The impact of psychiatric symptoms, interpersonal style, and coercion on aggression and self-harm during psychiatric hospitalization

Interpersonal style, a key component of personality and personality disorder, has emerged as an important characteristic that is relevant to aggressive behavior by patients in psychiatric hospitals. However, studies examining the relationship between interpersonal style and aggression have thus far only been conducted with patients with personality disorder and/or mild and stable symptoms of mental illness. This study explored the relative importance of patients' interpersonal style, psychiatric symptoms, and perceptions of staff coercion on aggression and self-harm during acute psychiatric hospitalization. One hundred and fifty-two patients (M = 38.32 years, SD = 12.06; 56.8% males and 43.2% females) admitted for short-term assessment and treatment to the acute units of a civil and a forensic psychiatric hospital were administered the Brief Psychiatric Rating Scale, Impact Message Inventory, and MacArthur Admission Experience Survey. Participants' files were reviewed and nursing staff were interviewed at the end of each patient's hospital stay to determine whether participants had self-harmed or acted aggressively towards others. Initial univariate analyses showed that thought disorder and dominant and hostile-dominant interpersonal styles predicted aggression. Using multiple regression and controlling for gender and age, only a hostile-dominant interpersonal style predicted aggression (β = .258, p < .05). No factors were significantly related to self-harm. These results suggest that measures of interpersonal style are sensitive to those aspects of interpersonal functioning that are critical to patient's responses to the demands of psychiatric in-patient treatment. Procedures to assess risk and engage and manage potentially aggressive patients, including limit-setting styles and de-escalation strategies, should take into account the interpersonal style of patients and the interpersonal behavior of staff.