Motivation and emotion/Book/2014/Aggression in intimate relationships

Overview
Aggression is behaviour which inflicts physical or psychological harm upon another person, such as verbal abuse, manipulation, shoving or punching. The role aggression plays in intimate partner violence can be escalated by various factors in life, such as self defense or something less mundane such as psychopathology i.e. personality disorders or PTSD. Furthermore, aggressive behaviours can be fostered through development and become entrenched in adult behaviour, there are several psychological and sociological theories that have tried to explain why some children who are exposed or subjected to familial violence then carry those behaviours into adulthood. As well as psychopathology and childhood violence or maltreatment, alcohol abuse has been identified as a risk factor for the perpetration of IPV. This chapter also covers a brief overview of some intervention and prevention techniques employed, and some suggested techniques from researchers studying the affects of IPV.

Introduction
What is aggression? What do you think constitutes aggressive behaviours? Perhaps your perception of aggression is only attributed to physically exerting ones superiority over another, like physical bullying — shoving, pushing, hitting etc. Maybe you believe aggression to be any action or state which is socially undesirable, such as moodiness, attention seeking, bragging. Or maybe you think of it more as actions which are deliberately antagonistic, such as being argumentative, disobedient or dishonest. Tremblay’s (2000) literature review of aggressive behaviours found a vast array of mechanisms used to define aggression, though not entirely dissimilar they did differ to some degree, some becoming aggregated with antisocial behaviour, some being preoccupied with the intent of the behaviour i.e. did Mark intend to make Milly cry? Others hypothesising that there was no need to encompass intent in their definition. Several studies in the latter half of the 20th century employed the moral judgement of the observer and whether there was a negative effect of the action upon the victim (Tremblay, 2000). Some more solidified definitions to come of this review include: Actions which inflict physical or mental harm upon another, And: Behaviour intended to inflict harm or injury to another person or other persons (Tremblay, 2000). However these definitions are conflicting as one details the intent to harm, while the other disregards intent in order to encompass both intentioned aggressiveness and unintentional aggressiveness.

There a quite a few ambiguous meanings of aggression, and the fact that the term itself is used interchangeably with violence, as well as synonymously with various other descriptions of behaviour including verbal abuse and/or manipulations, makes it hard to find an absolute to work with for the purposes of this chapter. For this reason we will be running with the assumption that aggression, and aggressive behaviours are any and all behaviours which inflict physical or psychological harm upon another person. As this chapter’s focus is on the context of aggression in intimate partner violence, we will be looking into various causes, antecedents and outcomes of IPV not only for the perpetrator but for the people who have fallen victim as well. This will include exposure to childhood violence and/or maltreatment as a possible predictor, IPV in applied psychology and the relationship between substance abuse and IPV, and lastly possible interventions to combat or remedy IPV. It should be noted on the outset that many examples used are somewhat gender biased as a lot of research uses male perpetrator samples.

Intimate Partner Violence and Psyhopathology
On television we see various adds outlining the possible outcomes of domestic violence, for example the Against Women: Australia Says No’ campaigns, from which we can draw the logical assumption that being the victim of violence can have lasting psychological affects, such as depression or anxiety. What these adds do not infer is the extreme consequences such as PTSD or Complex PTSD, as well as personality disturbance which may result in personality disorder symptoms or even manifest itself as schizotypal, borderline or paranoid personality pathology (Torres et. al., 2013). However, there may be psychopathological explanations for perpetration. Such as personality disorder which leave the individual without mechanisms to deal with highly arousing situations, or may inhibit one’s empathy (Mager, Bresin and Versona, 2014), thus giving them a predisposition to violent and aggressive behaviour.

Personality Disorders And IPV Perpetration
Personality disorders have been defined as an enduring inability to develop adaptive strategies for tasks that we take for granted in day to day life, thus leading to an impairment of self and interpersonal functioning (Torres et. al., 2013). They may also be associated with extremes of one or more personality traits such as neuroticism or extraversion, the extreme may be at either end of the scale however such as extreme introversion (Torres et. al., 2013).

Two personality disorders most commonly associated with IPV are antisocial and borderline personality disorders because of their association with characteristics such as lack of remorse or empathy, shallow emotion, callousness and consistent breach of social norm to name a few (Mager, et. al., 2014). Furthermore, research has indicated that personality disorder is a stronger predictor of spousal abuse than sexism or sexual inequality as has long been believed (Ross and Babcock, 2009), as well as suggesting that personality disorder is not simply correlated with IPV but may be an etiological factor in perpetration of violence. There have been two outstanding denomination systems for types of violence which encompass antisocial and borderline personality disorder. The first consists of three categories; family only batterers, borderline/dysphoric batterers, and finally generally violent/antisocial batterers (Ross and Babcock, 2009). Family only batterers are not generally violent persons, and tend to be the least abusive of the three categories, also do not tend to exhibit psychopathology (Babcock, Costa, Green and Eckhardt, 2004), however they have been known to sometimes show dependant personality traits (Ross & Babcock, 2009), family only batterers are almost indistinguishable from non-violent batterers other than their use of violence within the family (Babcock, et. al., 2004). Secondly is the Borderline/Dysphoric batterer, who often display borderline personality symptoms as is suggested by the title. These batterers engage in low to moderate violent behaviour outside the family (Babcock, et. al., 2004). Borderline batterers are commonly insecure and have an intense fear of abandonment which can be a trigger for violent behaviour, they also suffer from unstable moods. BPD itself is characterised by three core features, which are affective instability, impulsivity and identity disturbance (Trull, Stepp and Solhan, 2006), all common to borderline/dysphoric batterers (Ross and Babcock, 2009). Lastly we have generally violent/antisocial batterers, who engage in the most amount of violent activities outside of the home, and are also the most severe perpetrators of IPV (Ross and Babcock, 2009). Antisocial batterers are typically irresponsible (Levy and Scott, 2006), have a disregard for the safety of others, and frequently flout social behavioural norms (Babcock, et. al., 2004),

Secondly, is a two dimensional classification which breaks batterers down into reactive and proactive categories. Once again these categories are reflective of borderline and antisocial personality disorders, based on various characteristics generally displayed by perpetrators which correlate with the two personality disorders, the fact that BPD and ASPD are highly correlated with the two separate classification systems lends to the theory that PD’s are not necessarily just correlated but etiological factors. Reactive batterers, as the label suggests, react to various situations with violence such as perceived threats, which could be verbal aggression from their partners, threat to leave or withdraw (Babcock, et. al., 2004). This category overlaps with BPD inso that reactive batterers tend to be somewhat dependent on their partner, insecure and are often emotionally unstable, so threats of abandonment can trigger aggressive reactions and may also be a means to control or regulate negative emotions. (Ross and Babcock, 2009). Proactive batterers are calculating in their actions, and use the violence of is acceptable to them, as well as a tool to gain what it is they want. This category is associated with ASPD because, similarly with the previous category it overlaps heavily with various aspects of the disorder such as treating the partner as objects to be controlled. Proactive batterers may become violent without provocation and anger, and is often goal directed, used as a means to gain something they want, such as intimidating or dominating other or to assert control over another (Ross and Babcock, 2009). As well as being related to ASPD, proactive batterer’s exhibit some psychopathic traits as well, including manipulativeness, blatant disregard for safety of other and lack of empathy (Mager, et. al., 2014).

PTSD in Victims of IPV
IPV also has significant consequences for the victim. In extreme cases prolonged and/or severe abuse from an intimate partner can have extraordinarily damaging affects on the person’s adaptation to physical and social environments, self-perception, emotional regulation and interpersonal relations, to name a few (Torres, et. al., 2013). These symptoms have been used to form a variant of post traumatic stress disorder known as complex PTSD or disorder of extreme stress not otherwise specified, despite this inference from Torres and colleagues (2013) C-PTSD is not included in the DSM-5, and thus can not be considered. However, as many of the symptoms displayed do overlap with PTSD (DSM-V (2014) 5th ed.) it could be argued that people who are exposed to IPV are in fact displaying various behaviours associated with PTSD rather than an ambiguous denomination. However Torres et. al. (2013) do make claims that victims of IPV have been known to exhibit symptoms consistent with schizotypal, borderline and avoidant personality disorder, such as intimacy problems, low levels of hostility (i.e. become complacent and submissive).

Alcohol Abuse
In a self report study conducted on a male perpetrator sample by Fenton and Rathus (2010) men indicated that alcohol consumption, arguments and/confrontations and manipulation were all risk factors for violent behaviour. As previously mentioned while discussing the categories of batterers confrontation/assertion from a partner often escalates conflict to violence. However the previous topic did not cover how alcohol abuse can exacerbate relationship conflict. Furthermore the affects of alcohol abuse on IPV may be mediated by PTSD symptoms.

It is a constant query, what is it about alcohol that changes our behaviour so that we perform actions we would not usually? There are two theoretical frameworks used to explain why there is such a close relationship between alcohol abuse and IPV. The first assumption is alcohol myopia, which is that excessive alcohol consumption leads to a change in perception of social cognitions, leading to that person’s heightened sensitivity to a perceived threat (Hellmut, et. al., 2013). The second framework is the proximal effects theory, which suggests that alcohol misuse causes the person to experience behavioural disinhibition (Hellmut, et. al. 2013). Both behavioural disinhibition and hyper-sensitivity to perceived threat are assumed to precipitate IPV (Hellmut, et. al. 2013). It is a major assumption that our actions in a sober state are mediated by our perception of the physical and social consequences of those actions (Weisman and Taylor, 2001). In this case aggressive or violent behaviours. Whilst under the influence of alcohol we are simply unable to process, or unaware of those consequences, by altering cognitive processes and reducing the person’s awareness, or inhibiting the ability to process contingency cues which moderate aggressive behaviour when a person is sober (Wesiman and Taylor, 2001). However this assumption was disproven, Weisman and Taylor (2001) found that intoxicated people are fully aware of the consequences of their actions, however what alcohol does do for them is limit their regard for the consequences i.e. they do not care about the consequences, they choose to ignore them. Which may have implications for persons who are not usually violent, but do display other borderline behaviours such as physical intimidation i.e. standing over someone. Interestingly alcohol abuse was found to be less of a risk factor for women than men, as research suggests that women’s use of IPV against their partners is as self defence for IPV victimisation (Hellmut, et. al. 2013).

Alcohol abuse is somewhat prolific in batterers also suffering from PTSD, the most common theory for to explain this is tension reduction theory, which was found to be used both among people suffering from PTSD and their victims (Hellmut, et. al., 2013). The primary motive for alcohol abuse is to relieve stress and reduce negative emotions (Hellmut, et. al., 2013). Hellmut, et. al. (2013), found the severity of PTSD re-experiencing symptoms was indirectly related to psychological, minor and severe physical IPV through alcohol misuse. Re-experiencing is one of the most distressing symptoms of PTSD and may lead to more excessive consumption of alcohol as a numbing agent, and thus a higher risk of perpetrating IPV (Hellmut, et. al., 2013). However it is interesting to note that women’s use of alcohol is not related to PTSD symptoms but rather to IPV victimisation, research suggests that women use IPV as self defence from IPV and in turn use alcohol to reduce the distress from being a victim of IPV — a complicated web (Hellmut, et. al., 2013).

Childhood Maltreatment
There are several theories which try to frame how and why children who are victims of violence, or are exposed to inter-parental violence grow into adults who are abusive in their intimate relationships. These theories include social learning theory, social processing theory and social-psychological strain theory, to name a few (Malaniak and Spatz Widom, 2014). Early maltreatment of children is assumed to be the most detrimental as it has lasting consequences for the child’s social information processing patterns which are developed in the first eight years of life (Ehrensaft, et. al., 2003).

Social processing theory suggests that child abuse leads to the child’s failure to attend to appropriate social cues or misinterprets them as hostile, and conceptualises the world as aggressive and violent, while social-psychological strain theory suggests overwhelming emotions such as anger, frustration and resentment from childhood abuse can result in violent and criminal behaviours (Malaniak and Spatz Widom, 2014). These two theories may be explained by how childhood abuse manifests in adolescence. That being that adolescence who have been victims of childhood abuse do not develop adequate interpersonal function and are often rejected by their normative peers, which pushes them toward deviant, aggressive peer groups instead which reinforce antisocial and violent behaviour (Ehrensaft et. al.). Furthermore these adolescence often begin their romantic pursuance within deviant peer groups and often experience conflictual romantic relationships, by this time interpersonal skills and expectation of romantic relationships are well established from family and peer contexts, which may be a pathway to IPV in adulthood given the violent nature of their childhood, and deviant nature of their adolescence (Ehrensaft, et. al.). Childhood maltreatment, including but not limited to excessively physical punishment, punitive punishment, inconsistent punishment, physical or sexual abuse, peer rejection, association with deviant peer groups are also risk factors for conduct disorder (CD) during adolescence (DSM-V (2014) 5th ed.) which has been associated with IPV perpetration in adulthood (Ehrensaft, et. al.). CD may be a mediator between IPV and earlier family risk factor, such as maltreatment, however it is not a necessary ingredient for the development of coercive and aggressive conflict resolution tactics in intimate relationships (Ehrensaft, et. al.). Some of the most robust predictors of adult perpetration of IPV are childhood behavioural problems, inter-parental violence and excessive punishment, not CD (Ehrensaft, et. al.).

Intervention and Prevention
Several studies suggest that IPV intervention programs need to be targeted for that specific kind of perpetrator (Ehrensaft, et. al., Fenton & Rathus, 2010, Hellmut, et. al., 2013, Palmstierna, et. al. 2012 and Ross & Babcock, 2009) i.e. identification of major risk factors such as psychopathology which can then be used to tailor intervention programs for bordeline/pysphoric batterers, for example.

Research suggests that partner violence prevention should be targeted during early childhood by means of the family, preventing patterns of excessive punishment from becoming entrenched and later reproduced when the child grows up, which limits the child’s risk of developing CD, which while not necessarily causal still diminishes the likelihood of furture IPV perpetration (Ehrensaft, et. al.). Prevention of childhood maltreatment may also halt the trajectory of antisocial behaviour across the lifetime, further reducing the risk of IPV perpetration (Ehrensaft, et. al.). Niolon et. al. (2009) stated that primary prevention of IPV focuses on adolescence, delivered through classroom curriculum which aims to alter the students knowledge, attitudes and beliefs about IPV, and also aggressive behaviours which may possibly be a risk factor for IPV perpetration in later life.

There are two types of intervention that will be reviewed, one from the main perpetrator’s perspective, in this case specifically batterers who have been ordered to attend batterer intervention programs because of their engagement in IPV, and secondly an intervention program for women with young families who may be in a home where IPV is prevalent. What these two intervention strategies have in common is that they are specific, or tailored for individuals and take into account past and present violence patterns. Batterer intervention programs attempt to utilise psycho-educational and cognitive change techniques in order to reduce recidivism in IPV perpetrators (Crane and Eckhardt, 2013). However the administration process of these programs is somewhat lack lustre, resulting in low attendance, and non-significant changes in recidivism (Crane and Eckhardt, 2013). One of the reasons for this may be that BIP often neglect to acknowledge or fail to assess individual differences in batterers, so Crane and Eckhardt (2013) proposed that motivational interviewing preclude the BIP, during their study they discussed the usage of examining the clients willingness to make changes to aggressive behaviour, known as readiness to change, which is based on a range of stages, beginning with the pre-contemplative stage to the maintenance stage, and found that other research had turned over associations between readiness to change pretreatment and the positive outcome yielded by intervention therapy. This readiness to change may be facilitated by motivational interview which includes the assumptions that:
 * most individual engaging in maladaptive behaviours are aware of the consequential disadvantages but are ambivalent to change those behaviours,
 * Ambivalence is the reflection of uncertainty of the costs and benefits of reducing abusive behaviour, or apathy toward severity of abuse,
 * The therapists role is to encourage therapeutic change through a non-demanding, judgement free delivery (Crane and Eckhardt, 2013).

The cognitive behavioural approach of the motivation interview could be enhanced were it prolonged, rather than a single session brief interview, as there were evident changes in attitudes following the interview, but no actual significant changes in recidivism after the tradition BIP was finished. Palmstierna, et. al. (2012) found that in a 15 week group based cognitive behavioural therapy program attendees self reported violence was significantly and substantially lower than it was prior to commencing the program, CBT has also been associated with a reduced rate of re-assault ranging for 44% to 64%. Much like Crane and Eckhardt (2013), Palmstierna, et. al. (2012) agree that motivation and desire to change is an important variable, however they found that participants not receiving, or waiting to receive CBT showed no behavioural changes, indicating that motivation and desire are not enough. Which given Crane and Eckhardt’s findings that recidivism was not changed once traditional BIP was commenced, may explain why motivational interviewing was still ineffective — because BIP does not facilitate behavioural change, and motivation is not enough.

The second kind of intervention program is the Nurse-Family Partnership, which is designed to assist under privileged new mother, who are already at risk of IPV based on their socio-economic status, which has been identified as a risk factor (Niolon, et. al., 2009) This intervention consists of home visits which strategically assess and attempt to alleviate IPV. Nurses do this by running an initial assessment consisting of three scales which depending on how many factors are relevant to that house hold will progress directly to one of two steps. If there is sufficient cause to assume that IPV is occurring then the nurse will introduce the mother to the brochure driven intervention. The brochure consists of four components which include:
 * Information about IPV, and issues of power and control in relation to severe cases,
 * A condensed Danger Assessment Scale, which is used to assess variable predictive of sever injury or possible homicide,
 * Safety planning and effective safety behaviours, in which the nurse will work with the client to devise a safety plan that is suited to her and the child, and,
 * A list of community resources which allows women access to assistance in the area should they need it (Niolon, et. al. 2009).

If there is no cause to believe that the mother and child are in danger of IPV they progress to skills based curriculum called Within My Reach Curriculum, which begins with the client outlining where they see themselves in five to ten years, and then with regard to that goal discusses the importance of a healthy relationship, what healthy and unhealthy relationships are, and tools for developing and maintaining a healthy relationship (Niolon, et. al. 2009). Women who received this intervention did enjoy lower rates of re-abuse in the following 12-months than women who only received a referral card for local assistance (such as domestic violence hotlines). Furthermore Niolon et. al. (2009) suggest that this particular intervention is successful because it takes into account the presence of violence in past and/or present relationships, recognises that women may be the victim, perpetrator or both in relation to IPV and that younger people may change partners frequently which allows them to develop a program which is not contingent on one relationship.

Conclusion
As far as aggression goes in the context of intimate partner violence there are multiple explanations for why aggressive behaviours become exacerbated in intimate relationships. Which include a variety of psychological disorders, such as borderline and antisocial personality disorders, also congruent with batterer subtypes, PTSD and substance abuse disorders. PTSD and substance abuse are both risk factors for IPV and have been found to mediate each other in relation to IPV. Further still exposure and subjection to violence and other aggressive behaviours during developmental years can serve as a risk factor for the development of conduct disorder during adolescence and have enduring consequences for intimate relationships into adulthood. It was found that while intervention and prevention programs do exist, they are largely ineffective, possibly due to their general scope, and inability to cater for individual difference or their ignorance of individual difference.