NCM 116 – Care of Clients with Maladaptive SEM 02
Patterns of Behavior, Acute and Chronic FINALS
Lecturer: Dr. Cefer S. Sales, RN, MD, MHM, CHA
UNIT 3 – CHAPTER 11: ANGER, HOSTILITY, AND AGGRESSION
INTRODUCTION enhance relationships with others and to avoid the
expression of the so-called negative or unfeminine
• Anger, a normal human emotion, is a strong,
emotions such as anger.
uncomfortable, emotional response to a real or
perceived provocation. Anger results when a person
is frustrated, hurt, or afraid. HOSTILITY AND AGGRESSION
o Handled appropriately and expressed assertively, • There are stages or phases identified in aggressive
anger can be a positive force that helps a person incidents:
resolve conflicts, solve problems, and make o triggering phase – incident or situation that
decisions. initiates an aggressive response
o When expressed inappropriately or suppressed, o escalation phase – a crisis phase, a recovery
however, anger can cause physical or emotional phase, and a postcrisis phase.
problems or interfere with relationships. • As a client’s behavior escalates toward the crisis
• Hostility, also called verbal aggression, is an emotion phase, he or she loses the ability to perceive events
expressed through verbal abuse, lack of cooperation, accurately, solve problems, express feelings
violation of rules or norms, or threatening behavior. appropriately, or control his or her behavior; behavior
o A person may express hostility when he or she escalation may lead to physical aggression.
feels threatened or powerless.
o Hostile behavior is intended to intimidate or cause RELATED DISORDERS
emotional harm to another, and it can lead to • The media gives a great deal of attention to people
physical aggression. with mental illness who commit aggressive acts. In
• Physical aggression is behavior in which a person reality, clients with psychiatric disorders are much
attacks or injures another person or destroys more likely to hurt themselves than other people.
property. • Although most clients with psychiatric disorders are
o Both verbal and physical aggression are meant to not aggressive, clients with a variety of psychiatric
harm or punish another person or to force diagnoses can exhibit angry, hostile, and aggressive
someone into compliance. behavior.
o Clients with paranoid delusions believe they are
ONSET AND CLINICAL COURSE protecting themselves, they retaliate with hostility
or aggression.
ANGER o Some clients have auditory hallucinations that
• Although anger is normal, it is often perceived as a command them to hurt others.
negative feeling. o Aggressive behavior is also seen in clients with
• Anger can be a normal and healthy reaction when dementia, delirium, head injuries, intoxication
situations or circumstances are unfair or unjust, with alcohol or other drugs, and antisocial and
personal rights are not respected, or realistic borderline personality disorders.
expectations are not met. • Violent patients tend to be more symptomatic, have
• Anger becomes negative when the person denies it, poorer functioning, and show a marked lack of insight
suppresses it, or expresses it inappropriately. compared with nonviolent patients.
• Anger that is expressed inappropriately can lead to • Some clients with depression have angry attacks as
hostility and aggression. the depressed person feels emotionally trapped.
• The nurse can help clients express their anger Anger attacks involve verbal expressions of anger or
appropriately by serving as a model and by role- range but no physical aggression, then followed by
playing assertive communication techniques. remorse.
o Assertive communication uses “I” statements o This anger attacks may be related to irritable
that express feelings and are specific to the mood, overreaction to minor annoyances, and
situation, for example, “I feel angry when you decreased coping abilities.
interrupt me,” or “I am angry that you changed the • Intermittent Explosive Disorder (IED) is a rare
work schedule without talking to me.” psychiatric diagnosis characterized by discrete
• Some people try to express their angry feelings by episodes of aggressive impulses that result in serious
engaging in aggressive but safe activities, called assaults or destruction of property.
catharsis, such as hitting a punching bag or yelling. o This diagnosis is made only if the client has no
o However, catharsis can increase rather than other comorbid psychiatric disorders.
alleviate angry feelings. o The person describes a period of tension or
• Activities that are more likely to be effective in arousal that the aggressive outburst seems to
decreasing anger: walking or talking to another relieve.
person and CBT techniques such as distraction, o Afterward, however, the person is remorseful and
problem-solving, and changing one’s perspective or embarrassed, and there are no signs of
reframing. aggressiveness between episodes
• High hostility and anger are associated with increased o IED develops between late adolescence and the
risk of coronary artery disease and hypertension. third decade of life. Clients with
Simply suppressing or attempting to ignore angry o IED are often are men with dependent personality
Patterns of Behavior, Acute and Chronic FINALS
Lecturer: Dr. Cefer S. Sales, RN, MD, MHM, CHA
UNIT 3 – CHAPTER 11: ANGER, HOSTILITY, AND AGGRESSION
INTRODUCTION enhance relationships with others and to avoid the
expression of the so-called negative or unfeminine
• Anger, a normal human emotion, is a strong,
emotions such as anger.
uncomfortable, emotional response to a real or
perceived provocation. Anger results when a person
is frustrated, hurt, or afraid. HOSTILITY AND AGGRESSION
o Handled appropriately and expressed assertively, • There are stages or phases identified in aggressive
anger can be a positive force that helps a person incidents:
resolve conflicts, solve problems, and make o triggering phase – incident or situation that
decisions. initiates an aggressive response
o When expressed inappropriately or suppressed, o escalation phase – a crisis phase, a recovery
however, anger can cause physical or emotional phase, and a postcrisis phase.
problems or interfere with relationships. • As a client’s behavior escalates toward the crisis
• Hostility, also called verbal aggression, is an emotion phase, he or she loses the ability to perceive events
expressed through verbal abuse, lack of cooperation, accurately, solve problems, express feelings
violation of rules or norms, or threatening behavior. appropriately, or control his or her behavior; behavior
o A person may express hostility when he or she escalation may lead to physical aggression.
feels threatened or powerless.
o Hostile behavior is intended to intimidate or cause RELATED DISORDERS
emotional harm to another, and it can lead to • The media gives a great deal of attention to people
physical aggression. with mental illness who commit aggressive acts. In
• Physical aggression is behavior in which a person reality, clients with psychiatric disorders are much
attacks or injures another person or destroys more likely to hurt themselves than other people.
property. • Although most clients with psychiatric disorders are
o Both verbal and physical aggression are meant to not aggressive, clients with a variety of psychiatric
harm or punish another person or to force diagnoses can exhibit angry, hostile, and aggressive
someone into compliance. behavior.
o Clients with paranoid delusions believe they are
ONSET AND CLINICAL COURSE protecting themselves, they retaliate with hostility
or aggression.
ANGER o Some clients have auditory hallucinations that
• Although anger is normal, it is often perceived as a command them to hurt others.
negative feeling. o Aggressive behavior is also seen in clients with
• Anger can be a normal and healthy reaction when dementia, delirium, head injuries, intoxication
situations or circumstances are unfair or unjust, with alcohol or other drugs, and antisocial and
personal rights are not respected, or realistic borderline personality disorders.
expectations are not met. • Violent patients tend to be more symptomatic, have
• Anger becomes negative when the person denies it, poorer functioning, and show a marked lack of insight
suppresses it, or expresses it inappropriately. compared with nonviolent patients.
• Anger that is expressed inappropriately can lead to • Some clients with depression have angry attacks as
hostility and aggression. the depressed person feels emotionally trapped.
• The nurse can help clients express their anger Anger attacks involve verbal expressions of anger or
appropriately by serving as a model and by role- range but no physical aggression, then followed by
playing assertive communication techniques. remorse.
o Assertive communication uses “I” statements o This anger attacks may be related to irritable
that express feelings and are specific to the mood, overreaction to minor annoyances, and
situation, for example, “I feel angry when you decreased coping abilities.
interrupt me,” or “I am angry that you changed the • Intermittent Explosive Disorder (IED) is a rare
work schedule without talking to me.” psychiatric diagnosis characterized by discrete
• Some people try to express their angry feelings by episodes of aggressive impulses that result in serious
engaging in aggressive but safe activities, called assaults or destruction of property.
catharsis, such as hitting a punching bag or yelling. o This diagnosis is made only if the client has no
o However, catharsis can increase rather than other comorbid psychiatric disorders.
alleviate angry feelings. o The person describes a period of tension or
• Activities that are more likely to be effective in arousal that the aggressive outburst seems to
decreasing anger: walking or talking to another relieve.
person and CBT techniques such as distraction, o Afterward, however, the person is remorseful and
problem-solving, and changing one’s perspective or embarrassed, and there are no signs of
reframing. aggressiveness between episodes
• High hostility and anger are associated with increased o IED develops between late adolescence and the
risk of coronary artery disease and hypertension. third decade of life. Clients with
Simply suppressing or attempting to ignore angry o IED are often are men with dependent personality
