127 Case study challenging behavior 6 1. Introduction In residential care for individuals with an intellectual disability, challenging behavior is an often used umbrella term for repeatedly engaging in dangerous or threatening behaviors. These can be outer-directed, like aggression towards people or damaging property, and inner-directed, such as self-injurious behavior (Ali et al., 2014; Emerson et al., 2001). The latter is defined as inflicting deliberate damage on- or destruction of one’s own body tissue with or without suicidal intent, for example by skin cutting, burning, scratching, or ingesting inedible objects (Nock, 2010). For staff, these behaviors are hard to grasp and sometimes difficult to anticipate. Managing incidents afterwards with freedom restricting measures, such as seclusion or fixation, remains an unwanted and increasingly unaccepted common-practice that is harmful to clients and increases staff stress and turnover (Deveau & McGill, 2016; van Dorp et al., 2021). Staff typically describe challenging behaviors as a way the individual communicates unmet “complex needs” (Griffith & Hastings, 2014). Although group-level research reveals many biological, psychological and social correlates of challenging behavior (Ali et al., 2014; Crowell et al., 2009; Tevis & Matson, 2022), it remains vague what this oftenused adjective “complex” means at the individual level. Research focused on the individual rather than on the group can efficiently advance our understanding of complex phenomena (Hekler et al., 2019). Therefore, this study provides a unique exploration of patterns of chronic aggressive and self-injurious behaviors in one woman with a mild intellectual disability and borderline personality disorder, day-by-day over the course of 560 days. The overall goal is to obtain an in-depth understanding of when and why challenging behaviors occur, using an analytical strategy inspired by complex systems theory (cf. Thelen & Ulrich, 1991). This complex systems lens differs from the dominant biomedical perspective on psychopathology. That is, from a complex systems perspective psychiatric disorders are not understood as latent entities that cause symptoms through (relatively static) hard-wired biological mechanisms, but as dynamic patterns of behaviors, emotions and cognitions that are formed over time (Hayes & Andrews, 2020; Olthof et al., 2023). Complex systems principles have guided individual-specific explorations of dynamics in high-risk young adults (Schreuder et al., 2023), people with depression (Schreuder et al., 2022; Wichers et al., 2016; Wichers et al., 2018) and dissociative identity disorder (Fartacek et al., 2016; Schiepek et al., 2016). While these studies all used quantitative timeseries analyses to describe the dynamics, qualitative methods are just as well-suited within a complex systems framework. Central to complex systems theory is a holistic approach to understand the person in their environment (Olthof et al., 2023)
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