What's Behind the Aggression?

Many things can influence a person’s behaviour and lead to aggression. In CPI training, we use the term Precipitating Factors to describe possible causes for aggressive behaviour - whether this “difficult” behaviour presents itself verbally or physically.

CPI defines Precipitating Factors as “The internal or external causes of behaviour over which staff have little or no control.”

Examples of Precipitating Factors

The causes behind aggressive behaviour can include (but are not limited to):

• Fear, anxiety, stress
• Unmet physical needs (hunger, silence) or emotional needs (recognition, love)
• Traumatic experiences
• Pain
• Impaired cognitive ability (eg, a result of intellectual disabilities, mental illness, or dementia)
• Impaired communication skills
• Frustration
• Lack or loss of choice or personal power
• Lack of dignity; not feeling respected
• Coping mechanisms (e.g., displaced anger, projection, learned helplessness)
• Attitudes and behaviours of others (family members, peers, staff, etc.)
• Physical environment (space, cleanliness, noise, temperature, etc.)

Causes of aggressive behaviour don’t occur in a vacuum, and they have a way of stacking up. In your work, you might find that aggressive behaviours start surfacing when:

• A daughter is barely coping with insomnia as she’s told she has two weeks to find a new place that can handle her dad’s dementia behaviours.
• A patient who was admitted for fainting is cold, alone, unable to communicate that he's losing his sight, about to be discharged without being seen by Ophthalmology, and aware he can’t manage on his own.
• A wife is panicked about where her husband is - all she knows is she got a call that he’s been admitted to your hospital.
• A student’s day starts with a fight with his stepdad, then he fails a test and hears one girl tell another that he’s useless.
• A woman who’s nonverbal has a painful ear infection, the sun is shining on her puzzle so brightly she can’t see the pieces, and her brother who talks about her like she’s not there is wiping her nose instead of handing her a tissue.
• A colleague who was up half the night with a sick kid is being cursed at by a client.
• A new boy has been in five other facilities, has suffered restraint-related injuries, and is currently seeing his mum for the first time in two years.
• A resident’s husband recently died, she’s been moved to an unfamiliar room, her dog has been taken away, and she can’t find her pillow.

Though the factors that set a person off may seem minor, they are often the tip of an iceberg, with the primary cause lying just under the surface.

Understand the factors behind the causes of aggressive behaviour

Behaviour is communication. Whether you’re dealing with verbally aggressive behaviours (screaming, swearing, name calling), hostile body language (dirty looks, angry gestures), or physically aggressive behaviours (throwing, hitting, biting, kicking), the behaviour is an attempt to express something that’s usually rooted in fear, frustration, pain, or just an inability to make unmet needs known.

And the reality is that we’ve all been there. Maybe you know someone who’s verbally lost it and kicked a few things as they try to care for a family member living with dementia or confronted a child after they were suspended from school.

Not only are aggressive behaviours often rooted in Precipitating Factors; they can also often be attempts at coping - especially if the person has survived trauma. If your response isn’t trauma-informed, it could cause the person to feel more anxious, disconnected, or aggressive.