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Course: Mental Health Nursing

Topic: Clinical Manifestations of Anger and Violence

The Nurses International Community

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Module Goals

Learners will be able to:

Identify the predisposing factors of abusive behaviors.
Discuss the characteristics of victims and victimizers.
Describe the physical and psychological effects on the survivors of intimate partner (IPV), child abuse, and sexual assault.
Discuss the concept of elder abuse, its identification and treatment.
Identify the nurse’s role in identification, prevention and treatment of IPV, child abuse and sexual assault.

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Anger, Aggression and Violence

Anger: “A strong feeling that makes you want to hurt someone or be unpleasant because of something unfair or unkind that has happened” (Cambridge Dictionary, n.d)

Aggression: Aggression is behavior that is intended to harm another individual who does not wish to be harmed.

Baron & Richardson, 1994

as cited on Jhangiani & Tarry, 2014

Image by: Maxipixel

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Violence

“The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.” (WHO, 2002)

According to Jhangiani & Tarry (2014),

Violence is a subset of aggression, all violence is aggressive.
Extreme physical harm, injury or death, is its goal.

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Anger

Anger is an emotion that is expressed in response to an outer stimulus that causes negative feelings because of hurt, betrayal, disappointment, deception, of loss.
A natural response to a threat, helping prime oneself for protection or stand up for ourselves.
if not managed, may have an impact on relationships, as well as physical and emotional health.

The Centre for Youth AOD Practice Development, n.d.

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What Causes Anger?

Fear
Frustration or difficulty understanding
Misunderstanding or being not listened to
Embarrassment or Humiliation
Experience of injustice
Desire to control a situation
Experience of Pain (including withdrawal from substances)
Physical discomfort (tired, hungry or in pain)

The Centre for Youth AOD Practice Development, n.d.

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Critical Thinking Exercise

Discuss the difference between anger and aggression and provide examples.

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Every Individual is Different When it Comes to Anger

The experience of anger is influenced by:

How easily one is angered
How often it occurs
How intensely it is felt
How long it lasts
How comfortable one is with feeling angry and expressing it

The Centre for Youth AOD Practice Development, n.d.

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Common Ways People Deal with Anger

Loss of control and explode in rages that may lead to physical abuse or violence.
Sit with their anger and either wait for it to pass or redirect it to a healthy outlet such as exercise.
May suppress it, “bottle it up” or ignore it which may lead to passive-aggressive behaviour.

The Centre for Youth AOD Practice Development, n.d.

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Factors that Influence the Anger Response

The above responses are influenced by:

Beliefs about what’s acceptable and why (culture).
Learned habitual behaviour.
Gender.
Underlying issues and conditions like physical and mental health issues.
Use of alcohol and other drugs.
Stress and recent Irritation.
Level of self-awareness and emotional literacy.

The Centre for Youth AOD Practice Development, n.d.

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Clinical Signs of Anger

Angry thoughts may be accompanied by:

Muscle tension
Headaches or an increased heart rate

Verbal expressions: Yelling, arguing, profanity, and sarcasm.

Physical Expression: Clenched fist, throwing things , breaking things or hitting a wall.

Note: Sometimes, anger is not expressed externally but remains as internal rumination

Mind Diagnostic, 2021

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How to Keep Anger at Bay?

Anger management doesn’t mean ignoring what one is feeling and waiting for the feelings to pass.

Relaxation techniques: yoga, mediation, exercise.
Cognitive restructuring: Avoid words like ‘always, never, I demand’.
Solve the Problem: Every problem has solution.
Communicate Effectively: Don’t jump to conclusions.
Use humor.
Change environment.
Be easy on yourself.
Ask for help if needed.

American Psychological Association, 2005

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Use Relaxation Techniques:

Practice a deep breathing exercise
Slowly repeat a calm word or phrase such as "relax," "take it easy."
Use imagery; visualize a relaxing experience from either your memory or imagination.
Practice yoga, meditation and non-strenuous exercise. Go for a walk if possible. These will relax the muscles and provide a calmer effect.

Cognitive Restructuring: Change the way we think, do not practice cursing, swearing, don't exaggerate things, and be overly dramatic. Try replacing these thoughts with more rational ones. For instance, never use words like "you never" or "you always" when talking about yourself or someone else, "I would like" something is healthier than saying, "I demand" or "I must have" something.

Solve the Problem: Sometimes, the cause of anger is challenging, natural, and unavoidable problems. Remember that every problem comes with a solution. Focus on finding a solution, make a plan, check the progress, understand your strengths, don't have a "punish-myself" attitude if the solution does not come right away, ask for help/assistance if needed.

Communicate effectively: Do not jump to conclusions, do not judge people, have patience and listen to their part of the story. See the big picture, don't act or say anything that comes in your head (if there is heated discussion), think carefully, take enough time to process information.

Use humor: "Silly humor" can help defuse rage in several ways. It can help to get a balance on a situation. Being harsh, laughing off, or sarcastic humor is an unhealthy way of dealing with anger.

Changing Your Environment: Sometimes environment acts as a trap. Get some personal time, take a break, go for a walk, get some quiet time,

Being easy on ourselves: Avoid the chaos, find alternatives, give time to oneself, self-care.

Ask for Help if necessary (Professional, friends, family, colleagues).

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Aggression

A person who is aggressive does not necessarily act out with violence.

Aggression may have negative effects, on both a societal and individual level.

American Psychological Association, 2012

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Potential Reason for Aggression

Environmental Cause: Existence of aggression in family, society or community.
Biological Cause: High testosterone causes aggressive behaviour whereas Serotonin has calming effect. Brain injury or dysfunction.
Impulse: Lack of self control
Substance Use: Alcohol, drugs
Climate: People living in hotter climate tend to be more aggressive.

Note: The characteristic and risk factor of aggression varies with different age groups

Mind Diagnostic, 2021

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Why Are Some People More Aggressive Than Others?

Environment - Environment plays a significant role in nurturing a person’s behavior and attitude. E.g., if a child is regularly exposed to an environment where their parents and family members are aggressive/impulsive, they tend to adopt nature and turn out to be aggressive. If people know that they need to act aggressively to get things and meet their needs, they will act aggressively.

Biology - Several biological factors are related to aggression. For example, serotonin is said to decrease aggression, whereas testosterone is said to increase with aggressive behavior.

Impulse - An individual who struggles with impulse control is more likely to exhibit aggressive behavior.

Substances use- Alcohol, some other form of drugs may make people impulse, and there is a likelihood to get aggressive.

Climate - Various researches show that climate is directly related to the environment they are leaving. For example, people tend to be more aggressive in hotter areas and areas that lack seasonal variation.

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Characteristics and Risk Factors for Aggressive Behavior

Liu et.al, 2013

Age Group	Characteristic	Risk Factors
Toddlers	Crying, screaming, biting, kicking, throwing, and breaking objects. Aggressive behavior peaks before age two.	Genetic, biological, environmental, imitation, poor parenting
School Aged Children	Teasing, irritability, bullying, fighting, cruelty to animals, and fire-setting. Non-physical aggressive behavior increases.	Genetic, biological, environmental, imitation, poor parenting

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Characteristics and Risk Factors for Aggressive Behavior

Liu et.al, 2013

Age Group	Characteristic	Risk Factors
Adolescents	Serious aggressive behavior, violence appear. Gang fighting, stealing, rape, sexual assults, dating violence.	Learned aggressive behavior in childhood, depression, family and other relationship difficulties, and a family history of suicide, substance abuse

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Characteristics and Risk Factors for Aggressive Behavior

Liu et.al, 2013

Age Group	Characteristic	Risk Factors
Adults	Domestic violence, sexual abuse, child abuse, and homicide.	substance use, brain injury
Elderly	Pain, discomfort Aggressive behavior aimed at fellow, care providers,	Alzheimer’s disease, confusion, misunderstanding of motives. Multifactorial etiology

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Critical Thinking Exercise

The nurse reinforces the behavioral contract for a child having difficulty controlling aggressive behaviors on the psychiatric unit. Which of the following is the best rationale for this method of treatment?

It will assist the child to develop more adaptive coping methods.
It will avoid having the nurse be responsible for setting the rules.
It will maintain the nurse’s role in controlling the child’s behavior.
It will prevent the child from manipulating the nurse.

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Preventive Strategies for Aggression

Age Groups	Strategies
Toddlers	Give age appropriate tasks and expectations Set limits on hurtful aggressive behavior Remove stimulus if there is a trigger
School Aged Children	Institutional Programs: relationship/team building, therapies. Teaching communication skills to express anger, frustration, etc. Teacher-led classroom discussions Avoid use of physical restraints

(Liu et.al, 2013)

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Toddlers:

Parents should present child with age/developmentally appropriate tasks and expectations.

Parents must set limits on hurtful aggressive behavior.
If there is a “trigger” to the aggressive behavior, the child can be removed from stimulus situation.

School Aged Children:

Classroom-based programs that emphasize skill-building, such as self-monitoring and self-regulating emotions and behaviors; increasing relationships among peers; and using communication skills to express anger, frustration, etc.
Teacher-led classroom discussions about aggressive behavior to facilitate open communication about aggression as a problem and make students more aware of its existence, possible triggers, and consequences.
Institute programs (e.g. massage therapy, relaxation breathing, music therapy) to reduce aggressive behavior
Avoid use of physical restraints
Inclusion of parents and family to reinforce learned skills in the home.

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Preventive Strategies of Aggression

Liu et.al, 2013

Age Groups	Strategies
Adolescents	Teaching conflict resolution, social competency, awareness of substance use, role playing, coping strategies, problem solving activities Creating a positive academic environment, extracurricular activities, sports, and arts programs. Institute programs: different therapies for relaxation
Adults	Prevention strategies, occupational programs, positive working environment, awareness of substance abuse

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Adolescents:

Teaching conflict resolution and social competency in the classroom setting.
Target specific risk factors associated with adolescent aggressive behavior, such as underage alcohol use.
Classroom discussions, including role playing and skill rehearsal, to help adolescents learn coping strategies and problem solving.
Creating a positive academic environment, including extracurricular activities, sports, and arts programs. Additionally, a positive school environment should include the presence of teachers and other professionals who convey a caring and supportive attitude toward students.
Institute programs (e.g. massage therapy, relaxation breathing, music therapy) to reduce aggressive behavior

Adults:

Use of the prevention strategies for children and adolescents mentioned above, particularly school programs, (where children and teens spend much of their time), may prevent aggressive behavior later in adulthood.
Occupational programs that focus on awareness of workplace violence, bullying, and anger management.
Target specific risk factors associated with adult aggressive behavior, such as substance abuse
If necessary, prevent harm to vulnerable parties (e.g. children)

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Preventive Strategies of Aggression

Liu et.al, 2013

Age Groups	Strategies
Elderly	Pain management, proper personal care, providing honor and respect, clear communication, providing enough lightning, reducing noises, avoiding confusions, avoiding use of restraints Implement special care units for aggressive clients Special training for the staff to deal aggressive clients

Image by: Pixabay

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How Anger Differs from Aggression

American Psychological Association, 2012

ANGER	AGGRESSION
A normal and typical feeling associated with hostile thoughts, physiological arousal and maladaptive behaviors	Is a decision, an intentional behavior that aims to harm another person
Expressed through loud verbalizations	Might involve physical assaults, battery that ends up criminal justice
May not be expressed for dominance and control	Often reflects a desire for dominance and control
People often want to act aggressively when angry but, not all anger ends in aggression	Aggression may cause impulse and violence

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Aggressive Behaviour Among Nursing Professionals

Evolved role of nurse
Workplace violence
Physicians and nurses often the recipients and/or perpetrators
Nature of nurse’s role

Liu et.al, 2013

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The work of nurses has evolved to often directly involve many forms of aggressive behavior, such as the identification of child abuse, the treatment of victims of aggressive behavior in the emergency department, as well as the emotional and psychological care of sexual assault and rape victims.

Workplace violence is also a well-documented phenomenon in healthcare settings

Physicians and nurses often the recipients and/or perpetrators

Nursing involves the physical and emotional care of individuals who may be momentarily unstable both physiologically and psychologically, therefore the work of nurses in administering care often causes pain and discomfort to the client.

The nature of nurse’s role increases their likelihood of being threatened, verbally abused, or even physically assaulted while providing care.

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Critical Thinking Exercise

Think for a moment about situations that anger you.

Are these likely to create aggressive behaviors?

If so, how might you change your behavior to reduce the likelihood of being aggressive?

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Violence

May be predatory, impulsive, reactive, or defensive in nature.
May target a specific person or group of people, be sexual in nature.
May result in death, physical and mental disabilities.
May impair the development of the nervous and immune systems.
Hundreds of millions of men, women, and children suffer non-fatal forms of interpersonal violence, with many suffering multiple forms.

WHO, 2017a

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Types of Violence

Homicide: Involves the killing of a person by another with intent to cause death or serious injury, by any means.
Child maltreatment: Abuse and neglect of children under 18 years of age in the context of a relationship of responsibility, trust or power.
Intimate partner violence: Behaviour within an intimate relationship that causes physical, sexual or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviours.

WHO, 2017a

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Types of Violence

Youth violence: Youth violence refers to violence that occurs among individuals aged 10–29 years who are unrelated and who may or may not know each other.
Elder abuse: A single or repeated act, or lack of appropriate action, occurring within any relationship that cause harm, distress to the age group above 60 years of age.
Sexual violence: Any sexual act, attempt against a person will regardless of their relationship.

WHO, 2017a

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Violence

Causes:

Frustration
Exposure to violent media
Violence in the home or neighborhood
Tendency to see other people's actions as hostile even when they're not.

Risk of aggression increases when:

Drinking
Substance Use
Insults and other provocations
Environmental factors like heat and overcrowding.

WHO, 2017a

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Homicide

Effects on lives of survivors:

Psychological: Anxiety, depression, post-traumatic stress disorder, aggression, guilt, vulnerability.
Socio-occupational: Poor performance at school and work, poverty, insecurity, corruption, criminal activities, poor social and economic development.

Risk Factors:

Troubled relationships, gender (male have higher homicide rates), political transitions, dictatorship, lack of effective rules, regulations/laws, injustice, economic inequities, easy access to guns and weapons, use of alcohol and other substances.

WHO, 2017b

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Homicide

Prevention:

Public transit system and upgrading of urban infrastructure to improve residents’ access to jobs and attract new businesses to impoverished neighbourhoods.

Address Violence: Aim to stop the spread of violence in communities by detecting and interrupting conflicts, identifying and treating the highest risk individuals, and changing social norms.

WHO, 2017b

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Youth Violence

Effects on victims:

Health Problems: poor general health, heath risky behaviours, mental and neurological problems.
Social and behavioural problems: perpetration of violence, violence victim, relationship problems.
Impaired cognitive and academic performance.

Risk Factors:

Ethnic minority, low socioeconomic status, substance use, obesity, LGBTQ, less parent supervision, moral disengagement, problem relationships.

WHO, 2017c

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Youth Violence

Preventions:

After school activities
Peer mediation programs
Poverty deconcentration
Reduce alcohol and substance use
Preventing school bullies
Social skills programs
Neutralizing potential violent situations

WHO, 2017c

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Critical Thinking Exercise

A 15-year-old boy was hospitalized in a psychiatric unit because he initiates frequent fights with peers.

Which implementation is most appropriate?

Anticipate and neutralize potentially explosive situations.
Ignore minor infractions of rules against fighting.
Isolate the adolescent from contact with peers.
Talk to the adolescent each time fighting occurs.

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Intimate Partner Violence

Effects on Victims:

Health Problems: Sexual and reproductive, communicable diseases, mental and neurological, risky behaviours.
Social and behavioural problems: Perpetration of violence, violence victim, relationship problems.
Impaired cognitive and academic performance.

Risk Factors:

Marital dissatisfaction, neurological problems, gambling, substance use, cohabitation, sexual dissatisfaction, anger, hostility, low education.

Preventions:

Violence prevention programs, gender equity programs, communication skills trainings.

WHO, 2017d

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Sexual Violence

Effects on Victims:

Health Problems: Sexual and reproductive, communicable diseases, mental and neurological, risky behaviours.
Social and behavioural problems: Perpetration of violence, violence victim, relationship problems.
Impaired cognitive and academic performance.

Risk Factors:

Hyper-masculinity, attitudes supportive of sexual violence, hostility towards women, dominance and control, less social support.

Preventions:

Rape awareness programs at school, community, effective communication skills trainings.

WHO, 2017e

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Elder Abuse

Effects on VIctims:

Health Problems: Poor general health, excessive health service use, mental and neurological, non-communicable diseases.
Social and behavioural problems: Placement in nursing home.
Impaired cognitive performance.

Risk Factors:

physical impairment, ethnic minority, poor family relationships, low socioeconomic status, mental and neurological disorders.

Preventions:

Caregiver support programs, educational interventions.

WHO, 2017f

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Child Maltreatment

Effects on Victims:

Attachment problems, mental and neurological problems, health risk behaviours, poor emotional functioning, adolescent pregnancy, poor social skills.

Risk Factors:

Younger parenthood, poor family relationships, poor parent-child relationship, poor parenting skills, social skills, step-parents, behavioural problems.

Preventions:

Parenting programs, sexual abuse awareness programs, clinical enquiry and referral.

WHO, 2017g

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Nurse’s Role in Anger, Aggression and Violence

Nurses who have worked with people who are aggressive or violent have reported the following reactions:

Anger
Desire to appease
Avoidance
Inconsistency of care

State of Queensland, 2010

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Anger: Aggressive or violent behaviours can cause a nurse to experience similar feelings of rage and anger, as they may come to resent being treated abusively by the person. This may result in a subconscious or even a conscious desire to punish the client.
Desire to appease: A desire to appease the person may develop as staff attempt to avoid confrontation. This may be the reaction of someone who has personal problems dealing with anger and who may wish to ‘buy peace’ at any price.
Avoidance: Fear of being hurt or spoken to aggressively can lead to a nurse wanting to avoid the person. However, if staff members do not intervene when appropriate, an aggressive or violent situation may become out of control.
Inconsistency of care: The fact that some staff may wish to avoid and others appease the person may lead to inconsistency of care. This in turn can lead to conflicts arising between staff members.

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Nurse’s Role in Anger, Aggression and Violence

Safety first
Develop a relationship
Have empathy and trust
Promote effective coping mechanism
Encourage social support and engagement
Support families and the client

State of Queensland, 2010

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Responding to Aggressive or Violent Client

Be aware of policies and procedure.
Prior to face to face contact:

Do not prejudge the situation.
Determine if a male or female members staff has more calming influence on the person.
Communicate with co-workers.
Ensure compliance with home visiting policies and procedure.
Understand and consider the client's cultural background.

State of Queensland, 2010

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Make sure you are fully aware of policies and procedures in your place of work for dealing with potentially dangerous situations in both a community and hospital setting. Part of orientation to any new position is to thoroughly understand the policies and procedures relating to aggressive incidents and to ensure that mandatory training requirements for your area of work are completed. Following are some other suggestions that may be helpful to consider when responding to the person who is aggressive or violent.

To consider prior to face-to-face contact:

The fact that a person has been known to be violent in the past is good reason to take extra care. However, it does not mean that the person will be aggressive on any particular occasion. Do not prejudge the situation.
Determine whether a male or female member of staff will have a more calming influence on the person. At times, the presence of a man is too threatening. At others, it is reassuring that a male may have greater physical control over the situation. A male may see a female member of staff as nurturing and supportive and be less likely to try to hurt her.
Communicate to co-workers when you are entering the person’s room or cubicle.
Ensure compliance with home visiting policies and procedures when you are visiting a person’s home and attend with a colleague if possible.
A person’s cultural background can influence the way symptoms of mental illness are expressed or understood. It is essential to take this into account when formulating diagnosis and care plans. Indigenous mental health workers or multicultural mental health coordinators and the Transcultural Clinical Consultation Service are available in many facilities for advice and assistance in understanding these issues.

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Nurse’s Role in Anger, Aggression and Violence

During face-to-face contact

Remain calm
Ensure safety
Have a clear access to the exit door
Regularly orient yourself to the situation and roles
Avoid power struggles
Encourage the client to articulate their feelings
Avoid verbal confrontations
Avoid being emotional or defensive
Differentiate between verbal aggression and customary language
Help client to identify triggers and management strategies
Educate the family members/caregivers

State of Queensland, 2010

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During face-to-face contact:

Remain calm. This will communicate that you are in control. Speak in a calm, firm voice (slowly with measured tones) without emotional response or yelling. If the person is standing, ask him or her to sit down, and tell you what is causing the frustration.
If a person is violent/aggressive, the nurse should immediately contact security and ensure the safety of all people in the vicinity.
To protect yourself in a person’s room or cubicle, ensure you have clear access to the exit door in case the person becomes agitated or wants to leave. Leave the door to the room open and pull the curtain if privacy is necessary. This will avoid the person feeling trapped and will also ensure your protection. Work with a colleague if possible. To protect yourself when visiting a person at home, you may encourage the person to sit outside to talk.
Power struggles can result in violence, so do not force a person who is agitated to have blood taken or to go for tests. Instead, prioritise what care must be administered, and place your focus on that. Ensure that all procedures are explained to the person and that his or her permission has been gained prior to carrying them out.
Regularly orientate yourself to the situation and your role. This can help de-escalation and will help you maintain your focus.
Encourage the person to articulate his or her feelings by clarifying and reflecting on your own understanding of them. Use non-confronting eye contact, ask questions and restate in your own words what you understand the person is trying to tell you. Reflecting a person’s feelings can be very effective, if it is done in a genuine and appropriate way. Saying something like “It seems like this long wait is really frustrating you. Is there anything we can do to help?” Recognise and accept that the person has a right to express anger, and that expression of anger towards you does not mean that you are doing a bad job. Avoid reacting defensively and taking things personally; instead, try to look for the feelings that are behind the behaviour. Reinforce to other staff the person’s right to express angry feelings.
Avoid verbal confrontations. Reassure the person that you are there to help.
Avoid becoming emotional or defensive in your responses. Try to focus, instead, on the current issues. Let the person know that you are interested in what he or she has to say. Recognise that in some situations where people are frustrated or fearful, there may be little a nurse can do to help except to allow expressions of anger and listen empathetically.
Distinguish between verbal aggression and a person’s customary language. Some people use swear words and slang as part of their everyday language and may not have the intention of being aggressive or offensive.
Encourage the person to speak with a mental health worker or social worker, or to accept medication voluntarily, if appropriate. Try dialogue such as: ‘It seems that things are a bit out of control at the moment. Will you let us help you? Taking this medication will help calm things down.’
Help them to identify triggers and any management strategies, if appropriate. It is important to do this when the person is calm and open to discuss the issues. If the person has a mental illness it may be important to consider to what degree the symptoms are contributing to the tendency towards aggression and violence.
Gather other history from family or friends to help understand why the person is acting this way.
Provide family members and carers with information about aggression and violence, if appropriate, as well as reassure and validate their experiences with the person. Encourage family members and carers to look after themselves and seek support if required. Be aware of your own feelings when caring for a person who is aggressive or violent. Arrange for debriefing for yourself or for any colleague who may need support or assistance — this may occur with a clinical supervisor or an employee assistance service counsellor.

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What Would a Nurse Do?

The nurse is called into a room where a client suddenly began shouting at a family member.

What should the nurse do first?

Position themself with an unhindered exit out of the room
Summon the security personnel to come to the room
Camly approach the client and ask them to explain what has happened in their view
Ask the family members to leave the room

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Red Flags

A teenage girl who presents at the clinic with vesico-vaginal fistula.
A husband who appears excessively jealous.
A partner who hurts children and pets when he is upset.
An 8- year-old of female presents with partial removal of clitoral hood ( due to acceptance of female mutilation in some cultures).
A client appears with bruises at different stages of healing.
A child or other client appears afraid to speak in the presence of a parent, spouse.

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Cultural Considerations

The reason and severity of aggression may vary with culture. e.g. The United States has high incidences of violence compared to other such as Canada, Australia, New Zealand, and the Western European countries. (Jhangiani & Tarry, 2014)

Other countries in Eastern Europe, Africa, Asia, and South America have more incidences of violence than the United States (Jhangiani & Tarry, 2014)

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Cultural Considerations

People differ in their general attitudes toward the appropriateness of using violence. Some people are simply more likely to believe in the value of using aggression as a means of solving problems than are others (Jhangiani & Tarry, 2014)

In the context of Bangladesh, Bengali respondents have more wealth, more self-esteem, more prestige and they can dominate the people belonging to Santal respondents. It is, perhaps, these reasons that are responsible for differential aggression in people with high and low socio-cultural group or status in the context of Bangladesh (Rahman, 2009)

Among children, boys show higher rates of physical aggression than girls (Loeber & Hay, 1997)

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Cultural Considerations

Some Cultures Tolerate violence against women (Devi et.al, 2003)

“Stone keeps a knife in good form and beating keeps a woman in good form.” (Proverb: Assam, India).
“Rearing a woman is same as rearing a hen in a Muslim's house”. (Proverb: Bangladesh).
“The man is the woman’s honor.” (Proverb: Africa).
Sexual activity, including rape, is a marker of masculinity and girls are responsible for controlling a man’s sexual urges.
A man is socially superior and has the right to assert power over a woman.
Physical violence is an acceptable way to resolve conflict in a relationship.

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References:

American Psychological Association. (2005). Anger: Controlling Anger Before it Controls You. https://www.apa.org/topics/anger/control

American Psychological association. (2012). How to recognize and deal with anger. https://www.apa.org/topics/anger/recognize

Cambridge Dictionary. (n.d.). Anger. Https://Dictionary.Cambridge.Org/Dictionary/English/Anger

Devi. B. (2003). Women in the mirror of Indian languages: Proverbs in indian languages and the status of women. http://www.languageinindia.com/jan2003/womeninindianlanguages.html

Jhangiani, R., Tarry, H. (2014). Principles Of Social Psychology (1st Ed.). Victoria, B.C. : Bc Campus. Licensed Under Cc By 4.0. Https://Opentextbc.Ca/Socialpsychology/

Liu, J., Lewis, G., & Evans, L. (2013). Understanding aggressive behaviour across the lifespan. Journal of psychiatric and mental health nursing, 20(2), 156–168. https://doi.org/10.1111/j.1365-2850.2012.01902.x

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References:

Mind Diagnostic. (2021). Aggression Definition: What's The Difference Between Aggression And Anger?. https://www.mind-diagnostics.org/blog/aggression/aggression-definition-whats-the-difference-between-aggression-and-anger

Rahman, R. A.K.M. (2009). Cultural Differences In Aggression: A Case Study In Bangladesh. Journal Of Life And Earth Science. Vol. 3 (4). Pp. 43-46. Doi Https://Doi.Org/10.3329/Jles.V3i0.7445

State of Queensland (Queensland Health). (2010). Queensland Mind Essentials: Mental Illness Nursing Documents. https://www.health.qld.gov.au/__data/assets/pdf_file/0029/444773/mindessentialsfinal.pdf

The Centre for YouthAOD Practice Development. (n.d.). Anger and Aggression: Understanding problematic anger and aggressive behaviour. https://www.oohctoolbox.org.au/anger-and-aggression#:~:text=While%20anger%20is%20a%20feeling,or%20verbal%20threats%20or%20insults

World Health Organization. (2002a). World report on violence and health: summary. https://www.who.int/violence_injury_prevention/violence/world_report/en/summary_en.pdf

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References:

World Health Organization. (2017b). Violence Info: Homicide. https://apps.who.int/violence-info/homicide/

World Health Organization. (2002c). Violence Info: Youth Violence. https://apps.who.int/violence-info/youth-violence

World Health Organization. (2002d). Violence Info: Intimate Partner Violence. https://apps.who.int/violence-info/intimate-partner-violence

World Health Organization. (2002e). Violence Info: Elderly Abuse. https://apps.who.int/violence-info/elder-abuse

World Health Organization. (2002f). Violence Info: Sexual Violence. https://apps.who.int/violence-info/sexual-violence

World Health Organization. (2002g). Violence Info: Child Maltreatment. https://apps.who.int/violence-info/child-maltreatment

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