Verbal and non‐verbal behaviour immediately prior to aggression by mentally disordered people: enhancing the assessment of risk

Abstract

In this study we seek to enhance the assessment of imminent violence risk by providing empirical data on the types of verbal and non-verbal behaviour exhibited by 31 psychiatric inpatients immediately prior to assaulting a staff member, and 31 non-aggressive controls. Verbal abuse, high overall activity level and standing uncomfortably close to the intended victim were the most common behaviours immediately prior to the assault, but most preassault behaviours were also exhibited when patients were not assaulting staff. In the 3 days prior to the assault, aggressive patients differed from non-aggressors in terms of verbal abuse, abnormal activity level (P < 0.05), threatening gestures and threatening stance (P < 0.01). Only one patient was aggressive in the absence of any predictive behaviours. We conclude that most patients exhibit easily identifiable signs of imminent aggression, but that many of these signs occur in the absence of aggression.

Evaluating the validity of anger regulation problems, interpersonal style, and disturbed mental state for predicting inpatient violence

“…From a psychopathological perspective, institutional violence has also been found to be associated with positive symptoms of psychosis, such as paranoid and threat-control override symptoms (Hoptman et al, 1999;Link, Monahan, Stueve, & Cullen, 1999;Lowenstein, Binder, & McNiel, 1990) and general disturbances in mental state (Lowenstein et al, 1990;McNiel and Binder, 1994), including confusion, irritability, threats of violence, and verbal abuse (Linaker and Busch-Iverson, 1995;Noble and Rodger, 1989;Whittington and Patterson, 1996). Research suggests that assessment tools such as the six-item Broset Violence Checklist (Linaker and Busch-Iverson, 1995) that focus on the latter psychopathological and behavioural associations indicate reasonable predictive accuracy for violence 24 hours after assessment (Almvik and Woods, 1998).…”

Assailant and Victim Behaviors Immediately Preceding Inpatient Assault

“…Investigators have relied on second hand data such as review of chart notes or interviews with staff. Some have considered the behaviors' specificity to assault (17,18), but not others (14,19). Only one group (18) considered the dangerousness of the attack.…”

“…Whittington et al (18) asked staff members who had been victimized to score certain assailant behaviors as present or absent in the 5 minutes before assault, but also in the 3 days prior. In the 5 minutes preceding assault, 45% or more of assailants showed verbal abuse, swearing, loud voice, high activity levels, threatening gestures, fast speech, and standing uncomfortably close.…”

Aggression management in a children's hospital setting

“…In many of these studies the researchers are primarily focused on assessing the validity of a particular screening tool (Mulvey and Lidz 1993, Harris and Rice 1997, Nijman and co-workers 2002, and Whittington and Patterson 1996 and do not investigate the impact of situational variables on aggressive behaviour.…”

“…Predictors of aggressive behaviour against others included sex, with males more likely to be physically violent, number of hospitalisations, and alcohol abuse. Whittington & Patterson (1996) researched verbal and non-verbal behaviour in a cohort of 31 psychiatric patients immediately prior to assaulting a staff member and in 31 non-aggressive controls. Data was collected from nine wards of one rural psychiatric hospital over a 14-month period.…”