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Preventing episodes involving aggression and reducing coercive measures are important goals in in-patient mental health settings. Antecedents may provide insight into how episodes are described to develop. However, most studies reflect staff perspectives, and often describe and temporally specify antecedents inconsistently.
Aims
This scoping review mapped reported antecedents to episodes involving aggression and episodes involving coercive measures, and identified which appeared shared or specific to either phenomenon.
Method
This review followed the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidance, and included 39 studies from systematic searches across Ovid Medline, APA PsycINFO and Scopus. Reported antecedents were extracted, standardised and mapped to six analytical domains.
Results
The review mapped 240 antecedents, many of which appeared shared across the phenomena. Patient studies emphasised experiences of restrictive care, loss of autonomy and poor interaction quality. Staff studies emphasised immediate, observable situations related to risk management, such as patient aggression, denied requests and interpersonal conflict. Most studies did not specify the temporal boundaries of antecedents.
Conclusions
The perspectives represented in studies and the ways antecedents are conceptualised influence which antecedents become visible in the literature. Overlapping antecedents indicate that episodes involving aggression and episodes involving coercive measures are often described as part of the same escalation process, although patient and staff studies seem to highlight different stages. Prevention efforts therefore require attention to the entire trajectory, and to the point at which staff perceive intervention as necessary. Future studies should incorporate both perspectives, prioritise patient involvement, and more clearly define and temporally specify antecedents.
Antipsychotics are used to manage hostility and aggressive behaviour in schizophrenia, but their comparative efficacy remains unclear.
Aims
To compare the efficacy of antipsychotics for reducing hostility and aggressive behaviour in schizophrenia.
Method
We searched PubMed, PsycINFO, ClinicalTrials.gov, and the Cochrane Schizophrenia Group’s register to 25 April 2025. Two reviewers screened studies and extracted data. We included randomised controlled trials in adults with schizophrenia or related psychotic disorders assessing hostility or aggressive behaviour with ≥48 h follow-up. Standardised mean differences (SMDs) were synthesised in a frequentist random-effects network meta-analysis. Confidence was assessed using Confidence In Network Meta-Analysis. The protocol was registered in PROSPERO (CRD42024572272).
Results
Forty-one studies involving 21 025 participants and 18 antipsychotics were included. Most studies were based on double-blind, parallel-group trials (37/41, 90%), with a median follow-up of 8 weeks (interquartile range = 6). The most common outcome measures were hostility items or related subscales from symptom rating scales (36/41, 88%). Compared with placebo, several antipsychotics reduced hostility and aggressive behaviour. Clozapine (SMD –0.75, 95% CI –1.13 to –0.38), paliperidone (–0.62, –0.88 to –0.36), and olanzapine (–0.60, –0.86 to –0.35) showed the largest effects. Smaller but significant effects were observed for asenapine, risperidone, aripiprazole and haloperidol (SMD range –0.52 to –0.30). Confidence in the evidence was low or very low, mainly due to within-study bias and incoherence.
Conclusions
Antipsychotics reduced hostility and aggressive behaviour in predominantly short- to medium-term studies. Clozapine, paliperidone and olanzapine appeared most effective, although low-certainty evidence limits conclusions about differences between antipsychotics. Further trials with aggressive behaviour as the primary outcome and longer follow-up are needed.
Environmental enrichment can have complex, contradictory effects on aggression and animal welfare. Although increasing enrichment may reduce aggression by limiting the visibility of competitors, it may also intensify territorial defence and harm the welfare of subordinates who are the target of territorial aggression. However, it remains unclear how variation in the complexity of an enrichment structure defended by a single dominant individual influences welfare outcomes for subordinates. In the cichlid fish Astatotilapia burtoni, dominant males defend structures as mating territories, whereas subordinate males do not. To establish social hierarchies, we housed two differently sized males (larger become dominant) and six females in one compartment containing one defendable structure. We manipulated structure complexity by placing 1, 2, or 3 halves of terracotta pots clumped together. Increasing cave number did not enhance territoriality: dominant males showed similar aggression rates, relative gonad sizes, and testosterone levels across treatments. Cave number did not significantly affect mortality, body condition, growth rate, or fin damage in subordinate males. Status-specific behaviours were also not affected by cave number. Although relative gonad size and testosterone levels were generally higher in dominants, these differences were not always significant in the 2- and/or 3-cave treatments, suggesting weaker physiological differentiation between social states. Overall, increasing environmental enrichment had little effect on welfare, but might result in reduced physiological distinctions between dominant and subordinate males. Therefore, careful consideration of enrichment strategies is essential for accurately interpreting status-specific outcomes in laboratory settings.
Aggressive behavior, shaped by genetics and environmental or contextual influences, is expressed differently across development and may lead to criminal justice involvement through arrests and incarceration for some individuals. This study examined the differential impacts of early childhood contextual risk and polygenic risk on a developmental cascade from middle childhood physical aggression and dysregulation to adolescent antisocial behavior, to criminal justice system involvement by age 19, and whether these risks were mitigated by random assignment to the Family Check-Up (FCU) prevention program. The sample included high-risk toddler (N = 731; Mage = 28.2 months, SD = 3.28; 49.5% female, 50% White, 28% Black, 13% Hispanic) and parent dyads involved in a randomized-controlled trial of the FCU and followed longitudinally across 11 waves from ages 2 to 19. Results supported a developmental cascade from middle childhood physical aggression (parent reported) to self-reported legal system involvement at age 19. Early cumulative contextual risk predicted arrests (b = 0.35, p = .001), while a risk tolerance polygenic score predicted self-reported adolescent antisocial behavior (b = 0.51, p = .005). Further, the FCU attenuated the genetic effects on antisocial behavior in adolescence. Findings highlight the value of early prevention for reducing the impact of genetic and contextual risk on rates of justice system involvement by young adulthood.
Social stressors are frequent in everyday life. Examples are conflicts and disputes with other persons, separation and loss of partners, and interaction and self-assertion problems. If such situations are accompanied by injustice, harassment, breach of trust, and humiliation, and if possibilities to defend oneself are limited, then intense negative reactions can arise, for example, embitterment. This is a complex and burning emotion that includes feelings of frustration, self-reproach, anger, fury, aggression, helplessness, despair, insult, degradation, and hopelessness. Embitterment is familiar to everyone and can already be observed in childhood. As injustice is experienced as aggression towards oneself, embitterment can be understood as a form of counter aggression that tries to equalize by taking revenge, even if this has dire costs for oneself. A way to prevent such dysfunctional developments or heal negative experiences is to use wisdom. There is much scientific and experimental research in this field that has defined wisdom as the capacity to deal with difficult situations and dilemmas in life, offering options to ameliorate despair, aggression, and embitterment.
Premenstrual dysphoric disorder (PMDD) is a condition linked to the menstrual cycle and characterised by cyclic emotional distress, irritability and anger, which can disrupt social functioning. Intermittent selective serotonin reuptake inhibitor treatment is effective in alleviating symptoms, yet the neural underpinnings of its efficacy in PMDD remain unknown.
Aims
This randomised, placebo-controlled trial aimed to evaluate the impact of intermittent escitalopram treatment on PMDD symptoms and aggressiveness, and on neural responses to social provocation.
Method
Women with PMDD were randomised to receive either intermittent escitalopram (20 mg/day) or placebo during the luteal phase. Outcomes of interest were changes in mood (assessed by the Daily Record of Severity of Problems), self-rated state aggression (measured by the Aggression Questionnaire) and neural responses to aggression-related stimuli, captured by functional magnetic resonance imaging during the Point Subtraction Aggression Paradigm.
Results
Intermittent escitalopram treatment significantly reduced PMDD symptoms compared with placebo, in particular irritability or anger (Cohen’s d = −0.93, 95% CI [−1.48, −0.38]). Aggressiveness, which was positively associated with these symptoms (Pearson’s r = 0.33, 95% CI [0.06, 0.55]), diminished following treatment (Cohen’s d = −0.42, 95% CI [1.4 × 10−4, 0.84]), with the reduction in irritability or anger partly mediating this association (standardised indirect effect −0.32, 95% CI [−0.77, −0.03]). Escitalopram treatment was nominally associated with lower reactivity to provocation in the anterior insula (involved in salience and threat detection) (Cohen’s d = −0.34, 95% CI [−0.66, −0.02]), the activation of which was positively related to irritability or anger (Spearman’s ρ = 0.39, 95% CI [0.07, 0.64]).
Conclusions
This randomised controlled trial provides timely confirmation of escitalopram as an effective treatment for PMDD within a contemporary clinical context and using prospective daily symptom ratings. Functional neuroimaging suggests that modulation of serotonergic function in PMDD is related to corticolimbic circuits involved in irritability or anger and interpersonal behaviour.
Resource-guarding behaviour is common in companion dogs and negatively impacts human safety, canine welfare, and the human-canine bond. Experiences with resources during critical sensitive periods of development have the potential to influence adult behaviour around resources. Dog breeder management of puppies’ access to resources (e.g. milk, food, and toys) is largely unknown. In this study, dog breeders in Canada and the US (n = 293) were recruited through convenience sampling to complete a cross-sectional survey on breeding and resource management practices and their puppies’ behaviour around resources. Descriptive statistics and logistic regression models were used to determine how resources were managed, the association between management practices and reported competitive behaviour around resources, and the use of aversive-based training methods. Breeder introduction and type of food and toys provided to puppies varied greatly. Most breeders reported intervening during suckling, feeding, and playing to ensure access to resources and habituating puppies to sensory stimuli. Factors associated with increased odds of reported competitive behaviour around food included breeder intervention during suckling and eating, country and breed. Increased odds of reported competitive behaviour around toys was associated with food competition, breeder intervention during play, puppy toy preferences, and whether littermates played together. Increased odds of the use of aversive-based training methods was associated with puppy competitive behaviour during suckling, eating, and playing. This research highlights the need for longitudinal studies on the development of competitive behaviour from birth to sexual maturity and optimal puppy resource management for the prevention of unwanted behaviours in adulthood.
Drawing on the “social misfit” hypothesis, this study tested whether peer victimization is more predictive of maladjustment when children have many same-race classmates who they view as low in aggression. Also accounted for were children’s race, the racial composition of the classroom, and children’s perceptions of other-race peers. Data were collected in the fall, winter, and spring of a school year from 1,424 4th and 5th grade children (Mage = 10.06; SDage = 0.67; Rangeage = 8.43–13.03; 683 girls; 741 boys; 39.61% Black; 60.39% White) in the Southeastern United States. Measures included children’s ratings of the aggressiveness of their participating Black and White classmates; teacher-reports of depressive symptoms, anxiety, and social withdrawal; and peer-reports of peer victimization, aggression, and prosocial behavior. Consistent with the social misfit hypothesis, when children viewed same-race classmates as low in aggression, peer victimization was more strongly associated with internalizing problems in the fall for Black children (R2: 0.05–0.16) and with heightened anxiety in the spring for White children with many same-race classmates (R2 = 0.09). Although some protective effects of viewing other-race classmates as aggressive emerged, associations with heightened anxiety (R2: 0.06–0.09) underscored the need to promote positive interracial relationships to optimize children’s mental health.
This chapter deals with individual criminal responsibility rather than state responsibility. A range of international criminal courts and tribunals are examined, from the Nuremberg Tribunal following the Second World War to the more recent International Criminal Tribunal for the Former Yugoslavia, the International Criminal Tribunal for Rwanda and the Mechanism for International Criminal Tribunals, which deals with matters remaining after the demise of these tribunals. The International Criminal Court is discussed in some detail and in terms of governing principles and organisation, with references to relevant case law. A number of hybrid courts and other internationalised domestic courts and tribunals are then referred to, including those concerning Sierra Leone, Cambodia, Kosovo, East Timor and Bosnia. The chapter proceeds to examine a series of international crimes, from genocide to war crimes, crimes against humanity and aggression. These crimes are analysed and discussed in the light of practice and case law, both in terms of definition and implementation.
Aggression has been closely linked to suicidal ideation in schizophrenia (SCZ). However, whether its correlates differ by suicidal ideation status remains unclear.
Aims
This study aimed to assess the prevalence of aggression and compare the clinical correlates and predictive models of aggression in chronic SCZ patients with and without suicidal ideation.
Method
A total of 659 chronic SCZ patients were recruited from 10 psychiatric hospitals in China. A brief interview assessed the presence of suicidal ideation in patients. Participants were assessed using the Insomnia Severity Index, Hamilton Depression Rating Scale, Modified Overt Aggression Scale and Positive and Negative Syndrome Scale.
Results
SCZ patients with suicidal ideation exhibited a higher prevalence of aggression than those without (39.46 v. 22.15%, p < 0.001). Regardless of suicidal ideation status, patients with aggression were younger and presented with more severe clinical symptoms across multiple domains, except for negative symptoms which showed differential associations between groups. Among patients with suicidal ideation, those exhibiting aggression had a higher proportion of females and lower body mass index. Logistic regression analysis indicated that, in patients without suicidal ideation, male gender was an independent risk factor for aggression (odds ratio 1.856) whereas milder negative symptoms acted as a protective factor. In patients with suicidal ideation, positive and general psychopathology symptoms were positively associated with aggression whereas negative symptoms retained a protective effect.
Conclusions
Our findings suggest that aggression is more prevalent in patients with suicidal ideation, and its clinical correlates differ significantly based on suicidal ideation status. Stratified assessment of aggression risk considering suicidal ideation is warranted.
International criminal law is the branch of public international law under which individuals may be held criminally responsible for the offences of genocide, crimes against humanity, war crimes, and the crime of aggression. International criminal law seeks to prevent impunity by holding accountable those individuals who are responsible for serious violations of international criminal law. This chapter begins with the history of international criminal law, starting with the aftermath of the First and Second World Wars, and ending with the creation of a spate of international criminal courts and tribunals in recent decades. The chapter then covers substantive aspects of international criminal law, namely the crime of genocide, crimes against humanity, war crimes, and the crime of aggression. Finally, the chapter covers key procedural aspects of international criminal law, including the jurisdiction of international courts and tribunals, the admissibility of cases, modes of liability, and immunities. The International Criminal Court is a focal point in this chapter
This chapter introduces jus ad bellum: the rules of law determining when states may resort to war or, more broadly, the use of armed force. In order to put the current jus ad bellum rules into perspective, the chapter begins by introducing the concept of collective security and demonstrating how this was applied during the League of Nations era. The following sections set out the relevant rules of the UN Charter on the prevention and regulation of recourse to the use of force, with a particular focus on the prohibition on the threat or use of force. The chapter also discusses the collective use of force, meaning the use of force authorized by the Security Council, and the unilateral use of force in self-defence. Finally, the chapter examines whether new exceptions to the prohibition of the use of force are emerging, in particular humanitarian interventions and the responsibility to protect.
Research on the joint role of testosterone and cortisol in aggression has produced inconsistent results, with limited attention to adolescence, a stage characterized by considerable hormonal changes, and to the distinction between within-and between-person effects. This study examined whether peer victimization moderates testosterone–cortisol associations with bullying perpetration in adolescents. Assessed at three 3-month intervals, participants (471 adolescents, Mage = 14.97, SD = 0.70; 47.1% female) reported bullying perpetration and victimization and provided saliva samples for the analysis of hormones. Random-intercept cross-lagged panel models revealed a three-way interaction (testosterone × cortisol × victimization). Increases in testosterone predicted changes in bullying perpetration when cortisol decreased. These effects were moderated by victimization. When victimization was below average, testosterone increases predicted more bullying perpetration; when it was above average, testosterone increases predicted less perpetration. These findings highlight that peer victimization shapes how testosterone–cortisol interactions influence adolescent aggression, underscoring the interplay of biological and contextual factors in adolescent adaptation.
The study is the first to examine the effects of children’s and therapists’ in-session behaviors on later therapeutic alliance (TA; i.e., relational bond, task collaboration) as rated by children and therapists in an intervention for children with aggressive behavior. One hundred eighty children (ages 9.3–11.8; 69% male; 78% Black), screened as having aggressive behavior by teacher and parent ratings, received a 32-session group-based cognitive-behavioral intervention (Coping Power) at their schools. TA ratings were collected from children and therapists at mid- and end-of-intervention using the Therapeutic Alliance Scale for Children. Children’s and therapists’ behaviors during the first 16 sessions were coded by independent observers. Children’s negative in-session behaviors predicted lower child- and therapist-rated TA (averaged across mid- and end-of-intervention). Children’s in-session positive behaviors, at both the individual and group-wide level, predicted higher later TA. Therapists’ efforts to manage deviant behavior predicted stronger child-reported ratings of the relational bond and of child- and therapist-rated task collaboration. Exploratory analyses indicate that the effect of children’s in-session behaviors on later TA is moderated by therapists’ skills in managing the group and in managing deviant talk and behavior in sessions. Clinical and research implications of the findings are discussed.
A framing case study describes the trial of Hissène Habré, the deposed leader of Chad who was prosecuted for multiple international crimes in Senegal. The chapter then discusses international criminal law. The chapter first discusses major principles of international criminal law and its evolution. It next discusses the key elements for establishing criminal guilt, including: the definition of core crimes; modes of responsibility and liability; and possible defences. Finally, the chapter surveys the major institutions that enforce international criminal law by discussing the operations of the International Criminal Court and the assertion of universal jurisdiction by domestic courts.
Skin picking disorder is characterized by repetitive excoriation of one’s skin. Although skin picking disorder is associated with substance use problems, no previous research has examined the associations of alcohol use on skin picking symptomatology.
Methods
Adults with skin picking disorder (n = 182) were recruited from the general community via an online survey. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) to measure alcohol use and various self-report measures to assess clinical profiles and associated characteristics. We compared variables of interest between those with hazardous alcohol use in the past year (AUDIT ≥8) compared to those with low-risk or no alcohol use in the past year. We also examined the extent to which skin picking disorder symptoms were dimensionally related to AUDIT scores while controlling for confounders.
Results
Of the 182 adults with skin picking disorder, 62 (34.1%) met criteria for hazardous alcohol use. Hazardous drinking was associated with less frequent skin picking but higher overall picking-related severity and impairment, aggression, and rates of comorbid borderline personality disorder, gambling disorder, and compulsive sexual behavior disorder. Skin picking-related impairment predicted the degree of hazardous drinking while controlling for sex.
Conclusions
This study highlights the importance of screening for hazardous alcohol use in people with skin picking disorder. More research is needed to explore the relationship between aggression, hazardous alcohol use, and skin picking, as well as how treatments might best be adapted to treat individuals with this cluster of symptoms.
In this chapter, we examine several aspects of children’s lives with their peers. Following ethologist Robert Hinde’s classification, social behaviors are described in terms of interactions, relationships, and groups. In a first section, we examine children’s peer interactions and relationships, including friendships. We then examine the dynamics of peer groups. Next, we look at a phenomenon that has been of great interests to psychologists, educators, and parents, that of antisocial behavior, specifically aggression. Prosocial behaviors, including comforting, sharing, and helping, also have developmental histories and are the topics of the next section. We conclude the chapter by looking at the development of moral reasoning and moral behavior, topics that have important theoretical, psychological, and practical implications.
Foreign national courts are categorically prohibited from prosecuting a head of state of another country. From the beginning of the twenty-first century until very recently, this view was nearly unanimous. A 2002 decision of the International Court of Justice, in the Arrest Warrant case, strongly supports it. According to the court, heads of state enjoy ‘full immunity’ from foreign criminal jurisdiction. Thus, the prohibition to prosecute foreign heads of state even extends to those who perpetrate aggression and other war-related crimes. That view is based on a twenty-first century myth. According to the myth, heads of state have long – ‘from time immemorial’ – enjoyed an absolute personal immunity from foreign jurisdiction. This article identifies the origin of the myth and parses through crucial historical facts that disprove it, particularly, the indictments against Hitler as the sitting head of state of Germany, their endorsement by the United Nations War Crimes Commission, and the judgment of the International Military Tribunal. A proper debunking of this myth is not only important as a matter of setting the historical record straight but is also relevant for present-day debates about the prosecution of heads of state (or heads of government) who – like Vladimir Putin, Bashar al-Assad, Min Aung Hlaing, and Benjamin Netanyahu – might be responsible for aggression, genocide, war crimes, crimes against humanity, and other crimes.