Assessing the functions of aggression in psychiatric inpatients

Conflict is inevitable in psychiatric wards where patients are admitted and treated involuntarily. Moreover, in these wards aggression is common and most probably also inevitable. How staff understand the determinants of a patient's aggression impacts on their willingness to help the patient. Causal attributions also influence the nature of prevention, management and treatment strategies that are activated. Traditionally, the most common way of describing and classifying aggression has been according to the anger-mediated/instrumental dichotomy. This is however, a flawed dichotomy that may limit options for prevention, management and treatment. This paper describes a behaviorally oriented classification and recording system that may be used to structure assessments of aggression in psychiatric wards. It also describes an aggressive behavior recording form that can be used by nursing staff to monitor and record the functions of aggression. The advantage of these two instruments is that they emphasize the adaptive value of aggression for the patient and encourage the identification of function, from which effective treatments may be derived. An indirect benefit associated with the focus on function is that the number of incidents classified as motiveless (having no obvious function) may be reduced. For ward staff, this may lessen fear and increase confidence in their management of aggressive patients. Future research needs and opportunities for clinical application are described