Demanding Controlling Behavior

This post is a bit long, but I feel this topic needs extra attention as this behavior is not only challenging, but exhausting as well.  You’d appreciate a word or gesture of gratitude, however, it may often seem that nothing you do is good enough, no matter how hard you try.  Demanding controlling behavior adds a lot of tension to the relationship, especially when the person you’re caring for is your parent.  Here are some examples of how demanding controlling behavior may be manifested:

Placing a sense of urgency on every request: This becomes more noticeable as the level of independence declines.  For example, at one time they were able to drive to the store whenever they needed something, but now they must wait for someone to take them or get it for them.  In their world, minutes seem like hours, hours seem like days, days seem like weeks, and as such, their sense of urgency grows. They want what they want, and they want it now!

Yelling or cursing: This may be an expression of anger and/or fearfulness about their current condition and what lies ahead.  It’s difficult not to take it personally, but chances are it’s their way of venting and, in a sense, they’re fighting back against their circumstances.

Refusing to participate in their own care: This can take many forms such as refusing to bathe, exercise, get out of bed, follow a diet plan, etc.  It’s important not to jump to the conclusion that this is passive aggressive behavior.  It could be that they are falling into a state of depression.  If this behavior continues or i, it’s best to talk it over with their doctor.

Manipulating you through guilt, sympathy, or other emotions: We’re all familiar with this tactic. As frustrating as it is, we must admit it works much of the time, and this just encourages the behavior to continue. It takes a strong person to stand firm and not give in when it comes to what you know is best for them.

Crying or screaming: We usually associate this behavior with children or someone who is developmentally challenged. However, it’s not uncommon in adults who are overwhelmed by their illness or disability. This behavior demonstrates extreme frustration in action. It will run its course, although probably not as quickly as you would like.

Dropping or breaking things “by accident:” Passive aggressive behavior such as this allows them to be in control without facing the consequences. After all, it was “an accident.”

Giving you the silent treatment: Their silence can be heard loud and clear. They’re upset with you or with their dependency on others to meet their needs. It could be another form of passive-aggressive behavior. However, if it’s combined with other symptoms such as excessive crying, refusing to eat or care for themselves, it could be a sign of depression. In this case, their physician needs to be alerted.

Criticizing everything you do: Every person has their own preferred way of doing things, their own timeline, and their perceived order in which they should be done. When that’s not matched exactly, which is nearly impossible, they become critical of you personally. They’re really just upset that they aren’t able to do it themselves, in their own way.

Complaining no one cares about them: Coming to grips with a disability or facing death is a lonely journey. No one can do it for them. You and others are offering support, but the bottom line is they must find their own inner strength to work through it. This journey must be done within themselves, and is indeed a lonely one which can often be confused with feeling no one cares.

Note: You may be experiencing the same feeling on your own journey as family caregiver. Once again, determining if you are in a maze or walking the labyrinth will be a factor in how the journey goes. Your path will become an example and source of strength for your loved one as well. Never underestimate how much your attitude, words, and actions affect those around you.

Pestering until they get what they want: Eventually you’ll reach a point of exasperation and give in. We’ve all been there. The problem is, you’ll give in begrudgingly and a negative tone is set. Now, you’re angry and they’re not as happy as they thought they’d be because of your reaction.


All of the behaviors listed above can be very challenging, testing your patience. Why are they acting this way?  Realizing what’s at the root of their behavior can make it more tolerable. There are several possible underlying causes for these unwanted behaviors. Consider the following.

Personality Trait:  If the person always had a tendency to be demanding and controlling, this trait will now be intensified. A person is always at their worst when they don’t feel well or are under stress.

Loss of Independence: Your loved one’s world may be shrinking for a number of reasons such as losing the ability to drive, relying on others for their care, or experiencing diminished cognitive function. They’re trying valiantly to hold onto their independence by controlling as much as they can in their environment, and this includes you.

Loss of Self Esteem: A person’s dignity is as important as food, water, shelter, and love. If your family member has lost purpose in life, he/she starts to feel useless and worthless. They may find purpose now in controlling those around them to feel important again and gain attention.

Boredom: Something as simple as not having enough to occupy their minds and hands can lead to demanding behavior.  The days and nights will seem endless to them if they having nothing interesting to do.

Fear: Facing the unknown is unnerving for you, so imagine how frightening this is for your loved one. With so much time on their hands, they imagine all sorts of awful scenarios. Who will take care of me? What if I don’t recognize my friends and family in the future? What if I can’t tolerate the pain? What if I have to go to a nursing home and no one comes to visit me? What if I run out of money? How long will I have to live like this? The list is endless.

You’ve probably heard the adage, “The best defense is a good offense.” When a person is frightened, they may go into the offensive mode, exhibited by controlling behavior.

Anger: Imagine how you would feel in their situation. Anger and resentment are normal reactions to a debilitating or terminal illness. This emotion may linger until they are able to accept their reality. Until that occurs, the anger may be exhibited by constant demands.


This list is not complete by any means; however it will give you some insight into the possible triggers causing this behavior. If you can figure out the root of their actions, you will find it easier to come up with a solution. Here are some suggestions for managing this undesirable conduct:

Inclusion: Include the person in as many choices as possible pertaining to their care. For example, ask for their input in developing their care plan, in compiling important documents, in deciding what to eat, what time of day (and which days) they want to bathe, what clothes or pajamas they want to wear, what room they want to sit in, etc.

Respect: Ask for their opinion about anything, such as TV shows, books, news stories, old movies, child rearing, what color looks best on you, etc. By asking them about even simple things, they will feel a sense of value. It gives them dignity and respect.

Involvement: Give them something to do based on their abilities. If they’re able to use a computer, ask them do some research for you, or look up something they’ve shown interest in, or use social media as a way to touch base with friends.  If they enjoy drawing or coloring, offer coloring books, sketch paper, paints, colored pencils, and the like.  If their abilities are limited, you might have them sort through a container of buttons or yarn and sort them by color or size. Giving them something to do with their hands, even as simple as shredding junk mail or finding an item in a catalog gives them a sense of purpose and occupies their mind.

Mental Activity: Are they able to read? If not, is there someone who would like to read a story or a newspaper to them? Perhaps they would enjoy listening to audio books from the library. Subscribe to their favorite magazine. Offer crossword and jigsaw puzzles. Encourage them to write a note to a friend or family member.

Legacy: Ask them to tell their own story in their own words by using a tape recorder. Give them a specific topic each time so they stay focused and avoid rambling. For example, if the person is elderly they can talk about their school days, where they grew up, what they did for entertainment, what jobs they’ve held, etc.  This is good for their memory and they’ll feel a sense of accomplishment. If the person is young, they can talk about their dreams and wishes, or use it as a daily journal. This is a great opportunity for them to talk out loud, which they may not do as often anymore due to decreased social interaction. As a bonus, they can also listen to the tapes anytime they like.

Communication: Communicate clearly and in simple terms anything you’re doing regarding their care. For example, “I’m going to warm up some towels now for your shower.” When they understand what’s going on, their fears and anxiety lessen.

Attitude: Keep a cheerful attitude with them. Avoid arguing or raising your voice. If you find yourself reaching your limit, walk away for a few minutes for a breath of fresh air.

Prioritize: If they’re trying to control things by not cooperating with their care, determine the priority of the matter. If it’s possible to postpone the task, ask them to choose a specific day/time to do it and then follow through.

Rewards: Be sure to offer thanks and praise when they’re cooperative and courteous with you. Positive attention will be something they seek, making your life a bit easier.


I hope you have found this post about demanding controlling behavior helpful in caring for your loved one.  If so, please “Like” by clicking the button below.  You may also find my Amazon Kindle book “Gentle Caregiver: Practical Advice & Support for the Family Caregiver”  to be helpful as well.

Paranoia

Someone suffering from paranoia can be difficult to care for as their delusions and fears can be extreme.  Imagine what it would be like not knowing who you can trust.  The ever-present anxiety must be exhausting, and it can get in the way of their care routine.  Some of the more common fears associated with paranoia include the following:

People are stealing from them.  This can be exhibited by insisting on keeping certain items with them. They may start  hiding personal belongings or other items. If they forget where they’re hidden, it reinforces their belief of being a victim of theft and the cycle continues.   They may make repeated calls to the police.

They’re being poisoned. This could be the reason behind their refusal to eat or drink what’s prepared for them. They may also refuse medications for this reason.

People are plotting against them. This fear becomes magnified if their sense of hearing is failing, because they may misunderstand what is said or believe everyone is whispering so he/she can’t hear their plot.

Family or friends are actually strangers in disguise. This could result in fearful and angry outbursts, uncooperative behavior, hiding, and withdrawal. In a worst case scenario, they could become violent.

Spies are watching them. This could be part of a delusion that they’re extremely important.  You may find them in a darkened room with the blinds or curtains drawn. They may refuse to leave the house.  It’s also likely you’ll discover electronics such as computers, televisions, radios, lamps, phones, etc. dismantled as they search for evidence of spy technology.

Others want to bring harm upon them. They may isolate themselves and/or keep weapons at hand for protection.

Their mind is controlled by the government or alien beings. This could also be the result of delusions regarding their intelligence and imagined high standing in society. Auditory hallucinations (hearing voices) are apt to feed into their belief.

What causes paranoia? It’s not an illness in itself, but rather a symptom of an underlying problem such as:

  • Schizophrenia
  • Psychosis
  • Dementia / Alzheimer’s
  • Enzyme imbalance
  • Toxicity related to failing liver or kidney function
  • Personality disorder
  • Extreme anxiety or prolonged stress
  • Lack of sleep
  • Dehydration
  • Drug addiction
  • Traumatic experience

It’s sad, and sometimes frightening, to watch someone you love living in fear. Here are a few suggestions to help you handle this challenge:

Avoid arguing with them or trying to prove them wrong.  Reasoning rarely works and it could result in their loss of trust in you.. They may act as though they see your point, but do they really, or are they just playing along to throw you off track?

Check your body language and tone of voice. Relax your muscles so your hands are open, your jaw and face are at ease, and your arms are at your side or folded in your lap. Speak in a calm manner. You don’t want to raise any alarms with them by your unintentional actions.

Remind yourself that their fears are real to them. Acknowledge their concern, but don’t dwell on it. Divert their attention to something pleasant such as their favorite activity, book, TV show, etc.

Learn where their favorite hiding places are. It’s not unusual for a paranoid person to hide something and move it repeatedly until they no longer remember where it is.

Be sure they’re getting enough fluids. Keep an unopened bottle of water or their favorite beverage within easy reach. Let them choose what foods they want to eat.

Keep weapons such as knives, guns, bats, and anything that could be used to cause bodily harm away from them. Paranoia may lead them to initiate defensive and/or offensive actions. Think “safety first” and remove yourself if necessary.

Make note of their behavior on their care plan, and include anything that might have triggered it.  Relay this information to their physician, who may prescribe medications to alleviate the symptoms.

Difficult Behavior: Poor Hygiene

As far as difficult behavior is concerned, poor hygiene is one of the more difficult subjects to broach. You don’t want to hurt their feelings or seem insensitive, yet something needs to be done.

The signs of this problem are fairly obvious to everyone it seems, except perhaps to the offending parties:

  • Unpleasant odor
  • Greasy hair
  • Bad breath
  • Dirty and/or food-stained clothes
  • Long finger/toe nails
  • Disheveled appearance
  • Open sores

You might wonder how anyone can stand living like that. Actually there are several possible underlying causes.  Here are some of the more common ones:

Depression  Someone who is severely depressed doesn’t care about their appearance.  They don’t have the energy or motivation to take care of themselves.  Reasoning and trying to ‘talk’ a person out of a clinical depression is not going to work. They will need professional help and possibly medication.

Dementia  This condition often brings other difficult behaviors along with it, such as aggressiveness, paranoia, hallucinations, unwillingness to cooperate, and more.  In this case, you may need assistance from another family member or a professional caregiver to carry out the tasks associated with hygiene.

Sense of Sight and Smell is Failing  The person may have no sense that anything is amiss.  They’re used to the smell or their sense of smell may be failing.  If their vision is also failing, they don’t notice stains on their clothes, or uncombed hair, etc.  In this case, it’s best to politely let them know about the problem and take steps to assist them with their grooming needs.

Memory Problems  It could be they simply don’t remember that bathing, brushing teeth, washing hair, etc. needs to be done routinely.  This is where a care plan, in which they’ve had input, can add structure to their daily routine.  A daily list may be helpful as each item can be checked off as completed.  This could be especially appropriate for someone who is living semi-independently, but is forgetful.

Inability to Keep Track of Time  Most of us live by the clock and calendar to ensure we meet deadlines, remember appointments, and such.  This gives us a clear picture of where we are in our life’s timeline.  However, for young children, those with dementia, and elderly people who have no set schedule, time has less meaning; everything just flows together.  For example, it may have been a week since they brushed their teeth, but to them it seems it was yesterday or perhaps only a few hours ago. 

It may help to have what I call ‘markers’ during the day.  For example, do they watch the news or a cartoon first thing in the morning?  Make it routine that when the program ends, grooming begins.  Or it could be right after breakfast.  Whatever ‘marker’ you choose, be consistent so that it becomes habit.  This structure will also add to their sense of well-being.

Fear of Falling, Vulnerability, Embarrassment, Discomfort  No one likes to feel exposed and vulnerable.  Those with disabilities or the elderly have a definite fear of falling, and may also find they chill easily.  It’s understandable that showering or bathing in these instances is something they dread and want to put off as long as possible.

Regression  This is especially true for someone with Alzheimer’s.  They may need someone to take the initiative for their hygiene as they are not able to handle it themselves.  If you think about how their life was ‘in the olden days’ you’ll realize they probably only bathed once a week.  That was the norm in those days and they don’t understand why it needs to be done so often now.

Control  This is a means of claiming independence.  They don’t want to be told what to do or when to do it, so they go to the extreme just to prove that they are still in control of their life.  This can happen at any age.  It’s a passive temper tantrum without the kicking and screaming.

Medical  Many medical conditions, and sometimes medications, can cause loss off muscle control leading to incontinence, involuntary bowel movements, drooling, and spilling food.  This causes embarrassment for them and they may try to hide it.

This is one serious aspect of poor hygiene that cannot be ignored as it can lead to skin ulcerations and bladder infections, as well as contaminated furniture, clothes and bed linens. In a worst case scenario, this could result in septicemia, a life threatening infection. Refusing a cleanup is not an option in this case.  

What Can Be Done in General:

  • Try to determine the reason for the behavior; speak with their doctor about it.
  • You may need to lower your standards. Bathing 1- 2x per week may be adequate, with spot cleanups as needed.
  • Prepare a bowl of warm water, soap, and wash cloth/towel for a “bird bath” if they’re fearful of the tub or shower.
  • Provide a shower chair, non-slip mat, and hand rail if they have a fear of falling when bathing.
  • Offer to assist them. Move slowly and explain what you’re doing as you proceed, and for your own protection, wear disposable gloves. Be gentle and speak in a soothing tone. Keep their private parts covered with a towel and ensure that no one else is going to walk in. Dry each area before proceeding to the next to prevent chills.  There are also packaged disposable towelettes available for quick cleanups; just carefully warm them in the microwave  before use.
  • Help them brush their teeth, or offer to clean their dentures for them.
  • Keep their hair short. Use a dry shampoo if necessary or run a wet wash cloth with shampoo through their hair, rinse with a wet wash cloth, dry, and comb into place.
  • Help them shave.
  • Use pads or diapers if they have problems with bladder or bowel control. Keep bedding, clothes, and furniture clean and dry to avoid sores, odors, and infections.

Providing hygiene to another is distasteful to some people.  This is nothing to be ashamed of.  Keep in mind, your discomfort will be transferred to them, so it might be better to find someone else to handle it, or hire a home health aide.

Other difficult behaviors a family caregiver may face can be found by clicking here.


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Behavior Problems: Identify the Challenges

IDENTIFYING CHALLENGING BEHAVIOR

There are many common behavior problems caregivers face, and they’re probably the most frustrating and challenging to handle.  They’ll test your patience and challenge your creativity to maintain peace.

Look over this list and see if any sound familiar.  Those that are underlined are linked to a post.

Demanding / Controlling

Crying / Pouting / Temper Tantrums

Paranoia

Hallucinations

Physical, Verbal, or Emotional Abuse

Poor Hygiene

Fits of Rage

Refuses to Cooperate

Offensive or Inappropriate Language

Repetitive Questions, Stories, or Complaints

Wandering

Each one of the behaviors listed will eventually have its own post under this category.  If you’re struggling with a different behavior issue, please send me a message via “Contact Marti” and I will try to address it, or post your concerns in the Comments section below for an open forum discussion.

WHAT CAN I DO NOW?

Do your best to remain calm.  As a rule of thumb, yelling at them or arguing will only serve to escalate the situation.  This can result in a snowball effect.  It certainly doesn’t help them, and it most certainly will increase your own stress level, which is the last thing you need.

While it’s sometimes difficult not to take things personally, try to understand these problems are usually a manifestation of their illness or feelings of helplessness.

Report any changes in behavior to their doctor or hospice team.  Some of the behaviors could be a side effect of one of their medications.  It could also signal a deterioration in their condition.

Track the incidences:  date, time, behavior exhibited.  This might give a clue as to the cause.  For example, does it occur at a specific time of day or night? After taking a particular medicine?  After a certain person visits?  etc…

If necessary, walk away for a few minutes to calm yourself.

If you or the patient are in risk of bodily harm, call 911 for help, then notify the doctor or hospice care team.  Abuse is never acceptable, and you will be of little help to them if you’re injured.


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