ANGER A normal human emotion

Strong, uncomfortable, emotional response to a real or perceived provocation.
Results when a person is frustrated, hurt, or afraid.
Energizes the body physically for self-defense, when needed, by activating the “fight-or-flight”
response mechanisms of the sympathetic nervous system.
HOSTILITY An emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or
threatening behavior.
PHYSICAL AGGRESSION Behavior in which a person attacks or injures another person or that involves destruction of
Both verbal and physical aggression are meant to harm or punish another person or to force
someone into compliance.
Onset a nd c linic al c our se: ang er

Anger becomes negative when the person denies it, suppresses it, or expresses it inappropriately.
Possible consequences are physical problems such as migraine headaches, ulcers, or coronary artery disease and emotional problems
such as depression and low self-esteem.
Anger that is expressed inappropriately can lead to hostility and aggression.
Some people try to express their angry feelings by engaging in aggressive but safe activities such as hitting a punching bag or yelling.
Such activities, called CATHARSIS, are supposed to provide a release for anger. However, it can increase rather than alleviate angry
Cathartic activities may be contraindicated for angry clients. Activities that are not aggressive, such as walking or talking with another
person, are more likely to be effective in decreasing anger.
Hostile and aggressive behavior can be sudden and unexpected.
Stages or phases can be identified in aggressive incidents:
1. triggering phase
2. escalation phase
3. crisis phase
4. recovery phase
5. postcrisis phase
TRIGGERING An event or circumstances in the Restlessness, anxiety, irritability, pacing,
environment initiates the client’s response, muscle
which is often anger or hostility. tension, rapid breathing, perspiration, loud
voice, anger.
ESCALATION Client’s responses represent escalating Pale or flushed face, yelling, swearing,
behaviors that indicate movement toward a agitated, threatening, demanding, clenched
loss of control. fists, threatening gestures, hostility, loss of
ability to solve the problem or think clearly.
CRISIS During a period of emotional and physical Loss of emotional and physical control,
crisis, the client loses control. throwing
objects, kicking, hitting, spitting, biting,
scratching, shrieking, screaming, inability to
communicate clearly.
RECOVERY Client regains physical and emotional Lowering of voice; decreased muscle tension;
control. clearer, more rational communication;
physical relaxation.
POST-CRISIS Client attempts reconciliation with others Remorse; apologies; crying; quiet, withdrawn
and returns to the level of functioning before behavior
the aggressive incident and its antecedents.
ANGER ATTACKS Sudden intense spells of anger that typically occur in situations in which the depressed person
feels emotionally trapped.
It involve verbal expressions of anger or rage but no physical aggression. It is described as
an uncharacteristic behavior that is inappropriate for the situation and followed by remorse.
The anger attacks seen in some depressed clients may be related to irritable mood,
overreaction to minor annoyances, and decreased coping abilities.
INTERMITTENT EXPLOSIVE DISORDER Rare psychiatric diagnosis characterized by discrete episodes of aggressive impulses that
result in serious assaults or destruction of property.
The aggressive behavior the person displays is grossly disproportionate to any provocation
or precipitating factor.
This diagnosis is made only if the client has no other comorbid psychiatric disorders.
The person describes a period of tension or arousal that the aggressive outburst seems to
relieve. Afterward, however, the person is remorseful and embarrassed, and there are no
signs of aggressiveness between episodes.

Intermittent explosive disorder develops between late adolescence and the third decade of

Positive relationships with parents. To understand acting-out behaviors. the Philippines. similar behavior patterns are seen in Laos. Originally reported from Malaysia. MA N A GING AGGRESSIVE BEH A VIOR In the triggering phase. psychosis. Benzodiazepines can reduce irritability and agitation in older adults with dementia. Aggressive behavior was often seen as a means of re-establishing control. thus. and those whose families are of lower socioeconomic status are at increased risk for failing to develop socially appropriate behavior. Use of clear. Carbamazepine (Tegretol) and valproate (Depakote) are used to treat aggression associated with dementia. this can lead to aggressive behavior. those who receive inconsistent responses to their behavior. attributed to the suppression of anger. aggressive. PRN Medications should be offered. such as walking. to feel temporarily less helpless or powerless. and personality disorders. and prone to aggressive behavior. and depression. The nurse should allow the client time to express himself or herself. insomnia. mental retardation. and is characterized by sighing. CULTURAL CONSIDERATIONS HWA-BYUNG is a culture-bound syndrome that literally translates as anger syndrome or fire illness. short statements is helpful. It is seen in Korea. Children and adolescents often “act out” when they cannot handle intense feelings or deal with emotional conflict verbally. Use of antipsychotic medications requires careful assessment for the development of extrapyramidal side effects. risperidone (Risperdal). Temper tantrums are a common response from toddlers whose wishes are not granted. the nurse can help the client to use relaxation techniques and look at ways to solve any problem or conflict that may exist. and psychomotor excitement. and peers. BOUFFÉE DELIRANTE is a condition observed in West Africa and Haiti. anxiety. predominately in women. and among the Navajo. which is normal for these stages of growth and development. conduct disorder and mental retardation. which can be quickly treated with benztropine. Puerto Rico. or homicidal behavior directed at other people and objects. abdominal pain. Atypical antipsychotic agents such as clozapine (Clozaril). psychotic clients. ETIOLOGY: NEUROBIOLOGIC THEORIES Low serotonin levels may lead to increased aggressive behavior increased activity of dopamine and norepinephrine in the brain is associated with increased impulsively violent behavior structural damage to the limbic system and the frontal and temporal lobes of the brain may alter the person’s ability to modulate aggression. Western psychiatrists would be likely to diagnose it as depression or somatization disorder. Haloperidol (Haldol) and lorazepam (Ativan) are commonly used in combination to decrease agitation or aggression and psychotic symptoms. the nurse must take control of the situation. Polynesia. ETIOLOGY: PSYCHOSOCIAL THEORIES Infants and toddlers express themselves loudly and intensely. calm manner in order to de-escalate the client’s emotion and behavior. As a child matures. the nurse should approach the client in a nonthreatening. Children in dysfunctional families with poor parenting. . and the ability to be responsible for oneself foster development of these qualities. and personality disorders. improving mood. simple. During the escalation phase. irritability. As the client’s anger subsides. Patients who are agitated and aggressive but not psychotic benefit most from lorazepam which can be given in 2-mg doses. also may help the client relax and become calmer. suggesting that the client is still in control and can maintain that control. It is characterized by a sudden outburst of agitated and aggressive behavior. he or she is expected to develop impulse control and socially appropriate behavior. Physical activity. teachers. if ordered. and olanzapine (Zyprexa) have been effective in treating aggressive clients with dementia. marked confusion. every 45 to 60 minutes. The person engages in acting-out behavior. Episodes may include visual and auditory hallucinations and paranoid ideation that resemble brief psychotic episodes. it is important to consider the situation and the person’s ability to deal with feelings and emotions. or is a threat to self-esteem. success in school. Precipitated by a perceived slight or insult and is seen only in men. TREA TMENT Lithium has been effective in treating aggressive clients with bipolar disorder. Rejection can lead to anger and aggression when that rejection causes the individual emotional pain or frustration. easily frustrated. brain injury. The nurse can encourage the client to express his or her angry feelings verbally. Clients with intermittent explosive disorder typically are large men with dependent personality features who respond to feelings of uselessness or ineffectiveness with violent outbursts. Conveying empathy for the client’s anger or frustration is important. Papua New Guinea. resulting in a person who is impulsive. Atypical antipsychotics were more effective than conventional antipsychotics for aggressive. ACTING OUT Immature defense mechanism by which the person deals with emotional conflicts or stressors through actions rather than through reflection or feelings. AMOK is a dissociative episode characterized by a period of brooding followed by an outburst of violent. or achieving retribution. such as verbal or physical aggression.

do not attempt to remove the weapon. The nurse should tell the client that aggressive behavior is not acceptable and that the nurse is there to help the client regain control. calm voice. Be aware of factors that increase the likelihood of violent behavior or agitation. Do not use physical restraints or techniques without sufficient reason. or yell suddenly). Call the client by name. If the client tells you (verbally or nonverbally) that he or she feels hostile or destructive. Psychiatric facilities offer training and practice in safe techniques for managing behavioral emergencies. Remain aware of the client’s body space or territory. The client is transported by gurney or carried to a seclusion room. Do not restrain or subdue the client as a punishment. (Never reach for a knife or other weapon with your hand. or ag gr e ssive c lients • Identify how you handle angry feelings. remain calm. and only staff with such training should participate in the restraint of a physically aggressive client. Always maintain control of yourself and the situation. If you do not feel competent in dealing with a situation. and staff assistance procedures and legal requirements. seclusion. Be aware of PRN medication and procedures for obtaining seclusion or restraint orders. Four to six trained staff members are needed to restrain an aggressive client safely. Use verbal communication or PRN medication to intervene before the client’s behavior reaches a destructive point and physical restraint becomes necessary. This technique. Do not recruit or allow other clients to help in restraining or subduing a client. hosti l e. and restraints are applied to each limb and fastened to the bed. Do not help to restrain or subdue the client if you are angry. Be familiar with restraint. Initially. N ur si ng c ar e plan: aggr es si ve beha vi or Build a trust relationship with this client as soon as possible. try to help the client express these feelings in nondestructive ways. Four staff members each take a limb. but do not threaten the client. Increasing your skills in dealing with your angry feelings will help you to work more effectively with clients. direct speech. one staff member protects the client’s head. Use simple. where you are. The client should be directed to take a time-out for cooling off in a quiet area or his or her room. but state limits and expectations. the nurse should offer them again. When the client becomes physically aggressive during the crisis phase. and so forth. Do not threaten the client. the nurse should obtain assistance from other staff members. ideally well in advance of aggressive episodes. • Do not take the client’s anger or aggressive behavior personally or as a measure of your effectiveness as a nurse. or a blanket wrapped around your arm) between you and the weapon. four to six staff members should remain ready within sight of the client but not as close as the primary nurse talking with the client.The nurse should provide directions to the client in a calm. obtain assistance as soon as possible. Tell the client what you are going to do and what you are doing. if needed. If the client refused medications during the triggering phase. Poi nts to c o nsider w hen wor ki n g wi th a ngr y. tell the client your name. indicates to the client that the staff will control the situation if the client cannot do so. the staff must take charge of the situation.) Distract the client momentarily to remove the weapon (throw water in the client’s face. • Discuss situations or the care of potentially aggressive clients with experienced nurses. do not trap the client. Calmly and respectfully assure the client that you will provide control if he or she cannot control himself or herself. mattress. clear. Keep something (like a pillow. . and one staff member helps control the client’s torso. sometimes called a SHOW OF FORCE. If it is necessary to remove the weapon. firm voice. Allow the client freedom to move around (within safe limits) unless you are trying to restrain him or her. Talk with the client in a low. assess your use of assertive communication and conflict resolution. try to kick it out of the client’s hand. If you are not properly trained or skilled in dealing safely with a client who has a weapon. If the client’s behavior continues to escalate and he or she is unwilling to accept direction to a quiet area. Do not strike the client.