Anger/Aggression Management

Anger need not be a negative expression. Anger is a normal human emotion that, when handled appropriately and expressed assertively, can provide an individual with a positive force to solve problems and make decisions concerning life situations. Anger becomes a problem when it is not expressed and when it is expressed aggressively.

Anger
* Anger is an emotional state that varies in intensity from mild irritation to intense fury and rage. Anger causes physiological changes (e.g., increased heart rate, blood pressure, and levels of biogenic amines. Anger is
Not a primary emotion; learned

Typically experienced as an automatic inner response to hurt, frustration, or fear A physiological arousal, instilling feelings of power and generating preparedness Significantly different from aggression Capable of being under personal control

Anger has positive and negative functions

Aggression
Is one way that individuals express anger Is a behavior that is intended to threaten or injure the victims security or self-esteem Can cause damage with words, fists, or weapons, but it is virtually always designed to punish.

Predisposing Factors to Anger and Aggression

Role-modeling is one of the strongest forms of learning. Role models can be positive or negative. Earliest role models are the primary caregivers. As the child matures, role models can be celebrities or any other influential individual in the childs life.

Operant Conditioning
Operant conditioning occurs when a specific behavior is positively or negatively reinforced. A positive reinforcement is a response to the specific behavior that is pleasurable or produces the desired results. A negative reinforcement is a response to the specific behavior that prevents an undesirable result from occurring. Anger and aggression can be learned through operant conditioning.

Neurophysiological Disorders
Several disorders of, or conditions within, the brain have been implicated in episodic aggression and violent behavior. They include Temporal or frontal lobe epilepsy Brain tumors Brain trauma Encephalitis

 Aggressive behavior may have some correlation to alterations in brain chemicals. These include
Hormonal dysfunctionassociated with hyperthyroidism

Alterations in the neurotransmitters epinephrine, norepinephrine, dopamine, acetylcholine, and serotonin; these chemicals may play a role in facilitation or inhibition of aggression.

Socioeconomic Factors
High rates of violence exist within the subculture of poverty in the United States. Poverty is thought to encourage aggression because of the associated deprivation, disruption of families, and unemployment.

Environmental Factors
Several environmental factors have been associated with an increase in aggressive behavior. They include
Physical crowding of people Discomfort associated with a moderate increase in environmental temperature Use of alcohol and some other drugs, particularly cocaine, amphetamines, hallucinogens, and minor tranquilizers/sedatives Availability of firearms

Characteristics of anger
Anger can be identified by a cluster or characteristics that include
Frowning Clenched fists Low-pitched words forced through clenched teeth Yelling and shouting

Characteristics of anger
Intense or no eye contact Easily offended Defensive Passive-aggressive Emotional overcontrol and flushed face Intense discomfort Tension

Aggression
Aggression can be identified by a cluster of characteristics that include
Pacing Restlessness Tense face & body Verbal or physical threats Threats of homicideor suicide

Increased agitation Overreaction to environmental stimuli Panic anxiety, leading to misinterpretation of the environment Disturbed thought processes Suspiciousness Disproportionate anger

Assessing Risk Factors

Prevention is the key issue in management of aggressive or violent behavior. Three factors are important considerations in identifying extent of risks Past history of violence Client diagnosis Current behavior

 Past history of violence is considered the most widely recognized risk factor for violence in a treatment setting. The most common client diagnoses associated with violence include Schizophrenia

Organic brain disorders Mood disorders Antisocial, borderline, and intermittent explosive personality disorders Substance use disorders

Certain current behaviors are predictive of impending violence and have been termed the prodromal syndrome. They include
Rigid posture Clenched fists and jaws Grim, defiant affect Talking in a rapid, raised voice Arguing and demanding Using profanity and threatening verbalizations Agitation and pacing Pounding and slamming

Nursing diagnoses

Planning/Implementation
Remain calm. Set verbal limits on behavior. Keep diary of anger. Avoid touching the client. Help determine source of anger. Ignore derogatory remarks. Help find alternative ways of releasing tension. Role-model. Observe for escalation of anger. When behaviors are observed, first ensure that sufficient staff is available. Techniques for dealing with aggression include: Talking down, Physical outlets, Medications, Call for assistance, Restraints, Observation and documentation Ongoing assessment, Staff debriefing