Aggression is characterized by anger or violent feelings along with harmful social interaction and an intention of inflicting damage to others.

What Is Aggression?

Aggression is an intentional or unintentional expression of anger or rage that involves physical and emotional harming of oneself or others. In some instances, aggression can be a normal response to threats or violence. It can be expressed in a variety of forms either physically or verbally. According to a study ¹ , “Aggression is any behavior, including verbal events, which involves attacking another person, animal, or object with the intent of harming the target. Similarly, violence is intentionally using physical force to hurt, damage, or kill someone or something.” Occasional display of aggressive behavior as a response to an unforeseen event may be considered normal in some circumstances. Experts believe that aggression arises out of frustration, which can be described as an unpleasant emotion resulting from interference with achieving a goal.

Aggression and violence are still central, clinical, public health, and safety issues worldwide. It is important to take into account that abnormal aggressive behavior is a symptom of a wide range of psychiatric and neurological diseases. A 2013 study ² found the prevalence rate of physical, verbal, and relational aggression was 9.9%, 6.3%, and 1.6% respectively.

Understanding Aggression

This condition can have negative effects on an individual. Aggressive behavior displays a violation of social boundaries. In extreme cases, it can even lead to legal proceedings. The individual may experience irritation or restlessness that tends to make them feel impulsive. Some individuals with this condition may even fail to realize which behaviors are socially appropriate. For instance, they may engage in aggressive behavior to take revenge or provoke someone without realizing its consequences. In some settings, it can involve bodily harm such as biting, hitting, or pushing. However, most conflicts are resolved by threat displays and intimidating thrusts that cause no physical harm. Experts argue that the causes of the condition can be due to biological, psychological, or socioeconomic factors.

A 2017 study ³ found that some patients exhibiting abnormal aggression, engage in such behavior because they find violence rewarding. However, others may do so due to inappropriate emotional reactivity to perceived social threats and poor impulse control. According to research ⁴ , the manifestation of violence and aggression depend on certain intrinsic and extrinsic factors, such as –

1. Intrinsic factors:

• Personality traits
• Existing intense mental distress
• Problems with anger management

2. Extrinsic factors

• Physical and social settings where aggression and violence occur
• Attitudes of individuals with violent or aggressive behaviors
• Characteristics of the victims
• Perceived risk of danger to others
• Experience and training of health and social professionals

Aggression At A Glance

1. Aggression is an intentional or unintentional expression of anger or rage that involves physical and emotional harming of oneself or others.
2. It can be expressed in a variety of forms either physically or verbally.
3. Aggression arises out of frustration, which can be described as an unpleasant emotion resulting from interference with achieving a goal.
4. Aggressive behavior displays a violation of social boundaries.
5. The primary goal of treatment is to address the underlying conditions associated with aggressive behavior.
6. Recovery is possible with therapy and medications.

Types of Aggression

Experts believe that there are multiple forms of aggressive behaviors expressed either intentionally or non-intentionally. They are:

1. Accidental Form

This type is a non-intentional form and usually occurs as a result of carelessness. It is mostly seen in children and can occur when they are playing or if an individual is in a hurry. For instance, a person running to get a taxi may run into someone or knock over a child.

2. Expressive Form

This act is intentional but is not meant to cause any physical or emotional harm. For instance, a child who throws toys or books is demonstrating expressive aggressive behavior. Although this behavior can be frustrating to a parent, it is not done to cause any harm.

3. Hostile Form

This type is intentional and is meant to cause physical or psychological harm. Some of the hostile forms are bullying, malicious gossiping, or rumor spreading. Reactive aggression ⁵ , which is also a form of hostile aggression occurs as a result of provocation. It is usually characterized by high emotional reactivity.

4. Instrumental Form

This type can arise as a result of conflict over objects or when one’s rights are in question. It is also known as predatory aggression. This is often carefully planned and is usually used to satisfy a larger goal. For instance, a student who wants to sit at a particular table may retaliate if someone else sat on it. They may do so by knocking over the individual’s belongings from the desk. Hurting another person in a robbery is also an example of this type.

5. Affective Form

This is also known as impulsive aggression and is usually characterized by intense anger. This form is usually unplanned and tends to occur in the heat of the moment. For instance, when someone yells at an employee at the mall because they can’t seem to get them the right piece is a form of impulsive aggression. Research ⁶ suggests that this form is caused by anger and it usually triggers the acute threat response system in the brain that involves the amygdala, hypothalamus, and periaqueductal gray (PAG).

Forms Of Aggression

Aggression can be demonstrated in various ways. Some of them include:

1. Physical aggression

Physical aggression can be defined as the behavior that involves physically harming others. A 2006 study ⁷ suggests that the frequency of using this form increases during the first 30 to 42 months after the birth of a child and then decreases steadily. This form can also be shown against objects such as slamming the door or throwing objects.

2. Verbal aggression

Verbal aggression can be defined as the behavior that involves being verbally abusive to others. This form is similar to bullying, except for physical aggression. It includes being angry, screaming loudly, or giving verbal threats. It can develop due to frustration, social learning, psychopathology, or the inability to deal with an issue. In romantic relationships, research ⁸ findings have shown a negative correlation between commitment, destructive confrontation and communicative acts of abuse. Happily married couples are more likely to resolve disputes without the use of verbally aggressive messages.

3. Emotional Aggression

This can be defined as the behavior wherein the individual gives only a small amount of thought and acts out of emotional losses or impulsive emotions. For instance, a jealous lover flipping out when their partner speaks to someone of the opposite gender or a sports fan breaking the TV because their favorite team lost the game.

Aggression In Children

A 2005 study ⁹ pointed out that children are also found to act aggressively in some circumstances. These can include poor relationship skills, underlying health issues, or stress and frustration. Some children also tend to imitate aggressive behavior from what they have observed. It can be from television or in their daily lives. Children also tend to lash out aggressively out of fear. It is more common for children with schizophrenia, paranoia, or other conditions. In the case of bipolar disorder, they may act aggressively during the manic episode.

Children also act aggressively when they are irritated or find it difficult to cope with emotions. This is more common in children with autism spectrum disorder or cognitive impairments. It occurs due to their inability to express their emotions. Children with Attention Deficit Hyperactivity Disorder (ADHD) may also display signs of aggression. They tend to become impulsive and engage in socially unacceptable behaviors.

Signs And Symptoms Of Aggression

The signs and symptoms may vary depending on the underlying disease, disorder, or condition. The symptoms may be a combination of psychological, cognitive, and physical factors.

1. Psychological and Cognitive Symptoms

The psychological and cognitive symptoms include:

• Anxiety
• Irritability
• Agitation
• Confusion or forgetfulness
• Depressed or flat mood
• Difficulty in concentrating or attention
• Difficulty with memory, thinking, talking, comprehension, writing or reading
• Hallucinations or delusions
• Heightened awareness
• Personality changes
• Poor judgment
• Sleep disturbances
• Withdrawal from society

2. Physical Symptoms

This may also be associated with physical symptoms. They include:

• Appetite changes
• Changes in pupil size
• Fatigue
• Incontinence
• Seizures and tremors
• Weight changes

Read More About Anxiety Here

Causes Of Aggression

The specific cause of this condition is unknown. Some experts believe that abnormal brain chemistry or structural changes may play a significant role in developing this condition. However, it is commonly found as a symptom of diseases, disorders, or conditions.

1. Biological Factors

Studies ¹⁰ have found that men are more likely to resort to physical aggression than women. While researchers found that women usually don’t engage in physically aggressive behavior. However, they found that women engage in non-physical forms of aggression such as verbal, relational, and social rejection. Genes may also play a significant role in developing aggressive behavior. A 2016 scientific review ¹¹ found several genetic influences that underlie aggression in humans. Certain people born with a deficiency in an allele monoamine oxidase that is responsible for metabolizing serotonin. This can cause an increase in serotonin levels and excess serotonin is found to be directly linked with aggressive behavior. Another 2013 report ¹² also found that testosterone plays a major role in developing aggressive behavior.

2. Environmental Factors

Environmental factors such as how a person is raised play a significant role in developing this condition. A 2016 study ¹³ found that domestic violence is one of the most important factors for developing this condition. Children who grow up in an aggressive environment are more likely to believe that such extreme forms of violence and hostility are socially acceptable. For instance, an experiment ¹⁴ was conducted to understand how observation can play a role in aggressive behavior. Psychologist Bandura’s famous bobo doll experiment demonstrated how aggression was a learned behavior. Children watched a video clip of an adult model behaving aggressively towards a boho doll. They were found to imitate the aggressive behavior displayed in the video clip.

3. Psychiatric and Cognitive Factors

A report ¹⁵ found that aggression may be caused by a number of psychiatric or cognitive disorders that include:

• Antisocial personality disorder
• Attention deficit hyperactivity disorder
• Autism
• Borderline personality disorder
• Conduct disorder
• Dementia
• Alzheimer’s disease
• Huntington’s disease
• Intermittent explosive disorder
• Oppositional defiant disorder
• Post-traumatic stress disorder
• Schizophrenia
• Substance abuse

Read More About Schizophrenia Here

4. Life-threatening factors

Aggression may also be a symptom of a serious life-threatening condition. They include:

• Acute delirium i.e sudden mental changes due to illness or toxicity
• Alcohol or drug intoxication or withdrawal
• Hypoglycemia i.e low blood sugar
• Mania i.e elevated mood or energy levels that can occur in bipolar disorder
• Meningitis i.e infection or inflammation of the sac around the brain and spinal cord
• Stroke
• Traumatic brain injury

5. Other Causes

Other causes of this condition may include:

• Brain tumors
• Traumatic head injury

Complications Associated With Aggression

Since it can occur due to serious illnesses, failure to seek treatment can lead to serious complications and permanent damage. Hence, it is important to diagnose the underlying condition associated with aggressive behavior in order to treat the symptoms effectively. Once diagnosed the doctor will devise a treatment plan that will attempt at reducing the aggressive behavior in the patient. The potential complications associated with this condition are:

• Difficulties at work, in school, in social environments and relationships
• Drug and alcohol abuse
• Drug overdose or alcohol poisoning
• Increased risk of injury
• Legal issues and violations
• Self-harm
• Suicide or violence

Read More About Alcoholism Here

Treatment Of Aggression

The treatment depends on the severity of the condition and the underlying physical or mental condition associated with it. The treatment options are:

1. Cognitive Behavioral Therapy (CBT)

This therapy involves analyzing and understanding the thoughts and patterns that are triggering aggressive behavior. Once identified these thoughts and patterns are altered with positive ones to attain the desired acceptable behavior. Cognitive Behavioral Therapy also helps to develop coping mechanisms to better channel the thoughts and feelings that are associated with violent behavior. The patient is also taught to assess the consequences of their behavior. A 2018 study ¹⁶ showed promising results in treating patients with aggression who suffered traumatic brain injuries.

2. Psychodynamic Therapy

Psychodynamic therapy involves understanding the patterns and emotions related to aggressive behavior in order to gain insight into the current behavior. This therapy attempts to understand the emotions behind resorting to violence and aggressive behavior. The therapists then encourage the patient to become conscious of their vulnerable feelings that are triggering their aggression. Some of these emotions or feelings may include shame, humiliation, or fear that are expressed through aggressive and violent behavior. Although research ¹⁷ is still in progress, psychodynamic therapy showed evidence of treating patients with aggressive behaviors and the underlying conditions associated with it.

3. Medications

There are no medications prescribed by the Food and Drug Administration (FDA) to treat aggression. However, doctors may prescribe medications for treating underlying conditions. Antidepressants or anti-anxiety medications may be prescribed to treat symptoms of depression and anxiety. In the case of schizophrenia, anti-epileptic medications (AEDs) such as phenytoin and carbamazepine may be prescribed. For excess aggressive behavior or in case of manic disorders, mood stabilizers are also prescribed to keep the symptoms at bay. A 2009 study ¹⁸ found strong evidence of efficacy in impulsive aggression from randomized controlled trials with AEDs.

Recovery From Aggression

It is important to treat this so that it doesn’t develop into any violent acts. Recovery is possible with therapy and medications. The primary goal of treatment is to address the underlying conditions associated with aggressive behavior. The doctor will devise a treatment plan based on the symptoms of the condition. Abnormal aggressive behavior rarely occurs unless there is any underlying reason involved. Hence, it is important to seek professional help to conclude a diagnosis.

References:

1. Soreff SM, Gupta V, Wadhwa R, et al. Aggression. [Updated 2021 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448073/ [↩]
2. Meysamie, A., Ghalehtaki, R., Ghazanfari, A., Daneshvar-Fard, M., & Mohammadi, M. R. (2013). Prevalence and Associated Factors of Physical, Verbal and Relational Aggression among Iranian Preschoolers. Iranian journal of psychiatry, 8(3), 138–144. [↩]
3. Fanning JR, Keedy S, Berman ME, Lee R, Coccaro EF. Neural Correlates of Aggressive Behavior in Real Time: a Review of fMRI Studies of Laboratory Reactive Aggression. Curr Behav Neurosci Rep. 2017 Jun;4(2):138-150. doi: 10.1007/s40473-017-0115-8. Epub 2017 May 20. PMID: 29607288; PMCID: PMC5875983. [↩]
4. National Collaborating Centre for Mental Health (UK). Violence and Aggression: Short-Term Management in Mental Health, Health and Community Settings: Updated edition. London: British Psychological Society; 2015. (NICE Guideline, No. 10.) 2, INTRODUCTION. Available from: https://www.ncbi.nlm.nih.gov/books/NBK356335/ [↩]
5. Flanigan, M. E., & Russo, S. J. (2019). Recent advances in the study of aggression. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 44(2), 241–244. https://doi.org/10.1038/s41386-018-0226-2 [↩]
6. Blair R. (2012). Considering anger from a cognitive neuroscience perspective. Wiley interdisciplinary reviews. Cognitive science, 3(1), 65–74. https://doi.org/10.1002/wcs.154 [↩]
7. Côté SM, Vaillancourt T, LeBlanc JC, Nagin DS, Tremblay RE. The development of physical aggression from toddlerhood to pre-adolescence: a nation wide longitudinal study of Canadian children. J Abnorm Child Psychol. 2006 Feb;34(1):71-85. doi: 10.1007/s10802-005-9001-z. PMID: 16565888. [↩]
8. Rill, L., Baiocchi, E., Hopper, M., Denker, K., & Olson, L. N. (2009, October 2). Exploration of the relationship between self-esteem, commitment, and verbal aggressiveness in romantic dating relationships. Taylor & Francis. https://www.tandfonline.com/doi/abs/10.1080/08934210903061587 [↩]
9. Reebye P. (2005). Aggression during early years – infancy and preschool. The Canadian child and adolescent psychiatry review = La revue canadienne de psychiatrie de l’enfant et de l’adolescent, 14(1), 16–20. [↩]
10. Staniloiu, A., & Markowitsch, H.  Gender differences in violence and aggression – a neurobiological perspective. ScienceDirect.com | Science, health and medical journals, full text articles and books. https://www.sciencedirect.com/science/article/pii/S187704281200287X [↩]
11. Fernàndez-Castillo N, Cormand B. Aggressive behavior in humans: Genes and pathways identified through association studies. Am J Med Genet B Neuropsychiatr Genet. 2016 Jul;171(5):676-96. doi: 10.1002/ajmg.b.32419. Epub 2016 Jan 15. PMID: 26773414. [↩]
12. Turner D, Basdekis-Jozsa R, Briken P. Prescription of testosterone-lowering medications for sex offender treatment in German forensic-psychiatric institutions. J Sex Med. 2013 Feb;10(2):570-8. doi: 10.1111/j.1743-6109.2012.02958.x. Epub 2012 Oct 22. PMID: 23088739. [↩]
13. Foshee VA, McNaughton Reyes HL, Chen MS, Ennett ST, Basile KC, DeGue S, Vivolo-Kantor AM, Moracco KE, Bowling JM. Shared Risk Factors for the Perpetration of Physical Dating Violence, Bullying, and Sexual Harassment Among Adolescents Exposed to Domestic Violence. J Youth Adolesc. 2016 Apr;45(4):672-86. doi: 10.1007/s10964-015-0404-z. Epub 2016 Jan 8. PMID: 26746242; PMCID: PMC5859571. [↩]
14. Do L.L.T.N. (2011) Bobo Doll Experiment. In: Goldstein S., Naglieri J.A. (eds) Encyclopedia of Child Behavior and Development. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-79061-9_379 [↩]
15. Soreff SM, Gupta V, Wadhwa R, et al. Aggression. [Updated 2021 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448073/ [↩]
16. Iruthayarajah J, Alibrahim F, Mehta S, Janzen S, McIntyre A, Teasell R. Cognitive behavioural therapy for aggression among individuals with moderate to severe acquired brain injury: a systematic review and meta-analysis. Brain Inj. 2018;32(12):1443-1449. doi: 10.1080/02699052.2018.1496481. Epub 2018 Jul 9. PMID: 29985654. [↩]
17. Fonagy P. (2015). The effectiveness of psychodynamic psychotherapies: An update. World psychiatry : official journal of the World Psychiatric Association (WPA), 14(2), 137–150. https://doi.org/10.1002/wps.20235 [↩]
18. Stanford MS, Anderson NE, Lake SL, Baldridge RM. Pharmacologic treatment of impulsive aggression with antiepileptic drugs. Curr Treat Options Neurol. 2009 Sep;11(5):383-90. doi: 10.1007/s11940-009-0043-3. PMID: 19744405. [↩]