title: Highly Aggressive Women in a Forensic Psychiatric Hospital.
abstract: In this study, we compared three groups of women admitted to a public forensic inpatient facility over the course of a two-year period. Detailed and systematic examination of social and psychiatric histories revealed that the group with the most persistent levels of aggression differed from the other two groups with respect to frequency of self-harming behavior, intellectual impairment, hypothyroidism, a childhood diagnosis of attention deficit-hyperactivity disorder (ADHD), and age of onset of psychiatric and behavioral symptoms. The high-aggression group also had the highest rate of childhood physical and sexual abuse, but the difference between that group and the two lower aggression groups did not achieve statistical significance. From the standpoint of childhood adversity, 94 percent of those in the high-aggression group had been placed outside of the original home by age 11. Eighty-nine percent were intellectually impaired. At admission, physical examinations revealed that 50 percent had a history of hypothyroidism and two-thirds were obese. Before admission, most had manifested severe aggression and emotional dysregulation, as evinced by high levels of self-harm, suicide attempts, and aggressive behavior in previous institutional settings that was both frequent and intense. Patients who share these characteristics are currently placed on a ward at the hospital with a milieu and individual therapy programs that are based on a dialectical behavior therapy approach that targets key symptoms of emotional and behavioral dysregulation.
authors.affiliation: Dr. Beck is Professor Emeritus, Dr. Robbins is Adjunct Assistant Professor, and Dr. Menditto is Adjunct Associate Professor, University of Missouri Medical School, Columbia, MO. Alicia Pardee is Staff Psychologist and Program Director, Fulton State Hospital, Fulton, MO. Dr. Hammer is Assistant Professor at the University of Kentucky, Lexington, KY. Dr. Tubbesing is Chief Psychologist at Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph, MO. beckn@health.missouri.edu.
authors.forename: Niels C
authors.initials: NC
authors.lastname: Beck
authors.affiliation: Dr. Beck is Professor Emeritus, Dr. Robbins is Adjunct Assistant Professor, and Dr. Menditto is Adjunct Associate Professor, University of Missouri Medical School, Columbia, MO. Alicia Pardee is Staff Psychologist and Program Director, Fulton State Hospital, Fulton, MO. Dr. Hammer is Assistant Professor at the University of Kentucky, Lexington, KY. Dr. Tubbesing is Chief Psychologist at Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph, MO.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Hammer
authors.affiliation: Dr. Beck is Professor Emeritus, Dr. Robbins is Adjunct Assistant Professor, and Dr. Menditto is Adjunct Associate Professor, University of Missouri Medical School, Columbia, MO. Alicia Pardee is Staff Psychologist and Program Director, Fulton State Hospital, Fulton, MO. Dr. Hammer is Assistant Professor at the University of Kentucky, Lexington, KY. Dr. Tubbesing is Chief Psychologist at Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph, MO.
authors.forename: Sharon
authors.initials: S
authors.lastname: Robbins
authors.affiliation: Dr. Beck is Professor Emeritus, Dr. Robbins is Adjunct Assistant Professor, and Dr. Menditto is Adjunct Associate Professor, University of Missouri Medical School, Columbia, MO. Alicia Pardee is Staff Psychologist and Program Director, Fulton State Hospital, Fulton, MO. Dr. Hammer is Assistant Professor at the University of Kentucky, Lexington, KY. Dr. Tubbesing is Chief Psychologist at Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph, MO.
authors.forename: Tara
authors.initials: T
authors.lastname: Tubbesing
authors.affiliation: Dr. Beck is Professor Emeritus, Dr. Robbins is Adjunct Assistant Professor, and Dr. Menditto is Adjunct Associate Professor, University of Missouri Medical School, Columbia, MO. Alicia Pardee is Staff Psychologist and Program Director, Fulton State Hospital, Fulton, MO. Dr. Hammer is Assistant Professor at the University of Kentucky, Lexington, KY. Dr. Tubbesing is Chief Psychologist at Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph, MO.
authors.forename: Anthony
authors.initials: A
authors.lastname: Menditto
authors.affiliation: Dr. Beck is Professor Emeritus, Dr. Robbins is Adjunct Assistant Professor, and Dr. Menditto is Adjunct Associate Professor, University of Missouri Medical School, Columbia, MO. Alicia Pardee is Staff Psychologist and Program Director, Fulton State Hospital, Fulton, MO. Dr. Hammer is Assistant Professor at the University of Kentucky, Lexington, KY. Dr. Tubbesing is Chief Psychologist at Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph, MO.
authors.forename: Alicia
authors.initials: A
authors.lastname: Pardee
mesh_terms: D000328:Adult; D017668:Age of Onset; D000374:Aggression / Q000523:psychology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D057189:Checklist; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D008607:Intellectual Disability / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D008016:Life Change Events; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D008875:Middle Aged; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D014754:Violence / Q000523:psychology