Anger & Aggression

Biological Theories

Neurophysiological influences

Biochemical influences

Genetic Influences

Neurophysiological influences

alterations in limbic system,
amygdala is less modulated

Biochemical influences

Norepinephrine and
Dopamine are increased,
serotonin is decreased.

Genetic Influences

• Possible hereditary

• Disorders of the brain
  (organic brain syndromes,
  brain tumors/trauma,
  encephalitis, temporal lob
  epilepsy)

Psychological Theories

Psychodynamic Theory

Learning Theory

Psychodynamic Theory

• unmet needs for satisfaction and
  security leads to underdeveloped
  ego.

• When frustration occurs, aggression
  and violence supply the person with
  needed power and prestige to boost
  self-image and validate significance
  to life they were missing.

Learning Theory

• Children learn behaviors through role
  models

• Children abused or disciplined with
  physical punishment are more likely
  to behave in abusive manner as
  adult

Sociocultural Theories

Societal Influences

Societal Influences

• Aggression is primarily
  product of one’s culture
  and social structure

• American culture has been
  founded on general
  acceptance of violence as
  means of problem solving.

• Poverty, prolonged
  unemployment, family
  breakdown, exposure to
  community/familial
  violence have been linked
  to increased aggression.

Sexual assault

any type of sexual act in which an individual is
threatened or coerced, or forced to submit against his or her will

Rape

type of sexual assault. Expression of power and dominance by
means of sexual violence.

Acquaintance rape

rapist is acquainted with victim (first date,
dating for months, schoolmates)

Marital rape

spouse is liable for sexual abuse towards marital
partner against their will.

Statutory rape

unlawful intercourse of someone over age of
consent and person under age of consent. Age of consent varies
state-to-state (14-18)

Types of Victim responses

Expressed response pattern

Controlled response pattern

Compounded rape reaction

Silent rape reaction

Expressed response pattern

expresses fear, anger, and anxiety
(crying, sobbing, restlessness, and tension)

Controlled response pattern

feelings are masked or hidden (calm,
composed, or subdued affect is seen)

Compounded rape reaction:

additional symptoms of depression,
suicide, substance abuse, psychotic behaviors

Silent rape reaction

tells no one about assault; anxiety
suppressed and emotional burden is overwhelming. May not be
revealed until forced to face another sexual crisis in her life that
reactivates previously unresolved feelings

VA Law for 12 & under

13

and 14

• 12 & under: mandatory reporting if positive for sexual
  transmitted infection, pregnant, injury, reports

• 13: if person had sex with is aged within 3 years of
  minor. If 3 years and 1 day, then mandatory reporting is
  required

• 14+: can receive sexual reproduction care without
  consent of parent

Signs of trauma include:

Insomnia

Depression

Aggressive Behaviors

Numbness

Hypervigilant

Anger/Anxiety

Guilt

Physical impairments

Isolative/detachment

Nightmares

Substance abuse

Flashbacks

Trauma-informed care

method that acknowledges the importance of understanding a patient's complete situation

Trauma-informed care treatment

realization

recognize

respond

resist

Realization

understand the impact of trauma on the individual, family, and community.

Recognize

Be aware of the signs of trauma and its effects.

Respond

Adjust your tone, behavior and interventions to be helpful and supportive to the patient.

Resist

Take steps to prevent re-traumatization from hindering their recovery.

Passive Aggression

• Express anger indirectly

• Afraid of being rejected

• Difficulty with discussing issues

• Frustrates others around them

Hostile Aggression

Deliberate attempt to harm or
destroy

Aggression Etiology:

pathological:

triggers:

• Pathological: psychosis, TBI, pain,
  substance use

• Triggers: excessive stimuli, lack of
  resources, lack of activities

Assault cycle

triggering phase

escalating phase

crisis phase

recovery and depression phase

triggering phase

nonviolent anger

escalating phase

threatening anger/possible loss of control

crisis phase

loss of control

forensic nurse puts victims clothes in __________ bag

PAPER

Antipsychotic deescalation meds

& side effects

Haloperidol

Droperidol

Olanzapine

Risperidone

Ziprasidone

side effects

EPS risk

QTc prolongation

orthostatic hypotension

Benzodiazepines deescalation meds

& side effects

Lorazepam

Midazolam

side effects:

Caution with pt with CNS depression (use of alcohol)

Dissociate anesthetic deescalation meds

& side effects

Ketamine

side effects:

Increase risk need for intubation

SEVERLY agitated