SELF-DIRECTED AND OTHER-DIRECTED AGGRESSION IN CHILD AND ADOLESCENT PSYCHIATRIC-INPATIENTS

Objective: To examine self- and other-directed aggression in 89 childr en and adolescents on a psychiatric inpatient unit to determine ways i n which aggressive and nonaggressive patients differ and to discover t hose factors associated with self-directed versus other-directed aggre ssion. Method: Three types of data were collected: ongoing observation s of aggressive behavior during hospitalization, Child Behavior Checkl ists completed by a parent or guardian at admission, and patient and f amily history data gathered from a retrospective chart review. Results : Compared with nonaggressive patients, aggressive patients were more likely to have a history of antisocial behavior, to be victims of abus e or neglect, to have lived in a foster home, and to have had several primary caretakers. Both groups of aggressive patients engaged in thre e types of aggressive behavior with equal frequency and were strikingl y similar on a host of other variables. Only the number of primary car etakers with whom a patient had lived discriminated self- from other-d irected aggressive patients; patients who experienced frequent disrupt ions in caretaking were more likely to engage in acts of self-injury d uring hospitalization. Conclusions: Whether a particular patient will engage in aggressive behavior during hospitalization can be accurately predicted from preadmission characteristics; however, the manner in w hich a patient is likely to aggress, i.e., toward others or self, is d ifficult to predict because of striking similarities between types of aggressive patients. Further investigations are needed to determine ho w self- and other-directed aggressive patients differ and to elucidate relationships between disrupted, unstable, or inadequate caretaking a nd aggression, particularly self-injury, in children and adolescents.