...clarifying demographic clinical characteristics of patients that contribute to an increased propensity for aggressive behaviour. Concurrent research has identified range of situational demands, antecedent interactions, functions and precipitants to aggressive behaviour. Rarely has research attempted to understand how these predisposing characteristics sensitise a patient to environmental events, or predispose a patient to act aggressively for particular purposes. This article describes the results of a study that examined the interaction of demographic, clinical, affective and behavioural characteristics with the function of aggressive behaviour. Results revealed several statistically significant relationships. In these instances, the individual characteristics evidently predisposed patients to an increased risk of aggression that satisfied or attempted to satisfy certain functions. Awareness of these associations might assist in the delineation of methods for managing a patient during hospitalisation; patients could be assisted to satisfy psychological needs and staff may be able to provide psychiatric treatment in a manner that reduces the likelihood of aggression.

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A considerable body of research investigating aggression perpetrated by psychiatric inpatients has accumulated, clarifying the demographic and clinical characteristics that are often associated with an increased propensity for aggressive behaviour (Daffern & Howells, 2002; Davis, 1991). Concurrent research has identified a range of situational demands, antecedent interactions, functions and precipitants of aggression (Daffern, Howells, & Ogloff, 2006; Depp, 1976; Powell, Caan, & Crowe, 1994; Shepherd & Lavender, 1999; Sheridan, Herion, Robinson, & Baxter, 1990; Whittington & Wykes, 1994). Rarely has research attempted to understand how these individual characteristics sensitise a patient to factors operating within the ward environment. Against this background, we investigated the relationship between a range of demographic, clinical, affective and behavioural characteristics of patients admitted for psychiatric treatment with the function of the aggressive behaviour. This approach is commonly referred to as functional analysis.

Essentially, functional analysis seeks to clarify the factors responsible for the development, expression and maintenance of problematic behaviour by assessing the behaviour of interest, the individual's predisposing characteristics, the antecedent events considered important for the initiation of the behaviour and the consequences of the behaviour, which maintain and direct its developmental course (Haynes, 1998; Jackson, Glass, & Hope, 1987; Sturmey, 1996). While functional analysis has demonstrated efficacy in prescribing interventions for problem behaviours such as self-injury (Iwata, Dorsey, Sliferer, Bauman, & Richman, 1982) and has been recommended as a legitimate assessment approach for anger management problems (Howells, 1998), there is only one report in the literature of its use for the assessment of psychiatric inpatient aggression (Shepherd & Lavender, 1999).

Previously, as part of a research program working towards the development of a function analysis of psychiatric inpatient aggression, a range of individual patient characteristics associated with aggressive behaviour were identified (Daffern, Howells, Ogioff, & Lee, 2005); these included a recent history of substance use, an entrenched history of aggression, a recent history of antisocial behaviour, and symptoms of psychosis including thought disturbance, auditory hallucinations and conceptual disorganisation. Concurrently, it was shown that incidents of aggression perpetrated by these same patients usually served rational functions, were precipitated by identifiable events and were not simply the result of a spontaneous manifestation of underlying psychopathology (Daffern et al., 2006). A number of dynamic interpersonal and contextual factors that contribute to aggression were identified: specifically, staff-patient interactions associated with treatment or maintenance of ward regime that are considered provocative or that threatened status. There was little evidence supporting the proposition that aggression was used to obtain tangible items, sanctuary or sedation. Neither was aggression used frequently to reduce social isolation or to observe others suffering.

In this article, the interaction between individual (potentially predisposing) patient characteristics and the functions for aggression is described by examining whether patients with certain characteristics are more likely to behave aggressively for each function. Clarifying the nature of these interactions may assist staff identify particular susceptibilities or tendencies within patients and either offer treatment to ameliorate these, or manage and treat the patient in a manner that may limit the influence of these vulnerabilities. There was only one preconceived hypothesis about the nature of the associations between patient characteristics and function. On the basis of past research that implies patients behave aggressively to reduce social distance, it was anticipated that socially isolated and under-assertive patients would more frequently behave aggressively to reduce social distance or gain attention (Whittington, 1994).

Method

Setting

The setting for this project was the Thomas Embling Hospital (TEH), the secure inpatient hospital of the Victorian Institute of Forensic Mental Health, in Melbourne, Australia. The TEH provides psychiatric assessment and treatment for prisoners with a serious mental illness requiring involuntary hospital treatment, people detained as being unfit to plead (i.e., incompetent to stand trial) or not guilty because of mental impairment, offenders or alleged offenders referred by courts for psychiatric...

NOTE: All illustrations and photos have been removed from this article.



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