Inledning: Patienter med psykisk ohälsa och personlighetsförändringar på röntgenavdelning utgör en grupp av patienter som kan bete sig verbalt eller fysiskt aggressivt. Våld på arbetsplatser förekommer i alla arbetsmiljöer men vårdpersonalen är mest utsatt.  Precis som alla andra vårdtagare har dessa patienter rätt till jämlik och säker vård. Syfte: Syftet med studien var att ta fram praktiska råd som röntgensjuksköterskor kan använda för att bemöta patienter med psykisk ohälsa/personlighetsförändringar och kunna förebygga och hantera situationer med aggression och våld. Metod: Studien utfördes som en allmän litteraturöversikt. Tolv vetenskapliga artiklar analyserades. Resultat: Studien kom fram till tre faktorer som kan bidra till att aggressiva situationer i vårdmiljön uppstår (interna, externa och kommunikativa). Det beskrivs fem typer av signaler som röntgensjuksköterskor ska vara uppmärksamma på för att förutse aggression: vad patienten säger, ändringar i rösten, ansikte, beteende, kroppsspråket och i känslouttryck. Många praktiska råd lyfts fram och de flesta baseras på holistiskt synsätt på patienten. Det är viktigt att bygga upp en förtroenderelation på gemensam basis, respektera patientens val och på så sätt låta patienten ha kontroll över sitt liv. Kontinuerlig utbildning och träning med olika scenario rekommenderas att tillämpa på arbetsplatserna för att öka röntgensjuksköterskors kunskap inför möten med denna patientgrupp. Slutsats: Studien besvarade forskningssyfte genom att lyfta fram faktorer som kan leda till aggression, signaler från patienter som röntgensjuksköterskor ska vara uppmärksamma på och praktiska råd som är viktiga vid bemötande av patienter med psykisk ohälsa/personlighetsförändringar.

A National Survey indicated that 1.6 million adolescents in the U.S. were arrested in 2010 and 1.5 million in 2011 for erratic aggressive behaviors, thus showing a decline from the 2.18 million adolescent arrests in 2007. Residential facilities in the state of Pennsylvania offer a group intervention called Aggression Replacement Training (ART) to help adjudicated adolescents regain control of erratic behaviors. The purpose of this study was to examine the extent to which level of group participation in ART and certain demographic factors (age, gender, ethnicity, family socioeconomic status, parental involvement, and education) predict decreased aggression and increased anger control among these youth. Cognitive theory and change theory were used to guide this causal-comparative investigation. The overarching research question was, does a youth's level of ART group participation (i.e., attentive, inattentive, and resistant) result in a subsequent reduction in risk assessment as measured by post Aggression Questionnaire score differences. Data were collected for the period of 2011-2014 from archival records from 5 residential facilities (n = 160) in Pennsylvania and were statistically analyzed. Findings from an analysis of variance indicate that ART group participation predict decreased erratic aggressive behaviors and increased anger control among adolescents. Findings from multiple regression analyses indicate that parental involvement predicts attentive participation level, whereas ART group participation, gender, and parental involvement predicted a reduction in risk assessment. Study findings may assist other treatment facilities and affiliated agencies in the U.S. with developing and implementing effective interventions for youth who exhibit erratic aggressive behaviors.

[Truncated abstract] The overall aim of the research reported in this thesis was to explore the viability and utility of the construct of psychopathy and aggression in children and adolescents. Specifically, by taking a developmentally informed approach it sought to develop new instrumentation which measured psychopathic-like-traits, and verbal proactive and reactive aggression in non-referred mainstream school children and adolescents. To achieve this, four separate yet interrelated studies were conducted. Study One comprised three phases relating to the development and validation of two new instruments. In Phase One the instruments currently used to measure psychopathy were reviewed and items relevant to young persons were selected for inclusion in a draft version of the new psychopathy screening instrument. Phase Two, which sought to further explore the construct of psychopathy in children and adolescents, comprised a series of interviews with school principals, deputy principals, psychologists, and education officers at the main juvenile detention centre in Perth, Western Australia. These interviews provided information relating to the behaviour and characteristics of children and adolescents who present with psychopathic-like-traits. As a consequence of the feedback from the Phase Two data, Phase Three reviewed the instrumentation currently used to measure aggression in children and adolescents. From this items were selected for possible inclusion in an aggression questionnaire. The data gathered over these three phases resulted in 117 psychopathy related items being generated for the new instrument, which were subsequently reduced to 56 when duplicated items were identified and the extant knowledge of the construct applied. The 56 items were retained in a draft version of the newly developed instrument, which was named the Child and Adolescent Psychopathy Screening Instrument (CAPSI). The Study One data revealed the instrumentation used to date provided few measures of physical and verbal aggression - a characteristic of psychopathic-like behaviour. Thus, a review of instrumentation together with the information from the interviews resulted in 63 aggression items being generated. ... Study Four utilised information from the CAPSI and the CASA in conjunction with in-depth interviews to generate case studies to further elucidate the characteristics of children and adolescents with psychopathic-like-traits and extreme aggression. Case studies were undertaken with seven male students ranging in age from 8 to 15 years who had been suspended from mainstream schools. All boys scored very highly on the new instruments. All presented with extreme aggression, with some exhibiting proactive or premeditated aggression combined with a superficially engaging personality, insincere charm, lack of remorse, and lack of empathy. The findings from all four research studies are discussed in the light of the literature reviewed and the aims of the research. Implications are then drawn for researchers and clinicians, and directions for further research are suggested.

<p>Under 1990-talet implementerades i Sverige en metod för behandling av aggressivitethos barn och unga, som kallas Aggression Replacement Training (ART). Metoden ärutvecklad i USA av Arnold P. Goldstein och hans kollegor. Metoden har sin teoretiskagrund inom den sociala inlärningsteorin och bygger till stor del på behandlingsprinciperinspirerade av kognitiv beteendeterapi. ART som behandlingsmetod för aggressiva barnoch unga har fått stor spridning i Sverige och en av de kommuner som erbjuder ARTsom öppenvårdsinsats inom socialtjänsten är Västerås. Denna uppsats utgår från ettuppdrag från familjebehandlingen i Västerås Stad, som önskar belysa vilka eventuellaupplevda effekter deras variant av ART har gett. Förutom detta syftar uppsatsen ocksåtill att teoretiskt beskriva ART med avseende på teoretiskt ursprung och praktiskttillämpning. Studien, som har en kvalitativ ansats, utgår från en specifikbehandlingsgrupp om fem barn, vars föräldrar har intervjuats om vilka eventuellaeffekter de upplever att behandlingen gett. Resultaten är inte helt entydiga, då vissaföräldrar väldigt tydligt upplevt stora förbättringar när det gäller ilska och aggressivitethos sitt barn, medan andra föräldrar inte tycker sig se några större förändringar.Genomgående är dock föräldrarna nöjda med metoden och dess genomförande somsådant, men efterfrågar t.ex. intensivare och mer långvariga insatser för att ökamöjligheten för deras barn att ta till sig behandlingen fullt ut.</p> / <p>During the 1990’s a method of treatment for aggression and anger problems in childrenand youth was introduced in Sweden, witch is called Aggression Replacement Training(ART). ART was first developed in the United States, by Arnold P. Goldstein andcolleagues. The method has its theoretical foundation in the social learning theory and isinspired by the treatment principles found in cognitive behavioural therapy. ART as atreatment method for aggressive children and youth has been widely spread in Swedenand one of the cities that offers ART within their social services are Västerås. This essayis a mission from the unit of family treatment in Västerås Stad, who has an interest inelucidate possible treatment outcomes from their work with ART. In addition to that, thepurpose of this essay is to describe the theoretical foundations and practical appliancesof ART. This study, which has a qualitative approach, emanate from a specific treatmentgroup of five children, whose parents has been interviewed about what, if any, outcomethey experience that the treatment has resulted in. The results are not really univocal.Some of the parents experience very significant improvements in their child’sexpression of anger and aggressiveness, whereas some other parents don’t experienceany improvement at all. Consistently though, all of the parents are very pleased with themethod itself and its implementation, but some of them ask for more intensive and farreachinginterventions, to increase the possibilities for their children to fully ingest thetreatment.Key</p>

Ziel dieser Untersuchung war es frühe Risikofaktoren von aggressivem Verhalten bei Kleinkindern in einer Stichprobe von Teenager-Müttern und ihren Babys aus sozial schwachen Verhältnissen (high risk sample) zu identifizieren. In den zurückliegenden zwei Jahrzehnten haben Wissenschaftler immer wieder auf die Bedeutung von Strategien hingewiesen, die es ermöglichen, Kinder und Babys mit einem Risiko für aggresives Verhalten zu identifiezieren. Eine frühe Identifizierung ist besonders wichtig, weil schon Babys und Kinder eine signifikante Psychopathologie besitzen können und u. U. von einer Behandlung profitieren. Außerdem postulieren einige Entwicklungstheorien, dass der Ursprung einer späteren Psychopathologie schon in Verhaltensmustern in den ersten Lebensjahren erkannt werden kann. Dies scheint insbesondere für aggressives Verhalten zu gelten. Deshalb besteht grosses Interesse daran, relevante Faktoren in der frühen Kindheit zu identifizieren, die es erlauben aggressives Verhalten im weiteren Verlauf der Kindheit vorauszusagen. <br /> <br /> Methodik<br /> 60 Teenager-Mütter im Alter zwischen 14 und 20 Jahre und ihre Kleinkinder im Alter zwischen 12 und 17 Monaten aus sozial schwachen Verhältnissen wurden untersucht (high risk sample). Die Teenager-Mütter füllten Fragebögen über ihre Kleinkinder (The Infant-Toddler Social and Emotional Assessment [ITSEA], Carter & Briggs-Gowan, 1993) und über sich selber aus (The Parenting Stress Index [PSI], Abidin, 1990, The Symptom CheckList-90-Revised [SCL-90-R], Derogatis, 1986, The Demographic Qüstionnaire, Zelenko et al., in press). Die Kleinkinder nahmen weiters an zwei objektiven Laboruntersuchungen teil (The Strange Situation Procedure, [SS], Ainsworth, 1978, The Bayley Scales of Infant Development Assessment, [BSID-II], Bayley, 1993).<br /> Die Studie untersuchte folgende Beziehungen: (1) Psychosoziale Funktionen der Mutter mit berichteter (berichet von Mutter anhand des ITSEA) und beobachteter Aggression und negativer Emotionalität bei Kleinkindern (beobachtet während des BSID-II und SS), (2) berichtete Aggression und negative Emotionalität mit beobachteter Aggression und negative Emotionalität bei Kleinkindern, (3) negative Emotionalität mit Aggression bei Kleinkindern, (4) Emotionsregulation mit Aggression und negativer Emotionalität bei Kleinkindern, und (5) eine mögliche Interaktion zwischen Emotionsregulation und negativer Emotionalität in Beziehung zu Aggression bei Kleinkindern. Zusätzlich wurde die Frage untersucht, ob Geschlecht einen Einfluss hat auf die oben genannten fünf Beziehungen.<br /> <br /> Ergebnisse<br /> Mütter mit höheren Depressionenswerten und Stresswerten berichteten signifikant mehr negative Emotionalität und tendenziell mehr Aggressionen bei ihren Kleinkindern als Mütter mit niedrigeren Depressionswerten und Stresswerten. Keine signifikanten Beziehungen konnten festgestellt werden zwischen Depressionswerten und Stresswerten der Mutter und objektiv beobachteten Aggressionen und negativer Emotionalität bei Kleinkindern. Die Beziehung zwischen beobachteter und berichteter negativer Emotionalität bei Kleinkindern war schwach signifikant. Keine signifikante Beziehung konnte jedoch zwischen beobachteter und berichteter Aggression bei Kleinkindern gezeigt werden. Sowohl berichtete als auch beobachtete negative Emotionalität korrelierte signifikant mit berichteter und beobachteter Aggression bei Kleinkindern. Eine signifikante Beziehung zwischen Emotionsregulation und negativer Emotionalität und Aggression bei Kleinkindern konnte aufgezeigt werden. Kleinkinder mit schwacher Emotionsregulation zeigten signifikant mehr negative Emotionalität und Aggressionen als Kleinkinder mit starker Emotionsregulation. Kleinkinder mit hohen negativen Emotionswerten und schwacher Emotionsregulation zeigten signifikant mehr Aggressionen als Kleinkinder mit hohen negativen Emotionswerten und starker Emotionsregulation und Kleinkindern mit niedrigen negativen Emotionswerten und schwacher oder starker Emotionsregulation. <br /> Das Geschlecht des Kleinkindes hatte einen signifikanten Einfluss auf folgende Beziehungen: Mütter mit höheren Depressionswerten und Stresswerten berichteten signifikant mehr Aggressionen und negative Emotionalität bei ihren Töchtern, jedoch nicht signifikant mehr Aggressionen und negative Emotionalität bei ihren Söhnen als Mütter mit niedrigeren Depressionswerten und Stresswerten. Das Geschlecht des Kleinkindes hatte keinen signifikanten Einfluss auf die Beziehung zwischen Depressionswerten und Stresswerten der Mutter und beobachteter Aggression und negativer Emotionalität bei Kleinkindern. Ein interessantes Ergebnis ergab sich hinsichtlich Geschlecht und Emotionsregulationsverhaltensweisen. Buben mit höheren Aggressionswerten schauten signifikant weniger zu ihrer Mutter und signifikant weniger in die Umgebung als Buben mit niedrigeren Aggressionswerten. Mädchen mit höheren Aggressionswerten schauten signifikant mehr zu ihrer Mutter, signifikant mehr in die Umgebung und signifikant mehr auf Spielzeuge als Mädchen mit niedrigen Aggressionswerten.<br /> <br /> Schlussfolgerung<br /> Die Ergebnisse der Untersuchung haben Implikationen für die Einschätzung und die Behandlung von Aggressionen bei Kleinkindern. Erstens, die Ergebnisse weisen darauf hin, dass es unter Umständen wichtig sein könnte verschiedene Messverfahren (Mutter Report und objektive Messverfahren) zu verwenden, um Kleinkinder zu diagnostizieren, die ein erhöhtes Risiko aufweisen im Laufe ihres Lebens Aggressionen zu entwickeln. Zweitens, Ergebnisse identifizierten mütterliche negative Attributionen als einen möglichen Risikofaktor für späteres Aggressionsverhalten bei Kindern. Zukünftige Studien sollten die Beziehung zwischen Aggressionsverhalten im Kleinkindalter und Aggressionen im späteren Leben untersuchen. Ein weiteres interessantes Ergebnis ergab sich hinsichtlich Emotionsregulation. Kleinkinder mit hoher negativer Emotionalität und schwacher Emotionsregualtion zeigten die meisten Aggressionen. Für die Behandlung und die zukünftige Erforschung von Kleinkindaggressionen sollten die drei Konstrukte (Emotionsregualtion, negative Emotionalität und Aggression) miteinander kombiniert werden und nicht alleine untersucht werden. / The primary focus on the present study was to identify early risk factors for infant aggression in a sample of high risk, low-income teenager mothers and their infants. Despite the amount of research on externalizing behavior, relatively little is known about its development in early childhood. Because chronically aggressive school-age children tend to be those who first display symptoms during preschool years, an examination of the early manifestations of aggressive behavior and the development of measurements for infants is needed. The present study explored a model of infant aggression development that emphasized infant aggression developing largely through the interaction of infant&prime;s dispositional characteristics with their caregiving environment.<br /> The study addressed the following relations: (1) Maternal psychosocial functioning with reported and observed infant aggression and negative emotionality, (2) reported measurements of infant aggression and negative emotionality with observed infant measurements of infant aggression and negative emotionality, (3) infant negative emotionality and infant aggression, (4) infant emotion regulation with infant aggression and negative emotionality, (5) the interaction between emotion regulation and negative emotionality in relation to infant aggression, and (6) attachment classification with infant aggression and negative emotionality. Finally, the question of whether these six relations would differ by gender was also addressed.<br /> Maternal psychosocial functioning was assessed with self-reported measurements. Infant aggression, negative emotionality and emotion regulation were measured during two standardized assessments, the Strange Situation and the Bayley Scales of Infant Development Assessment and maternal reported with the Infant-Toddler Social and Emotional Assessment. <br /> Several interesting findings emerged. One of the main findings concerned maternal attribution and its possible role as a risk factor for later externalizing behaviors. That is, mothers, especially depressed and stressed mothers, tended to report higher levels of infant aggression and negative emotionality than was noted by more objective observers. This tendency was particularly evident in mothers with girl infants. Another important finding concerned emotion regulation. Even at this early age, clear differences in emotion regulation could be seen. Interestingly, infants with high negative emotionality and low emotion regulation were observed to be the most aggressive. Also significant relations emerged for infant negative emotionality and aggression and vise versa. Thus, for purposes of treatment and scientific study, the three constructs (emotion regulation, negative emotionality, and aggression) should be considered in combination. Investigating each alone may not prove fruitful in future examinations. Additionally, different emotion regulation behaviors were observed for girl and boy infants. Aggressive girls looked more at the environment, their toys and their mother, whereas aggressive boys looked less at the environment and their mother and explored their toys more, although looked at the toys less. Although difficult to interpret at this point, it is nonetheless interesting that gender differences exist at this young age in emotion regulatory behaviors.<br /> In conclusion, although preliminary, findings from the present study provide intriguing directions for future research. More studies need to conducted focusing on infant aggression, as well as longitudinal studies following the infants over time.

Under 1990-talet implementerades i Sverige en metod för behandling av aggressivitethos barn och unga, som kallas Aggression Replacement Training (ART). Metoden ärutvecklad i USA av Arnold P. Goldstein och hans kollegor. Metoden har sin teoretiskagrund inom den sociala inlärningsteorin och bygger till stor del på behandlingsprinciperinspirerade av kognitiv beteendeterapi. ART som behandlingsmetod för aggressiva barnoch unga har fått stor spridning i Sverige och en av de kommuner som erbjuder ARTsom öppenvårdsinsats inom socialtjänsten är Västerås. Denna uppsats utgår från ettuppdrag från familjebehandlingen i Västerås Stad, som önskar belysa vilka eventuellaupplevda effekter deras variant av ART har gett. Förutom detta syftar uppsatsen ocksåtill att teoretiskt beskriva ART med avseende på teoretiskt ursprung och praktiskttillämpning. Studien, som har en kvalitativ ansats, utgår från en specifikbehandlingsgrupp om fem barn, vars föräldrar har intervjuats om vilka eventuellaeffekter de upplever att behandlingen gett. Resultaten är inte helt entydiga, då vissaföräldrar väldigt tydligt upplevt stora förbättringar när det gäller ilska och aggressivitethos sitt barn, medan andra föräldrar inte tycker sig se några större förändringar.Genomgående är dock föräldrarna nöjda med metoden och dess genomförande somsådant, men efterfrågar t.ex. intensivare och mer långvariga insatser för att ökamöjligheten för deras barn att ta till sig behandlingen fullt ut. / During the 1990’s a method of treatment for aggression and anger problems in childrenand youth was introduced in Sweden, witch is called Aggression Replacement Training(ART). ART was first developed in the United States, by Arnold P. Goldstein andcolleagues. The method has its theoretical foundation in the social learning theory and isinspired by the treatment principles found in cognitive behavioural therapy. ART as atreatment method for aggressive children and youth has been widely spread in Swedenand one of the cities that offers ART within their social services are Västerås. This essayis a mission from the unit of family treatment in Västerås Stad, who has an interest inelucidate possible treatment outcomes from their work with ART. In addition to that, thepurpose of this essay is to describe the theoretical foundations and practical appliancesof ART. This study, which has a qualitative approach, emanate from a specific treatmentgroup of five children, whose parents has been interviewed about what, if any, outcomethey experience that the treatment has resulted in. The results are not really univocal.Some of the parents experience very significant improvements in their child’sexpression of anger and aggressiveness, whereas some other parents don’t experienceany improvement at all. Consistently though, all of the parents are very pleased with themethod itself and its implementation, but some of them ask for more intensive and farreachinginterventions, to increase the possibilities for their children to fully ingest thetreatment.Key

Darbe atliktas agresyvaus vaikų globos namų (VGN) auklėtinių, turinčių specialiųjų poreikių, elgesio kaitos tyrimas. Iškelta hipotezė - tikėtina, kad agresyvaus VGN auklėtinių, turinčių specialiųjų poreikių, elgesio intensyvumas BGM neagresijos programoje numatytų edukacinių veiklų poveikyje mažės. Vykdytas linijinis eksperimentas, siekiant ištirti 8-17 metų specialiųjų poreikių turinčių VGN „Šaltinis“ auklėtinių, agresyvaus elgesio pokyčius. Atlikta statistinė (aprašomoji dažnių, vidurkių, koreliacijos) duomenų analizė. Tyrime dalyvavo trisdešimt devyni (iš penkiasdešimt vieno) 8-17 metų turintys specialiųjų poreikių VGN „Šaltinis“ auklėtiniai bei keturiolika šeimynų socialinių darbuotojų (8 pirminiame ir 6 pakartotiniame tyrime), įvardintų ekspertais, nes, praleisdami nemažai laiko su tyrimo dalyviais, gerai juos pažįsta ir gali pakankamai objektyviai atlikti jų elgesio įvertinimą. Empirinėje dalyje nagrinėjama tyrimo dalyvių charakteristika elgesio problematiškumo aspektu, jų agresyvumo raiška ir sąsajos su įvairiais parametrais, pasitikėjimas savimi bei jo sąsajos su agresyvumu ir agresyvaus tyrimo dalyvių elgesio pokyčiai. Svarbiausios empirinio tyrimo išvados: Tyrimo pradžioje kelta hipotezė, kad agresyvaus VGN auklėtinių, turinčių specialiųjų poreikių, elgesio intensyvumas BGM neagresijos programoje numatytų edukacinių veiklų poveikyje mažės, pasitvirtino. Tyrimo dalyvių, tiek berniukų, tiek mergaičių, daugumos agresijos formų raiškos intensyvumas nežymiai sumažėjo... [toliau žr. visą tekstą] / The present thesis deals with a study into aggressive behavioural alterations in children with special needs from foster homes. The hypothesis has been brought forward that aggressive behavioural intensity in children with special needs from foster homes is likely to decrease under the influence of educational activities under BGM Non Aggression Programme. A linear experiment was conducted to investigate the aggressive behavioural alterations in 8-17 year olds with special needs from “Šaltinis” Foster Home. A statistical (descriptive) analysis (of frequencies, averages, correlation) was carried out. The study included thirty-nine (out of fifty-one) 8-17 year olds with special needs from “Šaltinis” Foster Home and fourteen household social workers (8 in the primary study and 6 in the second study) identified as experts since they spend quite a lot of time with the study participants accordingly the latter are well-known to them and they are able to make a fairly objective assessment of their behaviour. The empirical part examines the study participants’ characteristics in terms of behavioural problems, the expression of their aggression and links to a variety of settings, self-confidence and its interface with the aggressiveness, and aggressive behavioural alterations in the study participants. The main empirical findings are as follows: The hypothesis that has been brought forward at the outset, i.e. aggressive behavioural intensity in children with special needs from foster... [to full text]

From a practical point of view, the well-proven antisuicidal and anti-aggressive effects of lithium are of utmost importance for a rational, safe and economical treatment of patients with affective disorders. Regular lithium long-term treatment reduces the otherwise 2- to 3-fold increased mortality of untreated patients with severe affective disorders down to the level of the general population. This is mainly due to the reduced suicide risk. Many international studies have confirmed this fascinating property of lithium which so far has not been demonstrated with comparable evidence for any other psychotropic compound. The antisuicidal effects of lithium might possibly be related to its anti-aggressive effects which have been shown in various species, populations and settings, such as animals, inhabitants of nursing homes for the elderly, mentally handicapped subjects, children and adolescents with hyperactive, hostile and aggressive behavior, and particularly in hyperaggressive inmates of correction units and prisons. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

No description available.

In my thesis I have focused on the issue of social networks and (social) bullying at elementary schools. In the first part of my paper I summarize the theoretical background and provide an overview of findings and opinions published by experts in relation to the issue of bullying and cyber-bullying, while in the second part of my paper I analyze the results of a research performed with the use of an anonymous questionnaire at four (4) elementary schools in the South Bohemia Region (Jihočeský kraj). The schools involved in the research were: two (2) schools with less than 270 pupils in the Prachatice region, one school with more than 270 pupils in the town of Prachatice and one school with more than 270 pupils in the city of České Budějovice. The purpose of the questionnaire investigation was to collect information on the extent in which aggressive behavior and cyber-bullying appear among pupils attending the 5th through 9th grades of the elementary school (age range 11-15). In the final part of the thesis I provide an overview of the results obtained through the research with the use of a BPAQ questionnaire (BussPerry Aggression Questionnaire and aggressive acts).