What is Distressed Behaviour in Health and Social Care?

Distressed behaviour refers to actions, reactions, or emotional expressions from a person who is experiencing physical discomfort, emotional upset, or psychological distress. It is commonly seen in health and social care settings, where individuals may be dealing with illness, injury, disability, or difficult life situations. Distressed behaviour is often a way for a person to communicate that something is wrong, even if they cannot put it into words. This may be because of a communication difficulty, cognitive impairment, or simply being overwhelmed.

In plain terms, distressed behaviour is the outward sign of inner upset. It can range from visible emotional behaviours, like crying or shouting, to more subtle signs such as withdrawal or refusing care. Understanding what causes this behaviour and how it presents is key for staff working in care settings, as it helps them respond appropriately and support the person in a way that calms and reassures them.

What Causes of Distressed Behaviour?

People in health and social care environments may show distressed behaviour for many reasons. Some common causes include:

• Physical pain, discomfort, or illness
• Fear, anxiety, or confusion
• Feeling unheard or ignored
• Frustration due to communication difficulties
• The effects of certain medical conditions or medications
• Past trauma or negative care experiences
• Environmental factors such as noise, overcrowding, or lack of privacy

When a person’s needs are not met, or when they feel unsafe or misunderstood, distress can arise. Sometimes the triggers may be small, but if the person is already feeling vulnerable, their emotional response may be strong.

Examples of Distressed Behaviour

Distressed behaviour can appear in different forms depending on the person, their needs, and the situation. In health and social care, these behaviours can range from very visible outbursts to subtle signs that might easily be missed. The examples below help show how varied distressed behaviour can be.

Physical Expressions

• Crying or sobbing loudly when feeling overwhelmed or frightened
• Shouting at staff or other people in the room
• Slamming doors or throwing lightweight objects to show frustration
• Restlessly walking back and forth in a corridor without stopping
• Refusing to sit down or stay in one place during a medical appointment

Emotional Reactions

• Becoming silent and withdrawn, avoiding eye contact or conversation
• Calling out repeatedly for a family member or trusted person
• Clinging to a care worker and refusing to let them leave
• Showing signs of panic, such as rapid breathing and trembling hands
• Breaking down in tears when faced with an unfamiliar situation

Non-Verbal Signs

• Turning away when offered food or medication
• Crossing arms and tensing the body during interaction
• Rocking back and forth in a chair
• Covering ears or eyes to block out noise or bright light
• Using repetitive movements like tapping fingers or rubbing hands together

Situational Examples

• A patient who has just woken up from surgery feels intense pain and begins shouting at staff, believing they are being ignored
• A resident in supported living becomes agitated and starts pacing after unfamiliar changes to the daily routine
• A child admitted to hospital refuses to speak and hides under the bed, showing fear of the new environment
• An adult with dementia wakes during the night and shouts that they must “go home,” believing they are in the wrong place
• A person receiving personal care pushes staff away repeatedly when they feel uncomfortable with the physical help being given

Behaviour Linked to Communication Difficulty

• A non-verbal individual banging hands on the table after staff misunderstand their request
• Someone speaking in a different language from staff raising their voice and gesturing rapidly when unable to make themselves understood
• Repeated pointing or tapping objects to indicate a need but becoming upset if responses are slow

Distressed behaviour is usually an indication that underlying needs are not being met or that the person feels unsafe, uncomfortable, or misunderstood. Spotting these behaviours early allows care staff to address the root cause and help bring the person back to a calmer and more comfortable state.

Emotional and Psychological Factors

Distressed behaviour often has an emotional root. Feelings like fear, loneliness, frustration, or helplessness may be overwhelming to the person experiencing them. For example, a resident in a care home with dementia may become distressed if they cannot recognise where they are, or if they believe they need to leave to “go home.” A patient recovering from surgery may become upset and anxious if they feel pain and perceive that staff are not responding quickly enough. Recognising that there is usually an underlying emotional or psychological factor helps care workers respond with empathy.

Physical Triggers

Sometimes distress is directly linked to a physical problem. This might be unmanaged pain, discomfort from being in one position for too long, or side effects from medication. A child in hospital may cry and resist treatment because of fear of needles or the discomfort of an examination. An older adult with arthritis might snap at staff when being assisted out of bed, since the movement causes them pain. Physical triggers should always be assessed as part of identifying the cause of distressed behaviour.

Communication Barriers

Distressed behaviour is often seen in people who cannot easily explain in words what they need or how they feel. This can happen with individuals who have learning disabilities, speech and language difficulties, or who speak a different first language from the staff caring for them. When frustration builds due to not being understood, behaviours such as shouting, pushing away carers, or walking off without permission can occur. In some cases, tools like picture cards or simple gestures can help reduce distress by giving the person a way to convey their thoughts.

Impact on Staff and Care Setting

Distressed behaviour can be challenging for care workers to manage. It may disrupt services, cause delays in care, or lead to misunderstandings. If not handled well, distress can escalate, increasing the likelihood of harm to the person or others. Staff may feel stressed or emotionally drained, especially if behaviour incidents happen regularly.

A supportive work environment with training on communication skills, de-escalation techniques, and emotional support can help staff remain calm and deal with distressed behaviour effectively. This is important both for the safety of the care environment and for maintaining a positive relationship between staff and those they care for.

Ways to Respond to Distressed Behaviour

Responding to distressed behaviour involves patience, empathy, and skill. Some helpful approaches include:

• Staying calm and speaking in a gentle tone
• Giving the person time to express themselves
• Listening without interrupting
• Checking for physical causes such as pain or discomfort
• Reducing noise or activity in the environment
• Offering reassurance and clear information about what will happen next
• Using familiar routines to create a sense of safety
• Involving family members or trusted individuals to help calm the person

Effective responses aim to reduce the distress, not just stop the behaviour. The way staff react can either ease tension or make it worse.

Training and Professional Skills

Health and social care providers often receive training on recognising and responding to different types of distressed behaviour. This may include:

• Understanding triggers and warning signs
• Learning about conditions that affect behaviour, like dementia or autism
• Practising de-escalation techniques
• Using positive behaviour support plans
• Communicating clearly and respectfully
• Documenting incidents so that patterns can be spotted

Good training improves staff confidence and helps ensure that responses to distress are compassionate and safe.

Examples from Care Settings

In a hospital ward, a patient recovering from a major operation may shout at staff when they feel their pain is getting worse. In this case, assessing pain levels promptly and adjusting medication can quickly lower distress.

In a residential care home, a person with advanced dementia may wander and become agitated if they cannot recognise their surroundings. Gentle redirection, accompanied by familiar objects, photographs, or calm conversation, can reduce confusion.

In supported living for people with learning disabilities, a tenant might refuse to attend a planned appointment, shouting and hiding in their room. Staff could work with them to explain the appointment in plain language, perhaps showing pictures of the location and allowing choices about travel, so the person feels more in control.

In a children’s ward, a young patient frightened of medical procedures might scream, cry, and refuse to walk to the treatment room. Staff might arrange for a parent to come along, explain the procedure step-by-step, and offer a distraction like a favourite toy or tablet.

Reducing the Frequency of Distressed Behaviour

While distress cannot be fully avoided, there are ways to reduce how often it occurs. These include:

• Maintaining good communication with individuals about their care
• Anticipating needs such as hunger, thirst, and toilet breaks
• Keeping environments calm and not overcrowded
• Supporting routines that are familiar and comforting
• Encouraging participation in decisions about care
• Treating individuals with dignity and respect at all times

When people feel valued and respected, they are more likely to trust staff and less likely to experience distress.

Final Thoughts

Distressed behaviour in health and social care is a way of expressing that something is wrong or uncomfortable, whether the cause is physical, emotional, or environmental. Staff who recognise and understand this behaviour can respond in a way that supports the individual effectively. Listening carefully, working to identify the cause, and taking steps to reassure or address the need are all part of good care practice.

By approaching distressed behaviour with patience, empathy, and skill, care workers can make a difference to the wellbeing of the people they support. This not only helps reduce the immediate distress but can build longer-term trust between people receiving care and the staff providing it.