Gender differences in reactive and proactive aggression

A review on the relationship between testosterone and the interpersonal/affective facet of psychopathy

Testosterone (T) has received increasing interest in the recent years as a probable biological determinant in the etiology of male-biased clinical conditions such as psychopathy (i.e. psychopathy is more prevalent in men and leads to an earlier onset and more severe expression of antisocial and aggressive behavior in men compared to women). In this review, the authors evaluated the potential relationship between T and different constructs closely related to the core characteristics of psychopathy (affective empathy, fear-reactivity, and instrumental aggression). After a thorough examination of the literature, it is concluded that high T exposure in utero and high circulating T levels throughout important life phases (most notably adolescence) or in response to social challenges (e.g. social stress, competition) could be an important etiological risk factor in the emergence of psychopathic behavior. Nevertheless, studies consistently indicate that high T is not related to a significantly reduced fear-reactivity and is only indirectly associated with the increased levels of instrumental aggression observed in psychopathic individuals. Therefore, psychopathy is likely to arise from an interaction between high T levels and other biological and socio-psychological risk factors, such as a constitutionally based dampened fear-reactivity, insecure/disordered attachment processes in childhood, and social discrimination/rejection in adolescence and/or adulthood.

Factor Structure of the Reactive-Proactive Aggression Questionnaire in Turkish Children and Gender, Grade-Level, and Socioeconomic Status Differences in Reactive and Proactive Aggression

The present study aimed to evaluate the factor structure of the Reactive-Proactive Aggression Questionnaire (RPQ) with Turkish children, and to investigate gender, grade-level, and socioeconomic status (SES) differences in reactive and proactive aggression. Participants consisted of 1,081 Turkish children (544 boys and 537 girls) aged 9 to 14 years. Findings from the confirmatory factor analysis provided evidence for the two-factor reactive-proactive model. It was also found that the factor structure of the RPQ was the same across gender groups. Reactive and Proactive Aggression scales and Total Aggression scale showed high internal consistency. Boys got higher scores on both Reactive and Proactive Aggression scales. Reactive and proactive aggression increased with age until Grade 7 in both boys and girls. Finally, the findings showed that, for both boys and girls, children with low SES had significantly higher reactive and proactive aggression scores than children with middle and high SES.

Interactive links between theory of mind, peer victimization, and reactive and proactive aggression

This study investigated the relation between theory of mind and reactive and proactive aggression, respectively, as well as the moderating role of peer victimization in this context. The 574 participants were drawn from a longitudinal study of twins. Theory of mind was assessed before school entry, when participants were 5 years old. Reactive and proactive aggression as well as peer victimization were assessed a year later in kindergarten. Results from multilevel regression analyses revealed that low theory of mind was related to a high level of reactive aggression, but only in children who experienced average to high levels of peer victimization. In contrast, a high theory of mind was related to a high level of proactive aggression. Again, this relation was especially pronounced in children who experienced high levels of peer victimization. These findings challenge the social skills deficit view of aggression and provide support for a multidimensional perspective of aggressive behavior.

Associations between trait anxiety and psychopathological characteristics of children at high risk for severe antisocial development

It is thought that among children at a high risk for antisocial personality disorder, the level of individual anxiety might constitute an important marker with respect to symptomatology and prognosis. The aim of the present study was to examine whether associations between anxiety and subtypes of aggression (proactive and reactive) exist in boys with early-onset subtype of conduct disorder (CD) and co-morbid attention-deficit hyperactivity disorder (ADHD). A detailed psychometric characterization of boys with ADHD and the early-onset subtype of CD (n = 33) compared to healthy controls (n = 33) was performed. The assessment included trait anxiety, internalizing and externalizing problems, symptoms of psychopathy and temperament traits, as well as subtypes of aggressive behavior. Descriptive statistics, correlation analyses, and group comparisons were calculated. The clinical group was characterized by higher levels of externalizing and internalizing symptoms. Individual anxiety was positively associated with harm avoidance, symptoms of oppositional defiant disorder (ODD), and by trend with reactive aggression. In contrast, boys with reduced levels of anxiety exhibited more callous-unemotional traits. Our results indicate that children with the early-onset subtype of CD and ADHD constitute a psychopathological heterogeneous group. The associations between individual levels of trait anxiety, temperament traits, and subtypes of aggressive behavior in children with ADHD and severe antisocial behavior emphasize the impact of anxiety as a potential key factor that might also be crucial for improvement in therapeutic strategies and outcome measures. Anxiety should be considered carefully in children with ADHD and the early-onset subtype of CD in order to optimize current therapeutic interventions.

Family conflict and childhood aggression: the role of child anxiety

Family conflict and childhood anxiety has been implicated in the development of aggressive behaviors, but the nature of these relationships has not been fully explored. Thus, the present study examined the role of anxiety in moderating the relationship between family conflict and childhood aggression in 50 children aged 7 to 13 years. Specifically, the study proposed that family conflict would be positively related to aggression in the context of higher levels of child anxiety. Parents completed self-report instruments examining family conflict and aggressive behavior exhibited by their children. Children completed a self-report measure of anxiety. The hypothesis was partially supported as family conflict was related to increased proactive but not reactive aggression in children with high levels of anxiety. Implications of these findings are discussed.

Prediction of aggression and restraint in child inpatient units

OBJECTIVE

The aim of the present exploratory study was to determine the predictors of aggression and restraint in children admitted to a child psychiatric inpatient unit in Melbourne, Australia.

METHOD

A retrospective review of incident report forms over a 12 month period at the State Wide Child Inpatient Unit (SWCIU) was conducted. These report forms were based upon 41 children aged 5-12 years, who had various psychiatric diagnoses including conduct disorder, attention-deficit-hyperactivity disorder and anxiety disorders.

RESULTS

A total of 70 children were admitted to the SWCIU during the audit period. Forty-one children aged 5-12 engaged in 235 violent incidents. A high-risk assessment and disruptive behaviour disorder were associated with aggressive behaviour and restraint. Disruptive behaviour disorder also predicted more serious episodes of aggression.

CONCLUSIONS

There are readily identifiable patient factors that predict aggression and the need for restraint in child inpatient units.

Co-occurring anxiety and disruptive behavior disorders: the roles of anxious symptoms, reactive aggression, and shared risk processes

The current review uses a developmental perspective to examine processes that may underlie and partially account for the association between anxiety disorders and disruptive behavior disorders among children and adolescents. We propose that one way to understand development of comorbid anxiety and disruptive behavior disorders is to examine symptoms that are precursors for or part of these syndromes, such as anxious symptoms and reactive aggression. We use a framework that considers these issues first at the syndrome or disorder level (e.g., anxiety disorders, disruptive behavior disorders), then at the symptom level (e.g., anxious symptoms and reactive aggression), and finally at the risk factor level (e.g., factors associated with anxious symptoms and/or reactive aggression). We apply various frameworks that have been put forth for understanding comorbidity of psychological syndromes to the co-occurrence of anxiety and disruptive behavior disorders and to the co-occurrence of reactive aggression and anxious symptoms where possible. We then identify gaps in the literature with regard to anxiety and reactive aggression, as well as anxiety and disruptive behavior disorders more generally. Finally, we provide a conceptual model describing how the relation of anxiety and reactive aggression may develop into clinically identifiable, comorbid anxiety and disruptive behavior disorders.

Hostility- and gender-related differences in oscillatory responses to emotional facial expressions

Hostility is associated with biases in the perception of emotional facial expressions, such that ambiguous or neutral expressions tend to be perceived as threatening or angry. In this study, the effects of hostility and gender on the perception of angry, neutral, and happy faces and on the oscillatory dynamics of cortical responses elicited by these presentations were investigated using time-frequency decomposition by means of wavelet transforms. Feelings of hostility predisposed subjects to perceive happy and neutral faces as less friendly. This effect was more pronounced in women. In hostile subjects, presentation of emotional facial expressions also evoked stronger posterior synchronization in the theta and diminished desynchronization in the alpha band. This may signify a prevalence of emotional responding over cognitive processing. These effects were also more pronounced in females. Hostile females, but not hostile males, additionally showed a widespread synchronization in the alpha band. This synchronization is tentatively explained as a manifestation of inhibitory control which is present in aggressive females, but not in aggressive males.

Aggression after paediatric traumatic brain injury: a theoretical approach

PRIMARY OBJECTIVE

To examine aggression in adolescent males with and without traumatic brain injury (TBI).

DESIGN

Quasi-experimental, matched-participants design.

METHODS

Thirty-nine adolescents were examined, including a TBI group (n = 11) and a matched, uninjured comparison group (n = 28). Participants with TBI were injured an average of 8.3 years (SD = 4.2 years) prior. Participants and parents completed the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL), both measures of global psychopathology. In addition, the theoretically-driven Reactive and Proactive Aggression Questionnaire (RPQ) and the Form of Aggression Scale (FAS) were completed.

MAIN OUTCOMES AND RESULTS

When compared using the YSR and CBCL, no group differences were detected. In contrast, using the self-report RPQ, participants with TBI reported more reactive and proactive aggression than non-injured peers. Using the FAS, participants with TBI reported engaging in aggression out of frustration and not to dominate or acquire objects.

CONCLUSION

Aggressive behaviours are a long-term outcome after paediatric TBI. Measures of global psychopathology do not permit detailed examination of specific behaviour problems such as aggression, which may provide inaccurate data from which to derive incidence rates. In contrast, theoretically-driven measures can provide greater insight into post-TBI aggression with important treatment implications.

Human proactive aggression: association with personality disorders and psychopathy

Aggressive behaviors can be divided into two categories: reactive and proactive. Reactive aggressive behaviors occur in response to a stimulus or provocation. Proactive aggressive behaviors occur without provocation and are goal directed. A number of findings have suggested that individuals displaying proactive aggression may be discerned from individuals not displaying proactive aggression on measures of personality, psychopathology and psychopathy as well as in aggressive histories and type and severity of aggressive behaviors committed. In this study, subjects were recruited from a large urban community and classified as proactive (n = 20), reactive-only (n = 20) or nonaggressive (n = 10) based on laboratory behavioral testing. Subjects were administered a battery of questionnaires and structured interviews pertaining to personality disorders and psychopathy. It was hypothesized that proactive aggressive subjects would show greater numbers of personality disorders and have greater psychopathy relative to reactive-only and nonaggressive subjects. These hypotheses were supported. These results suggest that proactive aggression may be identified in a laboratory-based task, and differences between proactive and reactive-only aggressors can be detected.

Self-perceived health among early adolescents: role of psychosocial factors

BACKGROUND

The authors examined self-perceived health and psychosocial health in 10-15 year old children and the relationship between children's self-perceived health and a set of psychosocial health status measurements.

METHODS

Data were collected from middle school students (n = 548; age range, 10-15 years of age; mean, 12.2 years; SD, 1.2 years) using randomly selected classes from four schools in different school districts in Szeged, Hungary. The self-administered questionnaires contained items on sociodemographics; school achievement; height and weight (body mass index); self-perceived health and fitness; health behaviors; and anger and psychosomatic health. The self-perceived health variable was dichotomized and expressed with poor/fair or good/excellent perceptions of one's own health.

RESULTS

Most of the children evaluated their own health as excellent or good. Logistic regression analyses revealed that poor academic achievement, socioeconomic status self-assessment, smoking, alcohol use, sports activity, self-perceived fitness, and high levels of anger and psychosomatic symptoms were associated with an increased likelihood of reported poor/fair perceptions of health.

CONCLUSIONS

Findings reflect that psychosocial factors are important influences of self-perceived health in an early adolescent population.

The relation between childhood proactive and reactive aggression and substance use initiation

The current study examined whether proactive and reactive aggression were associated with the risk for initiation of substance use from fourth to ninth grade in a sample of 126 aggressive children (66% male). In addition, the study examined whether these functions of aggression increased risk for initiation via peer delinquency and peer rejection. Proactive aggression was marginally significantly directly associated with risk for initiation of alcohol use and indirectly associated with risk for initiation of marijuana and tobacco use through peer delinquency. Reactive aggression was associated with increased risk for initiation of tobacco and marijuana use through a complex chain that included both peer rejection and peer delinquency. However, high levels of reactive aggression that did not lead to peer rejection were negatively associated with risk for initiation of tobacco and marijuana use. Implications for intervention are discussed.

A Meta-Analysis of the Distinction between Reactive and Proactive Aggression in Children and Adolescents

The present meta-analytic review aimed to clarify divergent findings concerning the relation between reactive and proactive aggression in children and adolescents. Fifty-one studies with 17,965 participants were included in the analysis. A significant correlation between reactive and proactive aggression was found. The strength of this relation varied considerably between studies, from -.10 to .89. Observational assessment and tilt/noise tasks were associated with smaller correlations than questionnaires. Within the large group of questionnaire studies, studies disentangling the form and function of aggression found lower correlations than studies that did not disentangle form and function. Among questionnaire studies, higher reliability was associated with larger correlations. Effect size did not depend on other study characteristics such as sample type, age, and informant type. It is concluded that reactive and proactive aggression are most clearly distinguished with behavioral observations and questionnaires that unravel form and functions of aggression.

Aggression and diagnosis in psychiatrically referred children

We investigated correlations between measures of proactive and reactive aggression subtype, and the severity and frequency of overt aggression and psychiatric diagnosis in a clinically referred sample of children compared to a non-referred community comparison group free of psychiatric diagnosis. All measures of aggression were significantly correlated suggesting that there might be an underlying aggression construct that is manifested in distinct but correlated domains of aggression across diverse psychiatric diagnoses in referred children. Regression analysis revealed robust correlations between the number of lifetime psychiatric diagnoses adjusted for lifetime duration of illness and all measures of aggression. Our results support the need to consider the development of psychosocial and psychopharmacological treatment interventions specifically targeting excessive maladaptive aggression within and across multiple psychiatric diagnoses in children.

Characterizing aggressive and noncompliant behaviors in a children's psychiatric inpatient setting

This study was conducted to evaluate aggression and noncompliance among child psychiatric inpatients in relation to demographic, clinical, and hospitalization characteristics, including the use of restraints and seclusion. Eighty six children (10.8+/-2.4 years old, 67% male) consecutively admitted to an inpatient psychiatric unit were rated weekly using the Modified Overt Aggression Scale (MOAS) and the Disruptive Behavior Rating Scale (DBRS) between November 1, 2002 and June 30, 2003. Moderate to high correlations were observed between the four types of aggression (verbal, and physical against self, others, or objects) and noncompliant behavior. In hierarchical regression analyses, only mental retardation emerged as a significant predictor of aggression and noncompliance. Aggression and noncompliance were associated with different characteristics of inpatient treatment. Aggressive behavior was significantly associated with the use of restraints and seclusion, and noncompliant behavior with length of hospitalization and number of psychiatric medications at time of discharge. Modifying milieu interventions for youths with mental retardation, and adapting behavioral interventions empirically proven to target noncompliance may be effective loci for reducing aggression in child psychiatric inpatient units.

The Reactive-Proactive Aggression Questionnaire: Differential Correlates of Reactive and Proactive Aggression in Adolescent Boys

This study reports the development of the Reactive-Proactive Aggression Questionnaire (RPQ), and the differential correlates of these two forms of aggression. Antisocial, psychosocial and personality measures were obtained at ages 7 and 16 years in schoolboys, while the RPQ was administered to 334 of the boys at age 16 years. Confirmatory factor analysis indicated a significant fit for a two-factor proactive-reactive model that replicated from one independent subsample to another. Proactive aggression was uniquely characterized at age 7 by initiation of fights, strong-arm tactics, delinquency, poor school motivation, poor peer relationships, single-parent status, psychosocial adversity, substance-abusing parents, and hyperactivity, and at age 16 by a psychopathic personality, blunted affect, delinquency, and serious violent offending. Reactive aggression was uniquely characterized at age 16 by impulsivity, hostility, social anxiety, lack of close friends, unusual perceptual experiences, and ideas of reference. Findings confirm and extend the differential correlates of proactive-reactive aggression, and demonstrate that this brief but reliable and valid self-report instrument can be used to assess proactive and reactive aggression in child and adolescent samples.

A risk and protective factors framework for understanding youth's externalizing problem behavior in two different cultural settings

OBJECTIVE

The main goal of the study was to analyze youth's externalizing problem behaviors based on a risk and protective factors framework in two different cultural settings.

METHOD

Data were collected among secondary school students in Szeged, Hungary (N=1240) and in Birmingham, AL, USA (N=1538). The self-administered questionnaires contained items on youth's externalizing problem behaviors as well as risk and protective factors.

RESULTS

In both samples, first year students in secondary (high) schools and boys reported greater levels of problem behaviors. Multiple regression analyses revealed that substance use, gang membership and low academic achievement were consistent risk factors and associated with higher reporting levels of problem behaviors in both cultures. Parental monitoring served as an important protective factor in both samples, while school protective factors were only significant for American students.

CONCLUSION

Findings draw attention to similar structures of certain risk and protective factors of youth's externalizing problem behaviors in different cultural settings. While there are universal risk factors (e. g., substance use, gang membership and low academic achievement), parental monitoring seems to be a universal protective factor against youth's externalizing problem behavior. An important difference is that the school domain seems to act as more important protection for American youth.

Reactive and proactive aggression in children--a review of theory, findings and the relevance for child and adolescent psychiatry

The clinical population of aggressive children diagnosed as having an oppositional defiant disorder (ODD) or a conduct disorder (CD) is heterogeneous, both with respect to behaviour and aetiology. Recently, the following distinction has been proposed that might further clarify this heterogeneity: reactive aggression is an aggressive response to a perceived threat or provocation, whereas proactive aggression is defined as behaviour that anticipates a reward. In this article we examine various aspects of this distinction. We will [1] examine the evidence that reactive and proactive aggression are distinct phenomena by discussing the theories underlying the distinction between the subtypes in humans and we briefly review evidence for a similar distinction in animals; [2] we critically review the literature on the measurement in children via questionnaires and behavioural observations; we then point out that the correlation observed between the subtypes is due to the fact that many children show both types of aggression; [3] we review the literature on specific characteristics of the subtypes giving attention to social information processing, peer status, biological correlates and developmental history, and demonstrate that there is some evidence to suggest that reactive and proactive aggression are distinct dimensions; [4] we discuss the relevance of the distinction between reactive and proactive aggression for child and adolescent psychiatry.

Familial Study of Suicidal Behavior Among Adolescents in Slovenia

Summary: The number of adolescents who attempt or complete suicide is increasing. Risk factors range from mental disorders, to problems at school, family problems, or difficulties in establishing relationships. A further important, and too often underestimated, risk factor for adolescent suicide is the presence of suicidal behavior in the adolescent's family. We investigated 184 high school adolescents in a region in Slovenia with a high suicide rate (30/100,000/year). They were questioned by means of an anonymous questionnaire about the presence of suicidal behavior in their relatives and about the presence of suicidal thoughts, plans, and acts in themselves. The results revealed that 13% of the adolescents studied had a relative who had attempted suicide and a further 9% of the adolescents had lost a relative due to suicide. About half of all females and almost a third of males had had suicidal thoughts (differences between sexes were statistically significant: χ2 = 6.13; p < .01). Attempted suicide among relatives was positively correlated with the presence of suicidal plans among adolescents (Φ = 0.15; p < .05). This correlation proved to be even stronger and statistically more significant in men when we split the sample by gender. All variables (suicidal thoughts, suicidal plans, and suicide attempts) in the adolescent males positively correlated with attempted suicide among their relatives (Φ = 0.28, p < .01; Φ = 0.26, p < .05; Φ = 0.34, p < .01; respectively). Our results speak in favor of a higher risk of suicidal behavior among adolescents with suicidal behavior in their families.