128 Chapter 6 and qualitative methods can provide a rich account thereof (Braun & Clarke, 2006). The current study therefore offers a holistic and dynamic exploration of a woman with a mild intellectual disability and borderline personality disorder, by employing a mixed-methods strategy with three overarching aims. In the following sections we introduce these three aims step-by-step, with more detailed theoretical background. 1.1 Summarizing daily life The first step is to qualitatively summarize the complex nature of challenging behavior. From a complex systems perspective, any person is considered a complex system, not just individuals with challenging behavior (Olthof et al., 2023). It is complex because there is no root cause for the way a person (i.e., system as a whole) feels, thinks, or behaves at certain moments in time. Emotions, thoughts or behaviors emerge from continuous and interdependent exchanges between the system’s internal state and its environment (van Geert, 2020). Complex systems are everchanging, which is why an integrative understanding requires a detailed description of the interplay between the system’s and context elements over a longer period of time. It is therefore necessary to sample personal experiences and contextual influences frequently over time, for example by making use of ecological momentary assessment (EMA). EMA is a method in which someone frequently selfreports on current or very recent behaviors and experiences over time (typically via mobile-phone) (Shiffman et al., 2008). The method is well-established in samples with borderline personality disorder, but although feasible (Hulsmans et al., 2023) not often used in mild intellectual disability research. In earlier work involving clients with borderline personality disorder, momentary self-injury was associated with daily ruminations or heightened negative affect (Gee et al., 2020). Other EMA studies found the intensity of anger associated with daily reports of aggression (Scott et al., 2017). Such internal experiences (i.e., related to thoughts, emotions, or other behaviors) are the primary focus of most EMA research, but there are few studies that explicitly investigate contextual influences and changes (Gee et al., 2020). This is remarkable, because theory indicates that (challenging) behaviors are not only internally driven but are to a large extend elicited by environmental factors (Olthof et al., 2023). For instance, self-injury, is known to occur more frequently when experiencing interpersonal stress (Coifman et al., 2012). However, internal factors and the environment differs between persons (Wright et al., 2016; Woods et al., 2020). Whereas one person’s self-injury may be triggered by an argument with parents, someone else’s work pressure may trigger it. To obtain a holistic summary of the person-environment interplay, we first explore person-specific internal states and environmental factors qualitatively.
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