Measurement by observations of aggressive behaviour and activities in clinical situations

Abstract

Clinical aggression (towards self or other persons or things) is often thought of as having a certain degree of disease specificity. Thus, suicidal ideation is often associated with major depression, self‐mutilation with borderline personality disorder, hostility with mania, negativism with schizophrenia or dementia and violence with explosive—impulsive disorder. Attempts to measure suicidal behaviour have pointed at the dimension of depression. Attempts to measure self‐mutilation have shown that this is a behaviour without association to depression or suicidal behaviour. It seems to be associated with borderline disorders as well as mental handicaps. Attempts to measure outward aggression in the clinical situation have identified an aggression factor very similar to that found in the general population by Buss (1971) . This includes passive versus active aggression, direct versus indirect aggression, and verbal versus physical aggression. Among the clinical rating scales the nine‐items Social Dysfunction and Aggression Scale (SDAS‐9) covers this construct. Furthermore, the SDAS‐9 measures both the generalised (day‐to‐day) aggression and aggressive acts. The scale is administered by the psychiatrist in collaboration with the nursing staff. Among scales specifically designed to be administered by the nursing staff are the Overt Aggression Scale (OAS), the Staff Observation Aggression Scale (SOAS), and the Scale for Assessment of Agitated and Aggressive Behaviour (SAAB). These three scales differ in the aspects of aggression to be measured and in the extent to which risk factors are considered. Among psychopathological risk symptoms are delusions, hallucinations, and lack of insight. Among other risk factors are medication and activities of daily living in the ward (ADL). It is important to differentiate in the measurement between aggressive behaviour and risk factors. Thus, the SDAS‐9 measures aggressive behaviour (generalised and attacks), the Brief Psychiatric Rating Scale (BPRS) or the Maudsley Assessment of Delusion Schedule (MADS) measure psychopathological risk factors (e.g. delusions and hallucinations), and the SOAS measures other risk factors (e.g. medication and ADL) .