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Aggression 

Aggression
Chapter:
Aggression
Author(s):

Robert L. Trestman

DOI:
10.1093/med/9780199360574.003.0048_update_001

Update:

Minor changes throughout;

Added four new references.

Updated on 28 Sep 2017. The previous version of this content can be found here.
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date: 18 January 2018

Managing aggression is a challenge for psychiatry in all settings. Recognizing opportunities for appropriate assessment and intervention in correctional settings is an important component of correctional psychiatry. Studies reflect significant risks of violence for both correctional officers and inmates. Although prison homicides occur at rates below estimated community homicide rates, the rate of non-lethal violence is substantial. The data for assault are less clear, as definitions of what constitutes assault vary. Inmate-on-inmate assault has been estimated to range from 2 per 1000 inmates to as high as 200 per 1000 inmates. However assault is defined, correctional officers who have been the target of offender violence have elevated risk of emotional exhaustion and burnout. Effectively addressing aggression requires a thoughtful and comprehensive approach that may incorporate elements of environmental management, evaluation of potential motivating factors, differential diagnosis, and a coordinated intervention. This always involves includes effective communication among stakeholders including the patient. Recommended milieu changes and psychotherapeutic and / or pharmacologic interventions need to be explicitly defined; available data are described in this chapter. Consistent oversight and follow up to measure the effects of each component of the intervention(s) is critical, as aggressive behavior may be both habitual and episodic. This chapter reviews the factors that contribute to the broad range of assaultive behavior observed in correctional settings, and some of the pragmatic issues and opportunities for assessment, diagnosis, and treatment of aggressive behaviors, both impulsive and predatory.

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