Violence and Aggressive Behavior

Joseph Austerman, DO* 1. *Division of Child & Adolescent Psychiatry, The Cleveland Clinic, Cleveland, OH * Abbreviations: ADHD: : Attention-deficit/hyperactivity disorder CBT: : Cognitive behavioral therapy DSM-V: : Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition GABA: : γ-Aminobutyric acid 5-HT: : Serotonin SSRIs: : Selective serotonin reuptake inhibitors It is imperative to understand the etiology and risk factors that contribute to aggressive behaviors. Equally important is effectively assessing and using targeted management strategies to reduce pathologic aggression. After completing this article, readers should be able to: 1. Recognize the biological and psychosocial determinants of aggression. 2. Use effective interviewing and screening measures to assess aggressive behaviors. 3. Coordinate psychosocial and biologic interventions to reduce aggression. Aggression is defined as harmful behaviors or attitudes inflicted upon others, which is a universal behavioral trait among animals. It is used either as a mechanism to further an individual’s or group’s power or as a mechanism of defense from a perceived threat. It is one of the basic human traits aiding in the mechanism of survival. However, societies place limits on acceptable levels of aggression and violence. These limits are culturally bound and influence what is considered pathologic versus acceptable. We categorize pathologic aggression into 2 categories: impulsive (emotional, reactive, affective) and premeditated (planned, predatory), which is defined by goal-oriented actions. Distinguishing impulsive from premeditated aggression is important, because of the different biological, psychological, and social etiologic factors as well as management strategies. Universally, the onset of developmentally normative aggressive behavior begins at age 2 or 3 years. Physical aggression is most common at age 2 to 3 years and declines thereafter, whereas verbal and indirect aggression increases throughout the childhood and adolescent years before declining throughout adulthood. The delineation between developmentally appropriate and pathologic aggression is not well defined. However, aggression may be considered pathologic when it is chronic or occurs in greater frequency and severity than developmentally expected. The type, severity, and frequency of pathologic aggressive …