Behavioral disorders refer to behavior that is considered “abnormal”. Is it about "troublemakers"? For the time being, norm only means that such a norm is set. But what a society considers normal is very different historically and culturally. In the West, for example, would we consider it disturbed behavior if a woman in Saudi Arabia tears the niqab off her face?
Definition and delimitation
"Behavioral disorder is a violation of the law that is considered disruptive and inappropriate by the agent himself or by someone in a position of power against him." (Havers, 1978)
Conversely, someone who adapts to the norm is not necessarily mentally healthy: generations of German men who were born around 1900 found it easier to murder millions of people on command than their authoritarian fathers, teachers or officers, who prepared them for this murder to offer even the slightest resistance.
A few decades ago, for example, homoeroticism and sexual promiscuity in Germany were regarded as disturbed behavior - as abnormal. These types of physicality only contradicted the morals of an uptight society and are in no way disturbances, but rather an expression of the broad spectrum of sexual diversity of people.
On the other hand, as with all mental disorders, it makes sense to start from suffering. Do those affected and do others suffer from their behavior? Do you have problems integrating into social relationships and groups because of this?
In today's psychiatric behavioral disorders, it is true that they burden those affected and their social environment: conspicuous disorders are unauthorized aggression against people and animals, deliberate destruction of objects, hyperactive acting out, extreme anxiety, disproportionate reactions, uncontrolled outbursts of anger, screaming, drenching in advanced Age or obscene behavior.
Different behavior disorders
The fault patterns take many forms. In general, four forms can be distinguished, which, however, merge into one another.
1.) Aggressive behavior disorders. These are expressed through extraordinary aggression, both verbally and physically. Those affected argue about nothing, destroy objects, get into tantrums because of vain reasons, threaten others and order them around.
2.) The opposite is true for pathological inhibitions: those affected withdraw, react hypersensitively, are over-anxious, cry frequently and suffer from extreme feelings of inferiority.
3.) Then there are disturbances in behavior that are inappropriate for age, but normal at a younger age. This most clearly includes wetting, but also life in a magical world, when the toddler phase, in which the child does not separate reality and imagination, is long gone.
If, for example, a three-year-old throws himself on the floor, cries and screams in the defiance phase to enforce his will, this is not a disruption, on the contrary, a healthy development. At this age, people see themselves as an individual that differs from their environment and other individuals: they develop a theory of mind. The reactions of defiance mean "I am I and I want something."
With a healthy development, the child learns in the years after that not only to differentiate social needs, but to articulate themselves in many ways and to develop a tolerance for frustration. This is even vital for adapting your own needs to the environment. So if a 14 year old who does not get his will throws himself on the floor, howls and screams, then this indicates a behavioral disorder.
The conspicuous behavior of certain personality disorders is a result of the unsuccessful adaptation of early childhood needs to social relationships and the outside world. It is one of the characteristics of borderline syndrome that those affected split caregivers into absolutely good and absolutely bad and fail to understand themselves and other people in their complexity.
Abnormalities in behavior between raging anger and symbiotic adjustment, outbursts of emotion that those affected cannot explain themselves and phases of apathy are a direct consequence of the development deficits - the sick have not developed a stable identity and no self-image from which they derive the self from others could differentiate from oneself.
4.) The fourth form is socialized delinquency. Those affected form gangs, often skip school, commit thefts or burglaries together with other delinquents. They practice the behavioral patterns in groups, at the same time learning them through imitation and direct reinforcement.
However, whether there are any disruptions depends on the social context. When adolescents in slums who have no social perspective secure their livelihood through drug trafficking or burglaries, it is not a matter of disrupted behavior, but a survival strategy. On the other hand, it can be described as a disorder if there are no “objective” reasons for the delinquent behavior. Kleptomania, for example, has nothing to do with someone stealing because they need things to live.
Inappropriate of the situation
A behavioral disorder must be strictly separated from what a milieu, a class, a political worldview or religion does not consider socially opportune. A characteristic of a disruption, on the other hand, is that the behavior does not represent an appropriate handling of the respective situation and does not lead to the goal from the perspective of the person concerned.
As a rule, it is not a matter of deliberately exceeding standards and rules. Behavior that serves to provoke people whose norms criticize those affected is not a disturbance. However, there are also people with significant disorders who rationalize them as provocation or protest, and the transitions are difficult to separate.
Causes of behavioral disorders
Various causes can be considered. Often the roots are in the family: These include mental illnesses of the parents (especially the mother), alcoholism of the parents, psychological, physical and sexual abuse in the home, loss of important caregivers, absent fathers, loveless parents, family neglect or a criminal career The parents.
Individual experiences also play a role: failure in social relationships, friendships or sexual disappointments; generally a lack of recognition by parents, classmates or teachers, chronic illnesses, the experience of being different, but also bullying in kindergarten, school or the living environment.
“Behavioral disorders” often represent an inner rebellion against hierarchies. Those affected unconsciously or semi-consciously refuse to follow the commands of parents and teachers. But they are intellectually unable or forced by the situation to express their displeasure as concrete criticism.
Instead, they protest through unwanted behavior. They refuse to go to school, make the break bread smeared by their mother moldy, do not do their homework, or do not take off their coats in class. Even wetting can be a form of protest.
Disrupted behavior can be caused by serious organic or psychological damage: These include brain damage, traumatization and various diseases. Many children are considered to be disturbed until it turns out that their unusual behavior is a symptom of a basic illness.
Mental disorders that are inextricably linked to behavioral disorders include bipolarity, depression, borderline syndrome, post-traumatic stress disorder, schizophrenia and the full spectrum of autistic disorders.
In addition, there are mood disorders, Tourette syndrome, Messie syndrome, Munchausen syndrome and all types of delusional diseases, from delusional jealousy to delusions of grandeur and conspiracy. Dissociality, narcissistic disorders, and anxiety disorders also characterize disordered behavior.
Behavioral disorders are also a typical sign of substance abuse: alcoholism, heroin or cocaine addiction, the excessive use of amphetamines, hallucinogens, ecstasy etc. leads to disturbed behavior in the medium term, even outside the intoxicated phase.
Many of these disorders are due to parenting errors. To put it simply: Children who are exposed to authoritarian parents, who are not allowed to do anything and have no space to develop, run the risk of becoming overly anxious. Children who are helplessly exposed to their parents' violence also use violence and develop aggressive behavior. Children whose parents suffer from borderline diseases or are extremely narcissistic learn to generally distrust binding statements and look for the hair in the soup.
In fact, most of the weaker behavioral disorders are the result of parenting: children behave conspicuously in social groups because they are spoiled too much; the two parents have different ideas about upbringing, which exposes the child to a double-bind situation in which it cannot do anything “right”; the parents project their problems, wishes and needs onto the child; the parents themselves suffer from mood disorders, anxiety disorders etc. and keep the child trapped in them.
The disorders can become a real problem, not least for those affected themselves: self-injurious behavior (SVV) refers to actions in which individuals destroy body tissue for goals that are not aesthetically or socially established, such as piercings, brandings or scarvings . Incisions in the subcutaneous tissue are by far the most common form of these self-made wounds.
Those affected injure themselves on every part of the body, but mostly on the arms and wrists. The severity of the actions varies from superficial wounds to those that leave permanent disfigurements. Scribing usually begins in the late teens or early adulthood. Some sufferers only inflict wounds a few times, while others establish this action as part of everyday life and feel bad if they temporarily stop it.
Immediately after scratching, they feel how (mental and physical) pressure subsides. When this feeling subsides, shame and guilt take its place, followed by the return of the excruciating emotions that drive people to hurt themselves to escape them.
Attention deficit disorder is characterized by inner restlessness, difficulty concentrating, irritability, hyperactivity, mood swings and, in more severe cases, a personality disorder.
Psychiatrists warn that ADD has developed into a fashion diagnosis that relieves parents and teachers of their responsibility if a child “becomes conspicuous.” Typical symptoms of ADD can also be caused by a lack of exercise, a pressure to perform that gives children freedom destroyed, in over-ambitious parents who put their children under constant pressure, etc. But that has nothing to do with the mental illness ADS.
The intellectual performance suffers because the people concerned jump from one topic to the next and thus do not save knowledge that they could later implement; in addition, school performance deteriorates. Hyperactive children have problems in the peer group and family relationships. Because they tease their behavior in social relationships, they develop anxiety and depression. Aggression can also result.
Some ADS patients slither into crime, experiment with narcotics early on, accidents from risky behavior accumulate, and when they are of age, traffic accidents accumulate because they drive too fast.
Hyperactive children often run into difficulties in their relationships with adults, later in partnerships and at work. They lack emotional self-control to organize their drive and motivation. The hyperactivity promotes memory impairments, a lack of spatial skills and language skills.
If the affected person does not get the symptoms under control, the problems accumulate in later years of life. At work, they cannot continuously work on a subject; they become a burden for themselves and for their colleagues. What their colleagues have worked through in weeks, they destroy by their inability to listen and concentrate.
They neither adhere to agreements nor do they respond to what takes time and effort for their colleagues. For example, some try to treat themselves with cannabis, but this becomes a trap. In addition to the psychological disorder, there is also the psychological dependence on the substance, and the inability to concentrate due to the inability to form clear thoughts. In any company structure that relies on cooperation and commitment, those who are disturbed become an imposition for everyone involved - including themselves. They destroy what others build up.
Types of ADS
There are several ways that ADS expresses itself:
The inattentive ADS, also known as Attention Deficit Disorder: The people affected by it are inattentive and can hardly concentrate, but are neither hyperactive nor overbearing. This disorder often goes unnoticed and is therefore often diagnosed too late, i.e. at a time when those affected already have massive development deficits.
This type affects more girls as a percentage than the other two. Those affected have difficulty hearing what they hear and do not pay attention to details. They are disorganized, forget and lose things.
Combined ADS is the most common form: inattentiveness is associated with hyperactivity and impulsiveness in these children.
The third form is the hyperactive-impulsive ADS. These students show hyperactive and impulsive behavior, but can focus their attention. This type is not common, it only affects every tenth child with ADD.
Recognizable signs of hyperativity and impulsiveness include speaking loudly, the problem of sitting in one place and playing calmly. They also interrupt others, run and climb dangerously, talk without thinking, and have trouble curbing their emotions and waiting for their turn.
This syndrome belongs to the autistic group. In contrast to classical autism, those affected are important to social relationships with other people, but one of their disturbances is that they do not understand social communication in essential points. This leads to behavior that makes it difficult for them to build friendships. You will then find no connection to your peers because of their lack of social skills. You have problems talking to other children or participating in group activity.
This can shake children with Asperger because they want to connect intensively with their peers. However, some sufferers have no desire to make friends and prefer to be alone. Young children with Asperger's syndrome sometimes display selective mutism. That means, for example, they only speak freely if they are familiar with those present and fall silent towards strangers. Direct family members are usually not affected because the child feels comfortable talking to them.
This avoidance behavior is evident in school and in public, and some children refuse to speak to strangers from a very early age. This sometimes disappears on its own, therapy helps other children. Those affected often find it difficult to empathize with others. As they get older, however, they learn how others react to them. They learn it, but they don't feel it. For example, while they respond appropriately and give the “right” answers, they don't understand why they are snubbing others.
This becomes apparent when Asperger children play too roughly with other children or use harsh words without knowing that they are offending the other person. When asked about this behavior, these children respond that what they said is true and they do not understand the problem.
People suffering from Asperger's often find it difficult to make eye contact with their conversation partners. Some believe that this behavior results from a lack of trust. Others suspect that eye contact makes those affected feel uncomfortable. There is even a theory that Asperger patients do not understand the importance of eye contact and why because they do not understand social communication. This can even lead to the opposite problem if the person forces eye contact and unsettles other people.
Depressed people suffer from depression. They are listless, constantly tired, and their thoughts revolve around suicide, hopelessness, and despair. They lose the joy of things they enjoy, they dull (lack of emotion) and they become lethargic.
The pondering is typical, those affected cannot switch off and their thoughts turn. Some develop delusional ideas: they feel guilty, see themselves as failures and suffer from objectively unfounded fears. Depression also manifests itself physically through swallowing problems, headache, back pain and body aches, loss of appetite, menstrual problems and lack of sexual desire.
Constraints are also behavioral disorders in which those affected compulsorily carry out a certain behavior: they unconsciously try to undo fantasies, impulses or actions that they are guilty of. Simply put: Whoever washes his hands and suffered from an authoritarian upbringing washes away from the fear of being punished for “sins”.
Treating obsessive-compulsive disorder should first separate the patient's thoughts and reality. Those with compulsive disorders usually react with relief when they understand that their thinking alone has no consequences.
Affective psychoses are mood disorders in which mood swings get so out of control that those affected can no longer check reality - or separate the unconscious and external reality. This includes the unreal fears of depressives and bipolar people as well as the megalomania of manicers. A person in a manic phase who thinks he is rebirth of Mother Theresa is not only manic but also psychotic.
Bipolar disorder is characterized by a change between euphoric megalomania (mania) and deepest depression (depression). The mania shows up as a constant exuberant mood that lasts more than a week. The main symptoms are a misperception of your own grandiosity, a reduced need for sleep (those affected are sometimes on the road for more than 48 hours), extreme conversationalism and even compulsion to speak, and also a flight of ideas.
The disturbed behavior shows itself as a flow of speech without any context, the ideas roll over, the thoughts race, social taboos play no role; Manic people overestimate themselves, are easily distracted, their actions change constantly; they behave ruthlessly and sexually. They hardly eat and sleep little. They lose their distance from the environment as well as their self-criticism.
In the irritable variant, the disturbed are extremely aggressive: they constantly feel provoked, insult, and they attack other people - physically and verbally. One trigger is that others don't take their castles in the air seriously. Severe manias turn into a psychosis: those affected have delusions.
They are scattered, they have a thousand great ideas, but they don't think through them to the end. You are distracted by unimportant stimuli and feel a strong urge to "do something". This manifests itself in sexual adventures, consumption frenzy, and financial "investments" that drive those affected into ruin. Since the manicers cross the boundaries of others, conflicts with fellow human beings, the police, shopkeepers etc. are inevitable.
This mood disorder is considered to be a manic phase if it significantly impairs the everyday life of the patient, damages professional life or disturbs social relationships. It requires hospitalization to prevent patients from harming themselves or others. It is essential for the distinction that this behavior is not the result of drug abuse, medication or medical treatment, or has no other physiological cause.
The depressive phase
The depressive phase follows this mania. The depressed mood lasts almost all day for several days in succession, those affected appear self-pitying and complain of inner emptiness. You suffer from insomnia or, conversely, an increased need to sleep. Their movements appear as if in slow motion, at the same time the patients are restless. The feeling of chronic exhaustion is typical.
Those affected find themselves worthless and feelings of guilt plague them. They are difficult to concentrate and unable to make decisions. Her thoughts revolve around death and suicide, but without making specific plans.
When does a behavioral disorder start?
We have to differentiate between a cross-cultural behavioral disorder and a cultural interpretation of behavior. Also, psychology today by no means considers many things as disturbed, which was only considered a few decades ago.
For example, not so long ago someone was considered "not right in the head" when talking to himself. Today, however, it is proven that soliloquies that are not delusional serve to reflect on questions, to raise awareness and to work out solutions.
Even extreme forms of behavior do not have to indicate a disturbance if they are established in a society: for example, if Shiites cut their skin to celebrate the martyr Hussein in order to stage his martyrdom, the non-cultural viewer may shake his head established behavior should not be seen as a disturbance.
The diagnostic key differentiates between organic and symptomatic-psychological as well as delusional, neurotic and mood disorders, behavioral disorders resulting from overload or as a result of personality disorders.
Furthermore, there is disordered behavior as a result of a developmental disorder and as a result of reduced intelligence, early and acquired disorders. The differences are huge, between emerging abnormalities and full-blown mental illnesses.
The forms that these disorders take vary greatly: First of all, there is little overlap between an overaggressive student who violently responds to any attempt to induce him to therapy, and a “fidgeting philippus” suffering from ADD and the Saws nerves of his environment.
When do we speak of behavioral disorders?
For a disruption, it is not decisive whether the garden neighbor who cuts the lawn with the nail scissors finds children playing naughty, but whether certain extreme behavioral patterns occur to an exceptionally high degree, for at least six months and in different areas of life.
There are also behaviors that are atypical for child development, even restrict this development and, above all, cause problems for the child. No matter whether a child suffers from chronic lack of concentration, is extremely shy, or is characterized early on by criminal behavior - it always puts himself aside.
Psychosocial symptoms in children
- The child does not adhere to agreed rules and violates the rights of other people without showing any remorse (dissocial disorder)
- The child is overly aggressive towards other people.
- It is extremely shy to an extent that goes beyond mere strangeness (anxiety disorder)
- The child is constantly in the center of attention and craves attention (narcissistic disorder)
- It steals frequently (outside of age-related tests of courage etc.)
Causes and resources
Today, an approach that focuses on the patient's resources rather than the causes of their behavior is playing an increasingly important role. This means that it is no longer just a question of why a person behaves problematically, but above all what skills he has to work constructively on this behavior.
Since behavior is the main symptom, regardless of the cause, the patient's overall situation can be improved if he changes it. In this way, psychologists, psychiatrists and psychotherapists can develop de-escalation strategies. Those are best worked out if the context in which the harmful behavior occurs is known.
Treatment and therapy
Conversation and behavioral therapies promise the best prospects for healing. The prerequisite is that, firstly, those affected want to change their behavior and, secondly, they know which one they should change.
First of all, this applies regardless of the underlying cause: A traumatized person who develops significant abnormalities when triggers activate his trauma can learn to avoid these triggers; If a child shows abnormal behavior after the separation of the parents or because one parent is latently mentally ill, then family therapy will probably help.
The first step in diagnosis is to recognize when the person concerned is behaving abnormally. A disorder is characterized by a general behavior of those affected. That means: someone who is extremely aggressive always attracts attention because he strikes himself, insults or attacks others - regardless of the situation
However, if a child shows itself to be aggressive only towards a certain teacher, but not towards its classmates, parents or peers, then there is almost certainly an antipathy towards the teacher, but not a disturbance.
This aspect is important because some parents and teachers like to stamp uncomfortable children with the ADS stamp, although in reality it is a legitimate protest against their self-rule. Even if many parents and teachers do not like to hear it: Despite, disobedience or lack of attention are also part of a completely normal development. Anyone who folds paper airplanes during the deadly lesson of a pedagogically insufficient teacher does not act disturbed, but appropriate to the situation.
In addition to therapy that is appropriate for every behavioral disorder, the treatment differs depending on the basic disease. For mental illnesses that are associated with a disturbed hormone level or a lack of minerals, appropriate preparations help, for bipolar lithium, for schizophrenia antipsychotics, for family-related cases, family therapy. Addiction therapy is recommended for alcohol or substance abuse. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Social Science Nina Reese, Barbara Schindewolf-Lensch
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ICD codes for this disease: F60-F69ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.