Ohio Hospital for Psychiatry is one of the leading treatment centers for individuals struggling with aggression. Located in Columbus, Ohio Hospital offers lasting recovery for adults and seniors struggling with mental health & co-occurring addiction issues.
Understanding Treatment for Aggression
Aggression is defined as any type of action(s) a person or group of people use with the intent to cause pain, suffering, and/or damage to another person, group of people, or property. Aggressive behaviors are powerful, antagonistic, and/or attacking and may occur with or without any provocation. Additionally, the offender must believe that his or her aggressive behaviors will damage the victim and as a result, the victim of the aggressive behaviors is compelled to evade the attack.
While anger and aggression often go hand-in-hand, they are not synonymous terms. Anger is a normal, necessary emotion that allows people to instinctively respond to danger and creates powerful emotions that enable a person to fight back if attacked. When anger is expressed in an assertive, non-aggressive manner, it allows people make their needs understood without hurting others. Uncontrolled anger, however, can become destructive and lead to aggressive, violent behaviors.
Understanding the Signs and Symptoms of Aggression
Aggression is often associated with physical violence but there are a number of types of aggressive behaviors. Physical aggression includes acts such as hitting, beating, or kicking another person while verbal aggression includes screaming at others or making threats. There are two main types of aggression: affective and instrumental aggression.
Affective aggression, also called “hostile aggression” or “retaliatory aggression,” is often used when a person feels intense anger. Affective aggressive acts can include impulsive, unplanned, overt, semi-uncontrolled, and spur-of-the-moment behaviors. Affective aggression is often used to physically or emotionally harm another person(s). Affective aggressive acts include:
Instrumental aggression, also called “predatory aggression,” is a purposeful, premeditated type of aggression that can be physical, emotional, or both. People who engage in instrumental aggression may act without provocation as an attempt to gain a particular outcome. This form of aggression includes preemptive, deliberate, and cold-blooded behaviors often carried out by people who feel no remorse for their actions. One of the most common form of instrumental aggression is “relational aggression,” which includes spreading rumors, gossiping, social exclusion, or otherwise hurting another person(s). Examples of instrumental aggression include:
- Spreading rumors
- Excluding others
- Destruction of objects
While the terms are often used interchangeably, aggression is not the same as conflict – conflict is the result of two or more people having opposing goals or interests. Conflict can be solved in many ways including negotiation, persuasion, or taking turns. Aggressive behaviors are a way that some people overcome conflicts, however not all conflicts involve aggression.
There are a number of motives for a person to engage in aggressive behavior, including:
- As a means to express anger or hostility
- To threaten or bully another person
- To achieve a goal
- As a means to an end
- To express possession or to assert dominance
- In response to fear or pain
- As a form of competition
What are the underlying causes of Aggression?
The cause for aggression has been hotly debated for centuries. The frustration-aggression theory suggests that when people are frustrated and cannot reach their goals, they become angry and behave in an aggressive manner. The social learning theory has received the most acceptance in today’s view of aggression and maintains that people learn to behave aggressively based upon their environment and use it to achieve their goals. It’s commonly accepted that the manner in which you respond to frustration in your world likely depends on what you have learned.
Researchers have spent much time trying to understand how differences in the brain explain the reasons why one person behaves aggressively while another does not. It appears as though there are a number of circuits and subcortical structures that play a central role in controlling aggression. The precise roles of these pathways may vary depending upon the trigger of the aggression. It appears that the prefrontal cortex of the brain is very important in terms of regulating aggression and other emotions. Lowered activity in the prefrontal cortex – particularly the medial and orbitofrontal areas – has been associated with violent and antisocial aggression. Low levels of neurotransmitters, particularly a deficit in the neurotransmitter serotonin, have been linked to impulsiveness and aggression.
What are the causes of Aggression in adults?
Aggression in adults can be the result of many factors working together or a symptom of a mental illness. There are a number of mental illnesses that can lead to the development of aggression in adults. The most common mental illnesses that can evoke aggressive behaviors include:
Antisocial personality disorder (ASPD): ASPD is a personality disorder characterized by a long-standing pattern of disregard for and abject violation of the rights of others, a history of criminal behavior and legal problems, and impulsive and outwardly aggressive acts. This may be caused by a decreased sense of morals or conscience.
Bipolar disorder: People who have bipolar disorder may act aggressively during a manic phase. Additionally, while struggling with depressive cycles, people who have bipolar disorder may become highly irritable, leading to outbursts of aggression.
Borderline personality disorder: People who have borderline personality disorder are prone to significant emotional instability which can lead them to lash out at others both verbally and physically during periods of anger and impulsiveness.
Histrionic personality disorder (HPD): HPD is a personality disorder characterized by patterns of extreme emotions and attention-seeking behaviors. If desired attention is not given, people with HPD may lash out in aggression to obtain the wanted attention.
Intermittent explosive disorder (IED): This disorder involves a pattern of episodes of impulsive, violent, aggressive, and angry outbursts that are completely out of proportion to the situation. Individuals who have IED may attack others or their possessions, causing property damage and bodily injury, then later feel tremendous shame for their actions.
Schizoaffective disorder: People who have schizoaffective disorder have symptoms of schizophrenia, such as hallucinations and delusions, as well as symptoms of a mood disorder. During a psychotic break, individuals who have schizoaffective disorder may become violent and aggressive as they respond to internal stimuli, such as “voices” or certain types of delusions.
Schizophrenia: While most individuals who have schizophrenia are not violent, occasionally the breaks in reality that characterize this disorder can lead to full-blown psychosis. During psychotic episodes, an individual may respond to internal stimuli and act aggressively toward others out of genuine fear.
Substance abuse: People addicted to drugs or alcohol may experience bouts of aggression during intoxication. Methamphetamines, PCP, and alcohol have particularly high rates of aggression during the high and can be quite dangerous for the individual and others around them.
Treatment of mental illnesses that can cause aggression must be tailored for the individual and their unique situation so that the best possible outcome is obtained.
What are the causes of Aggression in seniors?
Senior adults face a myriad of medical, emotional, behavioral problems and stresses not typically experienced by younger individuals. These problems can lead to the development of aggression in senior adults. Often, older adults who are struggling with aggressive behaviors have some type of underlying condition that causes some to act out. These may include:
Alzheimer’s disease: Alzheimer’s disease is the most common form of dementia in senior adults, causing up to 85% of all known cases of dementia. As Alzheimer’s disease directly impacts the brain by systematically destroying areas that are involved in emotional regulation, many senior adults who struggle with Alzheimer’s disease engage in aggression and violence in the later stages of the disease.
Dementia: While dementia is not a single syndrome but rather a group of syndromes, one of the hallmarks of this syndrome can include aggression and violence, often very out of character for the person. Senior adults experiencing dementia may not know who or where they are and lash out at loved ones and caregivers in response to benign stimuli. Still others may become aggressive as a result of fears or anxiety stemming from their confusion.
Psychosis: As psychosis is a generic term that refers to an altered mental state including a break from reality, older adults may experience this symptom as a result of existing medical conditions, medication interactions, and mental illnesses. The hallucinations and/or delusions characteristic of this mental state may cause an adult to lash out at others. Many times, older adults who have psychosis may become violent toward themselves or others.
Treatment for senior adults must be handled by a comprehensive team of medical and psychiatric personnel like those at our aggression treatment center in Columbus. This is necessary to rule out any other conditions such as adverse medication reactions and other medical reasons for this troubling symptom. At our hospital, we have a multidisciplinary team of geriatric specialists, which is the best approach to manage and treat aggression in seniors.