Intimate partner violence: A narrative review of the biological and psychological explanations for its causation

Aggression and Violent Behavior 18 (2013) 373–382

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Aggression and Violent Behavior

Intimate partner violence: A narrative review of the biological and psychological explanations for its causation Parveen Azam Ali a,⁎, Paul B. Naylor b a b

Faculty of Health and Social Care, University of Hull, Cottingham Road, Hull, HU6 7RX, UK Faculty of Social Sciences, The Open University, UK

a r t i c l e

i n f o

Article history: Received 2 September 2012 Received in revised form 31 December 2012 Accepted 15 January 2013 Available online 9 February 2013 Keywords: Intimate partner violence (IPV) Domestic violence Theoretical perspective Biological explanations Psychological explanations

a b s t r a c t Intimate partner violence (IPV) is a major social and public health problem that affects men and women across the globe regardless of their culture, religion and other demographic characteristics. During the last 100 years many different theories have been proposed to explain the phenomenon of IPV. Much research is been conducted using these theories as a guiding or underlying framework. However, it is difficult to find a single account that provides a succinct and up-to-date overview of these theories. As a result considerable effort is required to identify and retrieve relevant papers to understand the various theories which attempt to explain IPV. This article attempts to provide a succinct and up-to-date integrative review of the biological and psychological explanations of IPV. Both perspectives have been critically evaluated in the light of the available literature and an attempt has been made to discuss the strengths and limitations of each perspective in shedding light on the causation of IPV. © 2013 Elsevier Ltd. All rights reserved.

Contents 1. 2. 3.

Introduction . . . . . . . . . . . . . . . . . . . . . . Methods . . . . . . . . . . . . . . . . . . . . . . . Findings and discussion . . . . . . . . . . . . . . . . 3.1. The biological perspective . . . . . . . . . . . . 3.1.1. Head injury . . . . . . . . . . . . . . 3.1.2. Neurotransmitters . . . . . . . . . . . 3.1.3. Genetics . . . . . . . . . . . . . . . . 3.2. The psychological perspective . . . . . . . . . . 3.2.1. Psychopathology and personality theories 3.2.2. Attachment theory . . . . . . . . . . . 3.2.3. Anger/hostility . . . . . . . . . . . . . 3.2.4. Self-esteem . . . . . . . . . . . . . . . 3.2.5. Communication skills and assertiveness . 3.2.6. Substance and alcohol abuse . . . . . . 4. Conclusion . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . .

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1. Introduction The word violence is derived from the Latin word vis, referring to the use of force and physical supremacy against another person (Casique & Furegato, 2006). Violence or patterns of abusive behaviors

⁎ Corresponding author. E-mail addresses: [email protected] (P.A. Ali), [email protected] (P.B. Naylor). 1359-1789/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.avb.2013.01.003

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373 374 374 374 374 375 375 376 376 377 378 378 378 379 379 379

between intimate partners is defined as intimate partner violence (IPV) (Toro-Alfonso & RodrIguez-Madera, 2004). IPV is often thought to be violence against women (VAW) perpetuated by men. The first term used for such violence was ‘wife beating’ in the 1856 campaign for divorce reform in the UK (Heru, 2007, p. 376). Subsequently, ‘domestic violence’ became a popular term for such violence perpetrated by men against women in intimate relationships. Today, the terms IPV and domestic violence are often used interchangeably, but other terms for such behavior are also used. These

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terms include: domestic abuse, intra-family violence, wife abuse, spousal abuse, wife battering, dating violence, courtship violence, battering, violence against women and intimate partner abuse (Gelles, 1993; Saltzman, Fanslow, McMahon, & Shelley, 1999). Use of the term IPV is not only a recognition of the fact that violence can be perpetuated by both men and women with no limitation on their marital status or the heterosexual or homosexual nature of their relationship, but it also helps to distinguish it from other types of violence such as child abuse and elderly abuse. Interestingly the World Health Organization (WHO) (1997) originally did not use such a broad definition of IPV describing it as “the range of sexually, psychologically, and physically coercive acts used against adult and adolescent women by current or former male intimate partners”. Since then WHO (2002) has broadened its definition of IPV by acknowledging that it can be perpetrated by women as well as men as argued in many studies (Anderson, 2002; Archer, 2000, 2002; Brown, 2004; Capaldi, Kim, & Shortt, 2007; Capaldi & Owen, 2001; Carney, Buttell, & Dutton, 2007; Hamberger & Potente, 1994; Straus & Gelles, 1986). Many explanations for understanding and explaining IPV have been proposed. These explanations come from a wide range of perspectives including the biological, psychological, feminist, social learning, and ecological. However, it is very difficult to find evidence related to each of these different perspectives any one article. This paper is an attempt to present a brief integrative account of biological and psychological theories that have been proposed to explain IPV. The remaining perspectives will be the subject of a further article. Both perspectives in the present study have been critically evaluated in the light of the available literature and the strengths and limitations of each perspective are discussed.

2. Methods A search was undertaken of four databases: Medline, CINHAL, Google Scholar, and PsychInfo. To identify studies related to biological perspective various search terms were used including biological causes, head injury, brain injury, neurotransmitters, androgens, testosterone, serotonin, genetics, genes, genetic factors, genes, and aggression. To identify studies mentioned under psychological perspective various search terms including mental disorder, depression, psychopathology, personality disorder, psychological problems, attachment, attachment needs, attachment problem, attachment problems, attachment theory, anger, aggression, aggressor, aggressiveness, hostility, attachment

needs, attachment, attachment problems, self-esteem, self-worth, communication, communication skills, communication abilities, interpersonal skills, interpersonal abilities, interpersonal communication, assertiveness, and assertive were used. These terms were used in combination with the terms violence, domestic violence and alternative terms for IPV including intimate partner violence, intimate partner abuse, wife abuse, spousal abuse, women abuse, marital violence, and marital abuse. Table 1 presents examples of key words used, numbers of articles retrieved and numbers of articles included in the review. A search was also conducted using Google to identify studies not published in indexed journals. In addition, the reference list of each article was also reviewed to identify studies that may not be listed in databases. Through literature searching 1134 sources (including primary and secondary sources) were retrieved and scanned, 324 sources (including primary and secondary sources) were reviewed and 216 sources have been used in this study. Journal articles published in English in any journal during the period 1990–2011 were included to obtain only current and relevant literature. However, where needed classical work from previous years was also incorporated. Among 216 sources included in this study, 40 sources were published prior to 1990 (1943–1989). In addition, secondary sources such as books were also referred to and included in the review where needed. The review was conducted section-by-section. Each article and book was closely read and the main points and findings, strengths and limitations of each document were summarized. 3. Findings and discussion 3.1. The biological perspective The biological perspective of IPV centers on genetic, congenital, and organic causes of behavior. Consequently, the focus of biological research is the role of ethology, genetic defects, brain injury, neuropathology, brain infections, and medical illnesses affecting brain and structural or functional changes in the brain secondary to trauma in the development of violent and aggressive behavior (Cunningham et al., 1998; Johnson, 1996). 3.1.1. Head injury Head injury is known to have distressing consequences for the survivor and the family members. While survivors report facing difficulties with behavior, anger management, and self-monitoring (Hanks,

Table 1 Examples of Keywords used to search literature related to IPV. Terms

Alternative terms

Intimate partner violence

Intimate partner violence, IPV, intimate partner abuse, domestic violence, DV, domestic abuse, wife abuse, spousal abuse, women abuse, marital violence, and marital abuse.

Explanation of IPV Biological perspective

Psychological perspective

Total

Biological causes, head injury, brain injury, neurotransmitters, androgens, testosterone, serotonin, genetics, genes, genetic factors, genes and aggression Mental disorder, depression, psychopathology, personality disorder, psychological problems, Attachment, attachment needs, attachment problem, attachment problems, attachment theory, Anger, aggression, aggressor, aggressiveness, hostility Attachment needs, attachment, attachment problems, Self esteem, self worth, self-esteem Communication, communication skills, communication abilities, interpersonal skills, interpersonal abilities, interpersonal communication, assertiveness, assertive Alcohol, alcohol abuse, substance abuse, substance addiction, substance misuse, alcohol use, addiction,

Articles identified

Articles reviewed

150

53

680

146

60

26

30 30 26 58

15 10 14 14

100

46

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Temkin, Machamer, & Dikmen, 1999), spouse and family members report changes in the survivor's personality, irritability, rage outbursts and reduced impulse control as long term consequences of head injury (Parsons, Carpenter-Hyland, Burright, & Donovick, 1995; Wood, Liossi, & Wood, 2005). The possible link between head injury and IPV was not investigated until Rosenbaum and Hoge (1989) found that head injury was implicated in the 61.3% of their participants (N = 31) who perpetrated partner violence. Subsequently, Rosenabum and colleagues, and others, published numerous studies (Gosling & Oddy, 1999; Rosenbaum et al., 1994; Warnken, Rosenbaum, Fletcher, Hoge, & Adelman, 1994) on the association between head injury and IPV. Collectively, these studies concluded that head injury cannot be the cause of IPV, but that it might impair the impulse control mechanism which in turn may increase the risk of aggressive behavior. In addition, personality changes resulting from head injury may have an impact on relationship quality which consequently may lead to aggressive behavior in the head injury survivor. Research on the impact of brain injury on violent behavior has limitations since it is severely limited in the extent to which it can explain all causes of IPV (Holtzworth-Munroe, Smutzler, & Bates, 1997). For example, it fails to explain why all violent men do not necessarily have a history of head injury, and why not all men with a history of head injury are violent towards their intimate partners. Further research is warranted to better understand the phenomenon and to testify the association between head injury and IPV. 3.1.2. Neurotransmitters Understanding the role of androgens, particularly testosterone, is critical to understand aggression and aggressive behavior (Meyer-Bahlburg, 1981). Researchers have, therefore, tried to link various neurotransmitters, such as testosterone and serotonin, with deviant behaviors. Testosterone plays an important role in developing and maintaining masculine attributes in many species (Mazur & Booth, 1998). A positive association between testosterone and aggression has already been established in animals, but remains under-investigated and inconclusive in humans (Albert, Walsh, & Jonik, 1993; Archer, 1991). Elevated testosterone levels have been found in more violent compared with less violent male prisoners arrested for wife abuse and other crimes (Archer, 1991, 1994; Bergman & Brismar, 1994; Dabbs, Carr, Frady, & Riad, 1995; Mazur, 1995). Men with high testosterone levels tend to be more aggressive, have difficulty in maintaining good marital relationships, are more prone to having extra marital affairs and have lower quality marital interactions than men with low testosterone levels (Booth & Dabbs, 1993). Testosterone has also been found to be positively associated with verbal and physical aggression (Meyer-Bahlburg, 1981; Soler, Vinayak, & Quadagno, 2000), dominance (Gray, Jackson, & McKinlay, 1991), sensation seeking (Daitzman & Zuckerman, 1980), depressed occupational achievement (Dabbs, 1992) and criminal, violent and/or antisocial behavior (Dabbs, Frady, Carr, & Besch, 1987; Dabbs & Morris, 1990; Dabbs, Ruback, Frady, Hopper, & Sgoutas, 1988). At the same time, a lower level of serotonin is identified as predictive of impulsive and violent behavior (Badawy, 2003; Burrowes, Hales, & Arrington, 1988; Tuinier, Verhoeven, & van Praag, 1995; Virkkunen & Linnoila, 1993). Decreased serotonin levels have also been found to have a negative effect on mood and behavior whereas increased serotonin levels have been found to result in improved social interaction and decreased aggression (Young & Leyton, 2002). However, only one study suggested a positive association between serotonin levels and aggression (Lesch et al., 1996). Studies examining at the relationship between these neurotransmitters and IPV are not only scarce, but have produced inconsistent findings (Archer, 1991; Book, Starzyk, & Quinsey, 2001; Booth & Dabbs, 1993; Carré, McCormick, & Hariri, 2011). For instance, some studies report a strong positive association (Soler et al., 2000), some a moderate or weak association (Archer, 2006; Book et al., 2001; McKenry, Julian, & Gavazzi, 1995) while some could not identify a

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relationship at all (Archer, 1991; Archer, Birring, & Wu, 1998; Campbell, Muncer, & Odber, 1997; Carré & McCormick, 2008). It has also been noted that there are discrepant findings within some studies (Book et al., 2001). For instance, a study reported a positive link with aggressive behavior in 12–13-year-old boys, but could not identify any association for 15–16-year-old boys (Turner, 1994). Therefore, caution is needed when interpreting findings, particularly since many of studies on neurotransmitters have been conducted on animals. More research is needed to understand the role of neurotransmitters in causing violent and aggressive behavior generally and IPV, specifically. The reciprocal association between testosterone and aggression noticed in animals needs to be explored in humans as well (Archer, 1991; Book et al., 2001; Mazur, 1985). 3.1.3. Genetics Researchers interested in biological mediators of IPV have suggested a possible genetic contribution to the perpetuation of violence (Hines & Saudino, 2002; Saudino & Hines, 2007). Though many researchers have recommended exploring this issue (DiLalla & Gottesman, 1991; Herzberger, 1996; Widom, 1989), research related to the role of genetics in IPV is almost non-existent. Our comprehensive literature search only identified one study investigating the “extent to which genetic and environmental factors contribute to individual differences in intimate aggression” (Hines & Saudino, 2002, p. 701). This study involved 134 monozygotic and 41 dizygotic twins revealed familial resemblance in psychological and physical intimate partner aggression attributable to shared genes. Genetic influence was able to explain 16% and 15% of the variance in the perpetration and receipt of physical aggression respectively. Likewise, 22% and 25% of the variance in the perpetration and receipt of psychological aggression was attributable to genetic factors (Hines & Saudino, 2004). In another study, Saudino and Hines (2007) suggested that “… genetic influences are probabilistic, not deterministic” (p. 128). These authors also suggested that there is a genetic influence on victims of violence or aggression due to evocative or active genotype environment correlation. The evocative genotype-environment correlation refers to the victim's genetically influenced behaviors that could induce aggressive reaction from others, whereas, the active genotype-environment correlation refers to victim's tendency to select aggressive partners due to a congruency between genetically influenced traits (Saudino & Hines, 2007). With the exception of the studies presented so far, behavioral genetic research on IPV is unavailable. However, behavioral genetic research in related areas can serve as a guide to possible genetic influences on IPV. Most of this evidence is based on twin and adoption studies looking at delinquent behavior in children/adolescents and criminal/antisocial behavior in adults. These studies support the notion that aggression and the ability to control aggression are genetically influenced characteristics (Plutchik & Van Praag, 1989; Tellegen et al., 1988). Certain people, due to their genotype, may act more aggressively than others (Carey & Goldman, 1997; Coccaro, Bergeman, Kavoussi, & Seroczynski, 1997). Evidence also suggests that genetic factors combined with environmental influences increase the risk of aggressive, antisocial, and criminal behavior (Cadoret, Cain, & Crowe, 1983; Miles & Carey, 1997; Rutter, 1997). As mentioned earlier, there is a severe dearth of literature related to genetics and IPV. Researchers, such as Hines and Saudino (2002), call for behavioral genetic research to understand the mechanism of IPV better and thereby identify preventive strategies. There is hope that advances in genetic research, such as DNA research may facilitate future investigations of IPV. Evidence, although there is very little, suggests that there is an association between some infections/illnesses, such as encephalitis, meningitis, syphilis, herpes simplex, tuberculosis, AIDS, and violent behavior (Tardiff, 1992). In summary, very little attention has been paid to looking at the biological determinants of IPV. One reason for this could be the fear of providing men with an excuse for their

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violent behavior. Much research is needed to determine the links between biological factors and IPV. In the next section, theory and evidence from the psychological perspective on IPV are reviewed. 3.2. The psychological perspective The psychological perspective on IPV focuses on various factors that affect the individual perpetrator or the target or victim. The researchers have tried to explore the role of various psychological and psychiatric difficulties and disorders such as psychopathology, personality disorders, attachment needs, anger/hostility, substance and alcohol abuse, low self-esteem, and individual abilities such as excessive or weak assertiveness, communication difficulties, and poor problem solving skills. 3.2.1. Psychopathology and personality theories The initial theories related to IPV were based on the psychopathological orientation of violence. Based on studies conducted on known violent men in prisons, community based settings or victim women in shelters, some theorists believed that men who perpetuate violence and women who experience violence suffer from mental health problems such as depression (Hastings & Hamberger, 1994; Julian & McKenry, 1993; Murphy, Meyer, & O'Leary, 1993; Pan, Neidig, & O'Leary, 1994), personality disorders including antisocial personality, borderline personality disorder (BPD) (Edwards, Scott, Yarvis, Paizis, & Panizzon, 2003; Ehrensaft, Cohen, & Johnson, 2006a; Holtzworth-Munroe et al., 1997; Levy, Meehan, Weber, Reynoso, & Clarkin, 2005; Mauricio, Tein, & Lopez, 2007; Porcerelli, Cogan, & Hibbard, 2004), borderline personality organization (BPO) (Dutton & Starzomski, 1993, 1994; Dutton, Starzomski, & Ryan, 1996; Tweed & Dutton, 1998), and psychopathology (Danielson, Moffitt, Caspi, & Silva, 1998; Kessler, Molnar, Feurer, & Appelbaum, 2001; McKenry et al., 1995; Stueve & Link, 1997; Swanson et al., 1997). Initial studies in this area were often criticized for lacking a comparison group, small sample size, and for their descriptive nature in merely reporting percentages of violent men diagnosed for psychiatric illnesses, or comparing violent husbands' scores on standardized tests to norms. In response to such criticisms, more recent studies usually have large sample sizes ranging from 29 participants (Maiuro, Cahn, Vitaliano, Wagner, & Zegree, 1988) to 11,870 participants (Pan et al., 1994). Researchers now usually include a comparison or control group of non-violent husbands/partners. The number of groups compared in these studies varies depending on the objective and scope of the study ranging from a minimum of two groups to a maximum of four (Hamberger & Hastings, 1991; Maiuro et al., 1988). Most of these studies have used self-report questionnaires including the Minnesota Multiphasic Personality Inventory (Hathaway & McKinley, 1943) (Else, Wonderlich, Beatty, Christie, & Staton, 1993; Greene, Coles, & Johnson, 1994; Valliant, De Wit, & Bowes, 2004), the Million Clinical Multiaxial Inventory (MCMI: Millon, 1983; MCMI-II 1987) (Dutton, 1995; Dutton & Starzomski, 1994; Hamberger & Hastings, 1991; Hamberger, Lohr, Bonge, & Tolin, 1996; Hastings & Hamberger, 1988; Murphy et al., 1993; Porcerelli, Cogan, & Hibbard, 1998; Sugihara & Warner, 1999), the California Psychological Inventory (CPI: Barnett & Hamberger, 1992; Gough, 1975), the Beck Depression Inventory (BDI: Beck, Ward, Mendelson, Mock, & Erbaugh, 1961; Boyle & Vivian, 1996; Feldbau-Kohn, Heyman, & O'Leary, 1998; Hanson, Cadsky, Harris, & Lalonde, 1997; Rankin, Saunders, & Williams, 2000; Vivian & Malone, 1997), the test of Borderline Personality Organization (Dutton, 1994; Oldham et al., 1985) and various versions of the Conflict Tactic Scale (CTS: Straus, 1979) (Saunders, 1996; Tjaden & Thoennes, 2000). Among all psychopathological conditions, personality disorders, especially borderline personality organization, have been found to be more prevalent in violent husbands or male partners compared with less violent controls. Dutton and Golant (1995) believe that the prevalence of borderline personality organization ranges from

11 to 15% in the general population. However, Else et al. (1993) found that 33% of their abusive men participants fulfilled the criteria for borderline-antisocial personality traits. Similarly, Dutton and Starzomski (1994) examined 40 self-referred and 38 court-referred men to a treatment program for wife assaulters. Findings suggested that 79% of the study participants had personality disorders with 37% of them suffering from BPD. Dutton and Starzomski (1993) also compared wives' reports of their husbands' abusive behavior with the men's responses on various questionnaires on BPO. A significant association was identified between reported BPO scores by men and women's reports of male abusiveness. In addition, violent intimates also reported “significantly more anger of greater frequency, magnitude, and duration” (Dutton, 2002, p. 195), feelings of jealousy, trauma symptoms including dissociation, sleep disturbances, anxiety, depression, and post-sexual abuse trauma than non-violent intimates (Dutton, 1994, 1995). A significant positive correlation was also noted between men's self-report of anger and verbal abuse of wives' with wives' reports of emotional abuse by their husbands (Dutton, 1995). Studies have also been conducted to determine if there is a link between psychopathology in men and the victimization of women. It has been reported that female victims of violence suffer from borderline personality symptomology (BPS) (Sansone, Chu, & Wiederman, 2006; Sansone, Reddington, Sky, & Wiederman, 2007), depressive disorders (Cascardi, Daniel O'Leary, & Schlee, 1999; Coker et al., 2002; Golding, 1999; Nixon, Resick, & Nishith, 2004; Stuart, Moore, Gordon, Ramsey, & Kahler, 2006; Zlotnick, Kohn, Peterson, & Pearlstein, 1998), anxiety and post-traumatic stress disorder (PTSD) (Cascardi et al., 1999; Coker et al., 2002; Golding, 1999; Nixon et al., 2004; Scheffer & Renck, 2008; Stuart et al., 2006), psychological distress (Romito, Molzan Turan, & De Marchi, 2005), substance dependence, or suicidality (Vitanza, Vogel, & Marshall, 1995). A meta-analysis of the effects of IPV on the mental health of women reported that the odds ratios of depression, PTSD, alcohol abuse or dependence, and drug abuse or dependence in the group of victimized women were 3.80, 3.74, 5.56, and 5.562 times higher respectively, than in the control group (Golding, 1999). A cross-sectional study reported a rate of 75% and 54% of PTSD and major depressive disorders (MDD) respectively in female victims of IPV (Nixon et al., 2004). It is important to note here that no study was able to show any causal relationship between psychopathology and violence (Heru, 2007). However, results of a longitudinal study (Ehrensaft, Moffitt, & Caspi, 2006b) suggest that intimate partner abuse contributes to the development of psychiatric disorders among females as opposed to males. Moreover, people with psychiatric disorders regardless of gender are prone to becoming involved in abusive relationships (Ehrensaft et al., 2006b). Evidence also suggests that people who have been treated for IPV report a decline in their depressive symptoms (Kernic, Holt, Stoner, Wolf, & Rivara, 2003). Behavioral couple therapy treatment for alcoholism dependence has also been reported as effective in lowering IPV rates and improving relationships (O'Farrell, Murphy, Stephan, Fals-Stewart, & Murphy, 2004). Another study suggests that an integrated treatment approach to substance abuse, mental health, and trauma may be helpful for women victims of violence (Morrissey et al., 2005). Opponents argue that the studies establishing a psychopathological basis of VAW have been conducted on either people arrested for such crimes, court referred cases, people attending treatment programs, or women in shelters. Therefore, findings of these studies cannot be generalized to the general population. Psychopathological theory has also failed to acknowledge and address other issues, notably, why all people with psychopathology do not react violently towards their intimates and why some violent individuals do not suffer from psychopathological disorders. Some studies have found that men charged with battering were not psychopathic, but presented with a history of alcohol or substance abuse, a feeling of hostility and jealousy towards women, affective instability, impulse control disorder, or intermittent explosive

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disorder (Echeburua & Fernandez-Montalvo, 2007). Opponents also argue that considering psychopathology as the sole cause of VAW distracts society from examining and dealing with other factors, such as societal attitudes, cultural norms, and structural inequalities, that condone VAW. Finally, it is suggested that the theory of BPO needs further exploration and testing to confirm the “reliability of diagnosis or any valid predictors about treatment outcomes” (Cunningham et al., 1998, p. 9). 3.2.2. Attachment theory Attachment theory (Bowlby, 1988) postulates that IPV could be a result of disturbed attachment to the partner. Attachment theory attempts to explain the relationship between an infant and his/her mother (or mother substitute). Bowlby (1977) stressed that “attachment behavior is held to characterize human beings from cradle to grave” (p. 203). It is a process by which an infant seeks proximity to an identified attachment figure (mostly mother or her substitute) specifically in perceived distressing situations. An infant attaches to an adult who remains a constant caregiver in the initial months of his/her life (6 months to 2 years) and who is responsive and sensitive to the infant in social interactions. Bowlby (1988) believed that trust in the attachment figure and an assurance about the availability and accessibility of the attachment figure or vice versa develops slowly during infancy and continues to build in childhood and adolescence in its various forms. Expectations developed during those years “… tend to persist relatively unchanged throughout the rest of life” (Bowlby, 1973, p. 235). These expectations and the response of the attachment figure to the expectations lead to the development of “internal working models” that direct the individual's feelings, beliefs, and expectations in later relationships. Bowlby (1988) believed that disturbed or unmet attachment needs result in the development and provocation of interpersonal anger, and a feeling of rage. A perceived threat of separation or loss of attachment figures generates feelings of terror, grief and rage in the infant (Bowlby, 1969, 1973). Repeated experiences of unmet attachment needs during childhood

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may lead to the development of disturbed attachment patterns in adult relationships. Hazan and Shaver (1987) were the first to apply attachment theory to the adult relationship. They proposed romantic love as an attachment process and developed an instrument to measure the adult version of the infantile attachment patterns (secure, ambivalent, and anxious-avoidant) described by Ainsworth, Blehar, Waters, and Wall (1978). Subsequent studies confirmed that the attachment patterns of children and adults are similar and romantic and intimate relationship are the most significant attachment relationships in adult life (Hazen & Zeifman, 1994; Shaver & Hazan, 1993). Extending attachment theory, Bartholomew (1990) developed a four category model of attachment which is frequently used in studies of IPV. The model was created by dichotomizing Bowlby's two dimensions of positivity of representation of self (the degree of the sense of an individual's own self-worth) and others (the degree to which others are seen as supportive and trustworthy, or rejecting or unreliable) (see Fig. 1). The derived four attachment patterns are named secure, dismissing, fearful, and preoccupied. A secure person's views are positive about self and others (low dependence/anxiety and low avoidance), whereas a dismissing person's views are positive for self, but negative for others (low dependence/anxiety and high avoidance). On the other hand, a fearful person holds negative views of self and others (high dependence/anxiety and high avoidance) and a preoccupied person holds negative views of self, but positive views for others (high dependence/anxiety and high avoidance) (Bartholomew & Horowitz, 1991; Henderson, Bartholomew, & Dutton, 1997). These researchers proposed that the disturbed attachment to the intimate partner could explain the phenomenon of IPV. Parent–child relationships act as a prototype for adult relationships. Experiencing ongoing abuse and unmet or disturbed attachment needs leads to the development of working models of relationship characterized by rejection, role reversal, and fear. Such people expect others to be hostile, rejecting, and unavailable; therefore, they themselves behave in the same manner in their intimate relationships (Egeland, 1993;

Model of others (Avoidance)

Model of Self (Dependence) Positive (low) Negative (High)

SECURE

PREOCCUPIED

Positive (low) Comfortable with intimacy and autonomy

Negative

DISMISSING

(High) Dismissing of intimacy or attachment

Preoccupied with relationships

FEARFUL Fearful of intimacy or attachment

Fig. 1. Bartholomew's Model of adult attachment. Source: Bartholomew, K., & Horowitz, L. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226–244.

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Hines & Saudino, 2002; Zeanah & Zeanah, 1989). Research suggests that violent men or women usually have preoccupied, fearful and anxious attachment styles (Bond & Bond, 2004; Henderson, Bartholomew, Trinke, & Kwong, 2005; Schumacher, Feldbau-Kohn, Smith Slep, & Heyman, 2001; Stith, Smith, Penn, Ward, & Tritt, 2004). These men and women report frustrated attachment needs, excessive dependence on their partners, fear of rejection and abandonment, discomfort with closeness, jealousy (Babcock, Jacobson, Gottman, & Yerington, 2000; Dutton, 1995; Dutton, Saunders, Starzomski, & Bartholomew, 1994; Levy et al., 2005; Mauricio et al., 2007), and feeling less related to others (Julian & McKenry, 1993). The preoccupied and fearful attachment styles have also been found more prevalent among the victims of IPV (Bond & Bond, 2004; Henderson et al., 1997; Henderson et al., 2005). Researchers believe that research related to attachment theory can help identify people at risk of becoming abusive, why they act in such a way, which behaviors to expect, what circumstances force them to behave in this manner; and what might be the consequences (Gormley, 2005). Attachment theory, however, does not seem to provide a comprehensive explanation of IPV. It fails to explain the role of biological factors or to address why siblings from one family do not all behave in the same way (McClellan & Killeen, 2000). Further research related to this topic, especially on the role of attachment insecurity and on women's perpetration of or victimization through IPV is needed. 3.2.3. Anger/hostility Researchers have also investigated a link between anger/hostility and IPV. Findings of the majority of such studies conducted in clinical and community settings confirmed that violent husbands/intimate partners experience more anger and hostility towards their spouses than non-violent husbands/partner (Baron et al., 2007; Boyle & Vivian, 1996; Dutton et al., 1996; Feldbau-Kohn et al., 1998; Hanson et al., 1997; Holtzworth-Munroe, Rehman, & Herron, 2000; Holtzworth-Munroe et al., 1997; McKenry et al., 1995; Norlander & Eckhardt, 2005; Schumacher et al., 2001; Stith et al., 2004). A critical examination of the literature shows that findings about the relationship between anger, hostility and IPV are inconsistent. In an examination of eight studies, Schumacher et al. (2001) identified anger and hostility as consistent predictors of IPV, though, with varying degrees of effect size ranging from very small (r = 0.18) to large (r = 0.52). This variation was attributed to design and measures used in the studies. In another meta-analysis, Stith et al. (2004) examined 11 studies and reported anger and hostility as a moderate risk factor for IPV (r = 0.26). Similar findings were reported by a later meta-analytic review of 33 studies by Norlander and Eckhardt (2005). Evidence suggests that anger is one of the contributing factors to IPV (Norlander & Eckhardt, 2005; Schumacher et al., 2001; Stith et al., 2004). However, there are several points that need attention. The concept or construct of anger remains poorly defined in studies and is under-researched. The distinction or difference between the constructs of anger and hostility is not always clearly stated (DiGiuseppe, Tafrate, & Eckhardt, 1994; Eckhardt, Barbour, & Stuart, 1997; Norlander & Eckhardt, 2005). Likewise, the methods of assessing anger and their psychometric appropriateness have also been questioned (Eckhardt, Norlander, & Deffenbacher, 2004; Eckhardt et al., 1997). Similar concern was expressed by Norlander and Eckhardt (2005) about the definitions of anger and hostility and their relationships to aggressive behavior; they concluded that “… it would seem likely that methods of assessing these constructs are similarly unclear … (and so) “… the conceptual status of the anger—IPV relationship will continue to be limited by the inadequacies surrounding anger assessment” (p. 121). Others too have challenged the relationship between anger and IPV. For instance, Gondolf and Russell (1986), while making a case against anger management programs, suggested that considering anger as the cause of IPV partly blames the woman for arousing anger and, therefore, requires her to

change her behavior to reduce abuse. It also helps abusers to deny responsibility for abuse and to use anger as an excuse for their abuse, as is often the case with alcohol or substance use. Moreover, considering anger as the cause of IPV distracts attention from other important contributing factors such as issues of power and control and wider societal and cultural issues. In conclusion Norlander and Eckhardt (2005) say that “despite the seemingly obvious connection between feeling angry and acting aggressively, serious gaps exist regarding our ability to make a confident statement about whether anger ‘matters’ with regard to IPV”(p. 144) Therefore, there is a need to explore this issue further to understand its importance, consequences, and how it might be managed in relation to IPV. 3.2.4. Self-esteem Low self-esteem is also considered to be another psychological risk factor that contributes to IPV. However, findings of various studies in this respect are inconsistent. It is suggested that violent partners suffer from low self-esteem and perpetrate violence towards their partners in an attempt to defend or cover up their feelings of inferiority and shame and to improve their own feeling of self-worth (Crocker, Thompson, McGraw, & Ingerman, 1987; Papadakaki, Tzamalouka, Chatzifotiou, & Chliaoutakis, 2009; Tracy & Robins, 2003). Some studies have identified violent partners as suffering from low self-esteem (Cowan & Mills, 2004; Donnellan, Trzesniewski, Robins, Moffitt, & Caspi, 2005; Echeburua & Fernandez-Montalvo, 2007; Murphy, Meyer, & O'Leary, 1994), whereas, some others were unable to identify self-esteem as a significant variable (Russell, Lipov, Phillips, & White, 1989; Sugarman & Hotaling, 1989; Telch & Lindquist, 1984). 3.2.5. Communication skills and assertiveness Some literature postulates a relationship between social skills, such as communication, assertiveness, and problem-solving, and IPV (Holtzworth-Munroe et al., 1997; Schumacher et al., 2001). Evidence suggests that violent men tend to suffer from poor communication skills and display aversive behavior (Cordova, Jacobson, Gottman, Rushe, & Cox, 1993), are offensive and negative (Burman, John, & Margolin, 1992; Margolin, John, & Gleberman, 1988) or are defensive and negative (Burman et al., 1992) and engage in less positive or constructive communication (Berns, Jacobson, & Gottman, 1999; Holtzworth-Munroe, Smutzler, & Stuart, 1998) during interactions with their intimate partners, compared with non-violent men. It has been suggested that violent partners tend to lack these skills and use violence when they are unable to resolve marital conflicts with other less destructive options (Holtzworth-Munroe et al., 1997). Researchers have investigated two types of assertiveness including general assertiveness (being able to behave assertively generally in any situation) and spouse- specific assertiveness (an ability to behave assertively with one's spouse). However, results of these studies are not consistent as some of them reported a lack of less spouse specific assertiveness only (Dutton & Strachan, 1987; O'Leary & Curley, 1986; Telch & Lindquist, 1984); a lack of spouse specific assertiveness and general assertiveness abilities (Rosenbaum & O'Leary, 1981); or a lack of general assertiveness abilities only (Morrison, VanHasselt, & Bellack, 1987). Maiuro, Cahn, and Vitaliano (1986) found differences between violent husbands and their non-violent controls in relation to initiation assertiveness (ability to request or demand). However, they could not identify any differences between the two groups in relation to refusal assertiveness. Studies have also found victims of violence as unassertive especially while interacting with their spouses (Morrison et al., 1987; O'Leary & Curley, 1986; Rosenbaum & O'Leary, 1981). However, such unassertive behavior could be an adaptive response to the husband's violence, as behaving assertively or disagreeing with one's husband is identified as a risk factor for physical abuse of women (O'Leary, Curley, Clarke, & Rosenbaum, 1985).

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3.2.6. Substance and alcohol abuse The relationship between alcohol use or abuse and IPV remains controversial and debatable (Foran & O'Leary, 2008; Klostermann, 2006; Leonard, 2001; O'Leary & Schumacher, 2003). Research studies in this area can be categorized into three groups: those supporting a link between perpetration of IPV and alcohol or substance abuse; those supporting a link between victimization and alcohol or substance abuse; and those which identify a reciprocal relationship between alcohol abuse and both the perpetration of IPV and victimization. Despite the controversy, research has clearly reflected a positive and predictive association between alcohol problems and IPV (Chase, O'Farrell, Murphy, Fals-Stewart, & Murphy, 2003; Fals-Stewart, 2003; Fals-Stewart, Golden, & Schumacher, 2003; Kantor & Straus, 1987, 1989; Pan et al., 1994; Russell et al., 1989; Schumacher, Fals-Stewart, & Leonard, 2003; Schumacher et al., 2001; Stith et al., 2004; Thompson & Kingree, 2006). Violent husbands and male partners have been reported to have significant drinking problems compared with non-violent controls or the general population (Barnett, Fagan, & Booker, 1991; Hamberger & Hastings, 1991; Julian & McKenry, 1993; Kyriacou et al., 1999; Leonard & Blane, 1992; Leonard & Senchak, 1993; Murphy et al., 1993; Oriel & Fleming, 1998; Rosenbaum & O'Leary, 1981; Stith & Farley, 1993; Telch & Lindquist, 1984). O'Farrell and Murphy (1995) found that alcoholic men were six times more likely to be violent towards their wives than non-alcoholics. Violence perpetrated by alcoholic men was more frequent and severe than that perpetrated by non-alcoholic men. Although these studies have been conducted in various settings, such as emergency rooms of hospitals, primary health care settings, and family practice clinics, in general population and minority samples, results have consistently supported a link between alcohol and IPV. Women's perpetration of IPV has also been reported to have an association with substance or alcohol abuse (Chase et al., 2003; Cunradi, Caetano, Clark, & Schafer, 1999; Drapkin, McCrady, Swingle, & Epstein, 2005; Stuart, Moore, Ramsey, & Kahler, 2003). Studies also suggest a direct association between female victimization and substance abuse by women (Berenson, Stiglich, Wilkinson, & Anderson, 1991; El-Bassel, Gilbert, Schilling, & Wada, 2000; Kyriacou et al., 1999; McCauley et al., 1995; Miller, Downs, & Panek, 1993; Miller, Wilsnack, & Cunradi, 2000; Parks & Fals-Stewart, 2004; Roberts, Lawrence, O'Toole, & Raphael, 1997; Stewart & Cecutti, 1993). These studies have also been conducted in a variety of settings such as emergency rooms, primary care setting, prenatal clinics, alcohol treatment programs, and in the general population (Leonard, 2001). Alcohol or substance use or abuse in many such studies is identified as the consequence of experiencing violence rather than a cause. Some researchers suggest that victims use alcohol or substance abuse as a strategy for coping with violence perpetrated against them (Barnett & Fagan, 1993; Clark & Foy, 2000; Simmons, Lehmann, & Cobb, 2008). Results from two meta-analytical studies suggest significant but only small to moderate effect sizes for an association between alcohol use or abuse and IPV (Foran & O'Leary, 2008; Stith et al., 2004). Another meta-analysis suggested that there is only a weak relationship between alcohol use or abuse and IPV (Gil-Gonzalez, Vives-Cases, Alvarez-Dardet, & Latour-Perez, 2006). Tolman and Bennett (1990), in a narrative review of quantitative studies on battering men, suggested that chronic alcohol abuse is a better indicator of IPV than acute intoxication. Other researchers (Kilpatrick, Acierno, Resnick, Saunders, & Best, 1997; Polusny & Follette, 1995) believe that alcohol or substance abuse and IPV has a reciprocal relationship which works cyclically. Substance abuse is directly related to the physical and sexual assault which results in an increased risk of subsequent alcohol or substance abuse. Based on the evidence it is difficult to establish a causal link between alcohol abuse and IPV. However, it is likely to be an important contributing or facilitating factor and so is worthy of further research. Feminists are especially reluctant to accept the link between alcohol abuse and IPV.

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The reason could be that endorsing such association means taking away the responsibility of violence from men and providing them with an excuse for justifying their violence. This feminist account remains an avenue for further research (Fals-Stewart, Leonard, & Birchler, 2005; Klostermann, 2006; Leonard, 2001). Various theories are presented under the umbrella of psychological perspectives. Evidence suggests that various factors, such as psychopathology, personality disorders, attachment needs, anger/hostility, substance and alcohol abuse, self-esteem and individual abilities such as assertiveness, communication, and problem-solving skills, play an important role with respect to IPV. Opponents of each of the theories reviewed have questioned why not all men behave the same. Another major criticism is that accounting for violent and aggressive behavior in terms of, for example, psychopathology, psychiatric issues, anger and hostility and justifying the behavior of the batterer, does not very helpful to women. It is important to note here that none of the factors is identified as the sole cause, as the findings of the studies remains inconsistent. Nonetheless, all of these factors are important to consider while examining IPV. 4. Conclusion An examination of the literature on the dynamics of IPV reveals that the factors discussed above are helpful in explaining IPV. The biological perspective sees the issue of IPV as being caused by secondary to aggression, which results from structural and chemical changes in the brain due, for example, to trauma or head injury. Psychopathological theories consider that IPV results from psychopathology, mental illness, attachment problems, inability to manage anger and hostility, deficiency in various skills and abilities such as management of anger and hostility, lack of assertiveness, low self-esteem, and communication skill difficulties. It is clear that no single theory explored in this article fully explains the phenomenon of IPV. However, both the biological and psychological perspectives make an important contribution to our understanding of violence in intimate relationships. It is clear, however, that further research from these perspectives still needs to be conducted which attempts to ensure that the criticisms of the extant studies are avoided. References Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale NJ: Erlbaum. Albert, D. J., Walsh, M. L., & Jonik, R. H. (1993). Aggression in humans: What is its biological foundation? Neuroscience and Biobehavioral Reviews, 17(4), 405–425. Anderson, K. L. (2002). Perpetrator or victim? Relationships between intimate partner violence and well-being. Journal of Marriage and Family, 64(4), 851–863. Archer, J. (1991). The influence of testosterone on human aggression. British Journal of Psychology, 82, 337–343. Archer, J. (1994). Testosterone and aggression. Journal of Offender Rehabilitation, 21, 3–25. Archer, J. (2000). Sex differences in aggression between heterosexual partners: A meta-analytic review. Psychological Bulletin, 126, 651–680. Archer, J. (2002). Sex differences in physically aggressive acts between heterosexual partners: A meta-analytic review. Aggression and Violent Behavior, 7(4), 313–351. Archer, J. (2006). Testosterone and human aggression: An evaluation of the challenge hypothesis. Neuroscience and Biobehavioral Reviews, 30(3), 319–345. Archer, J., Birring, S. S., & Wu, F. C. W. (1998). The association between testosterone and aggression among young men: Empirical findings and a meta-analysis. Aggressive Behavior, 24(6), 411–420. Babcock, J. C., Jacobson, N. S., Gottman, J. M., & Yerington, T. P. (2000). Attachment, emotional regulation, and the function of marital violence: Differences between secure, preoccupied, and dismissing violent and nonviolent husbands. Journal of Family Violence, 15(4), 391–409. Badawy, A. A. B. (2003). Alcohol and violence and the possible role of serotonin. Criminal Behaviour and Mental Health, 13(1), 31–44. Barnett, O. W., & Fagan, R. W. (1993). Alcohol use in male spouse abusers and their female partners. Journal of Family Violence, 8, 1–25. Barnett, O. W., Fagan, R. W., & Booker, J. M. (1991). Hostility and stress as mediators of aggression in violent men. Journal of Family Violence, 6(3), 217–241. Barnett, O., & Hamberger, L. (1992). The assessment of maritally violent men on the California Psychological Inventory. Violence and Victims, 7, 15–28. Baron, K., Smith, T., Butner, J., Nealey-Moore, J., Hawkins, M., & Uchino, B. (2007). Hostility, anger, and marital adjustment: Concurrent and prospective associations with psychosocial vulnerability. Journal of Behavioral Medicine, 30(1), 1–10.

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