This document discusses anger, aggression, and their management in mental health nursing. It defines anger and aggression, describes their characteristics and functions, and presents several theories to explain them. Anger is an emotional response to threats or injustice that involves physiological arousal, while aggression refers to intended harmful behaviors. Both can have positive and negative effects depending on how they are expressed. The document also outlines principles for safely managing aggressive patients, as well as pharmacological and behavioral nursing interventions.

1. PRATIMA THAKUR
M.Sc. NURSING
MENTAL HEALTH NURSING
DEPARTMENT

2. It is an emotional state that varies in intensity
from mild irritation to intense fury and rage.
It is accompanied by physiological and
biological changes, such as increases in heart
rate, blood pressure, and levels of the
hormones epinephrine and norepinephrine.
(American Psychological
Association,2013).

3. CHARACTERSTIC OF ANGER
Anger is not a primary emotion, but it is typically
experienced as an almost automatic inner response to
hurt, frustration or fear.
Anger is physiological arousal. It instills feelings
of power and generates preparedness.
The expression of anger is learned .

4. The expression of anger can come
under personal control.
When anger is suppressed it is
resentment , which often manifests
itself in negative, passive-aggressive
behavior .

5. FUNCTION OF
ANGER

6. POSITIVE FUNCTION
OR
CONSTRUCTIVE USES
Anger energies and mobilizes the body for self –
defense .
Communicated assertively , anger can promote
conflict resolution.
Anger arousal is a personal signal of threat or injustice

7. Anger is constructive when it provides a
feeling of control over a situation and the
individual is able to assertively take charge
of situation .
It serves to increase self –esteem and leads
to mutual understanding and forgiveness.

8. NEGATIVE FUNCTIONS
OR
DESTRUCTIVE USES
Without cognitive input , anger may result in impulsive
behavior, disregarding possible negative consequences.
Communicated passive-aggressively , conflict escalated and
the problem that creates the conflict goes unresolved .
Anger can lead to aggression when the coping mechanism is
displacement .

9. It can
feeling ofwhen
control
be destructive
the feeling of
and the individual uses the
power to intimidate
others.
It masks honest feeling
,weaken, self –esteem and
leads to hostility and rage.

10. Aggression refers to behavior
that is intended to threaten
or injured the victim’s
security or self – esteem .it is
a response that aims to
inflicting pain or injury on
object or persons.
(Warren,1999 )

11. CHARACTERISTICS
Aggressive behavior is communicated verbally or
nonverbally
Aggressive people may invade the personal space of
others
Theymayspeakloudly andwith greater emphasis

12. They usually maintain eye contact over a prolonged
periodof timesothat the otherperson experiencesit
asan intrusive
Posture is erect and often aggressive people lforward
slightly towards the other person. The overall
impressionisoneof powerand dominance

13. TYPES OF AGGRESSION
Instrumental Aggression
Aggression aimed at obtaining an object,
privilege or space with no deliberate intent
to harmanotherperson

14. Hostile
Aggression
Aggression intended to harm another
person, such as hitting, kicking, or
threateningto beatup someone.

15. Relational Aggression
A form of hostile aggression that does
damageto another'speerrelationships,as in
socialexclusionorrumorspreading

16. MOYER CLASSIFICATION
Moyer (1968) presented an early and
influential classification of seven
different forms of aggression, from a
biological and evolutionary point of view.

17. Predatory aggression:
Attack on prey by a predator.
Inter-male aggression:
Competition between males of the same
species over access to resources such
as females, dominance, status, etc.

18. Fear-induced aggression:
Aggression associated with attempts to
flee from a threat.
Irritable aggression:
Aggression induced by frustration and
directed against an available target.

19. Territorial aggression:
Defense of a fixed area against intruders,
typically conflicts.
Maternal aggression:
A female's aggression to protect her
offspring from a threat. Paternal aggression
also exists.
Instrumental aggression:
Aggression directed towards obtaining some
goal, considered to be a learned response to
a situation.

22. THEORIES OF
AGGRESSION
PSYCHOLOGICALTHEORY
BIOLOGICAL THEORY
SOCIO-CULTURAL
THEORY

23. PSYCHOLOGICAL
THEORY

24. SOCIO-CULTURAL
THEORY
Social determinants of violence are:
 Povertyandthe inability to havebasic
necessitiesof life
 Disruption of marriages
 Productionof single-parent families
 Unemployment
 Difficulty in maintaininginterpersonalties,
family structureandsocial control.

25. BIOLOGICAL THEORY
Current biological research has
focused on three areas of the brain
believed to be involved in
aggression:
Limbic system
Frontal lobes
Hypothalamus.

26. PREDISPOSING FACTORS
GENETIC FACTORS
NEUROTRANSMITTERS
NEUROPHYSIOLOGICAL
DISORDERS

27. PSYCHOLOGICAL FACTORS
SOCIAL FACTORS
ENVIRONMENTAL FACTORS
SITUATIONAL FACTORS

29. General Principles of
Management
The safety of patient, clinician , staff ,other
patients and potential intended victims is of
most importance while looking after aggressive
patients
The doors should be open outwards and not be
lockable from inside or capable of being
blocked from inside.

30. Adequate caregiver training and the
availability of appropriate supervision are
critical safeguards in the treatment of
potentially dangerous patients.
For caregivers treating patients with a high
risk for violence behavior, training in basic
self defence techniques and physical
restraint techniques are useful.

31. DRUG TREATMENT
PURPOSES
To use sedating medication in an acute
situation to calm the client so that client
will not harm self or others.
To use medication to treat chronic
aggressive behavior.

32. ACUTE AGITATIONAND
Haloperidol-1 mg or 0.5 mg IM
Risperidone 0.5mg-1mg- In dementia
and schizophrenia.
Trazodone – 50-100mg . In older clients
with sun downing syndrome and
aggression.

33. BENZODIAZEPINES
Used due to the sedative effect and
rapid action. Most commonly lorazepam,
oral or injection.

34. CHRONIC AGGRESSION
Antipsychotic
Anxiolytics- Buspirone
Carbamazepine and valproate to treat
bipolar associated aggressive behaviour.
Antidepressants –trazodone in aggression
associated with organic mental disorder.
Antihypersensitive medication – Propanolol
to treat aggression related to organic brain

35. NURSING INTERVENTIONS
 Self awareness
 Patient education
 Communication strategies

36.  Environmental strategies
1. Room programme
2. Cathartic activities
 Behavioral strategies
a) Limit setting
b). Behavioral contracts
c). Time out
d). Token economy
e). Restraints