The causes of aggressive behavior
Many things can influence a person’s behavior and lead to aggression. In CPI training, we use the term Precipitating Factors to describe possible reasons why verbal aggression, physical aggression, and “difficult”
CPI defines Precipitating Factors as:
“The internal or external causes of behavior over which staff have little or no control.”
Examples of Precipitating Factors
Examples of the causes of difficult, challenging, upset, and aggressive behaviors include — but are by no means limited to:
- Fear, anxiety, stress
- Needs not being met (for example, physical needs such as needing to go to the bathroom, or emotional needs for love, affection, recognition, understanding, etc.)
- Traumatic experiences
- Impaired cognitive ability (for example, as a result of intellectual disabilities, mental illness, or dementia)
- Impaired communication skills
- Lack or loss of choice or personal power
- Lack of dignity; not feeling respected
- Coping mechanisms (for example, displaced anger, projection, learned helplessness)
- Attitudes and behaviors of others (staff, family members, peers, etc.)
- Physical environment (people, space, cleanliness, noise, temperature, etc.)
Causes of behavior don’t occur in a vacuum, and they have a way of stacking up. In your work, you might find that aggressive behaviors start surfacing when:
- 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 daughter is barely coping with insomnia as she’s told she has two weeks to find a new place that can actually handle her dad’s dementia behaviors
- 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 sworn at by a client
- A new boy has been in five other facilities, has suffered restraint-related injuries, and is currently seeing his mom 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 heart of the matter lying under the surface.
Understand the factors that contribute to aggression
Behavior is communication. Whether you’re dealing with verbally aggressive behaviors like screaming, swearing, or name calling...or hostile body language like dirty looks or angry gestures...or physically aggressive behaviors like throwing, hitting, biting, or kicking, the behavior is communication.
It's 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. For my part, I’ve been known to verbally lose it and perhaps kick a few things when events have stacked up as I try to ensure care for a family member with dementia — while she’s shrieking into my voicemail, staff are panicked, administrators are frustrated, and I’m angry and scared. (Think of how you would act — or have acted — and how you would want to be treated when something goes horribly wrong.)
Not only are aggressive behaviors often rooted in the factors I shared above, they can often be attempts at coping — especially if the person has survived some kind of trauma
. If your response isn’t trauma-informed
, it could cause the person to feel more anxious, disconnected, or aggressive.
Reducing increased aggression
One of the keys to handling increased aggression is Rational Detachment. When you’re rationally detached, you maintain control of your own behavior
by not taking negative comments or actions personally.
Without this ability, you might react defensively, which will only escalate a situation. Equipped with this skill, you’re better able to be productively supportive, to defuse aggressive behavior, and to encourage calm behavior.
Need more strategies? Our Top 10 De-Escalation Tips breaks down ten fundamental techniques from CPI training
It’s also crucial to remember:
With any type of behavior, the person wants what we all want: to be understood, to be treated with respect, and to satisfy their needs.
Also keep in mind that the person’s behavior is actually telling you
which intervention to use with them. That’s because for every level of behavior that a person displays, there’s a corresponding intervention
to help you de-escalate the situation — or even prevent it from accelerating in the first place.
When you understand the underlying causes of aggressive behaviors and empower the person to replace problem behaviors with positive behaviors that meet the same needs, you’re better able to guide them toward expressing themselves in a positive way.
Need to develop person-centered de-escalation strategies for someone in your care? Our Trauma-Informed Care Resources Guide includes a De-Escalation Preferences Form.
Teaching staff about the causes of aggressive behaviors
As you likely know, we train professionals to teach their colleagues our evidence-based system for crisis prevention and intervention. Barbara Shreve is a CPI Certified Instructor who wrote the following about a surprise that literally rose up when she was teaching her coworkers about Precipitating Factors:
An Unexpected Lesson About Crisis Behaviors
By Barbara Shreve
Where I work at Common Ground, we help clients who have mental health illnesses and/or substance abuse problems.
Last week I was training a CPI class where I used a can of soda pop as a prop to discuss Precipitating Factors.
In my trainings, as I tell a story about a client, I ask the group to shake the can and pass it to the next person when they hear a Precipitating Factor. These causes of behavior can often really stack up, and so at the end of the story, I ask, “Does anyone want to open the can of soda?”
Usually with this exercise, I get a nervous laughter response and a big, collective “NO!”
I then continue my discussion of Precipitating Factors, along with a side comment on staff fear and anxiety (another topic addressed in CPI training). I make this connection in reference to a group’s reaction of passing the can throughout our discussion and in reference to my question about whether they want to pop the can open.
This past week when I was teaching, I placed the shaken can on my desk, as I have done numerous times before...
... and it exploded.
My class broke into nervous laughter and thought this was part of the unit discussion.
After cleaning up a considerable mess of sticky walls and floors, I incorporated this unexpected event into a very teachable moment.
The class began a group discussion on the soda-pop can incident. We talked about the Integrated Experience (how staff attitudes and behaviors affect clients’ attitudes and behaviors and vice versa). We talked more about Precipitating Factors. We talked more about staff fear. And we talked about our team response with the cleanup.
At the end of the day, the participants commented that they would never forget this class.
As CPI Instructors, we all face challenges when teaching. The challenges and limitations that impact our teaching include physical space limits, time, class size, coworkers’ interest, learning capacities, etc. As CPI Instructors, we must all adapt our teaching plans and skills to ever-changing situations.
I have always enjoyed teaching the Nonviolent Crisis Intervention® program. It is such an integral part of how we interact with our clients. This particular class taught me firsthand the need for on-the-spot adaptability for teachable moments, and how the Integrated Experience is always a part of our everyday lives.
Will I continue to use the pop can as a prop? You bet, but with a certain amount of caution! And I’ll continue to impart how the important skills we learn in our classes make us better health care partners to the clients we help and serve.
About Barbara Shreve
Barbara Shreve is a registered nurse who has worked at the nonprofit organization Common Ground in Oakland County, MI since 2009. Barbara works with a dedicated and terrific group to help people move from crisis to hope. With additional training in CPI’s trauma-informed care materials, Barbara has been teaching her coworkers CPI techniques since 2011. Watch what her colleague Mike Taglione tells people about CPI training.
Over to you
I invite you to think about how you’re able to recognize Precipitating Factors during interactions with people in your care.
- Are you able to depersonalize crisis situations and rationally detach, while remaining supportive?
- Are you able to avoid becoming a Precipitating Factor yourself?
- Are you able to proactively address Precipitating Factors that could lead to crisis situations?
Keep in mind that while you may not be able to control many or all Precipitating Factors, you can control your own responses to aggressive behaviors.
If you need training to address the aggressive behavior of those you work with before things get physical, check out CPI Verbal Intervention™ Training.
Image Credits: 1. Have a nice day Photo/Shutterstock | 2. Chanintorn.v/Shutterstock | 3. Ann Yuni/Shutterstock