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The Dangerous and Severe Personality Disorder (DSPD) initiative in England and Wales, underway since 2000, provides specialized care to high risk personality disordered individuals in prison and secure psychiatric facilities. Entry to the service, for a capacity nationwide total of approximately 300 individuals at four sites, is determined in part by risk (whether or not the individual is more likely than not to commit an offence that might be expected to lead to serious physical or psychological harm from which the victim would find it hard to recover). This requires valid procedures for assessing risk to determine individuals’ suitability for entry into and transfer out of the service. Yet little is known about the validity of current risk assessment tools and personality measures with the DSPD population. One of the studies reported, the first of its kind with the DSPD population, described a prospective evaluation of the predictive accuracy of the HCR-20, VRS, Static-99, and Risk Matrix 2000 with 44 admissions to the DSPD unit at a high security forensic psychiatric hospital. Consistent with hypotheses, all tools predicted damage to property. HCR-20 Total and scale scores predicted interpersonal physical aggression with structured final risk judgments also predicting repetitive (2+ incidents of) interpersonal physical aggression. HCR-20 Risk Management scores were significantly associated with imminence of interpersonal physical aggression. The second study described a prospective evaluation of the predictive accuracy of Psychopathy Checklist-Revised Factor and Facet scores as well as scores for Cluster B traits using the International Personality Disorder Examination with the same sample. Partial support for hypotheses was found. Only Borderline PD dimension scores predicted damage to property. Histrionic PD predicted interpersonal physical aggression, and Histrionic, Borderline, and Antisocial PDs all predicted repetitive interpersonal physical aggression. Factor 1 and Facets 1 and 2 were also significant predictors of interpersonal physical aggression. Factor 1 and Histrionic PD scores were also significantly associated with imminence of this type of aggression. Results were discussed in terms of the practical utility of these tools with high risk forensic psychiatric inpatients and the functional link (between personality disorder and violence) criterion for DSPD service entry.

In the wake of 21 year old Don Sanderson’s death (January 1st, 2009), the direct result of head injuries sustained during an on-ice hockey fight, the social and political appetite for eliminating violence in amateur hockey appears to be at an all time high. Unfortunately, due to a variety of methodological and conceptual limitations previous research is currently unable to provide a unified and valid explanation for sport-specific aggression (Kirker, Tenenbaum, & Mattson, 2000). One of the primary impediments facing our understanding of sport-specific aggression is the descriptive and fragmented nature of the current body of literature. Over the years a number of independent lines of research have been undertaken, through which several psychological and social factors have been identified as potential determinants. However, in many cases these constructs have yet to be tested against athletes’ actual aggressive behaviour in sport and thus their predictive contribution to our understanding is still unknown. Consequently, the purpose of the current investigation was to assess the predictive influence of several commonly cited psychosocial constructs on amateur hockey players actual within-competition use of aggressive behaviour over a competitive season. A trait aggressive personality disposition emerged as the strongest and most stable predictor of athletes’ aggressive behaviour, accounting for 10 – 40% of the statistical variance depending upon the age and competitive level of the athletes under investigation. Differences in the overt expression of the this trait aggressive disposition between age cohorts (bantam / midget) and competitive levels (house league / rep) suggests that environmental and contextual factors also play a significant role in facilitating or repressing athletes’ aggressive behaviour. As such, the results of the current study support an interactive explanation for hockey-related aggression, whereby situational (e.g., team norms, perceived reinforcement) and personal factors (e.g., trait aggressive disposition, ego orientation) interact to either increase or decrease an athlete’s likelihood for committing aggressive penalty infractions over a competitive season. The current results are plotted and discussed within the parameters of Anderson and Bushman’s (2002) General Aggression Model (GAM), which is a frequently cited interactionist framework used in the broader study of human aggression.

<p>This thesis examined the use of aggression by youth in Pollsmoor Prison during incarceration. Though the incarceration of children and youth is a problem internationally, it is particularly problematic in South Africa where these prison facilities are overcrowded and result in disturbing social practices. They are often at risk for assault, rape and other violent interactions, often within a structured and hierarchical prison gang system. The gang culture within prisons is a crucial factor contributing to its high levels of violence, and its examination is vital to the understanding of power and aggression as a form of survival in prison.</p>

Research Doctorate - Doctor of Philosophy (PhD) / Swearing is a subject largely ignored in academic circles but impossible to ignore in the health workplace. Despite its prevalence there has been little academic research into swearing, and certainly none on its impact on nursing staff. Nurses are, of all health workers, most likely to be targets of verbal aggression with up to 100% of nurses in mental health settings reporting verbal abuse. Nurses encounter swearing from patients and their carers, staff, and managers, and use swearwords in communication with each other, but there is no reference in the literature to the effects on nurses of exposure to swearing. This study set out to rectify that lack of research into swearing by answering three main questions: 1. What is the extent of swearing /verbal aggression in a health care setting? 2. What are the implications of swearing for a therapeutic encounter? 3. What is the impact of swearing on nurses? A mixed methods approach was employed. Phase one of the study explored the context of care, utilising the Overt Aggression Scale to describe the nature and extent of swearing and verbal aggression across a range of acute and long-term inpatient mental health settings. Data were derived from 9,623 reports spanning a 10-year period. The sample comprised 384 (72.1%) males and 148 (27.9%) females aged between 9.5 years and 93.3, mean age 45.6, SD=21.00 years. Most frequently reported over the 10-year period was verbal aggression; incidents involving females occurred mainly in connection with the more severe levels of verbal aggression. “Psychosis” was recorded as the main perceived cause of verbal aggression, in itself an insufficient explanation. A rising tendency to cite psychosis emerged as the level of aggression rose and, on average, 1.9 interventions were recorded for each aggressive incident. Phase two surveyed 107 nurses across three health care settings paediatrics, adult mental health, and child and adolescent mental health – by means of a questionnaire designed to elicit a combination of both qualitative and quantitative data, the Nursing Swearing Impact Questionnaire, which included three standardised instruments. The quantitative data were subjected to descriptive and inferential statistical analysis. High levels of swearing were reported, 29% of nurses being sworn at 1 to 5 times per week and 7% “continuously.” A similar incidence occurred within the nursing team, but being sworn at in anger by another staff member was rare and the major use was in jest or in conversation. The study failed to find significant differences between mental health and paediatric settings in the frequency of swearing but did find gender-based differences. High levels of distress caused by being subjected to swearing were evident, particularly when the aggressor was a relative or carer of a patient. Moreover, the respondents appeared to have only a limited range of interventions for use in dealing with the experience of being sworn at. However, what emerges strongly from the data is the extent to which swearing is culture- and context-bound, and the fact that nurses share many of the views and attitudes about swearing held by society at large. The culmination of the findings suggests that swearing is both widespread and underreported in a range of health contexts. The implications of swearing are poorly understood by nurses. These, and the magnitude of their distress in being subjected to it, render them ill-equipped to deal with the experience. The concomitant negative effects on empathy result in the nurses’ distancing themselves from the patient when confronted and implementing only a restricted range of interventions and detrimental effects on the quality of the therapeutic relationship will have negative effects on patient outcomes. Given the levels of swearing reported and its consequences on the therapeutic relationship, further research is warranted.

Research Doctorate - Doctor of Philosophy (PhD) / Swearing is a subject largely ignored in academic circles but impossible to ignore in the health workplace. Despite its prevalence there has been little academic research into swearing, and certainly none on its impact on nursing staff. Nurses are, of all health workers, most likely to be targets of verbal aggression with up to 100% of nurses in mental health settings reporting verbal abuse. Nurses encounter swearing from patients and their carers, staff, and managers, and use swearwords in communication with each other, but there is no reference in the literature to the effects on nurses of exposure to swearing. This study set out to rectify that lack of research into swearing by answering three main questions: 1. What is the extent of swearing /verbal aggression in a health care setting? 2. What are the implications of swearing for a therapeutic encounter? 3. What is the impact of swearing on nurses? A mixed methods approach was employed. Phase one of the study explored the context of care, utilising the Overt Aggression Scale to describe the nature and extent of swearing and verbal aggression across a range of acute and long-term inpatient mental health settings. Data were derived from 9,623 reports spanning a 10-year period. The sample comprised 384 (72.1%) males and 148 (27.9%) females aged between 9.5 years and 93.3, mean age 45.6, SD=21.00 years. Most frequently reported over the 10-year period was verbal aggression; incidents involving females occurred mainly in connection with the more severe levels of verbal aggression. “Psychosis” was recorded as the main perceived cause of verbal aggression, in itself an insufficient explanation. A rising tendency to cite psychosis emerged as the level of aggression rose and, on average, 1.9 interventions were recorded for each aggressive incident. Phase two surveyed 107 nurses across three health care settings paediatrics, adult mental health, and child and adolescent mental health – by means of a questionnaire designed to elicit a combination of both qualitative and quantitative data, the Nursing Swearing Impact Questionnaire, which included three standardised instruments. The quantitative data were subjected to descriptive and inferential statistical analysis. High levels of swearing were reported, 29% of nurses being sworn at 1 to 5 times per week and 7% “continuously.” A similar incidence occurred within the nursing team, but being sworn at in anger by another staff member was rare and the major use was in jest or in conversation. The study failed to find significant differences between mental health and paediatric settings in the frequency of swearing but did find gender-based differences. High levels of distress caused by being subjected to swearing were evident, particularly when the aggressor was a relative or carer of a patient. Moreover, the respondents appeared to have only a limited range of interventions for use in dealing with the experience of being sworn at. However, what emerges strongly from the data is the extent to which swearing is culture- and context-bound, and the fact that nurses share many of the views and attitudes about swearing held by society at large. The culmination of the findings suggests that swearing is both widespread and underreported in a range of health contexts. The implications of swearing are poorly understood by nurses. These, and the magnitude of their distress in being subjected to it, render them ill-equipped to deal with the experience. The concomitant negative effects on empathy result in the nurses’ distancing themselves from the patient when confronted and implementing only a restricted range of interventions and detrimental effects on the quality of the therapeutic relationship will have negative effects on patient outcomes. Given the levels of swearing reported and its consequences on the therapeutic relationship, further research is warranted.

Research Doctorate - Doctor of Philosophy (PhD) / There is little evidence to show the critical factors that impact on managing aggression in people with dementia and what model of care ensures integrity for both the resident and the personnel responsible for their care. Aggression in this study is defined as an overt act, involving the delivery of noxious stimuli to (but not necessarily aimed at) another organism, object or self which is clearly not accidental. (Patel and hope 1002. p 212). This study used ethnographic techniques, incorporating the use of critical incidents, to explore and explain the culture and context of care situations where nursing personnel experience aggression and violence when dealing with residents with dementia. A Critical Incident Technique was used to identify behaviours of both staff and residents that contributed to and or reduced the amount of aggression that occurred. In particular, this study explored the nature of aggression and the responses of staff and the tensions that exist in the maintenance of rights of both personnel involved in care and the residents for whom they care. Findings revealed the extent to which responses to violence and aggression are related to staff education and understanding of dementia, as well as the illness the resident is suffering at the time. Staff had employed some creative ways to manage aggression in residents. This idicated that a model of care based on person centred care (Kitwood, 1997) would be appropriate for the management of these residents. A framework for an alternate model for the care of people with dementia who are violent and aggressive based on the person centred care approach is proposed and suggestions made for future research.

Thesis (L.L.M.)--University of Hong Kong, 1996. / Includes bibliographical references (leaf 64-67).

Konstanz, Univ., Diplomarbeit, 2007.

Thesis (L.L.M.)--University of Hong Kong, 1996. / Includes bibliographical references (leaf 64-67). Also available in print.