Week 4: Anger, Hostility, and Aggression

Anger

• Normal human emotion is characterized as a strong, uncomfortable response to real or perceived provocation.

• Results from frustration, hurt, or fear.

• Has both positive (problem-solving) and negative (destructive) aspects.

Hostility

• Expressed through verbal abuse, lack of cooperation, violations of rules, or threatening behavior.

  • Lack of cooperation can be a factor in workplace violence.

• Often occurs when feeling threatened or powerless; aims to intimidate or cause emotional harm.

Physical Aggression

• Involves attacking or injuring another person or destroying property.

• Intention is to harm, punish, or force compliance.

Onset and Clinical Course of Anger

• Anger is a healthy reaction when situations are unfair or personal rights are not respected.

• Assertion of anger can lead to problem-solving or conflict resolution.

  • Anger might propel you to find a solution.

• Public Perception: Often viewed negatively; many feel uncomfortable expressing anger directly.

Assertive Communication

• Techniques include:

  • Use “I” statements to express feelings (e.g., "I feel angry when you interrupt me").

    • “You” statements can make people feel accusatory and make them more defensive. Additionally, it can escalate conflicts.

  • Benefits: leads to productive discussions and reduces anger.

• Catharsis: Engaging in non-aggressive activities (e.g., walking or talking) is more effective than aggressive ones (e.g., hitting).

  • Cathartic: energy release.

• Cognitive-behavioral therapy techniques: Include distraction, communication skills, problem-solving, and reframing.

  • Linking thoughts to behaviors and emotions.

  • People may black out when getting angry, therefore, not acknowledging this emotion.

5 Phase Aggression Cycle

1. Triggering Phase

   • Definition: An event that initiates the client's response (anger or hostility).

   • Signs: restlessness, anxiety, irritability, pacing, muscle tension.

2. Escalation Phase

   • Definition: Increased loss of control.

   • Signs: pale/flushed face, yelling, swearing, agitation, hostility.

3. Crisis Phase

   • Definition: Loss of emotional and physical control.

   • Signs: throwing objects, kicking, inability to communicate.

4. Recovery Phase

   • Definition: Regaining control.

   • Signs: clearer communication, physical relaxation.

5. Postcrisis Phase

   • Definition: Reconciliation and return to normal functioning.

   • Signs: remorse, quiet behavior.

Managing Hostility and Aggression

• Nursing Actions: Build trust and identify early signs of agitation, such as restlessness or pacing.

  • Maintain a calm demeanor and use "I" statements to reduce defensiveness and prevent escalation.

• Environmental Management: Minimize stimulation by lowering noise and lights.

  • Respect the client's personal space and prioritize the least restrictive interventions.

  • Medications are often preferred over seclusion, which should not exceed 3 days.

• Restraints: Used only as a last resort.

  • Nurses must communicate the reasons clearly, reassess the client frequently for safety, and prioritize the client's dignity throughout the process.

Etiology and Related Disorders

• Psychiatric Correlations: Aggression is linked to paranoid delusions, dementia, and Intermittent Explosive Disorder (IED) (diagnosed in individuals ≥6 years old).

  • Note that clients with psychiatric disorders are statistically more likely to harm themselves than others.

• Biological Factors: Aggressive behavior is associated with low serotonin levels, increased dopamine/norepinephrine activity, and injury to the temporal lobes.

• Psychosocial/Cultural Factors: Dysfunctional family dynamics and interpersonal rejection increase risk.

  • Cultural syndromes (e.g., Hwa-Byung) influence how anger is expressed and perceived.

Treatment and the Nursing Process

• Pharmacology: Aggression is managed using mood stabilizers (Lithium), anxiolytics (Benzodiazepines), and atypical antipsychotics (Risperidone or Olanzapine).

• Early Intervention: Nurses should focus on the triggering phase of aggression to teach healthy coping mechanisms, such as cognitive reframing or physical exercise, to prevent a crisis.

Community & Continuity of Care

Aggression control relies heavily on community-based support and consistent follow-up, particularly for managing comorbid psychiatric conditions outside of acute settings.