Biosocial bases of aggressive and violent behavior—implications for nursing studies

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Abstract

Although aggression and violence have been increasingly viewed as a major public health problem with a biological and health basis, it has been under-researched in the nursing and health context. This paper reviews early biological risk factors for violence. These factors include pregnancy/birth complications, fetal exposure to nicotine, alcohol, and drugs, low cholesterol, malnutrition, lead and manganese exposure, head injuries and brain dysfunction, low arousal, low serotonin, low cortisol, and high testosterone. A biopsychosocial violence mode is proposed. Finally, the paper argues that nursing is ideally placed to develop a new body of knowledge based on a biosocial perspective that can lead to more effective prevention programs for violence.

Introduction

Aggressive and violent behavior are being increasingly viewed as a public health problem (Comerci, 1996; Gerbert et al., 2003) and violence prevention has become one of the most pressing issues facing our society today (Hann, 2002). While reducing aggressive and violent behavior and violence prevention are increasingly receiving international attention (Ahmad, 2004), the nursing profession has not fully acknowledged the potential role it may play in helping to reduce this major problem in society. Ironically, the nursing profession had its origins in warfare (a form of aggression and violence) over two century ago. Inspired by Florence Nightingale, nursing education and science evolved out of care for the victims of warfare, yet since then the profession has largely lost its links to violence and has not made major efforts to prevent violence. While we are living in a relatively peaceful world, the significance of violence for nursing professionals cannot be overemphasized.

This is not to say that nursing has completely ignored the victims of violence. Significant progress has been made by the nursing in the areas of domestic violence (Frost, 1999; Limandri and Tilden, 1996) and child abuse (McFarlane et al., 2000; Paavilainen et al., 2001, Paavilainen et al., 2002). While these area are mainly related to psychosocial aspect, yet within the last two decades, there has been a rapidly growing and increasingly significant body of knowledge built up on the biological bases of antisocial, aggressive, and violent behavior (Brennan et al., 1999; Caspi et al., 2002; Mednick et al., 1984; Raine 2002a; Virkkunen et al., 1995). Such research includes, among other areas, genetic studies, biochemical approaches, and brain-imaging research, a literature that has to date been little recognized in nursing science.

Why should one presume that there is a biological basis to violence that can give important clues for intervention and prevention research? Both twin and adoption studies have clearly shown that there is a genetic basis to antisocial, aggressive, and violent behavior (Mednick et al., 1984), as such, the biological context must be incorporated into any comprehensive account of violence. In addition, despite decades of attempts at psychosocial intervention for violence, there have been very few studies that show success in the long term, possibly because such studies have ignored biosocial complexities. Also, there is a growing body of empirical evidence that convincingly demonstrates some role for biological processes in shaping antisocial and violent behavior (Brennan et al., 1999; Moffitt et al., 1998).

The purpose of this paper is to emphasize one area in which nursing research/practice can make a critical societal contribution. First, recent studies on biological factors and aggressive/violent behavior will be reviewed. Second, a biopsychosocial model of aggressive and violent behavior of relevance to nursing will be outlined which integrates biological with social research. Third, implications for nursing research and practice will be briefly discussed. In addition, the following review will not extensively cover all biological factors, but will instead focus on the health risk factors that are directly relevant to nursing science. Furthermore, this review covers antisocial, aggressive, delinquent, and criminal behavior as well as violence. These constructs are not synonymous, but because antisocial and delinquent behavior are major risk factors for later aggression and violence (Farrington, 1989), they also are included in this review.

Section snippets

Prenatal factors

Prenatal risk factors for antisocial and violent behavior are especially relevant for maternal-child health nursing and midwifery because if these factors do indeed raise the risk for aggressive and violent behavior, there would be implications for prevention programs focused on nursing concepts. To date, studies have examined prenatal risk factors which include maternal exposure to alcohol, tobacco and drugs, pregnancy/birth complications, and malnutrition. Most of these studies are limited to

The significance of biosocial research

While the emphasis of this review lies with biological processes, the psychosocial context should not be forgotten. Farrington (1989) in a longitudinal survey of 411 London males from ages 8 to 32 years of age found that the best predictors of aggression and violence were poverty, family criminality, poor child-rearing, school failure, hyperactivity-impulsivity-attention deficit, and child antisocial behavior. Similarly, other authors have emphasized the importance of parenting (

Implications for nursing studies

Despite its historical links to the nursing profession which embraces biological perspectives, nursing science has not yet recognized the full implications that this new body of biological research has for violence prevention. The significance of understanding the etiology of aggression and violence for nursing science is broad. As indicated by this review, rather than having limited relevance to psychiatric nursing, violence etiology also bears on the nursing areas of maternal-child health

Acknowledgements

This work was supported in part by a NRSA award (1 F32 NR008661-01) from the National Institute of Nursing Research, USA to Jianghong Liu.

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