Aggression in Psychiatric In-Patients is State and Context-Dependent; Not Trait-Dependent


An examination by London-based researchers of the data related to aggression in adult psychiatric in-patient settings, published on January 4, 2013 in Acta Psychiatrica Scandinavica, found that while there were differences between aggressive and non-aggressive patients (being younger, male, involuntarily committed, or unmarried, among others), “the associations found between these actuarial factors and aggression were small. It is therefore important for staff to consider dynamic factors such as a patient’s current state and the context to reduce in-patient aggression.”

Abstract →
Dack, C., Ross, J., Papadopoulos, C., Stewart, D., Bowers, L.A.; Review and Meta-Analysis of the Patient Factors Associated With Psychiatric In-Patient Aggression. Acta Psychiatrica Scandinavica. Online January 4, 2013

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. Take a tip from Hell: screen your staff and so-called nurses for sadistic tendencies. My 7-time “tour” through psyche-incarcerations is more than enough experience to Know that some DO delight in the opportunities for thrill, and legally kicking someone’s … in other words, inpatients are not the only ones prone to aggression / violence.

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  2. Glad that you point this out. When I was locked on the unit there was a charge nurse who enjoyed “escalating” people to the point that they would do something so that a stat could be called. I watched and heard him egg people on to become violent. I called him on it a couple of times to his face and he denied doing anything wrong. Looking back on it now I don’t know why I didn’t report him.

    The tone of voice when talking with poeple is important as well as “requesting” rather than “demanding” that they do something. Treating people with respect helps a lot. Nothing about this is rocket science, just treating people properly rather than “less than.”

    There’s also the problem of the so-called antipsychotics making people violent. But of course no one wants to deal with that can of worms.

    A new staff person in the department where I work stated that after visiting the units for new staff orientation she wondered how what she saw happening on the units was of any help to people in getting better! Of course, everyone else in the office clammed up and changed the subject very quickly! We refuse to deal with what is really happending on these units where people are locked up against their will and then forced, without adequate informed consent, to take toxic drugs that may be causing them to be violent. What’s wrong with tis picture?

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