Common Causes
Mental Health Conditions
- Bipolar disorder:
- Irritability during manic or mixed episodes
- Decreased need for sleep
- Grandiosity and impulsivity
- May have psychotic features
- Depression:
- Irritability, especially in men and teens
- Feelings of worthlessness
- Sleep disturbances
- Loss of interest in activities
- Anxiety disorders:
- Overwhelm leading to irritability
- Fight-or-flight response
- Panic attacks may appear aggressive
- Social anxiety causing defensive behavior
- Personality disorders:
- Antisocial personality disorder
- Borderline personality disorder
- Narcissistic personality disorder
- Paranoid personality disorder
- PTSD:
- Hypervigilance
- Emotional dysregulation
- Flashbacks triggering aggression
- Avoidance behaviors
Neurological Conditions
- Dementia:
- Alzheimer's disease
- Frontotemporal dementia
- Vascular dementia
- Confusion and frustration
- Sundowning behavior
- Traumatic brain injury:
- Frontal lobe damage
- Impulse control problems
- Personality changes
- Difficulty with emotional regulation
- Epilepsy:
- Pre-ictal irritability
- Post-ictal confusion
- Temporal lobe epilepsy
- Brain tumors:
- Frontal lobe tumors
- Personality changes
- Increased intracranial pressure
Medical Conditions
- Hormonal imbalances:
- Hyperthyroidism
- Testosterone imbalances
- Cushing's syndrome
- Premenstrual dysphoric disorder
- Metabolic conditions:
- Hypoglycemia
- Electrolyte imbalances
- Liver disease
- Kidney disease
- Chronic pain conditions:
- Persistent pain causing irritability
- Sleep deprivation from pain
- Medication side effects
- Infections:
- UTIs in elderly
- Encephalitis
- HIV-related conditions
- Sepsis
Substance-Related Causes
- Intoxication:
- Alcohol
- Stimulants (cocaine, methamphetamine)
- PCP
- Anabolic steroids
- Withdrawal:
- Alcohol withdrawal
- Benzodiazepine withdrawal
- Opioid withdrawal
- Nicotine withdrawal
- Medication side effects:
- Corticosteroids
- Some antidepressants
- Stimulant medications
- Some sleep medications
Psychosocial Factors
- Environmental stressors:
- Financial problems
- Relationship conflicts
- Work stress
- Housing instability
- Trauma and abuse:
- Childhood trauma
- Domestic violence
- Recent traumatic events
- Sleep deprivation:
- Chronic insomnia
- Sleep apnea
- Shift work
Associated Symptoms and Signs
Behavioral Signs
- Verbal aggression (yelling, cursing, threats)
- Physical aggression (hitting, pushing, throwing objects)
- Passive-aggressive behavior
- Social withdrawal alternating with hostility
- Destruction of property
- Intimidation tactics
- Oppositional behavior
Emotional Signs
- Persistent anger or rage
- Mood swings
- Frustration intolerance
- Feeling threatened or persecuted
- Jealousy or envy
- Resentment
- Emotional dysregulation
Physical Signs
- Clenched fists or jaw
- Facial flushing
- Increased heart rate
- Muscle tension
- Trembling or shaking
- Heavy breathing
- Restlessness or pacing
Cognitive Signs
- Racing thoughts
- Difficulty concentrating
- Black-and-white thinking
- Paranoid thoughts
- Rumination on perceived slights
- Poor judgment
- Impaired problem-solving
Assessment and Evaluation
Professional Assessment
- Psychiatric evaluation:
- Mental status examination
- Risk assessment
- Psychiatric history
- Substance use screening
- Medical evaluation:
- Physical examination
- Neurological assessment
- Laboratory tests
- Brain imaging if indicated
- Psychological testing:
- Personality assessments
- Anger inventories
- Cognitive testing
- Trauma screening
Important History
- Onset and pattern of behavior
- Triggers and warning signs
- Previous violent behavior
- Substance use history
- Medication compliance
- Family history of mental illness
- Trauma history
- Legal history
Risk Assessment Factors
- History of violence
- Access to weapons
- Specific threats made
- Substance use
- Medication non-compliance
- Social support system
- Insight into behavior
Management and Treatment
Immediate Management
- De-escalation techniques:
- Remain calm and non-threatening
- Use neutral body language
- Give space and time
- Listen actively
- Avoid arguing or confronting
- Set clear boundaries
- Safety measures:
- Remove potential weapons
- Have an exit strategy
- Call for help if needed
- Document incidents
Professional Treatment
- Psychotherapy:
- Cognitive-behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Anger management therapy
- Family therapy
- Group therapy
- Medications:
- Mood stabilizers
- Antipsychotics
- Antidepressants
- Anti-anxiety medications
- Beta-blockers for physical symptoms
- Specialized programs:
- Intensive outpatient programs
- Partial hospitalization
- Residential treatment
- Substance abuse treatment
Long-term Strategies
- Lifestyle modifications:
- Regular exercise
- Stress management techniques
- Adequate sleep
- Healthy diet
- Avoiding triggers
- Skill development:
- Communication skills
- Problem-solving techniques
- Emotional regulation
- Mindfulness practices
- Conflict resolution
- Support systems:
- Support groups
- Family education
- Peer support
- Case management
Prevention and Early Intervention
Early Warning Signs
- Increasing irritability
- Social withdrawal
- Sleep disturbances
- Substance use changes
- Medication non-compliance
- Increased stress
- Physical tension
Prevention Strategies
- Regular mental health check-ups
- Medication adherence
- Stress reduction activities
- Healthy lifestyle habits
- Building coping skills
- Addressing trauma
- Substance abuse prevention
Crisis Planning
- Develop a crisis plan
- Identify triggers and warning signs
- List emergency contacts
- Know local crisis resources
- Communicate plan with support system
When to Seek Help
Emergency Situations
- Threats of violence to self or others
- Actual violence or assault
- Possession of weapons with threats
- Psychotic symptoms (hallucinations, delusions)
- Severe intoxication with aggression
- Inability to care for self
Urgent Evaluation Needed
- New onset of hostile behavior
- Significant personality change
- Escalating pattern of aggression
- Substance abuse concerns
- Non-compliance with treatment
- Family/friends expressing safety concerns
Routine Evaluation
- Persistent irritability affecting relationships
- Difficulty managing anger
- Work or school problems due to behavior
- Request for anger management help
- Family concerns about mood changes