Aggression has been defined as destructive, injurious or damaging, physical or verbal actions targeting other people, property or oneself. Aggression, which is aimed inward, may be demonstrated as self-injurious behavior. Aggressive behavior can also be viewed as actions which are impulsive or reactive and which frequently culminate in breaking rules or laws, going against social norms, or failure to respect the rights of others.
There are countless potential triggers for aggression that differ based on the person. Common triggers identified include:
- Nutritional deficits
- Feeling unsure of oneself
- Over-arousal and Over-stimulation
In addition, aggression can be expressed in a number of ways including:
Experts have also posted a number of purposes that aggression may serve for different people. These include:
- To communicate anger, enmity or resentment
- To establish dominance and control
- To frighten, coerce or threaten
- To attain a goal without putting in the requisite effort
- To convey ownership
- A reaction to fear
- A response to pain
- To compete with others while putting them at a disadvantage
Aggression is not always viewed as maladaptive. Most experts consider it to be a normal and frequently occurring behavior in young children developing social assertiveness, understanding competition in a manner that does not result in harm to others and meeting the normal challenges inherent in everyday life. Yet some say that there is a fine line between assertiveness and aggression, and goals such as these are facilitated by assertive actions and not aggressive ones.
There are numerous populations in which aggression is frequently observed, for example in the developmentally delayed and seniors with dementia, and it appears in all age groups across the lifespan.
Disorders with Aggression as a Main Characteristic
Aggression is also one of the main symptoms of disruptive behavior disorders as well as other disorders. Disorders that fall in this category include:
- Oppositional Defiant Disorder
- Conduct Disorder
- Antisocial Personality Disorder
- Intermittent Explosive Disorder
- Sadistic Personality Disorder
- Substance Use Disorder
- Paranoid Personality Disorder
- Authoritarian Personality Disorder
- Borderline Personality Disorder
- Post-Traumatic Stress Disorder
Treatment for Aggression in Children and Adolescents
Stimulant Medication, Mood Stabilizers, and Typical/Atypical Anti-psychotics have proven useful in limiting aggressive and destructive behaviors in children diagnosed with conduct disorder, ADHD, ODD, and co-morbid low IQ. While research supports these treatments for children who are developmentally delayed, it has not been shown to be effective in children with low IQ and co-morbid pervasive developmental disorder, autism, psychosis, head injury or seizure disorders.
Methylphenidate – This stimulant has proven extremely effective in treating ADHD including episodes of aggression. Recent studies have also shown this medication is effective in treating acting out behaviors in children with conduct disorder.
Mood Stabilizers and Typical/Atypical Anti-psychotics – The mood stabilizer lithium, commonly used for bipolar disorder, has been shown to be effective in decreasing aggression in children with treatment-resistant aggressive conduct disorder ages 5 to 12. The typical anti-psychotics including haloperidol, thioridazine and chlorpromazine are frequently used to treat aggression found in severe explosive disorders in children. The atypical anti-psychotic Risperidone has been used successfully to decrease or eliminate aggressive behavior in children with ADHD.
Behavior therapy has been shown to help control aggression in children and adolescents with ODD, ADHD, and CD. These techniques are based on learning principles and parents are taught different techniques such as reinforcement, ignoring, and alternate disciplinary strategies to help the child learn to control their anger. Parents are also provided with strategies to manage their own frustration.
Treatment for Aggression in Adults
Medication is often used to treat aggression in adults. However, it is important to determine the underlying cause of the aggression in order to have successful outcomes long term. Medication choices depend on what syndrome or disorder the aggression is part of in addition to individual differences among patients. Some of the more common medications used in this population include:
Benzodiazepines – These are medications frequently used to treat anxiety and other symptoms. Ativan is often the drug of choice when there is uncertainty about the cause of the aggression.
Anti-psychotics – Some of the newer anti-psychotics appear to be effective options for treating aggression in adults. In particular, Geodon, Clozaril, Risperdal, and Zyprexa have demonstrated good efficacy with lower side effects that first generation anti-psychotics. The also appear to have a cumulative effect of combating aggression over time. Most experts caution against using these medications unless the individual is suffering from a psychotic disorder or episode though there is some support for using them for aggression and violence in developmentally delayed adults.
Antidepressants – These medications have been shown to decrease negative mood, aggression and violence while increasing positive personality characteristics. Studies have demonstrated that people suffering from personality disorders and PTSD with associated aggression have responded well to treatment with antidepressants.
Mood Stabilizers – This class of medications, though not typical medications used to treat aggression, they have been used effectively in a number of psychiatric conditions that include symptoms of aggression or violence. These include dementia, borderline personality disorder, organic mood syndrome, bipolar disorder, schizophrenia, schizoaffective disorder, and mental retardation.
There are a number of psycho-therapeutic approaches offered at treatment centers to treat violence and aggression in adults. Two of the most frequently used are Cognitive Behavioral Therapy and Psychodynamic Therapy
Cognitive Behavioral Therapy – This intervention helps individuals assess their aggression related thoughts, learn to understand these thoughts as well as how the consequences relate to negative feelings and aggressive behaviors. Individuals work on the ability to challenge and replace negative thoughts that are associated with aggression with more positive adaptive thoughts. In addition, people are given more effective coping techniques to use in stressful situations.
Psychodynamic Therapy – This therapy modality helps individuals recognize unconscious conflicts and memories which have been prevented from entering the consciousness due to their overwhelming nature. As individuals slowly learn to bring out and cope with this dissociated material they also learn how these unconscious urges were inappropriately diverted into violent or aggressive actions. Once the unconscious material has been recognized the individual is taught healthier coping mechanisms for dealing with the negative emotions they are experiencing.
Continuing Care – What Comes Next?
When you have completed your treatment for aggression here at Lakeland’s behavioral health center in Missouri, we will do everything we can to ensure that a plan is put in place for continuity of care. You will work closely with a discharge planner in order to determine the next best step in your treatment process. We will also connect you and your family members with needed community resources after leaving the treatment clinic. If additional treatment is needed, we will help you to identify the most appropriate option. For some, this may be a Residential Program, a less intense Partial Hospitalization Program (PHP) or Intensive Outpatient Program (IOP). If it has been determined that you are ready to leave Lakeland’s treatment center and return home, we will work with you and your family members to make sure that everyone feels comfortable with the aftercare plan.