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Anger,

Hostility andAggression

By: Jonelle A. Sazon,

Grace V. Agregado

Edbert De Duque

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Anger

Wrath, indignation

a normal human emotion, is astrong, uncomfortable,emotional response to a realor perceive provocation.

Result when a person isfrustrated, hurt or afraid.

Response caused by a distinctchange in your internal and/or external state as aresponse to thoughts orevents that occur in yourexternal environment.

Fight or flight response

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Hostility

Verbalaggression, is anemotionexpressedthrough verbalabuse, lack ofcooperation,violation of rulesor norms, orthreating

behavior

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PhysicalAggression

is behavior inwhich aperson attacksor injuresanotherperson or thatinvolvesdestruction of

property.

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ONSET ANDCLINICALCOURSE

Anger becomesnegative whenexpressinappropriately

Possibleconsequences areproblems such asmigraine, headache,ulcers or coronaryartery disease

Anger can lead tohostility andaggression.

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Stages orPhases

Triggeringphase

Escalation

phase

Crisis phase

Recovery

phase

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Five-Phases Aggression Cycle

Phase Definition Signs, Symptoms, and

behaviors

Triggering Initiates client response-anger or hostility

Restlessness, anxiety,irritability, pacing

Escalation Movement toward a lost ofcontrol

Pale, yelling, swearing,agitated, threatening

Crisis Client loses control Throwing objects, kicking,hitting, spitting, biting

Recovery Regains physical andemotional control

Lowering of voice, decreasedmuscle tension, physicalrelaxation

Postcrisis reconciliation Remorse, apologies, crying,quite

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RelatedDisorders AuditoryHallucinations

Dementia

Delirium

Head Injuries

Intoxication withAlcohol

Intermittentexplosivedisorder-rare

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Acting Out

Is an immature defense mechanism by which the persondeals with the emotional conflicts or stressors throughactions rather than through reflections or feelings.

Verbal or physical aggression, to feel temporarily lesshelpless or powerless.

Act out

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EtiologyNeurobiologicTheoriesLow serotonin=increased

aggressive behavior

Increased dopamine andnorepinephrine =increased impulsiveviolent behavior.

Damage Limbic System

and the frontal andtemporal lobe may causealteration in personsability to modulateaggression

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PsychosocialTheories

Impulse control-ability to delaygratification

Poor Relationships:parents, peers

friends=inconsistentresponses behavior.

Low socioeconomicstatus= increased

risk for failingsocially appropriatebehavior.

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Cultural Considerations In US, women are not permitted to express anger openlyand directly, doing so would not be feminine.

Spector (2001) perceived black patients as being more

dangerous

Bouffee delirante, condition characterized by asudden outburst of agitated and aggressive behavior,

marked confusion and psychomotor excitement.

Amok is a dissociative episode characterized by a periodof brooding followed by an outburst of violent,

aggressive, or homicidal behavior.

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Treatment Treating the underlying or comorbid psychiatricdiagnosis such as schizophrenia or bipolar disorder.

Lithium- effective in aggressive clients

Carbamazepine (Tegretol) and valproate(Depakote)- treat aggression associated withdementia, psychosis, and personality disorders

Benzodiazepines- reduce irritability and agitation in

older adults with dementia

Rapid tranquilization- can be use to decreasedagitation and aggression for clients with psychosis.

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Application of the nursingprocess

Assessment and effective intervention with angry or hostile clientscan often prevent aggressive episodes.

Aggressive behavior is less common and less intense.

The nurse must be familiar with the signs, symptoms andbehaviors associated with the triggering , escalating, crisis,

recovery, and postcrisis of the aggression cycle .