A biopsychosocial perspective of aggression in the context of traumatic brain injury

Primary objective: The aim of this study was to explore the factors associated with aggression in the traumatic brain injury population. The focus of the study was to evaluate the (a) frequency and severity of aggressive behaviours in outpatients with traumatic brain injury (TBI), (b) ecological validity of the Ruff Neurobehavioral Inventory (RNBI) Anger scale, and (c) comorbid and pre-morbid factors associated with aggression in patients with TBIs. Research design: A multi-group comparative research design was employed. Methods and procedure: An outpatient sample of 67 patients with TBIs using the RNBI and clinical interviews. Main outcomes and results: Based on clinical ratings, 25% endorsed no aggression, 38% reported mild aggression and 37% reported moderate-to-severe aggression, which was validated with the RNBI Anger post-morbid scale. A MANOVA found that none of the pre-morbid RNBI scales were significantly elevated across the anger groups; however, pre-post-morbid differences between the groups were found. A principle component analysis showed three main domains: 'physical, cognitive and emotional' that related to elevated post-morbid anger. Conclusions: A biopsychosocial model of post-morbid aggression is proposed to advance both the diagnosis and treatment of patients with TBIs who experience elevated anger.