Managing Violence and Aggression: Part one

Dealing with verbal or physical abuse is not something many people associate with being a PA but, as the number of calls to the PA support service shows, it is something that affects many others. It may be that the person you care for has dementia and is unaware of their actions or your employer may be being bullying or nasty. Either way as PAs we need to talk about this issue and have strategies for dealing with it.

Skills for Care have recently produced a report following extensive research and investigation, including an online survey for PAs to complete in confidence. The report highlighted:

  • There is evidence that although most PAs do not experience violence at work, it does happen to some PAs; while a majority of PAs have experienced abuse – mainly verbal abuse.
  • PAs are worried about violence at work, however verbal abuse is more of a concern for PAs than other forms of abuse or violence.
  • PAs themselves largely identified the triggers for abuse and violence in the characteristics and situation of their employer, or linked to the individual relationship between PA and employer with triggers, such as the employer’s pain and frustration.
  • While physical assaults were seen as easier to recognise, some interviewees thought that identification of abuse and violence might be difficult for PAs to recognise as such, partly because of their lack of knowledge of rights and roles, partly because it might be linked to an individual’s condition and therefore seen as part of the job.
  • PAs face unique risks and challenges associated with their isolation and vulnerability, working often in people’s own homes (not unlike the risks and challenges faced by their employers).
  • Support in all its forms: training, supervision, mentoring, counselling and peer support are not available to many PAs
  • A number of those contacted reported problems linked to the lack of information available about a potential employer on which to make a proper assessment of risk, and the lack of any mechanism for reporting or recording problems.
  • The results indicate the need for further work to look at existing models of practice and what support might be needed by PAs and their employers to prevent and manage abuse or violence.

This report does reinforce what has been highlighted during our PA group and one-to-one support sessions.


Managing the risks

You need to be aware of any risk factors involved such as:

  • Previous incidents of violence and / or previous use of a weapon.
  • Misuse of drugs / alcohol.
  • Previous intent to hurt people.
  • Paranoia.
  • Signs of anger / frustration
  • Denial of their previous dangerous acts.

Violence and aggression can be split into three main categories:

  • Manipulative / Indirect
  • Overt Verbal
  • Physical

Manipulative / Indirect Aggression:

This includes aggression, sulking, scowling, sarcasm, veiled threats, patronising, uncalled for comments, blaming, gaining goals at the expense of others, using others to hide behind, body language, undermining behaviour, and malicious gossip.

Overt Verbal:

Aggression, bullying, offensive humour, obscene language, silencing others, unexpected outbursts, growling, racist / sexist comments, shouting and screaming, warning, open threats, taunting, pomposity, labelling, put downs, attacking, improper use of authority, over complicated terminology, retaliating and controlling behaviour.


Aggression, thumping tables, pointing fingers, pushing furniture, raised fists, moving too close, becoming tense, leering, hands on hips with one foot coming forward, looking down from high, leaning forward, following or stalking, pacing up and down, open threats, punching the air, flushed complexion, clenched fists, withdrawl without notice and kicking inanimate objects.


Our responses to aggression

  • Fear: This is our alert system when responding to a threat whether it is real or perceived. The possible responses to this fear might be…
  • Flight: Taking flight is our natural escape mechanism.
  • Fight: Fighting is a strong reaction to fear, although this is socially unacceptable, in certain circumstances there may be no other option.
  • Freeze: This is when we experience intense fear resulting in an inability to move or respond.


Our physical and emotional processing of aggression


  • Sweating
  • accelerated heart rate
  • increased blood pressure
  • shallow rapid breathing
  • tension in the body
  • tightening of facial muscles
  • dry mouth
  • shaking knees, hands, legs etc
  • nausea
  • teeth grinding


  • Embarrassment
  • anger
  • panic
  • hostility
  • anxiety
  • disbelief
  • surprise
  • self-doubt
  • guilt
  • insecurity
  • vulnerability

It’s really important you seek support, advice and guidance if you are experiencing any of the above. Many PAs have resorted to leaving their job due to these issues, and situations like can seriously affect your health if left unattended.


Help and support

  • Our PA Support Service can be called in complete confidence.
  • If you are becoming low in mood or suffering from anxiety it is important to contact your GP for help before the situation becomes worse.
  • If you are a member of a union contact them. Unison supports personal assistants.
  • Unison 0800 0 857 857
  • Samaritans 08457 90 90 90
  • Relate 03001001234
  • Acas (Advisory, Conciliation and Arbitration Service) 0300 123 1100
  • Support Line 01708 765200