7 problems with BPSD


The term “behavioural and psychological symptoms of dementia” (BPSD) is a harmful artificial construct used to inappropriately describe reasonable responses to adverse conditions and circumstances (RRACC) when such responses are expressed by people living with dementia (PLWD).

Some of the damaging and stigmatizing labels and descriptors associated with BPSD are “wandering,” “exit-seeking behaviour,” “challenging behaviours,” “combative,” “aggressive,” etc.

The term BPSD was coined in the late 1990s by the International Psychogeriatric Association (IPA). Twenty years on, a growing number of dementia care advocates worldwide are calling for the BPSD construct to be rejected by the geriatric healthcare professionals and researcher and to be banned from dementia care language (#BanBPSD). Prominent among those calling for the paradigm shift are dementia care pioneers Kate Swaffer, former nurse and care partner, speaker, blogger, activist, and author of What the Hell Happened to My Brain?, and Dr. Allen Power, geriatrician, speaker, author, trainer, consultant.

Dr. Power, whose books Dementia Beyond Drugs and Dementia Beyond Disease, are essential reading for geriatric health professionals, care workers and care partners, summarizes the problems with BPSD like this:

1 ) Relegates people’s expressions to brain disease

2 ) Ignores relational, environmental, historical factors and causes

3 ) Pathologizes normal expressions

4 ) Uses flawed systems of categorization

5 ) Creates a slippery slope to drug use

6 ) Fails to explain how drug use has been successfully eliminated in many nursing homes

7 ) Misapplies psychiatric labels, such as psychosis, delusions and hallucinations

Essentially, the broken lens of BPSD stops us from seeing the real causes of the reasonable reactions to adverse conditions and circumstances (RRACC) when expressed by PLWD, and thus impedes dementia care practitioners and researchers from finding and employing effective, enabling and engaging solutions to the distress experienced by many PLWD.

#IAmChallengingBehaviour #BanBPSD #WeCanCareBetter

101 potential causes of behaviour by people living with dementia that institutional care staff may find challenging

the broken lens of BPSD: why we need to rethink the way we label the behaviour of people who live with alzheimer’s disease


Subscribe to MAS now & get 5 free PDFs & a page of welcome links:

Take my short survey on behaviour here.


  1. I take care of my husband with Alzheimers. He does wander. In the middle of the night. He is agitated. I love him and feel his pain but I have to sleep sometime. Agitation is a very difficult behavior. I always feel in your newsletters like you are blaming caregivers. If you don’t like institutional caregiving why don’t you care for your loved one at home like I do. Sorry to be so blunt, but you might be a bit more even handed.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.