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PubMed2006

Trajectories of aggression from toddlerhood to age 9 predict academic and social functioning through age 12.

BACKGROUND: Using longitudinal data from the NICHD Study of Early Child Care and Youth Development, we examined behavior problems and social and academic outcomes from ages 9 through 12 in children classified into five trajectories of physical aggression, on the basis of maternal ratings obtained from 24 months through 9 years (N = 1195). METHODS: Outcome data were obtained from teacher reports, observations of children's behavior, and children's self-reports. RESULTS: Children on the high-stable aggression trajectory (3% of sample) showed the most severe adjustment problems, including poorer social skills, higher levels of externalizing problems, and more self-reported peer problems; those on the moderate-stable aggression trajectory (15%) showed poor regulation and inattention. Although children with moderate levels of early aggression that decreased sharply by school entry (12%) appeared well adjusted at follow-up, those who showed a low level of stable aggression (25%) evidenced some unanticipated social and behavior problems. Children in the contrast group (45%) were consistently very low in aggression from toddlerhood onward. CONCLUSIONS: Results highlight links between different patterns (stable or decreasing) and levels (high, moderate, low, very low) of aggression across childhood and children's later adjustment. For example, even quite low aggression that is stable appears to be a risk factor for some social problems; in contrast, moderate aggression that decreases sharply to no aggression by school entry is associated with good adjustment at age 12.

Age Factors↗
PubMed1997

The perception of aggression.

Several academic and clinical disciplines are involved in clarifying the concept of aggression by formulating operational and descriptive definitions. In the present paper the validity of the definitions of aggression, reported by nurses in an earlier qualitative study, is examined, using a survey approach among nurses of five general psychiatric hospitals in the Netherlands. Three dimensions of aggression were found; aggression as a normal, adaptive reaction, aggression as a violent reaction and aggression as a functional reaction. These findings match the results of the qualitative study. It was investigated whether there was a relation between personal and environmental characteristics of the nurses and the way they perceive aggression. The gender of the respondents, the setting in which they were working, the degree to which they used constraint measures and whether patients were voluntarily admitted or not, were related to the perception of aggression. The study points out that different instruments are needed to measure the prevalence or incidence of aggression and to diagnose or to intervene on aggression in clinical practice.

Adult↗
PubMed1997

Psychotic symptoms and physically aggressive behavior in Alzheimer's disease.

OBJECTIVE: To examine the relationship between psychotic symptoms and subsequent physically aggressive behavior in outpatients with Alzheimer's disease. DESIGN: This observational study used a time series design to measure the presence and frequency of physically aggressive behavior over a 52-week period. Multiple regression models were used to evaluate delusions and hallucinations, assessed at baseline, as predictors of physical aggression, controlling for demographic and clinical variables. SETTING AND PARTICIPANTS: Of 315 consecutive eligible outpatients from the Rush Alzheimer's Disease Center, referred for evaluation for dementia, 270 (86%) participated in the study. All participants met NINCDS/ADRDA criteria for probable Alzheimer's disease; Mini-Mental State Examination scores ranged from 0 to 27, with a mean of 14.9 (SD = 5.6). MEASUREMENTS: Psychotic symptoms, previous episodes of physical aggression, and demographic variables were measured at baseline through a structured interview with an informant living in the same household. Physically aggressive behavior was measured sequentially at 1-week intervals over a period of 52 consecutive weeks and also through structured informant interviews. RESULTS: A total of 75 persons had one or more episodes of physical aggression during the 52 weeks of observation. The presence of delusions significantly predicted the presence and frequency of physical aggression. Of participants with high rates of physical aggression (> 1 episode/month), 80% had delusions. This effect was robust, even after controlling for the effects of other clinical variables. By contrast, hallucinations did not reliably predict episodes of physical aggression. CONCLUSIONS: These data suggest that delusions, but not hallucinations, predict physically aggressive behavior in persons with Alzheimer's disease. In light of the persecutory nature of most delusional ideation in Alzheimer's disease, delusions may be associated with distortions in the perception of threat in common social situations.

Aged↗
PubMed2000

Reduction of frontal neocortical grey matter associated with affective aggression in patients with temporal lobe epilepsy: an objective voxel by voxel analysis of automatically segmented MRI.

BACKGROUND: Interictal episodes of aggression are often reported in patients with epilepsy. Some have characteristics of what has been referred to as episodic dyscontrol or intermittent explosive disorder (IED). Although structural brain abnormalities are thought to play a part in the pathophysiology of aggression, there are few in vivo studies of structural cerebral changes in patients with epilepsy and aggression. Using quantitative MRI, subtle structural brain abnormalities can be investigated in subgroups of patients with both epilepsy and episodes of affective aggression. METHODS: After automated segmentation of cerebral grey matter from T1 weighted MRI, the objective technique of statistical parametric mapping (SPM) was applied to the analysis of 35 control subjects, 24 patients with temporal lobe epilepsy (TLE) with a history of repeated, interictal episodes of aggression, and 24 patients with TLE without episodes of aggression. Both TLE patient groups were compared with each other and with the control subjects on a voxel by voxel basis for increases and decreases of grey matter. RESULTS: The patients with TLE with aggressive episodes had a decrease of grey matter, most markedly in the left frontal lobe, compared with the control group and with patients with TLE without aggressive episodes. CONCLUSION: These findings suggest that a reduction of frontal neocortical grey matter might underly the pathophysiology of aggression in TLE. These voxel by voxel comparisons can guide further in vivo studies into aggression.

Adolescent↗
PubMed1996

Aggression among psychiatric inpatients in Greece.

We studied, during 5 consecutive days, the prevalence, types and demographic, historical and clinical correlates of overt aggression in a population of 136 acute and chronic inpatients with mainly a diagnosis of psychotic disorder. Almost one fourth of them exhibited some sort of aggressive behavior. Verbal aggression was by far the most frequent type followed-in decreasing order-by physical aggression, aggression against property and self-aggression. Past threats of violence and attacks on others as well as concurrent motor excitement, agitation, low tolerance of frustration, difficulty in delaying gratification, depressive feelings, anger, hostility, affective lability and antisocial behavior differed significantly across the aggressive and the nonaggressive groups. The best short-term clinical predictors of aggression were different for each type, anger being their sole common predictor, and accounted for various proportions of the corresponding variances ranging from only 13.3% for self-aggression to 39.2% for verbal aggression.

Adolescent↗
PubMed2003

Differences between patient and staff perceptions of aggression in mental health units.

OBJECTIVE: This study examined the views of patients and staff involved in incidents of aggression to help understand emotions experienced, perceptions of causes, and recommendations for ways of reducing the frequency of aggression. METHODS: A total of 29 staff and 29 patients from four psychiatric inpatient units who were involved in 47 incidents of aggression over a four-month period were interviewed shortly after the incidents. RESULTS: Significant differences were found between staff and patient perceptions of the causes of aggression and recommendations for reducing it. Many staff members perceived the patient's illness as the cause of the aggression and believed that, to manage aggression, changes in medication were largely indicated. In contrast, patients perceived illness, interpersonal factors, and environmental factors as being almost equally responsible for their aggression, and nearly all patients emphasized the need for improved staff-patient communication and more flexible unit rules in helping reduce aggression. Patients and staff were generally satisfied with the way the aggressive incidents were managed, but more staff than patients had an opportunity to debrief. CONCLUSIONS: Staff and patients had different perceptions of causes of aggression and ways to reduce it. Staff supervision and training should highlight the need for understanding patients' perspectives.

Adult↗
PubMed2003

Patients' views of causes of aggression by patients and effective interventions.

OBJECTIVE: The authors studied patients' perceptions of the causes of aggression by patients and their recommendations for interventions to prevent assaultive behavior. METHODS: A total of 92 inpatient and outpatient veterans, the majority of whom had a psychiatric diagnosis and some a medical diagnosis, answered questions in individual interviews about whether they had ever witnessed an assault. RESULTS: Fifty-two participants had witnessed aggression. Participants' answers about the causes of patient-to-patient and patient-to-staff aggression were categorized into internal factors-cognition, feelings, and symptoms-and interpersonal stressors, such as personality conflicts and abrasive words. The majority of causes identified were in the category of interpersonal stressors-67 percent for patient-to-patient aggression and 60 percent for patient-to-staff aggression. The participants' answers about suggested interventions to prevent both types of aggression were categorized as individual patient, cooperative patient-staff, and staff interventions. For patient-to-patient aggression, 52 percent of the interventions suggested were for staff. This proportion was 74 percent for patient-to-staff aggression. For both types of aggression, only 10 percent of the suggested interventions involved patient-staff cooperation. CONCLUSIONS: The participants indicated that both patients and staff play important parts in causing and in intervening to prevent violence. This information can be used to help plan programs to prevent and intervene in aggressive behavior.

Adult↗
PubMed1997

Prevention of aggressive incidents on a closed psychiatric ward.

OBJECTIVE: This study examined whether staff members' use of interventions for preventing patients' aggression reduced the number of incidents of aggression on a closed acute admissions ward of a psychiatric hospital in the Netherlands. METHODS: The number and severity of incidents of aggression on three closed wards were measured using the Dutch version of the Staff Observation Aggression Scale (SOAS). Measurements were made for three months before and after staff implemented interventions for preventing aggression on one of the wards. Interventions included a protocol for talking to patients who exhibited aggressive behavior, discussing treatment goals with the patient shortly after admission, explaining why the ward's door was locked and the exit rules, providing a schedule of staff meetings to explain staff members' absence from the ward, and clarifying the procedure for making an appointment with the psychiatrists. RESULTS: The frequency of aggressive incidents was reduced on all three wards, with no significant difference between the ward where the interventions were implemented and the two control wards. A marginally significant difference in the severity of aggressive incidents was found between experimental and control wards after the introduction of the preventive measures, with incidents in the experimental ward tending to be less severe. CONCLUSIONS: This study failed to find a robust effect of specific intervention measures on aggressive incidents. However, it did find evidence suggesting that standardized reporting by staff of aggressive incidents on closed psychiatric wards may in itself result in straightforward reduction of violent incidents.

Aggression↗
PubMed1999

Aggressive behavior against self and others among first-admission patients with schizophrenia.

OBJECTIVE: Aggressive behavior directed against self and others was examined in a sample of patients with schizophrenia during their first hospitalization and during any subsequent hospitalizations over the next two years. METHODS: The charts of 138 patients (77 men and 61 women) with a first episode of schizophrenia or schizoaffective disorder admitted to a psychiatric hospital in Weissenau, Germany, were reviewed to obtain information about four types of aggressive behavior (verbal aggression and aggression against objects, self, and others). Similar chart reviews were conducted for 83 patients (47 men and 36 women) who were rehospitalized during the next two years. The severity of the four types of behavior was rated using the Modified Overt Aggression Scale. Stepwise multiple regression was used to identify predictors of the number and duration of rehospitalizations. RESULTS: Seventy-five percent of the men and 53 percent of the women in the sample exhibited some type of aggressive behavior during the first or subsequent admissions. Seventeen percent of men and 26 percent of women attempted suicide. Among the predictors of rehospitalization that were examined, which did not include medication compliance, only aggressive behavior against self and against others were significant predictors during the two years after first admission. Predictors of aggressive behavior against others were male sex, number of hospitalizations, and alcohol abuse (among men only). Self-directed aggressive behavior was correlated with days of hospitalization but not with number of rehospitalizations. CONCLUSIONS: Aggressive behavior against self and others is a frequent symptom of schizophrenia in the first two years of illness and plays a major role in rehospitalization.

Adult↗
PubMed2005

Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities.

BACKGROUND: Verbal and physical aggressive behaviours are among the most disturbing and distressing behaviours displayed by older patients in long-term care facilities. Aggressive behaviour (AB) is often the reason for using physical or chemical restraints with nursing home residents and is a major concern for caregivers. AB is associated with increased health care costs due to staff turnover and absenteeism. METHODS: The goals of this secondary analysis of a cross-sectional study are to determine the prevalence of verbal and physical aggressive behaviours and to identify associated factors among older adults in long-term care facilities in the Quebec City area (n = 2,332). RESULTS: The same percentage of older adults displayed physical aggressive behaviour (21.2%) or verbal aggressive behaviour (21.5%), whereas 11.2% displayed both types of aggressive behaviour. Factors associated with aggressive behaviour (both verbal and physical) were male gender, neuroleptic drug use, mild and severe cognitive impairment, insomnia, psychological distress, and physical restraints. Factors associated with physical aggressive behaviour were older age, male gender, neuroleptic drug use, mild or severe cognitive impairment, insomnia and psychological distress. Finally, factors associated with verbal aggressive behaviour were benzodiazepine and neuroleptic drug use, functional dependency, mild or severe cognitive impairment and insomnia. CONCLUSION: Cognitive impairment severity is the most significant predisposing factor for aggressive behaviour among older adults in long-term care facilities in the Quebec City area. Physical and chemical restraints were also significantly associated with AB. Based on these results, we suggest that caregivers should provide care to older adults with AB using approaches such as the progressively lowered stress threshold model and reactance theory which stress the importance of paying attention to the severity of cognitive impairment and avoiding the use of chemical or physical restraints.

Aged↗
PubMed1995

An investigation of gender differences in alcohol-related aggression.

OBJECTIVE: The majority of the research on alcohol-related aggression has been conducted on men. This bias has persisted despite mounting evidence indicating gender differences in aggression. As such, the purpose of this study was to investigate gender differences in alcohol-related aggression. METHOD: Subjects were 64 men and 64 women who competed against either male or female fictitious opponents on a modified version of the Taylor aggression paradigm in which electric shocks were received from and administered to a fictitious opponent during a competitive task. Aggression was operationalized as the intensity and duration of the shocks selected by the subjects. Subjects were assigned to either an alcohol, a placebo or a sober group. RESULTS: Alcohol increased both shock intensity and duration in men; however, it only increased shock duration in women. Men behaved more aggressively toward men, whereas women displayed equal levels of aggression toward both genders. Alcohol expectancies did not appear to have an effect on aggressive behavior for either gender. CONCLUSIONS: The findings of this investigation indicate that alcohol differentially affects aggressive responding in men and women. It is suggested that men are likely to express alcohol-related aggression in direct (shock intensity) and indirect (shock duration) forms, whereas women are most likely to use indirect forms (shock duration).

Adult↗
PubMed1999

The effects of a cumulative alcohol dosing procedure on laboratory aggression in women and men.

OBJECTIVE: This study directly compared the effects of cumulative alcohol dosing procedure on aggression in both women and men. METHOD: Thirteen women and 13 men consumed three beverages 1 hour apart. There were two experimental conditions: (1) a placebo day, when subjects consumed three 240 ml beverages, each containing only 1 ml of alcohol; and (2) an alcohol day, when subjects consumed three 240 ml beverages, each containing 0.35 g/kg of 95% alcohol. Alcohol doses for women were reduced by 8%. Prior to beverage consumption, and periodically after consumption, subjects participated in 25-minute laboratory testing sessions designed to measure aggression. In this paradigm, subjects could earn points by responding on a button, or aggress toward a fictitious opponent who ostensibly subtracted earnings from them. RESULTS: Both women and men showed an increase in aggressive responding after drinking alcohol but not placebo. As a group the greatest increases were observed after consuming the second alcohol drink (BAC = 0.08%). Aggressive responding, however, remained elevated for several hours after alcohol consumption. A post hoc analysis of the data indicated that subjects with high aggression levels under placebo conditions showed the greatest increases in aggression under alcohol conditions. CONCLUSIONS: These results indicate that at least under these conditions, alcohol does increase aggression in both women and men. The aggression-increasing effects of alcohol appear to be long-lasting and specific to individuals with the higher aggressive tendencies while sober.

Adult↗
PubMed2002

Effects of alcohol and trait anger on physical aggression in men.

OBJECTIVE: According to recent theoretical models, the alcohol-aggression link is predicated on the interaction among many variables, including the drinker's personality. The few studies that investigated effects of personal dispositions on alcohol-related aggression have been inconclusive, possibly because the role of dispositions related to affect were largely ignored. As such, the purpose of this study was to investigate the interactive effect of alcohol and trait anger on physical aggression. METHOD: Participants were 136 male social drinkers who reported high, moderate, and low levels of trait anger and were nonrandomly assigned to an "alcohol" or "no-alcohol" control beverage group. Participants competed in an aggression paradigm in which electric shocks were received from and administered at will to a fictitious opponent during a competitive task. Shock intensity, duration, and proportion of highest shock served as indexes of aggression. RESULTS: Intoxicated participants with moderate trait anger selected higher shock intensity and had a greater proportion of highest shock, compared with their sober counterparts. Within the alcohol group, high- and moderate-anger participants were more aggressive than low-anger participants. Intoxicated participants selected longer shock durations following both low and high provocation, and they evinced a greater increase in shock duration from low to high provocation than their sober counterparts. Independent of beverage group, men who reported a high or moderate level of trait anger displayed more aggression on all measures, compared with those who reported low anger disposition. CONCLUSIONS: The present findings suggest that individuals who report low levels of trait anger may be more resistant to the potentiating effects of alcohol on aggression and that the effects of alcohol on aggression may be most pronounced in men who have a moderate level of trait anger. Furthermore, independent of intoxication, trait anger appears to be a risk factor for physical aggression in men.

Adolescent↗
PubMed2006

To what extent is intoxication associated with aggression in bars? A multilevel analysis.

OBJECTIVE: The purpose of this study was to assess the relationship between level of intoxication and the frequency and severity of aggression at the person, incident, visit, and bar level for aggressive incidents observed in bars or clubs. METHOD: Hierarchical Linear Modeling (HLM) analysis of 1025 incidents of aggression documented by trained observers during 1334 nights of observation in 118 bars and clubs in Toronto, Canada, was conducted. RESULTS: Both level of intoxication of the crowd during the visit as well as mean level of intoxication at the bar level significantly predicted frequency of aggression. There was a positive association between level of intoxication and severity of aggression at both the incident and person level except for the highest level of intoxication at the person level, where severity of aggression was less than for moderate intoxication. A person-incident level interaction between intoxication and severity of aggression was also found. CONCLUSIONS: These results suggest that prevention efforts should focus on both identifying bars that typically have more intoxicated patrons and reducing the intoxication levels of patrons across bars generally. The results also showed a strong positive relationship between level of intoxication and severity of aggression (except at the highest levels), indicating that intoxication increases risk in terms of both frequency and severity of aggression. The significant interaction between person- and visit-level intoxication suggests that greater attention needs to be paid to group dynamics in alcohol-related aggression.

Aggression↗
PubMed1993

Alcohol, benzodiazepine-GABAA receptor complex and aggression: ethological analysis of individual differences in rodents and primates.

Research in animals has only recently been successful in reliably mimicking the long-established link between alcohol and heightened aggressive behavior. The present review highlights the large individual differences in the effects of acute low alcohol doses on aggressive behavior in rodent and primate species, paralleling the human condition. Subpopulations of both species show reliable and repeatable enhancement of aggressive behavior when administered low, acute alcohol doses. Statistical analysis of the temporal patterns of aggressive behavior indicate that alcohol prolongs aggressive bouts or "bursts" and increases the number of aggressive behaviors within each burst. However, the latency to initiate attack and the time between aggressive bursts are relatively unaltered by alcohol. These alcohol-induced increases in aggression can be potentiated by benzodiazepine agonists and prevented by antagonists. In addition, highly aggressive animals can be differentiated from nonaggressive ones at the GABAA-benzodiazepine receptor complex. These data suggest an important link between alcohol, aggression and the GABAA-benzodiazepine receptor complex.

Aggression↗
PubMed1993

A longitudinal investigation of alcohol use and aggression in adolescence.

Data from a prospective, longitudinal study of males and females tested at age 12, 15 and 18 years are used to study the relationship between alcohol use and aggression. Prevalence rates for alcohol use are similar for males and females. However, prevalence rates for aggressive behavior and alcohol-related aggression among females are lower than those for males and too low to permit meaningful analysis. Two series of nested structural equation models examine the interrelationships between alcohol use and aggressive behavior over time for all males in the sample and for male alcohol users only. The findings indicate that early aggressive behavior leads to increases in alcohol use and alcohol-related aggression, but that levels of alcohol use are not significantly related to later aggressive behavior. Thus, the data suggest that alcohol-related aggression is engaged in by aggressive people who drink. These data lend support to other research that indicates that early aggressive and antisocial behavior is predictive of later alcohol-related problems.

Adolescent↗
PubMed2003

Gender differences in psychological, physical, and sexual aggression among college students using the revised conflict tactics scales.

In response to criticisms of the Conflict Tactics Scales, Straus revised the original scale to include sexual aggression and injury. The purpose of the present study was to use this new scale to replicate and expand existing knowledge of psychological, physical, and sexual aggression in dating relationships. Four-hundred-eighty-one college students completed the Revised Conflict Tactics Scales. As expected, females reported perpetrating more psychological aggression than males; there were no gender differences in reported physical aggression; and psychological and physical aggression tended to co-occur. Contrary to previous research, there were no gender differences in injuries. As expected, males reported perpetrating more sexual coercion than females; however, females also reported perpetrating sexual aggression, and there were no gender differences in reported victimization. For males, sexual coercion perpetration (not victimization) was related to the perpetration and victimization of physical and psychological aggression. For females, both sexual coercion perpetration and victimization were related to the perpetration and victimization of psychological aggression and victimization from physical aggression, but not to physical aggression perpetration.

Adolescent↗
PubMed2001

Roles of outcome expectations and self-efficacy in preschoolers' aggression.

The present study examined preschool boys' beliefs for the outcome of aggression and their perceptions of self-efficacy for aggressive behaviors. 23 preschoolers (mean age 6.3 yr.; 12 aggressive boys and 11 nonaggressive boys) were presented stories about provocative situations and asked about three expectations for aggression: positive outcomes, peer rejection, and morality. Another 18 preschoolers (mean age 6.3 yr.; 9 aggressive boys and 9 nonaggressive boys) rated their self-efficacy for four strategies: aggression, verbal persuasion, seeking help from a teacher, and withdrawal. Aggressive preschoolers did not expect a negative outcome in the form of peer-rejection in response to aggression as much as nonaggressive boys, although the groups did not differ in their expectations of positive outcomes and morality. Also, aggressive preschoolers were more confident about aggression in situations including teasing or criticism but less confident about verbal persuasion than nonaggressive preschoolers.

Aggression↗