Comportamentul

agresiv

Maria Nistor & Lili Sepordi

Ce intelegem prin
comportament agresiv
agresiv?
?

Cateva tipuri

Auto si hetero
Verbala si fizica
Emotionala sau psihologica
Usoara, moderata si severa
Caracteriologica si situationala
Activa si pasiva
Reactiva si instrumentala

Perceptii

Ale publicului

In mass media

Ale profesionistilor

Ale beneficiarilor

Agresivitatea in tulb mentale

Marea majoritatea nu sunt periculosi.

Majoritatea actelor agresive nu sunt comise

de pers cu tulb mentale.

Sunt mai mult victime decat abuzatori.

Contributia altor factori este mai mare.

Exista anumiti factori care cresc riscul.

Factori de risc generali

Depedenta sau abuzul de subst

Episodul acut psihotic sau maniacal

Lipsa sau intreruperea medicatiei

Istoricul agresivitatii

Sexul, varsta, nivelul socio-economic redus

Expunerea la violenta in copilarie

A fi victima unui abuz

Agresivitatea in tulb de dezvoltare

1. Comunicare: frustrare, durere, nevoi, neglijare, abuz
2. Comport invatat si intarit (obt atentie, stimulare,
acces, contact; evitare/scapare din situatii, sarcini, stres)
3. Modulare disconfort fizic si emotional
4. Semn al unei tulb mentale sau medicale

Lowry, M. & Sover R. (1991) Functional existence of probl behav. The Habilit Mental Health Care
Matson, J.L., et al (2010) What is the evidence for environmental causes of challenging behaviors
in persons with intellectual disabilities and autism spectrum disorders?Research in Devel Disabilities

Interventii in tulb de dezvoltare

1.

Modificarea antecedentelor

2.

Strategii bazate pe intariri

3.

Controlul consecintelor

4.

Tehnici de blocaj

5.

Tratamament medicamentos

Brosnan, J & Healy, O. (2011). A review of behavioral interventions for the treatment of
aggression in individual with developmental disabilities. Research in Develop Disab.

Agresivitatea in demente
1. Exprimare, comunicare - disconfort, emotii,
supra/substimulare, pierderi, neintelegeri, suspiciune
2. Rezultat al frustrarii (<= dificult, dependenta,
interpretari sau perceptii gresite)
3. In contextul relatiei cu ingrijitorul - majorit actelor
au loc in timpul ingrijirii, calit relatiei, stresul ingrijitorului
4. Semn al unei tulb mentale sau medicale
Kunikm M. , et al (2010). Causes of Aggressive Behavior in Patients With Dementia. J Clin Psychiatry
Morgan, R. (2013). Modeling causes of aggressive beh in patients with dementia. The Gerontologist.

Interventii in demente
1.

Interventii pe modificarea fact activatori (durere,

stimuli, ingrijire, relatie, comp ingrijitori)

2.

Activitati pentru reducerea comport agresiv

(distragere, comunicare & blocare, izolare)

3.

Interventii pentru preventie (interv senzoriale,

sociale, comport, structurare act, training ingrijitori)

4.

Abordarea centrata pe persoana

Enmarker, I, et al. (2010). Management of person with dementia with aggressive and violent behaviour: a
systematic literature review. International Journal of Older People Nursing,.
Pulsford, D, et al. (2011). A survey of staff attitudes and responses to people with dementia who are
aggressive in residential care settings. Journal of Psychiatric and Mental Health Nursing

Agresivitatea in relatia cu profesionistii

1. Factori beneficiar (diag, istoric agresivitate, stil
interpersonal, interpretari, perceptie stres, nivel simpt)
2. Factori profesionist (experienta, stil interper, coping,
comunicare, convingeri, stres ocupat, disponibilitate)
3. Factori institutie (supraincarcare, organiz activit,
supra/substimulare, rata beneficiar - personal)
Nijman (2002) A Model of Aggression in Psychiatric Hospitals. Acta Psychiatr Scand
Whittington R & Richter D (2006) From the Individual to the Interpersonal: Environment and
Interaction in the Escalation of Violence in Mental Health Settings. In Violence in Mental Health
Settings (ed by Richter & Whittington), Springer.

Programe de interventii
1.

Non - violent crisis intervention (preventia

escaladarii prin ascultare empatie, de-escaladare, teh
fizice)

2.

Professional assault response training (principii

comportam, teh comunic, rezolv conflict, modele ale
agresivit, teh de auto-aparare, blocaj, izolare)

3.

Therapeutic options (analiza comportam aplicata, abilit

de conectare, abilit gestionare conflict de putere)

Morrison E & Love C (2003). An Evaluation of Four Programs for the Management of Aggression in
Psychiatric Settings. Archives of Psychiatric Nursing
Richter D (2006) Nonphysical Conflict Management and Deescalation. In Violence in Mental Health Settings
(ed by Richter & Whittington), Springer.

Posibile solutii
1.

Analiza si modificare comportamentala

2.

Comunicare asertiva si gestionare a conflictului

3.

De-escaladare verbala si comunicarea nonverbala

4.

Tehnici fizice (evaziune, auto-aparare, blocaj, izolare)

5.

Imbunatatirea relatiei (pre si post)

6.

Managementul propriilor emotii

Morrison E & Love C (2003). An Evaluation of Four Programs for the Management of Aggression in
Psychiatric Settings. Archives of Psychiatric Nursing
Richter D (2006) Nonphysical Conflict Management and Deescalation. In Violence in Mental Health Settings
(ed by Richter & Whittington), Springer.

Impactul expunerii la comp agresiv

Eval subiectiva a comp agresiv si a semnif acestuia

Impactul fiziologic (inundare, arousal ridicat)

Impactul emotional (stres, vinov, rusine, furie, anxietate,

vulnerab, neindrept, lipsa putere, ranire, ostilitate)

Impact cognitiv (ruminatii, erori, convingeri, evaluari)

Impact relationare (supra/subreactionare, distantare,

respingere pasiva)

Needham, I. (2006) Psychological Responses Following Exposure to Violence. In Violence in

Mental Health Settings (ed by Richter & Whittington), Springer.

Ce putem face

Constientizare si intelegere

Alocarea unui timp pt recuperare

Auto-linistire

Discursul interior

Cum sa vorbim despre

Cum sa ne reconectam cu beneficiarul