Anger, Hostility and Aggression

By: Jonelle A. Sazon,

Grace V. Agregado
Edbert De Duque

Anger
Wrath, indignation a normal human emotion, is a strong, uncomfortable, emotional response to a real or perceive provocation. Result when a person is frustrated, hurt or afraid.

Response caused by a distinct change in your internal and/ or external state as a response to thoughts or events that occur in your external environment.
Fight or flight response

Hostility
Verbal aggression, is an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threating behavior

Physical Aggression

is behavior in which a person attacks or injures another person or that involves destruction of property.

ONSET AND CLINICAL COURSE

Anger becomes negative when express inappropriately Possible consequences are problems such as migraine, headache, ulcers or coronary artery disease

Anger can lead to hostility and aggression.

Stages or Phases Triggering phase Escalation phase Crisis phase Recovery phase

Five-Phases Aggression Cycle

Phase Definition Signs, Symptoms, and behaviors

Triggering

Initiates client responseanger or hostility

Restlessness, anxiety, irritability, pacing

Escalation

Movement toward a lost of control

Pale, yelling, swearing, agitated, threatening

Crisis

Client loses control

Throwing objects, kicking, hitting, spitting, biting

Recovery

Regains physical and emotional control

Lowering of voice, decreased muscle tension, physical relaxation Remorse, apologies, crying, quite

Postcrisis

reconciliation

Related Disorders
Auditory Hallucinations Dementia Delirium

Head Injuries
Intoxication with Alcohol Intermittent explosive disorder-rare

Acting Out
Is an immature defense mechanism by which the person deals with the emotional conflicts or stressors through actions rather than through reflections or feelings. Verbal or physical aggression, to feel temporarily less helpless or powerless. Act out

Etiology
Neurobiologic Theories
Low serotonin=increased aggressive behavior

Increased dopamine and norepinephrine = increased impulsive violent behavior.

Damage Limbic System and the frontal and temporal lobe may cause alteration in persons ability to modulate aggression

 Psychosocial Theories
Impulse controlability to delay gratification Poor Relationships: parents, peers friends= inconsistent responses behavior. Low socioeconomic status= increased risk for failing socially appropriate behavior.

Cultural Considerations
In US, women are not permitted to express anger openly and directly, doing so would not be feminine. Spector (2001) perceived black patients as being more dangerous Bouffee delirante, condition characterized by a sudden outburst of agitated and aggressive behavior, marked confusion and psychomotor excitement. Amok is a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior.

Treatment
Treating the underlying or comorbid psychiatric diagnosis such as schizophrenia or bipolar disorder.
Lithium- effective in aggressive clients Carbamazepine (Tegretol) and valproate (Depakote)- treat aggression associated with dementia, psychosis, and personality disorders Benzodiazepines- reduce irritability and agitation in older adults with dementia Rapid tranquilization- can be use to decreased agitation and aggression for clients with psychosis.

Application of the nursing process

Assessment and effective intervention with angry or hostile clients can often prevent aggressive episodes. Aggressive behavior is less common and less intense. The nurse must be familiar with the signs, symptoms and behaviors associated with the triggering , escalating, crisis, recovery, and postcrisis of the aggression cycle .