The surprising news about a teenager engaging in fatal violent/aggressive behavior shocks us and grabs our attention. How could this happen?

Violent/aggressive behavior is a complex process that occurs within the brain. What happens in the brain is a neurobiological process that leads to violent behavior:

1. Top Down (Brake/rem)

The part of the brain in the prefrontal cortex, responsible for decision-making and self-control.

2. Bottom Up (Drive/gas)

The brain's amygdala region, which serves as the center for emotions and learned behaviors.

Within these brain regions, there are structures, neural circuits, neurotransmitters (chemicals in the brain), and physiological processes involved.

Damage to neural circuits in the brain can result in failures in both of these brain areas. The prefrontal cortex fails to control behavior and self-control, while the amygdala becomes hyperresponsive, triggering emotions at the slightest provocation. This ultimately leads to violent/aggressive behavior.

What can disrupt brain circuits and lead to violent behavior?

- Genetic factors within a family with a history of violent behavior
- Brain tumors, head trauma
- Metabolic disorders, physical illnesses
- Alcohol and drug use
- History of being a victim of violence, whether verbal, physical, or sexual
- Witnessing violence in daily life, at home, or in the surrounding environment
- Bullying
- Exposure to media violence, such as movies, games, YouTube videos, TV, social media, etc.
- Psychosocial stressors in daily life (financial issues, arguments, divorce, education, layoffs, living situations, etc.)

Violent Behavior by Children and Mental Disorders

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), some mental disorders characterized by aggression in children include:

- Oppositional Defiant Disorder (ODD)

A pattern of moodiness or easily being angered, argumentative or defiant behavior, and/or spiteful behavior lasting six months or more.

- Conduct Disorder (CD)

Persistent and stable behavior patterns that violate the rights of others and rules, such as bullying, theft, skipping school, and running away from home.

- Disruptive Mood Dysregulation Disorder (DMDD)

Characterized by frequent anger outbursts and easily irritable or depressed mood almost all the time.

- Psychosis

A disorder of reality judgment, an inability to distinguish between what is real and imaginary, characterized by hallucinations (hearing voices, seeing visions), delusions (false beliefs not based on reality, e.g., believing in special powers or abilities with certain actions).

- Bipolar Disorder

A mood disorder characterized by extreme mood swings from excessive happiness (manic episodes) to excessive sadness (depressive episodes).

- Major Depression

A mood disorder characterized by sadness, irritability, lack of enthusiasm, reduced energy, disrupted sleep and eating patterns, decreased focus, concentration, and thoughts of death.

- Antisocial Personality Traits

A personality trait with symptoms such as frequent disregard and violation of the rights of others, lack of empathy or compassion for others, lack of self-awareness, a sense of superiority over others, and manipulative behavior.

Types of Violent Behavior by Children/Adolescents to Be Watchful Of

- Temper tantrums
- Fighting/brawling
- Verbal threats to harm or kill
- Physical aggression towards people, such as hitting, hair-pulling, kicking, etc.
- Physical aggression towards objects, like breaking things, slamming, kicking objects, etc.
- Weapon use
- Torturing animals
- Playing with fire, arson
- Vandalism

The presence of the above behaviors should alert us that there is something amiss with the child and immediate intervention is needed to prevent harm.

Preventing Violent Behavior

- Shield children from exposure to violence.
- Provide sexual education and prevent sexual abuse.
- Early identification and management of violent behavior in children.
- Monitor media exposure to violence on TV, the internet, social media, games, videos, films.
- Increase positive physical activities for children, such as sports, music, organizations, spirituality, etc.
- Communication and closeness between parents and children are crucial, so parents can detect and provide assistance if the child undergoes psychological changes.

Treatment and Therapy for Violent Behavior/Aggression by Children/Adolescents

- Seek hospital treatment if there is dangerous behavior.
- Comprehensive psychological and psychiatric evaluations.
- Psychopharmacology: Medications to control violent behavior in children/adolescents, including mood stabilizers, antipsychotics, antidepressants, anti-anxiety medications (administered orally or by injection).
- Psychotherapy: Changing the child's thoughts and behaviors, Cognitive Behavioral Therapy (CBT), emotional regulation exercises, frustration expression exercises, Parent Management Techniques (PMT), etc.

Message to Parents

Parents play a crucial role in addressing violent behavior in children. Ensure that children are not exposed to various events/media containing violence that can disrupt their brains, leading to undesirable behavior. Show love and establish a strong emotional bond with your child. Improve communication with your child so that you can be a place for them to share their difficulties, confusion, and frustrations in life.

Schools, communities, and society as a whole also have the same responsibility. Let's eliminate violence in our surroundings. Spread love!

Author: dr. Lahargo Kembaren, Sp.KJ

References: 

American Psychiatric Association (2014). Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5) [Diagnostic and Statistical Manual of Mental Disorders (DSM?5)]. Madrid: Médica Panamericana.

Angold, A., and Costello, E. J. (1995). A test-retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C). Psychol. Med. 25, 755–762.