4.1. Describe types of challenging behaviour

This guide will help you answer 4.1. Describe types of challenging behaviour.

Challenging behaviour is a term used in health and social care to describe actions that can be difficult for staff, carers, or family members to manage. These behaviours may put the person or others at risk, disrupt daily activities, or make it harder for care to be delivered. It often means the person is expressing a need, frustration, or distress that they cannot manage or communicate in a different way. A person’s actions might arise from physical health, mental health, learning disability, sensory needs, brain injury, dementia, or emotional distress.

Workers should recognise the different forms that challenging behaviour can take. This helps to respond in a safe, calm, and respectful way.

In this guide, we cover the main types you are likely to see in health and social care settings. Each type can have different causes and levels of impact.

Aggressive Behaviour

Aggression can involve physical actions, verbal abuse, or both. It may happen suddenly or build over time. This type of behaviour can cause harm to others, damage property, or create fear.

Common signs include:

• Shouting or using offensive language
• Threatening behaviour
• Hitting, kicking, or throwing objects
• Spitting or biting

Aggression can occur when a person feels frustrated, scared, ignored, or is in pain. It might also be linked to mental health conditions, drug or alcohol use, or confusion caused by dementia or delirium. Understanding triggers is important, as aggression often comes in response to a situation the person finds distressing.

Self-injurious Behaviour

Self-injurious behaviour is when a person causes deliberate harm to themselves. This can range from mild to severe and may become repetitive.

Examples of self-injury include:

• Head-banging against a wall or floor
• Biting oneself
• Picking at skin or wounds
• Cutting or scratching
• Ingesting harmful objects

People may harm themselves to cope with overwhelming emotions, to communicate distress, or as a response to sensory needs. For example, some people with autism or learning disabilities may display self-injurious behaviour when anxious or overstimulated. Physical health issues such as pain or seizures can also be a reason.

Disruptive Behaviour

This behaviour interrupts normal activities, making it hard for staff or other people to focus or feel calm. Disruption might happen in group settings, classrooms, day centres, or wards.

Examples include:

• Shouting out inappropriately
• Refusing to follow agreed routines
• Using objects in a distracting or unsafe way
• Interrupting conversations or activities repeatedly

Disruptive behaviour might stem from boredom, misunderstanding of rules, attention-seeking, or frustration. It is more than simple restlessness, as it affects the atmosphere and the ability of others to take part in planned actions.

Withdrawn Behaviour

Withdrawn behaviour can be a type of challenging behaviour, especially when it affects a person’s health or social life. It may look quiet on the outside but can be a serious sign of distress or need.

Signs include:

• Avoiding eye contact
• Refusing to speak or interact
• Isolating themselves from others
• Avoiding activities they once enjoyed

This behaviour may be linked to depression, anxiety, trauma, fear, or physical illness. In people with dementia, withdrawal can be a sign of discomfort or confusion. A withdrawn person may be seen as easy to manage, but it can hide serious issues that need attention.

Non-compliance

Non-compliance happens when a person refuses to do what has been agreed or requested. In care settings, this might mean refusing medication, therapy, personal care, or safety instructions.

Examples:

• Refusing to eat meals prepared for them
• Not attending medical appointments
• Ignoring safety instructions such as fire drills
• Turning away carers who visit at set times

This behaviour might be linked to a wish to have control, mistrust, confusion, or communication problems. Medical side effects, mental health, or past negative experiences with authority can also play a part.

Impulsive Behaviour

Impulsive behaviour involves acting without thinking about the results. This can place the person or others in danger and can disrupt care routines.

Examples:

• Running into a road without looking
• Touching hot surfaces
• Interrupting someone unexpectedly in a high-risk area
• Making sudden physical contact with strangers

This can be linked to ADHD, brain injury, or mental health conditions. In some cases, reduced impulse control results from dementia or other neurological illnesses. Lack of thinking time before acting can cause repeated incidents.

Absconding or Wandering

Absconding means leaving a safe area without permission or against advice. Wandering often occurs without an intention to escape but still poses risks.

Examples:

• A person with dementia leaving a care home and getting lost
• Someone in a hospital ward walking out before receiving treatment
• A child with special needs running away from a group activity

Both behaviours can result in harm, exposure to unsafe environments, or difficulties in locating the person. Reasons can include confusion, agitation, a wish to return to somewhere familiar, or avoidance of a stressful situation.

Sexualised Behaviour

Sexualised behaviour in inappropriate settings can be challenging in health and social care. It may be verbal, physical, or non-contact behaviour.

Examples:

• Making sexual comments to staff or other residents
• Inappropriate touching
• Exposing themselves
• Masturbating in public areas

Such behaviour can result from mental health issues, dementia, brain injury, or learned habits from past environments. In some cases, the person may not understand social rules or boundaries. This type of behaviour can cause distress to staff and others, so it must be managed calmly and without shaming the person.

Stereotyped or Repetitive Behaviours

Some people show repeated movements, sounds, or actions that can be disruptive or harmful in certain settings.

Examples:

• Rocking back and forth
• Hand-flapping
• Repeating words or phrases
• Pacing up and down for long periods

This is common in people with autism, learning disabilities, or certain neurological conditions. The behaviour may help them self-soothe, manage anxiety, or cope with sensory needs. Not all repetitive behaviours are harmful, but they can become challenging if they cause injury, disrupt activities, or affect others.

Verbally Abusive Behaviour

Verbal abuse involves language that is offensive, aggressive, or hurtful. This can damage relationships and create a stressful environment.

Examples:

• Swearing at staff or peers
• Using discriminatory language
• Making threats
• Name-calling

In many cases this behaviour happens during anger, frustration, or fear. It might also be a symptom of certain mental health or neurological conditions that affect impulse control.

Property Damage

Some challenging behaviours involve damage to personal or shared property. This can cause safety risks and financial costs.

Examples:

• Breaking furniture or equipment
• Throwing or smashing objects
• Writing graffiti on walls
• Setting small fires

Property damage may be linked to anger, frustration, boredom, or lack of emotional regulation. It can also occur in people who enjoy the sensory feedback from breaking objects.

Passive-Aggressive Behaviour

This is a less direct type of challenging behaviour. The person resists or disrupts care without obvious confrontation.

Examples:

• Ignoring requests or pretending not to hear
• Using sarcasm to upset others
• Deliberately working slowly to cause frustration
• Withholding important information

It can make care tasks difficult and cause conflict between staff and service users. This type of behaviour may come from resentment, mistrust, or feeling powerless.

Substance-Related Challenging Behaviour

The use of alcohol or drugs can lead to many types of challenging behaviour. This might occur in supported housing, community care, or hospital settings.

Behaviour linked to substance use can include:

• Aggression
• Disorientation and confusion
• Mood swings
• Poor personal boundaries

This can pose risks for staff and others. It may also lead to difficulty in following treatment plans or maintaining healthy routines.

Behaviour Linked to Mental Health Crisis

During a mental health crisis, a person may behave in ways that are out of character and challenging to manage safely.

Possible behaviours:

• Threatening self-harm or suicide
• Aggression or hostility
• Paranoia and suspicion of staff
• Withdrawal from contact even in urgent situations

A crisis can be triggered by stress, medication changes, traumatic events, or worsening of a mental illness. This needs a sensitive and safe approach.

Final Thoughts

Challenging behaviour in health and social care is varied. It ranges from physical aggression to quiet withdrawal. Each type has different possible causes, and the same behaviour can mean different things for different people. Understanding the type of behaviour is the first step in reducing risks and helping the person feel supported.

Workers should remember that challenging behaviour is often a form of communication. It can signal unmet needs, discomfort, or distress. By recognising the type of behaviour and staying calm, you can respond in ways that protect everyone’s safety and dignity.