Aggression

Abstract Managing aggression is a challenge for psychiatrists in all settings. Recognizing opportunities for appropriate assessment and intervention in correctional settings is an important component of correctional psychiatry. Studies reflect significant risks of violence for both correctional officers and incarcerated persons (IPs). Although prison homicides occur at rates below estimated community homicide rates, the rate of nonlethal violence is substantial. The data for assault are less clear, as definitions of what constitutes assault vary. IP-on-IP assault has been estimated to range from two per 1,000 IPs to as high as 200 per 1,000 IPs. However assault is defined, correctional officers who have been the target of violence have an elevated risk of emotional exhaustion and burnout. Effectively addressing aggression requires a thoughtful and comprehensive approach that may incorporate elements of environmental management, evaluation of potential motivating factors, differential diagnosis, and coordinated intervention. This always involves effective communication among stakeholders, including the IP. Recommended milieu changes and psychotherapeutic and/or pharmacologic interventions need to be explicitly defined; available data are described in this chapter. Consistent oversight and follow-up to measure the effects of each component of the intervention(s) are critical, as aggressive behavior may be both habitual and episodic. This chapter reviews the factors that contribute to the broad range of assaultive behavior observed in correctional settings and some of the pragmatic issues and opportunities for assessment, diagnosis, and treatment of aggressive behaviors, both impulsive and predatory.