational. Much like being in a room full of mirrors with hundreds of reflections, people with HD are seeing all of these thoughts and emotions, and they’re trying to figure out which is real. They may doubt if any of them are real, yet then believe all of them are real. Imagine how overwhelming that would be. The only survival available is to choose, to decide what is real and hang on to it. Unfortunately, that often can be the irrational thoughts that take over.
Things just aren’t adding up. Things aren’t working like they should work. And there is no way to understand why, or to sift through things and get them lined up again like they should be. That is where the frustration begins. A loss of control. A loss of understanding that is frightening and overwhelming. It often comes out as frustration because acknowledging the fear that they truly are “losing their mind” is too much to process or accept.
Being hungry, thirsty, or having pain or other unmet needs isn’t something that people with HD can always express or process. Their bodies may hurt, but their minds may not tell them what they are feeling is pain. They may be hungry but can’t express their hunger. Gnawing at them is some feeling they can’t communicate, process, or meet for themselves. And yet, the feeling is relentless. They are at a loss of what to do. Remember, HD erodes the ability to know how to choose or how to do an act. The desire to act is there, yet all that comes out is to be frozen, unable to act on what they want to act on or unable to choose how to do it.
Perception, Unawareness, Lack of Emotional Recognition
Adding to this terrifying scenario is the inability to perceive exactly the responses around them. People with HD may be unaware of others’ responses, emotions, and much more. Although the facial cues that we normally would see and understand are there, they can’t pick up on those cues. They are left without understanding of any response, or they become extremely confused at the responses being received. When responses are negative or unexpected (and they are all unexpected), it’s like being hit in the head with a two by four. They are caught off guard, and now, added to all the above extreme confusion they are going through, they are baffled and often irrational. Reality is fractured.
Although it is natural to attempt to rationalize with a person who is behaving irrationally, all these factors make a rational discussion or reasoning with an irrational person with HD futile. This may sound hopeless, but it isn’t. Thankfully, there are ways to manage and to cope with irrational behaviors. Those will be discussed in a follow-up article.
About the Author
Debra E. Andrew lives in Utah, is happily married, has seven children, 23 grandchildren, and one soon-to-be great grandchild. Her love of health and wellness has led her to empower others in all eight areas of health and wellness in her daily life and businesses.
Debra is the creator of Business Hands, a non-profit serving those who are disabled and their caregivers; the founder of Power HC, PWR HC – Preventative Wellness Resource Health Community; a Huntington’s Disease Regional Advocate; and she has established several Facebook groups supporting those with Huntington’s disease, their caregivers, and families. She also has a blog, http://hdinsider.weebly.com, where you can find more of her articles.
Debra’s educational background includes Business Management, Marketing, and e-Commerce, and she holds a B.S. in Community Health and a minor in Community Health Education. She is also a Certified Brain Health Coach.
Debra’s husband, Allen, has Huntington’s disease, and Debra is his full-time caregiver. The Huntington’s disease incidence rate in Allen’s family is 80 percent.
The Huntington’s Post is made possible by grants from Teva Pharmaceutical and The Griffin Foundation.