Agression: Psychiatric Assessment and Treatment PDF

Preface

The genesis of this book dates back to the summer of 1996 when a group of clinical investigators first met in Philadelphia to discuss the state of human aggression research. At the time little was formalized in the way of a system of measures or concepts characterizing primary human aggression as a clinical disorder. A second, similar, meeting was held two years later, at which a plan was formulated to produce a volume containing comprehensive and specific summary articles on primary human aggression that would be of benefit to both clinical researchers and clinicians. The need for such a volume is clear. Despite the apparent relevance of aggression to society, and the emerging empirical scientific literature strongly indicating that aggression, particularly impulsive aggression, is rooted in complex genetic, biological, and psychodevelopmental relationships that can be identified and targeted for treatment intervention, there are few, if any, officially recognized clinical models that allow for the identification of individuals with clinically significant problems of aggression. Without such models there can be little relevant research. Without such research there can be few advances in knowledge that will be useful to those who attempt to study and treat such individuals.

This volume is divided into four sections, based on the idea that a discussion of general models of aggression should be followed by a discussion of more specific clinical models, a discussion of the clinical and research measurement of aggression and impulsivity, and, finally, a discussion of the treatment of human aggression as seen in clinical contexts. Our focus on primary human aggression is noteworthy because the vast majority of the literature is directed toward books on aggression in general, aggression due to other conditions, or aggression in the context of antisocial behavior. This book is concerned with aggression that does not stem from medical, pharmacological (e.g., during intoxication or withdrawal), or psychiatric (e.g., psychosis or mania) factors or from premeditation; accordingly, it is behavior that is not secondary to some other obvious factor associated with a condition or state about which a good deal is already known.

The first section discusses issues regarding possible models of aggression, including phenomenological models (Chapter 1), genetic models (Chapter 2), developmental models (Chapter 3), and biopsychosocial models (Chapter 4). The fifth chapter considers impulsivity because of its great relevance to aggression, especially impulsive and/or affective or reactive aggression. These chapters set the stage for the chapters in the second section, which discuss clinical models of aggression and anger.

The second section presents four clinical models of aggression that are in various stages of development. Chapter 6 discusses the research category of anger disorders, while Chapter 7 describes a variant of depressive disorder characterized by anger attacks. Chapter 8 discusses the clinical construct of impulsive aggression and Chapter 9 examines Intermittent Explosive Disorder as a categorical expression of impulsive aggression.

The third section focuses on measures of aggression and impulsivity. These chapters provide comprehensive reviews of how aggression and impulsivity can be measured in human and in clinical populations. Chapter 10 presents a comprehensive and critical overview of questionnaire and interview measures of aggression in adults, while Chapters 11 and 12 discuss the two most widely used laboratory measures of aggression. Chapter 13 is similar to Chapter 10 in that it presents a comprehensive review of various psychometric and clinical assessments of impulsivity. Chapter 14 is similar to Chapters 11 and 12 but focuses, instead, on laboratory assessments of impulsivity in human subjects. Chapter 15 concludes this section with a comprehensive review of aggression and impulsivity measures available for use in children and adolescents. The reader interested in obtaining a copy of a specific assessment presented in any of these chapters may refer to the published source cited or to the author of the particular chapter.

The fourth and final section of this volume deals with the clinical treatment of primary aggression. Chapter 16 follows up on Chapter 6, discussing the psychosocial treatment of anger disorders. Chapter 17 does the same for partner aggression. The final three chapters discuss psychopharmacological intervention using neuroleptics and lithium, serotonergic agents, and, finally, anticonvulsants.