Maladaptive Behaviors

Posted by Nurse Linda in Life After Paralysis on May 31, 2019 # Health

Occasionally, people react to situations in ways that are not effective for their health. Everyone does this to a certain degree. However, when the behavior is used to continuously avoid the perceived negative situation, maladaptation occurs.

In adaptive behavior, people rise to meet challenges in daily life. You might not want to get up and go to work, but you do. You might not want to take medication, but you realize you need these pills for a better quality of life, so you take them. Adaptive behavior is not just doing something you don’t like to do but it is facing challenges and finding ways to cope with needing to do things that you do not prefer.

Sometimes, we find strategies to deal with the things we don’t want to do. For example, you might not want to get up to that alarm to go to work but you know if you do, the reward will be a paycheck. You might find you will change jobs or negotiate a different start time, so you don’t have to wake so early. Some people will go as far as to change jobs, so they can look forward to going to work. Changing your mindset can help as with taking medication. If the medicine helps you and you can see the benefits, you will probably take it. If it comes with side effects, you can ask for a different formulation. The point is, you figure out a way to help yourself through life’s hurdles.

Maladaptive behavior can result when a person just does not see a path to their desired future. This can happen with any chronic illness or major lifestyle change. With maladaptive behavior, self-destructive actions are taken to avoid undesired situations.

One of the most used maladaptive behaviors is avoidance. Everyone uses this behavior at one time or another. This involves not doing something that should be done. It can be avoiding a person, like your healthcare professional, an activity, such as not performing a bowel program, or it can even be a thought such as not recognizing changes due to spinal cord injury. Avoidance becomes maladaptive when your physical or mental health is harmed or in danger of being harmed.

Avoidance seems like a simple solution because we have all used it so we all know how to do it. Which is that we just do not do something we should. However, it does result in anxiety and stress because we know we should be doing the exact thing we are avoiding. Developing a pattern of avoidance can lead to many mental health issues including anger outbursts or internalizing the anger, changes in socialization, lack of appetite, inability to sleep, low self-esteem and depression.

As these mental health issues build, they can convert to include physical components. At first, you might experience weight loss and fatigue.Several medical consequences have been attributed to the stress of avoidance: hypertension, ulcers, headaches, irritable bowel, muscle aches. Even the development of diabetes has been related to stress. Diabetes is at a higher risk for individuals with spinal cord injury as well.

Some individuals will develop maladaptive behavior by starting with avoidance and build into other, more intense maladaptive behavior. Others will just jump right into more detrimental types of maladaptive behavior including destructive behavior towards yourself.

Self-destructive behavior includes self-harm, eating disorders, and substance abuse. Self-harm is the physical destruction of the body that can appear in a variety of ways. Traditionally, self-harm is associated with the cutting of one’s own body. However, this behavior can be demonstrated in a variety of other ways as well. Examples can be pulling out hair, often seen with eyebrows, scratching, or burning. For individuals with spinal cord injury, it can be exhibited by creating, picking or keeping wounds from healing, refusal to follow needed activities such as catheterization, bowel program, or pressure releases.

Self-harm is caused by overwhelming stress, anxiety or depression. It is a coping mechanism as opposed to a compulsion. Occasionally, individuals with spinal cord injury, make a mistake and miss a catheterization time or get delayed in their bowel program. These oversights, although they still can lead to physical consequences, should not be confused with self-harm. We all error sometimes. Self-harm can be a one-time event or a pattern. It is caused by inner turmoil and can be self-punishing.

Eating disorders are a form of maladaptive behavior that cause self-harm. They can result in under or overweight issues which are particularly disastrous for individuals with spinal cord injury as both affect skin integrity, mobility, catheterization and bowel issues, body image and general health. Eating disorders can become diseases such as binge-eating, excessive dieting, bulimia, and attachment of well being to body image.

A person can use eating disorders as a method of gaining control in their life. If a person requires assistance for daily activities, using food can become a measure of control over their body. It can also be a temporary moment of taste pleasure when there is not much other perceived pleasure in life. Eating disorders are a result of stress, conflict, and anxiety which can be a result of spinal cord injury or other life crisis.

Substance abuse is the use of alcohol, prescribed or non-prescribed drugs or a combination to achieve a specific effect. Some people use these substances to numb the anxiety and stress perceived in their lives, others might use the substances for a complete blackout of life. As with other maladaptive behaviors, the goal is to create a false view of life where their problems and issues do not exist.

Substance abuse can lead to addiction which has been described as when the substance reaches a level where everyday life is affected. For some, this can be a dependence on alcohol to dependence on addictive medication. Some addictive substances, especially alcohol have been associated with suicide.

Individuals with spinal cord injury have compounded issues with substance abuse as pain medication might be needed to control comfort. However, some pain and spasticity medications are addictive. This can set up a difficult situation for the individual where certain medication is necessary for quality of life but with the undesired consequence of addiction. In this case, an educated choice has to be made.

If there are no other treatments that work for your pain or spasticity, you may need the particular medication. Other treatment choices might include different medications or alternative therapy such as exercise. If you do elect to continue with the necessary medication, remember not to just stop it at any point in time. Addictive medication can be withdrawn but must be done in a titrating way which is tapering off the dose very slowly. Not tapering this type of medication can lead to additional and increased pain that becomes even more difficult to treat in the future.

Knowing if someone has maladaptive behavior can be difficult to determine. Fortunately, you can get help from your health professional who can provide an in-office assessment. From that point, they can direct you to the most appropriate treatment plan if needed.

There are several ways to treat maladaptive behavior. A psychotherapist can help you discover the nature of the reason for your behavior as well as strategies to help you confront and deal with it. Some people might think they know the reason for their behavior but there actually might be other sources or compounding sources to the issue. Just to say you have a spinal cord injury so there is the source of your troubles might not be the reason at all. Having a spinal cord injury does not guarantee maladaptive behavior. Most individuals with SCI do not develop maladaptive behavior. It is a tough diagnosis but that does not mean you will have these types of concerns. Finding someone who can guide you through exploration and treatment is helpful.

Pediatric Considerations: Children with spinal cord injury or any chronic illness may not be aware that they have different needs than others. How they know life is normal to them. It is the rest of the population that appear different. Adolescents have more life experiences and will know their uniqueness. Parents who let their child know they are normal within themselves create normalized environments for children.

Control issues happen throughout life, with or without a spinal cord injury. Self-harm can be an issue at any age. Dealing with self-harm can be a challenge for children and parents. Alcohol abuse has been linked to suicide in adolescents without chronic illness. Finding the balance in your family is an ongoing process. A checkpoint with your healthcare professional or mental health specialist is a good opportunity for all individuals and parents.

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The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.