What Is BPSD? Understanding Distressed Behaviour in Dementia

BPSD stands for behavioural and psychological symptoms of dementia. It describes the distress many people living with dementia experience and express, such as agitation, withdrawal, repetition, resistance to care or a physical response. The term is widely used by clinicians and care services.

At PMH we encourage organisations to treat BPSD not as a set of symptoms to be managed, but as communication that has not yet been understood.

What does BPSD include?

BPSD is a broad term. In care settings it often describes:

• agitation or restlessness
• withdrawal or low mood
• repeated questions or actions
• resisting personal care
• calling out
• a physical response such as pushing or hitting out

What causes BPSD?

Distressed behaviour almost always has a cause. Common causes include:

• Pain or physical discomfort that the person cannot easily describe
• Unmet needs such as hunger, thirst, tiredness or needing the toilet
• The environment, including noise, poor lighting, unfamiliar spaces or a lack of meaningful activity
• How care is delivered, such as rushed personal care or unfamiliar staff
• Fear, frustration or confusion as the person's experience of the world changes
• A disconnection from who the person is, when care does not reflect their life story, routines and preferences

Many of these causes sit within the care team's control. That is why the first question should be "what is this person telling us?" rather than "how do we stop this behaviour?"

Why does the language matter?

When behaviour is described as challenging, the response tends to follow the label: manage, contain, redirect or medicate. Short-term measures may reduce incidents for a while, but without understanding the cause the distress returns. Left misunderstood, BPSD often drives restrictive practice and crisis admissions.

How can care homes respond to BPSD?

Pat Hobson's Behaviours that Challenge™ model gives care teams a structured way to respond to the cause:

1. Observe before assuming. Record what happened, not what you think caused it.
2. Understand the person. Use their life history, personality and preferences to interpret behaviour.
3. Recognise triggers. Look first at noise, lighting, routines and how care is delivered.
4. Respond compassionately. Choose the least restrictive option, as the Mental Capacity Act 2005 requires.
5. Review outcomes. Ask whether the person's wellbeing improved, not just whether the behaviour stopped.

The model works alongside PMH's Unique Life, Unique World Unique Environment™ framework, which helps teams understand the person, their perceived reality and their surroundings.

Getting support with BPSD

PMH's dementia care consultancy works with care homes, NHS trusts and local authorities to understand and respond to BPSD and reduce restrictive practice. For staff development, see our challenging behaviour training.

Frequently asked questions

Is BPSD the same as challenging behaviour? The terms are often used for the same behaviours. BPSD is the clinical term; "behaviours that challenge" is common in care settings.

Should medication be used for BPSD? Decisions about medication are for the person's prescriber. Any medication used to manage distress should be reviewed regularly, and care teams should always look for and address the cause of distress first.

Can BPSD be reduced? Understanding the cause, adapting the environment and delivering care around the person's life story can reduce distress for many people.