This chapter is focused on the fourth and final identified theoretical construct for behaviors: Theories in Compliance and Aggression (TCA). Behavioral categories emanating from TCA are the result of an imbalance in our emotional regulation and expression, to the point where expressions of non-compliance and aggression manifest. Such impairments can be a consequence of dysregulation of normal physiology or structural decline, as is the case in cognitive impairments.  In order to understand the implications of imbalanced emotional regulation on the generation of behaviors, it is imperative to understand the role of TCA in individuals with normal cognitive function.

Principles of Compliance

Compliance is considered the appropriate following of any instruction to perform a specific response within a reasonable and designated time.” Non-compliance is refusal to initiate or complete a request made by another person.

An interactional unit is a bi-directional relationship between a person receiving a command and a person delivering a command.

Forms of Non-Compliance

Kuczynski & Kochanska, (1990) define four basic forms of non-compliance that may be expressed in a person.

Negotiation: Person attempts to modify the nature / conditions of the command.

Passive Non-Compliance: Person does not acknowledge directions given to them.

Simple Non-Compliance: Person appears to acknowledge commands but refuses to comply. No associated hostility / anger.

Direct Defiance: Variant of non-compliance, accompanied by hostility / anger.

Principles of Aggression

Aggression is an overt act, involving the delivery of noxious stimuli to (but not necessarily aimed at) another organism, object or self, which is clearly accidental (Patel & Hope, 1992).

Aggression can be expressed as:

  • Physical aggression.
  • Aggressive resistance.
  • Physical threats.
  • Verbal aggression.
  • Refusal to speak.
  • Destructive behavior.
  • General irritability.

Compliance, Aggression and Dementia

As cognitive impairment in persons with dementia / major neurocognitive disorder (D /NCD) progresses, relationships with health care providers, care staff, and loved ones will change.

This is due to increasingly unbalanced emotional regulation and expression, which can cause certain behaviors. It can be expected to see the following behaviors manifest from principles of compliance and aggression: