Cracked and broken windowAggression and violence are terms often used interchangeably; however, the two differ. Violence can be defined as the use of physical force with the intent to injure another person or destroy property, while aggression is generally defined as angry or violent feelings or behavior. A person who is aggressive does not necessarily act out with violence. Issues with aggression and violence or their effects can be addressed in therapy with the help of a mental health professional.

Understanding Aggression and Violence

Aggression and violence are not the same. While a person who commits an act of violence may be acting with aggression, a person with an aggressive nature will not necessarily engage in violent acts. Although aggression can result in a physical or verbal attack, sometimes the attack may be defensive or impulsive and lack harmful intent. Often considered a physical expression of aggression, violence may be predatory, impulsive, reactive, or defensive in nature. Violence can develop from situational or environmental factors and may result from a mental condition or from personal or cultural beliefs.

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Both violence and aggression can have negative effects, on both a societal and individual level. Acts of violence may target a specific person or group of people, be sexual in nature, or occur following the use of alcohol or drug use. The Centers for Disease Control (CDC) estimates that, in the United States, 2 million emergency room visits each year are due to violent assaults, and about 16,000 people will be murdered each year. Young men between the ages of 18 and 24 are more likely to be victims or perpetrators of violence. Over a third of American women and over a quarter of American men have experienced stalking or physical or sexual violence by an intimate partner, and nearly half of all American women have experienced psychological aggression from an intimate partner.

Though it is difficult to identify all of the factors that may lead to the development of aggressive tendencies or violent behavior, social status, personal issues, and institutional forces may all be factors. Perpetrators of violence might repeatedly lose jobs, relationships, and family members. The criminal justice costs of violence are also high: People who repeatedly commit acts of violence may spend several years or even decades of their lives in prison.

Management of aggression can be facilitated through redirection, conflict mediation, and the establishing of boundaries and appropriate peer relationships. These kinds of strategies can help keep aggressive tendencies from repeatedly being expressed through violence, especially when the behavior is addressed in childhood.

Types of Aggression

Aggression can be defined in multiple ways, and research in various fields often describes differing types of aggression, but four general types of aggressive behavior are as follows:

  • Accidental aggression is not intentional and may be the result of carelessness. This form of aggression is often seen in children at play and can also occur when a person is in a hurry. For example, a person running to catch a bus may run into someone, or knock over a child.
  • Expressive aggression is an act of aggression that is intentional but not meant to cause harm. A child who throw toys or kicks sand is demonstrating expressive aggression: Though the behavior could be frustrating to another person or cause harm, causing harm is not the purpose of the behavior.
  • Hostile aggression is meant to cause physical or psychological pain. Bullying and malicious gossiping or rumor-spreading are forms of hostile aggression. Reactive aggression, or an aggressive action as a result of provocation, is also a form of hostile aggression.
  • Instrumental aggression can result from conflict over objects or what are assumed to be one's rights. For example, a student who wished to sit at a desk that was taken by another student may retaliate by knocking the other student's belongings from the top of the desk.

These four types of aggressive behavior are often seen in children but can also describe adult actions. Some long-standing popular ideas may hold that males are more aggressive than females, but research has shown that this is not the case. Although women may tend to use aggressive tactics verbally and indirectly and resort to physical aggression less often than men, research has shown that there is not a significant difference between males and females with regard to aggression.

Mental Health Conditions and Violent or Aggressive Behavior

Aggressive or violent tendencies can result from several different mental health conditions. Alcohol and drug abuse may produce violent behavior, even when a person is not usually violent. Posttraumatic stress and bipolar can also lead to the violent expression of aggressive thoughts. In some instances, brain injuries cause a person to become violent, and children who grew up in traumatic or neglectful environments can be more inclined to demonstrate aggression and resort to violence. Any life circumstance that causes stress, such as poverty, relationship problems, or abuse, can also contribute to aggression and violence.

Children who grow up with aggressive parents or who have aggressive role models, such as coaches and teachers, may also begin to demonstrate aggressive behavior or develop mental health conditions as a result. The act of bullying, for example, is significantly connected to mental health: Inconsistently or inappropriately disciplined children, as well as children who are abused, are more likely to become bullies and may then abuse their own children later in life. They are also more likely to experience depression and anxiety and may turn to drugs or alcohol or other addictive behaviors in order to cope. Children who are bullied by siblings are over two times as likely to experience depression or engage in acts of self-harm before adulthood and two times as likely to experience anxiety than those who were not bullied by siblings. They also are more likely to experience parasomnias, such as night terrors and sleepwalking, than children who did not experience bullying from a sibling.

Demonstrated aggressive and/or violent behavior may also indicate conditions such as intermittent explosive disorder (IED) or a conduct disorder. IED, a behavioral condition that typically presents in the teenage or early adult years, is categorized in the Diagnostic and Statistical Manual (DSM) as an impulse control disorder. This condition is often indicated by extreme expressions of anger, disproportionate to the situation, that may become uncontrollable rage. Conduct disorder, a condition that generally begins in adolescence, is listed in the DSM under attention-deficit and disruptive behavior and is characterized in part by physical and verbal aggression, destructive behavior, and cruel behavior toward humans and animals.

Two genes that have been determined to increase an individual's likelihood of committing a violent crime have recently been identified: the MAOA, or warrior gene, and a variant of cadherin 13, which has been linked to substance abuse and ADHD. In combination with other factors, such as substance use or environmental influences, the presence of these genes are likely to increase the possibility of one's acting on violent urges.

Effects of Aggression and Violence on Mental Health

Violence is found in many areas of life: in the workplace, at home, in sports performances, and in general public areas. It cannot usually be anticipated by the people it affects, and victims of violent acts may experience serious mental health issues as a result, such as posttraumatic stress, depression, and anxiety. A person in an abusive relationship, for example, may fear further repercussions and feel unable to leave the relationship, thus potentially subjecting him- or herself to further harm.

Sometimes perpetrators of violence have mental health issues such as narcissistic, antisocial, or borderline personality. While these mental health conditions are not necessarily indicative of violent behavior, a breakdown in coping skills can often contribute to aggressive or violent behavior, and antisocial personality is characterized, in part, by cruelty toward animals that may include violence. Passive aggression, or subtly aggressive behavior, is not characterized by violence, but by obscured criticism of another person's actions. A person demonstrating passive aggression may be argumentative or extremely critical of authority, complain of being underappreciated or misunderstood, or passively resist assigned tasks by procrastinating or "forgetting."

Treating Aggressive or Violent Behavior in Therapy

Many different types of therapy may be helpful in treating aggressive or violent behavior, depending on the reasons for the behavior as well as the personality and life experiences of the person in treatment. In domestic violence situations, however, couples therapy may not always be the best course of action as the process can further endanger the victim of the abuse, and some therapists will not work with an aggressor who seems unwilling or unable to change.

Cognitive behavioral therapy focuses on teaching those who demonstrate aggressive and violent behavior to better understand and control their aggression, explore various coping mechanisms to better channel the thoughts and feelings associated with violent behavior, and learn how to properly assess the consequences of aggression or violence.

In psychodynamic therapy approaches, people who resort to violence in order to hide deeper emotions are encouraged to become conscious of the more vulnerable feelings that may underlie their aggression. When these feelings, which may include emotions such as shame, humiliation, or fear, are expressed, protective aggression may dissipate.

When violence occurs as a result of abuse, such as when physical abuse that occurred in childhood leads an adult to resort to violent expression, therapy to treat the aftereffects of abuse may be helpful.

Case Examples

  • Mother enters therapy to redirect violent urges: Anya, 25, begins seeing a therapist because she is afraid of her temper. She is responsible for much of the care of her three-year-old son, as her husband works long hours, and because her son is in a defiant stage, she often finds herself experiencing stress as a result of his disobedience and lashing out at him physically. Anya reports to the therapist that in her frustration, she often gives her son several hard swats on his bottom or leg, enough to redden the skin, or slaps his hand away hard when he is bothering her while she attends to household chores. She defends herself by saying that she only does this when he is disobeying her, when she gets too upset to remain calm, but then breaks down, admitting that she feels terrible when her son cries and resolves never to do it again, but that she cannot seem to help the behavior. In sessions, she also reveals that when she gets angry, she often slams things down hard enough to break them, kicks walls, or experiences an urge to damage property. The therapist works with Anya, exploring the idea that she may have not learned adequate ways to express her aggression in adolescence, and helps her to see that inflicting physical punishment on a child is not helpful and could be considered child abuse. They discuss ways that Anya could deal with her frustration when her son is difficult to manage and how she might redirect the urges to punish him or break things into, for example, art or vigorous play. The therapist encourages Anya to join a support group. After several sessions, Anya reports that her temper has improved and that the support group is helping.
  • Teenage boy in court-mandated therapy for violent behavior: Isaac, 17, has been suspended from school several times for fighting, and he currently faces expulsion, a few months shy of graduation, for throwing a book at his teacher's desk when she assigned him detention for failing to complete an assignment. Police became involved with his latest altercation, and he was ordered by a judge to attend therapy sessions or be detained in a juvenile facility. Isaac's manner in therapy is somewhat embarrassed and apologetic. He tells the therapist that he never means to start fights or engage in violent behavior, but that sometimes, he becomes extremely angry with little cause: throwing his classmate's desk to the floor when he made a rude comment, punching a boy several times for tripping him in the hallway. In response to the therapist's questions, he reports that his mood is often irritable, but not to the extent of becoming violent, but that when he does act out violently, his aggression is often followed by exhaustion. Isaac also tells the therapist that his head often hurts and his chest becomes tight before he "explodes," as he puts it. Isaac also reports that he lives with his older siblings, who all left home as soon as possible to get away from their parents' frequent shouting matches and physical fights (although he states that neither of his parents ever used physical violence toward him). The therapist diagnosis Isaac with IED and begins working with him to identify his triggers and explore ways to control his violent urges, such as relaxation and cognitive restructuring. Isaac also begins attending an anger management group for teens, at the therapist's suggestion, and within a few weeks, reports improvement in his behavior.


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