Managing your loved one's aggression

Subject When my emotions are overwhelming

In some people and contexts, disease can cause an increase in behaviours that are challenging for friends and family to manage. Caregivers may find themselves very ill-equipped to cope with actions (verbal or physical) of an aggressive nature. For example, someone who is ill may, for various reasons, raise their voice, shout, criticize, accuse, swear, hurl insults, refuse to cooperate, get angry or push, hit, slap, bite, kick, throw items, etc.

What might be causing the aggression?

We can find explanations for the aggressive actions of the person who is ill by taking the time to assess their situation properly. There may be medical causes (e.g., side effects of medication), physical causes (e.g., pain or physical discomfort), cognitive causes (e.g., difficulty speaking or expressing their thoughts), emotional causes (e.g., feelings of loss, insecurity, abandonment or anguish), environmental causes (e.g., loud and distracting noises), social causes (e.g., others’ behaviour toward the person who is ill that contributes to fits of aggression) or behavioural causes (e.g., lack of inhibition caused by alcohol or drug use).

How to react to the aggression?

It is normal for your loved one’s aggression to upset you, challenge you, and scare you. There is no perfect method, but certain behaviours can be adopted to calm your loved one during an episode of aggression.

Stay calm.
Give your loved one physical space to calm down and protect yourself if the aggression is physical.
Use a respectful and calm tone and show a caring attitude toward your loved one. Raising your voice could escalate the situation.
Eliminate loud and distracting noises (e.g., television, radio, conversation) and stop irritants (e.g., doing several tasks at a time).
Avoid physical contact, this could intensify your loved one’s physical violence.
Distract your loved one by starting a new conversation or presenting a new activity.
Avoid threatening your love one (e.g., telling them that a loved one will no longer come to visit if they continue to be aggressive).
Avoid contradicting or confronting your loved one (e.g., saying: “You can see that I was right”);
At any time, if you are afraid of being hurt, leave the room and come back a few minutes later.

And after...

Whether the aggression is verbal or physical, when dialogue is possible, come back to the episode with your loved one and express your discomfort with the situation. Here are some examples of how you could approach the subject:

“I can see that this does not please you;”
“I see that you are not happy;”
“I understand that this can be frustrating;”
“I understand your misery and your anger;”
“What is bothering you?”;
“It makes me sad to see you like that.”

Give it some thought

Determining what triggered or caused the outburst can help in developing strategies to prevent, reduce or avoid episodes of aggression. Here are some ideas to explore:

Ensure that your loved one’s routine is stable and constant;
Subdivide activities into steps that are easy to manage;
Distract them, use humour;
To avoid surprising or scaring your loved one when you approach them, do so slowly, from the front and at the same level as them;
Pay attention to your non-verbal language (e.g., hands in fists, tense face, agitation, repetitive movements);
Keep a log book (e.g., noting down your loved one’s aggressive and happy moments helps identify the frequency, time of day and causes that triggered the aggressive behaviour).

If the situation gets out of control

It can be reassuring to establish a safety plan by noting the phone number of a trusted person you could contact in case of an emergency and identifying a place you could take refuge if needed. In case of imminent danger, get to safety and call 911.

Respect your limits

Episodes of aggression are never pleasant and in the long run can incite many emotions in you, irritate you and even make you angry. It is important to identify and respect your limits, in addition to implmenting strategies to prevent exhaustion or the risk that your anger will be directed at your loved one.

Try to keep the situation in perspective. Sometimes, putting off an activity that your loved one baulks at may prevent confrontation and an episode of aggression.
If an activity, such as personal care or getting dressed, is a more challenging moment, do not hesitate to solicit the help of outside resources.
Seek help from family and friends you trust and delegate certain tasks that are more difficult for you to perform with your loved one.
Do not try to deal with the stress and management of episodes of aggression on your own.
Explore the possibility of a care facility for your loved one if the situation requires it.
Talk to a health professional about it. They will be able to guide you.