Aggression

Aggressiveness or aggression as a symptom is a personality trait characterized by hostility and a negative attitude toward others. It manifests through violent actions aimed at harming others. Such behavior can lead to destructive and irreversible consequences. This pathological condition requires identifying its causes, timely treatment, and psychological intervention.

What is Aggression?

Aggression is marked by anger, irritability, and the infliction of physical or emotional harm. It can arise spontaneously in situations that hinder the achievement of one’s goals. At its core, aggression involves releasing negative emotions to alleviate inner discomfort.

There are two types of aggression:

• Constructive Aggression: Defensive actions that aid societal adaptation.
• Destructive Aggression: Deliberate actions intended to harm others.

Aggression may target oneself or others, leading to two categories:

• Autoaggression: Self-harm, including suicidal attempts.
• Hostile Acts Toward Others: Using physical force, making threats, expressing negativity, or displaying dislike.

Aggressive tendency can stem from character traits, nervous breakdowns, exhaustion, or mental and neurological disorders. It is crucial to seek help from a qualified specialist if such behavioral deviations arise in a loved one.

Definition in psychology

In psychology, aggression is defined as behavior intended to cause harm or injury to another individual or oneself. This harm can manifest physically, verbally, or even relationally, encompassing a broad spectrum of actions. But aggression and assertiveness are not the same things. Assertiveness involves expressing one’s needs and opinions without intending to cause harm, whereas aggression is inherently aimed at inflicting damage, whether psychological or physical.

Several theories attempt to explain the roots of aggression.

1. Frustration-aggression theory proposes that frustration, stemming from the blocking of a goal-directed behavior, leads to aggression.
2. Social learning theory emphasizes the role of observational learning and modeling, suggesting that individuals learn aggressive behaviors by observing others.
3. Biological theories point to genetic predispositions, hormonal influences (such as testosterone), and neurological factors as contributing to aggressive tendencies.
4. Finally, situational factors, such as provocation, environmental stressors, and the presence of weapons, significantly influence the likelihood of aggressive behavior. Understanding the interplay of these biological, psychological, and social factors is crucial for comprehending and addressing aggressive behavior.

Forms and Types of Aggression

Aggressiveness is categorized into two primary forms:

1. Malignant (Destructive): Focused on causing destruction.
2. Benign (Constructive): Aimed at preserving life.

Common forms of aggression include:

• Physical: Inflicting bodily harm or using physical force.
• Verbal: Threats, insults, shouting, or sarcasm.
• Active: Direct expression of aggression (e.g., hitting).
• Passive: Concealed forms like boycotts or gaslighting.
• Direct: Inflicting physical or emotional harm directly on the victim.
• Indirect: Harming objects or people significant to the victim.
• Offensive: Harmful actions toward a non-hostile victim.
• Defensive: Aggressive responses to violence or its threat.
• Provoked: Triggered by specific actions leading to an aggressive reaction.
• Unmotivated: Hostility without apparent cause.
• Uncontrolled: Episodes of rage, anger, or emotional outbursts.
• Stimulative: Attempting to elicit external responses.
• Sanctioned: Aggression within accepted social norms.

Despite its negative connotation, aggression can serve essential functions in certain contexts, such as:

1. Defending personal boundaries.
2. Satisfying physiological needs.
3. Resisting external aggression.
4. Enabling evolutionary change by replacing the old with the new.

Causes

The formation of aggressiveness as a personality trait is influenced by many factors: an unfavorable family environment, negative peer influence, and others. Hostile behavior in a child is shaped by the environment in which they are raised. Observing people’s actions, the child “learns” aggression. This behavior becomes ingrained in their memory and later serves as a tool for manipulation.

The causes of aggression in adults can be divided into several groups:

• Psychosocial: Low social status and standard of living, promotion of violence in the media, humiliation, and insults from others.
• Behavioral: Unacceptable actions that complicate interpersonal communication, such as aimless time-wasting, behaviors that provoke disapproval, and antisocial actions.
• Personal: Aggression is more likely in irritable, easily excitable individuals, those leading an antisocial lifestyle, and people with choleric or sanguine temperaments. Other contributing factors include a willingness to take risks, low or inflated self-esteem, and communication difficulties.
• Personal problems: Instability, loss of a job or family.
• Mental illnesses: Depression, schizophrenia, personality disorders (psychopathy), epilepsy, and neuroses.
• States of intoxication: Aggression may arise due to dependence on alcohol or narcotic substances. The use of psychoactive drugs disrupts cognitive functions, perception, consciousness, motor activity, and behavior.

Factors contributing to the onset of aggression include stressful situations, extreme fatigue, negative external influences (overheating, prolonged time in a stuffy room, noisy environments, etc.), engagement with violent computer games, work involving excessive strain, and physical pain.

Symptoms and manifestations

This disorder is expressed in the form of episodes of rage, anger, and fury. The most severe manifestation is a state of hatred. The symptoms of psychological aggression include:

• Constantly elevated tone during conversation;
• Insults directed at others, devaluing their achievements;
• Fixation on negative aspects;
• Dislike, irritation, hostile actions and statements, threats;
• The patient’s conviction that others are to blame for everything.

Aggression can be a symptom of mental illnesses such as schizophrenia and other disorders in the schizophrenic spectrum, psychosis (alcoholic, organic, etc.), personality disorders, senile dementia, bipolar affective disorder, epilepsy, and others. Timely consultation with a psychiatrist will help identify the cause of aggressive behavior and select the optimal treatment.

The appearance of aggression in patients suffering from schizophrenia is associated with inadequate emotional reactions and delusional experiences. Such behavior is aimed at relieving internal tension.

In dementia, patients lose self-control and may insult others without realizing their behavior. In such cases, aggressiveness is often triggered by distress over the inability to perform habitual activities or by physical discomfort.

As epileptic disease progresses, personality changes intensify. Patients become resentful, irritable, intrusive, selfish, and constantly irritated, neglecting the interests of others.

Classification

In most cases, these manifestations of aggression are uncontrollable and pose a danger to others.

Depending on the cause of the condition, aggression is classified as reactive or spontaneous, arising without particular reasons.

By purposefulness, aggression can be:

• Motivated, where the goal is premeditated harm.
• Unmotivated, which often indicates mental illnesses.

There is active and passive aggression. The peculiarity of the passive form lies in the fact that a person’s actions are directed not at the irritant itself but at other objects. This type is often disguised as care and attention (hidden aggression). Active aggression manifests in direct actions and open aggressive behaviors, such as pressure, humiliation, physical harm, violence, etc.

Episodes of aggression can manifest in several forms:

• Verbal, such as swearing, shouting, or insults.
• Physical, involving the use of force, physical assault, or violent acts.
• Through facial expressions and intonation.

Excessive aggressiveness can lead to devastating consequences both for the patient and for the people around them. In adolescence, suicidal attempts, self-harming behaviors, and infliction of injuries on others are not uncommon.

The combination of aggressive behavior, impulsivity, and severe depression increases the risk of suicide and can result in irreversible outcomes.

To prevent further development of this dangerous condition, it is crucial to seek medical help as early as possible.

If your loved one has been agitated for a long time and constantly conflicts, it is essential to consult an experienced specialist without delay.

ICD-10 classification

The International Classification of Diseases, 10th revision (ICD-10) doesn’t classify aggression as a single, distinct disorder. Instead, aggressive behavior is considered a symptom or feature of various mental and behavioral disorders. The specific ICD-10 code used depends on the underlying condition causing the unwanted emotions.

For instance, aggression may be a prominent symptom in:

1. Disruptive, impulse-control, and conduct disorders: These include oppositional defiant disorder (ODD), conduct disorder (CD), and intermittent explosive disorder (IED). The ICD-10 codes for these disorders would be used, not a specific code for aggression itself.
2. Personality disorders: Certain personality disorders, such as antisocial personality disorder, are characterized by a pattern of disregard for and violation of the rights of others, often manifesting as aggression. The specific personality disorder diagnosis would dictate the ICD-10 code.
3. Neurological conditions: Traumatic brain injury, dementia, and other neurological conditions can sometimes lead to aggressive behavior as a result of brain damage. The underlying neurological condition would be coded, with aggressive tendency noted as a symptom.
4. Substance-induced disorders: Intoxication or withdrawal from certain substances can trigger aggressive behavior. The ICD-10 code would reflect the substance-induced disorder.

Diagnosis and treatment

The diagnosis and treatment of the disorder are conducted by a psychiatrist. The standard examination includes the following methods:

1. Patient interview and conversation: During the consultation, the specialist identifies factors that may have triggered aggression, as well as its duration and intensity.
2. Analysis of information: Information is gathered from relatives, colleagues, and friends.
3. Observation of behavior: This takes place either during the consultation or in a clinical setting. Patients often exhibit hostility toward medical staff and other patients, as well as irritability and rudeness.
4. Psychodiagnostic tests and questionnaires: These tools assess the degree and form of this condition, its role within the personality structure, and its combination with other character traits. Techniques such as the Buss-Durkee Hostility Inventory, Assinger’s methods, and projective techniques are commonly used.

Outpatient treatment for this condition is possible if acute symptoms are absent and episodes occur sporadically. In severe cases or when episodes are frequent, inpatient treatment with constant supervision is necessary.

Both medication therapy and psychotherapeutic techniques are employed to reduce aggression levels.

Aggression scale

Several aggression scales are used in research and clinical settings to measure the severity and frequency of aggressive behavior. These scales vary in their specific items and scoring methods but generally assess different types of aggression (physical, verbal, relational) and their intensity. Some commonly used scales include:

1. Buss-Perry Aggression Questionnaire (BPAQ): This self-report measure assesses four facets of aggression: physical aggression, verbal aggression, anger, and hostility.
2. Conflict Tactics Scales (CTS): This scale assesses the use of various conflict resolution strategies, including aggression, within relationships.
3. Reactive-Proactive Aggression Questionnaire (RPAQ): This questionnaire differentiates between reactive aggression (impulsive, in response to provocation) and proactive aggression (planned, goal-directed).

The choice of aggressive behavior scale depends on the specific research question or clinical context. These scales provide a standardized method for measuring aggression, allowing researchers and clinicians to track changes in aggression over time and compare aggression levels across different groups.

Psychotherapy

Psychotherapy is a critical component of the treatment program. Sessions with a specialist help the patient understand the causes of irritation and anger, master ways to manage negative emotions, and develop self-control skills. The following methods are used:

• Individual consultations and group meetings
• Psychoanalysis
• Cognitive-behavioral therapy
• Autogenic training

Physical exercises, breathing techniques, meditation, and other relaxation methods are also highly effective.

Medication therapy

In severe cases, where there is a real threat, medication is required to stabilize the condition. Medications help normalize mental states, reduce the frequency of aggressive episodes, and prevent future occurrences.

• Benzodiazepines: Administered in short courses
• Atypical antipsychotics: Used either as a one-time treatment or regularly in cases of mental disorders associated with aggression
• Antidepressants: Prescribed to alleviate symptoms in depressive states of various origins
• Mood stabilizers (normotimics): For stabilizing mood
• Neurometabolic agents and others

With timely therapy and professional intervention, patients can learn to control negative symptoms and prevent aggressive actions.

Aggression replacement training (ART)

Aggression Replacement Training (ART) is a comprehensive program designed to teach prosocial skills and reduce aggressive behavior. It’s particularly effective for individuals with conduct disorders, antisocial tendencies, or a history of aggressive acts. ART is not a quick fix but a structured, multi-component intervention that focuses on three key areas:

• Skill Streaming:

This component teaches specific prosocial skills, including problem-solving, self-control, and conflict resolution. Participants learn to identify problems, generate solutions, and evaluate the consequences of their actions before acting on impulse.

• Moral Reasoning:

This element focuses on developing a sense of empathy and moral reasoning. Participants explore the impact of their actions on others and learn to consider the perspectives of others. This helps them understand the ethical implications of aggressive behavior.

• Anger Control:

This section equips individuals with strategies for managing anger effectively. Participants learn to recognize the signs of anger, develop coping mechanisms, and implement techniques to calm themselves down before reacting aggressively.

ART typically involves group sessions, individual therapy, and sometimes, parent or family involvement. Its effectiveness stems from its multi-faceted approach, addressing both the cognitive and behavioral aspects of aggression. The program aims to replace aggressive behaviors with more constructive and adaptive responses.

Prevention of aggressive behavior

Preventive measures should start in early childhood. The foundation is harmonious relationships between children and parents, built on trust, care, and the development of proper social interactions in preschools and schools. Early intervention is crucial when behavioral disorders appear.

Early intervention and collaboration with a specialist can help control aggressive tendencies and prevent harmful actions. Proactive measures include fostering harmonious relationships, promoting trust and care, addressing issues early, and encouraging positive interactions in schools and homes.