CHAPTER 25 Anger and Aggression

1. CHAPTER 25Anger and Aggression

2. Anger and Aggression • Anger: A normal emotional response to a perceived threat, frustration, or distressing event • In a crisis, is often one of first coping behaviors employed • Can be directed outward through aggressive, violent, or passive-aggressive behavior • Can be directed inward to produce depression or suicidal ideation or behavior • Associated with anxiety and loss of control • Can be a coping mechanism to meet needs • May be motivation or encouragement for action • Table 24-1 expressions of anger (Cont’d…)

3. Anger and Aggression (…Cont’d) • Aggression: A forceful attitude or action expressed physically, symbolically, or verbally • Passive aggression is indirect expression of anger through subtle, evasive, or manipulative behaviors. • Acting out is inappropriate, determined, or destructive behavior as expression of current or past anger. • Assertiveness: The ability to express feelings or needs directly in a way that respects rights of other people yet retains personal dignity (Cont’d…)

4. Gender Aggression • Agression acts towards women • Currently aggression aimed towards a woman’s virginity or fidelity

5. Anger and Aggression throughout Life Cycle • Anger begins in infancy and ends with death • Infancy • Unmet needs expressed through diffuse rage reactions • Loud, uncontrollable crying and screaming • Profuse perspiration • Difficulty breathing (sometimes “turning blue”) • Flailing arms and legs (Cont’d…)

6. Anger and Aggression throughout Life Cycle (…Cont’d) • Toddler stage • Temper tantrums • Focus aggression on the person or thing they blame for their anger • Observe behavior of others in the environment and pattern their own actions after them (Cont’d…)

7. Anger and Aggression throughout Life Cycle (…Cont’d) • Preschool age • Often direct anger toward others, especially age peers or younger children • Early school age • Frequently assault each other • Pre-adolescence • Most children have stopped hitting. • Learn to channel aggression into physical activities like sports or physical conditioning • Slander, gossip, and practical jokes provide outlets for aggressive feelings (Cont’d…)

8. Anger and Aggression throughout Life Cycle (…Cont’d) • Adolescence • Fighting is organized, controlled, purposeful • The peer group becomes the strongest influence • Peer groups whose activities are illegal or disruptive to others are known as gangs. • Adulthood • Emotional control increases with age • Between ages 22 and 45 mMost expressions of aggression and fighting occur within the family. • After age 45, few people engage in physical aggression. • Until the age approx 70 when cog. Imp. Result in aggressive or hositle behaviors

9. Scope of Problem Today • Worldwide concern • Wife beating in many countries • Homicide is the thenth leading cause of death for all citizens • Injuries are the 2nd leading cause of death for Native Americans • Black males – between ages 5 and 15 years murder was the 3rd leading cause of death

10. Theories of Anger and Aggression • Biological theories • Aggression and violence are the result of physical or chemical differences. • Research is focusing on areas of the brain that influence emotional control and aggressive behaviors. • Certain neurotransmitters are being investigated as possible factors in the development of violent tendencies. • Psychosocial theories • Focus on interactions in social environment • Violence arises from interpersonal frustration. • Aggressive behaviors are learned. (Cont’d…)

11. Theories of Anger and Aggression (…Cont’d) • Sociocultural theories • Aggression is explained from a social and cultural group viewpoint. • Cultural theories state that aggressive or violent acts as products of cultural values, beliefs, norms, and rituals. • Many cultures have rules that sanction violence. • Functional model • Aggression and violence serve certain functions in society as catalysts or motivators for action. • Aggressive behaviors are used to achieve fame, fortune, and power. (Cont’d…)

12. Theories of Anger and Aggression (…Cont’d) • Conflict theories • Aggression regarded as a natural part of all human interactions • Individuals, groups, and societies seek to further their own causes. • Conflict regarded as a natural part of human associations • Resource theory • Aggression is a fundamental feature of society. • The person who has the most resources has the greatest force or power. (Cont’d…)

13. Five Stages of Assault Cycle • Assault: Aggressive behavior that violates another’s person or property. • Assaultive behaviors • Causing physical pain • Rape • Murder • Suicide • Robbery, theft • Battery • Passive-aggressive acts • Emotional abuse (Cont’d…)

14. Five Stages of Assault Cycle (…Cont’d) • Trigger stage • Stress-producing event elicits anger, fear, anxiety, or similar response • Coping mechanisms are chosen in an attempt to achieve control. • “Assaultive” persons’ ability to solve problems or use nonviolent behavior decreases as aggressive feelings escalate • For lack of effective coping options, assaultive behavior becomes automatic. • Crisis interventions are very successful if begun early in this stage. (Cont’d…)

15. Five Stages of Assault Cycle (…Cont’d) • Escalation stage • Building stage—each behavior moves client a step closer to total loss of control. • Aggressive behaviors become increasingly ineffective in regaining control. • Frustration and anger only increase. • Intense emotions also make aggression escalate. • Intervention is crucial at this stage if violence to be prevented. (Cont’d…)

16. Five Stages of Assault Cycle (…Cont’d) • Crisis stage • Potential for danger increases • Assaultive behavior occurs • Acting out takes many forms: to physical harm to others, abuse or torture of animals, or destruction of property • Verbal abuse: screaming, shouting, and cursing • At this stage clients are unable to listen to reason, follow directions, or engage in mental exercises. (Cont’d…)

17. Five Stages of Assault Cycle (…Cont’d) • Recovery stage • Cooling-down period • Client slowly calms and returns to normal behavioral responses and actions. • Interventions include assessing for injury or trauma and providing a safe, quiet environment where client can recover. • Depressive stage • Period of guilt and attempts to reconcile with others • Assailant may offer loving care to victim. • As time passes, assaultive event is slowly “placed in the past.”

18. Anger Control Disorders • Aggressive behaviors are commonly encountered in clients with substance abuse, mood, anxiety, and depressive disorders • Potential for violence exists with schizophrenia and other psychotic disorders • Clients with eating, sleeping, or somatiform disorders seldom are aggressive towards others but are high risk for suicide due to the tendency to focus their anger inward • 3 Categories related to Anger Control Disorders: • Conduct disorders - childhood • Impulse control Disorders - later in life • Adjustment Disorders - anytime

19. Aggressive Behavior Disorders of Childhood • Conduct disorder: A pattern of behavior that violates the basic rights of others or flouts major-age-appropriate societal norms and rules • Main groups • Aggressive conduct • Nonaggressive conduct • Deceitfulness • Rules violations • Usually diagnosed in late childhood or early adolescence

20. Impulse Control Disorder • Essential feature is failure to resist impulses, drives, or temptation to perform an act that is harmful to self or others • Typically, client begins to feel an increasing tension when presented with the trigger stimuli. • Emotions build until it becomes impossible to resist or control the impulse. • Acting on the impulse produces gratification, pleasure, and release of tension. • Guilt, remorse, or regret may or may not be felt after impulse has been acted upon.

21. Adjustment Disorders • Adjustment disorder: negative emotional or behavioral response to an identifiable source • Characteristic features • Difficulty adapting to new situations • Overwhelmed by changes required during stressful time • Distress so great that it interferes with activities of daily living • Stressor may be single event, continuous, or repeated. • Regardless of cause, client has difficulty coping effectively.

22. Assessing Anger and Aggression • Basic mental status exam • Psychosocial assessment • Find out internal and external stressors are present • Coping skills used to adapt to stressors • Investigate relationships • Cultural, spiritual and occupational area of client’s life • Values and beliefs • Observe reactions and behaviors during the interview

23. Guidelines for Intervention • First step in controlling aggression is to assess client’s potential for engaging in inappropriate behaviors. • Levels of interventions for clients with aggressive or potentially aggressive behavior • Preventing violence • Protecting the client and others • Secluding or restraining the out-of-control client

24. Level One – prevention of violence • Establish and maintain trusting therapeutic relationship • Level Two – protecting the client and others from harm • Level Three – out of control client – restraints • Monitor client every 15 minutes