Beruflich Dokumente
Kultur Dokumente
a r t i c l e
i n f o
Article history:
Received 18 December 2014
Received in revised form 29 November 2015
Accepted 8 March 2016
Available online 14 March 2016
Keywords:
Intimate Partner Violence
Battering
Battering typologies
Attachment styles
Personality disorders
a b s t r a c t
Woman battering is a serious social problem that occurs across all racial, ethnic, and socioeconomic boundaries,
and that affects not only the physical, mental, and emotional health of victims but also that of perpetrators. This
article is a comprehensive literature review on battering typologies that explores also the mediating role that antisocial and borderline personality traits may play in explaining the relationship observed in a number of studies
between insecure attachment styles and battering perpetration. Since the groundbreaking work that
Holtzworth-Munroe and Stuart conducted in 1994, research on battering typologies has consistently shown
that male batterers do not represent a homogeneous group of persons. Specically, different studies have classied batterers in two or three subtypes that differ in terms of severity of intimate partner violence perpetrated,
generality of the violence, psychopathology of Axis I and Axis II, drug and alcohol use, and attachment styles. Recent studies have also detected a consistent association between insecure attachment styles and battering that
may be mediated by dysfunctional personality traits, specically borderline and antisocial personality disorders.
Implications for clinical practice, limitations of existing research, and suggestions for future research are
discussed.
2016 Elsevier Ltd. All rights reserved.
Contents
1.
2.
3.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Search strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Theoretical perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.1.
Psychological theories . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.
Psychopathology and battering. . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.1.
Personality disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.
Batterer typologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.1.
Batterer typologies identied from 1994 to the present . . . . . . . . . . . . .
6.
Attachment theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.1.
Infantcaregiver attachment . . . . . . . . . . . . . . . . . . . . . . . . .
6.2.
Adult romantic attachment and personality disorders . . . . . . . . . . . . . .
6.3.
Attachment insecurity, personality disorders, and battering . . . . . . . . . . .
7.
Attachment insecurity and battering: the potential mediating role of personality disorders.
8.
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9.
Implications for prevention and treatment . . . . . . . . . . . . . . . . . . . . . .
10.
Strengths and limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11.
Agenda for future research . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
http://dx.doi.org/10.1016/j.avb.2016.03.005
1359-1789/ 2016 Elsevier Ltd. All rights reserved.
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30
1. Introduction
Family violence is the most prevalent form of violence in the United
States (Owen, Thompson, Shaffer, Jackson, & Kaslow, 2009). One type of
family violence is Intimate Partner Violence (IPV), which can be dened
as a pattern of violent and coercive behaviors that involve physical, sexual, psychological, and/or emotional harm perpetrated by one dating,
cohabitant, or married partner against the other, either in an existing
or past relationship (Family Violence Prevention Found, 2008;
Saltzman, Fanslow, McMahon, & Shelley, 2002). IPV is a widespread
problem and every year over 20% of women worldwide experience at
least one act of physical or sexual assault from a male partner (Tjaden
& Thoennes, 2000), with even more women victimized by psychological
aggression (Ro & Lawrence, 2007). While the majority of IPV is mutually
perpetrated and experienced as low-level violence, similar to situational
couple violence (Johnson, 1995, 2006), a portion of IPV is predominantly perpetrated by men and involves severe levels of violence, similar to
intimate terrorism (Johnson, 1995, 2006) or, in other words, battering.
Woman battering is the most severe type of IPV. Prior research with
battered women suggests that battering is a chronic, continuous phenomenon that is empirically and conceptually distinct from episodic
discrete acts of physical assault (Ferraro & Johnson, 1983). The term
battering is conventionally used to refer to severe male partner violence,
although there is disagreement regarding exactly what denes a batterer (Holtzworth-Munroe & Meehan, 2004). In fact, while some researchers describe battering exclusively as the presence of severe and/
or frequent violence, others insist that battering involves also wife injury or fear of the husband, or that the violence must function to control
and dominate the victim. In the present paper I adopt a comprehensive
framework referring to battering as the use of patterned physical and/or
sexual violence combined with psychological, emotional, and/or economical abuse from a male partner toward his female partner in the
context of a current or former heterosexual intimate relationship
(Smith, Thornton, DeVellis, Earp, & Coker, 2002). According to this formalization, battering consists of a variety of abusive tactics executed
by intimate partners including physical and/or sexual assault; threat, intimidation, and humiliation; isolation and restriction of resource access;
threat to the safety of children and other family members or close
friends; control of activities and time spent outside the home; and use
of any weapons to force unwanted activities.
Woman battering is a serious social problem that occurs across all
racial, ethnic, and socioeconomic boundaries, and that affects not only
the physical, mental, and emotional health of victims but also that of
perpetrators (Family Violence Prevention, 2008). Due to the severity
and chronicity of the violence that characterizes battering and because
of the associated intense fear generated in victims, it is very likely that
this phenomenon is highly unreported in the general population,
make it a challenge for researchers to gather reliable statistics about
its prevalence and incidence. Nevertheless, a few studies reported recent estimates showing that every nine seconds, somewhere in the
United States, a woman is battered by someone she knows (Roberts &
Roberts, 2005) and approximately 30% of all female homicides in a
given year occur as a consequence of battering (Koziol-McLain et al.,
2006; Shackelford & Mouzos, 2005). According to a recent estimation,
every year as many as 8.7 million women are abused by their partners
(roughly 20% worldwide) and approximately 2 million of them needed
emergency medical attention as a result of battering (Roberts & Roberts,
2005; Smith et al., 2002). In addition, close to 500 chronically battered
women have killed their partners each year in the attempt to cope
with the explicit terroristic death threats, because of post-traumatic
stress disorder (PTSD) symptoms, or while in a condition of psychosis
inducted by alcohol or drug used with the purpose of self-medicating
themselves (Richardson, 2003; Roberts & Roberts, 2005).
The aftermaths of battering often have a physically and psychologically destructive impact upon the battered woman. Research indicates
that intimate partner abuse can serve as a catalyst for both direct and
indirect physical health problems and that these victimization experiences are often associated with an increase in mental health symptomatology (Archer, 2000; Breiding, Black, & Ryan, 2008; Coker et al., 2002;
Follingstad, 2009; Robertiello, 2006; Roberts & Kim, 2006; Shorey,
Febres, Braseld, & Stuart, 2012; Sillito, 2012; Smith et al., 2002). In addition to the health risks associated with injuries such as, head and neck
injuries, and miscarriage, battering is associated with higher rates of
self-reported overall poor health and development of chronic diseases
such as, diabetes, arthritis, asthma, and heart diseases. Furthermore,
the impact of the battered woman syndrome results in subsequent
higher risks of depression, anxiety, PTSD symptoms, alcohol and drug
abuse, suicide attempts, and feelings of fear.
Even though numerous theories have been developed and employed
to account for the occurrence and maintenance of woman battering
such as feminist theories, social learning theory, sociological theories,
and psychological theories, no one has been able to completely elucidate the mechanisms involved in the phenomenon and to explain the
complex interaction of several risk and protective factors correlated
with battering perpetration and victimization (Schumacher, FeldbauKohn, Smith Slep, & Heyman, 2001). Moreover, because numerous empirical studies, literature reviews, and meta-analyses of standard model
interventions with perpetrators of IPV have found little or no effects on
decreasing violent behavior (Dutton & Corvo, 2006), there is a clear
need for studies laying the basis for evidence-based practice with
battering perpetrators (Corvo, Dutton, & Chen, 2008).
Previous studies adopting a psychological perspective have shown
that male batterers are not a homogeneous group of persons and have
identied several subtypes among batterers that differ regarding severity of marital violence, generality of the violence (toward the partner
only or toward others as well), psychopathology of Axis I and Axis II
(i.e., clinical syndromes and personality disorders), drug and alcohol
use, and attachment styles (e.g. Dutton & Golant, 1995, Gottman et al.,
1995, Holtzworth-Munroe & Stuart, 1994, Holtzworth-Munroe, Stuart,
& Hutchinson, 1997, Tweed & Dutton, 1998). Therefore, it is highly
probable that one standard intervention for battering does not t the
needs of all the perpetrators and consequently that it shows a different
degree of effectiveness according to the specic personality characteristics of the beneciaries. Further research on batterer characteristics can
help improve current interventions and develop if necessary different
intervention programs for subgroups of batterers with specic personality traits (Buck, Leenaars, Emmelkamp, & van Marle, 2012).
In light of the aforementioned ndings of previous research, and
considering the existing gap between research and treatment programs,
the purpose of the present paper is to provide a comprehensive literature review on battering typologies presenting also the most recent
ndings on the association found between attachment insecurity and
battering perpetration and the mediating role that personality disorder
traits may play in explaining this association. Initially I will review the
research on batterer typologies focusing specically on the differences
found in personality characteristics and attachment styles of different
batterer types. My hope is that a deeper knowledge of psychological,
emotional, and behavioral tendencies specic to different personality
organizations and attachment styles will be valuable in the development of future tailored intervention programs that will be more adequate and effective (Buck et al., 2012; Mauricio & Gormley, 2001).
Since the vast majority of studies conducted on battering consider exclusively male batterers, I decided to focus the present literature review
on battering perpetrated by men. Despite that, it is necessary to highlight that more and more studies over the past 30 years have reported
a high prevalence of IPV perpetrated by female partners, with part of
this abuse representing high levels of violence and falling under the category of battering (e.g.Ansara & Hindin, 2009, Capaldi & Owen, 2001,
Langhinrichsen-Rohling, Selwyn, & Rohling, 2012, Straus, 2011). Therefore, for a prevention and intervention perspective it is also crucial to
start studying also this new phenomenon that has heretofore been
neglected by family violence scholars.
2. Search strategy
The literature review was structured to nd research articles that
investigate the mediating role of personality disorder traits in the
relationship between attachment insecurity and perpetration of IPV. I
searched four online databases, Psyc-INFO, Medline (PubMed), Google
Scholar, Scirus (ScienceDirect), and Scopus for the following key
terms: battering, or intimate partner violence, or domestic violence, and personality, or personality disorder*, and attachment,
or insecure attachment, or attachment insecurity. The asterisk
(i.e., the truncation symbol) allowed for the inclusion of alternate
words ending of the search term (i.e., disorder* yielded articles containing disorder and disorders). Finally, all reference lists of the articles included in the manuscript were reviewed in order to nd more articles
that meet the following criteria.
Adopting these search criteria, three different literatures that have
largely developed separately from one another have been combined:
literature on battering typologies, literature on batterers' attachment
patterns, and literature on the specic role that personality disorder
characteristics play in explaining the relationship between insecure attachment and perpetration of IPV.
Since the purpose of the present work is to generate a comprehensive literature review, I did not include a specic timeframe while
researching articles. However, in order to review the most current theoretical thinking and experimental ndings on the topic, in synthetizing
the literature on battering typologies, I focused predominantly on studies carried out in the last two decades, from 1994 to present. The decision to focus the review to the past 20 years was generated noticing
that the most recent ndings are comparable to those of previous
research. Furthermore, from the 90s to the present, research methods
changed improving sample techniques, modifying research designs,
and rening statistical analyses. Focusing the discussion on the most
up-dated research allows a complete critical synthesis of the state of
current knowledge on the topic, and a discussion of the most relevant
directions for future research. In addition, numerous review articles
and meta-analyses were collected and used to gather a broad in depth
understanding of the topic.
Despite its relevance for the development of more effective prevention and intervention programs, the specic role that personality disorder traits may play in explaining the relationship observed in research
between insecure attachment patterns and battering perpetration, has
been relatively neglected by researchers studying battering and by
family violence scholars. In fact, the search of the psychological and
sociological manuscripts yielded only a few articles. It is important to
emphasize the need for more up-to-date research that discusses the
specic role that various factors, especially personality disorder features, may perform in explaining the connection between attachment
insecurity and perpetration of violence by batterers.
3. Theoretical perspectives
Over the years several theoretical frameworks have been adopted in
order to explain the dynamics of battering and the persistence of abusive relationships (Chornesky, 2000). Most of the traditional explanations of violence against women have focused on a unidimensional
explanation of battering that takes into account only one factor involved
such as feminist theories, social learning theory, family systems theory,
sociological theories, and psychological theories (e.g. Bandura, 1977,
Gelles, 1993, O'Leary, 1993, Yll & Bograd, 1988). Conversely, more
recent and comprehensive theorizations have adopted a multilevel
explanation that considers factors related to different and various
aspects of woman battering such as attachment theory (e.g., Dutton,
1995a, 1995b, 1995c, 1995d, 1995e; Dutton, Saunders, Starzomski, &
Bartholomew, 1994; Stosny, 1995). It is important to note that there is
some overlap in the theories and that no single theory provides a complete explanation of battering (Schumacher et al., 2001). Moreover,
31
each theory carries with it certain implications about the factors most
likely to be associated with increased risk for woman battering.
3.1. Psychological theories
Psychological theories place emphasis on individual differences in
personality traits of batterers to explain partner aggression, such that
individuals who show certain personality characteristics are more likely
to perpetrate violence in the context of a romantic relationship than
other people with different personality features (e.g., O'Leary, 1993).
According to this perspective, in attempting to understand male violence, early attention to this problem focused on the psychopathology
of batterers. In the literature, men who physically abuse women have
been described as manifesting a variety of impairments in cognitive,
emotional, and social functioning, including low self-esteem, lack of impulse control, high levels of anger and hostility, lack of assertiveness,
and the use and abuse of alcohol and drugs (Beasley & Stoltenberg,
1992; Dinwiddie, 1992; Dutton et al., 1994; Dutton, 1995a, 1995b,
1995c, 1995d, 1995e; Dutton, Starzomski, & Ryan, 1996; Hastings &
Hamberger, 1988; Kantor & Straus, 1989; Moore et al., 2008;
Schumacher et al., 2001; Stuart et al., 2006; Stuart et al., 2008; Stuart,
O'Farrell, & Temple, 2009). Moreover, a wide range of mental conditions
of Axis I and Axis II have been commonly correlated to increased rates of
IPV perpetration. Indeed, early research demonstrated that, relative to
comparison groups of nonviolent men, men entering batterer treatment
programs evidenced more psychopathology (see review by HoltzworthMunroe, Bates, Smutzler, & Sandin, 1997). In particular, batterers reported depressive symptomatology, bipolar disorder symptoms, anxiety,
PTSD symptoms, hysteria, and paranoia (Bell & Orcutt, 2009;
Danielson, Moftt, Caspi, & Silva, 1998; Dinwiddie, 1992; Gleason,
1997; Hamberger & Hastings, 1991; Hastings & Hamberger, 1994;
Julian & McKenry, 1993; Maiuro, Cahn, Vitaliano, Wagner, & Zegree,
1988; McKenry, Julian, & Gavazzi, 1995; Schumacher et al., 2001;
Shorey et al., 2012).
Regarding Axis II personality disorders, research has shown that Antisocial Personality Disorder (ASPD) and Borderline Personality Disorder (BPD) traits are often associated with the perpetration of woman
battering, combined with narcissism, avoidance, and aggressiveness
(e.g., Beasley & Stoltenberg, 1992; Danielson et al., 1998; Dinwiddie,
1992; Dutton et al., 1996; Gleason, 1997; Hamberger & Hastings,
1991; Hastings & Hamberger, 1994; O'Leary, Malone, & Tyree, 1994;
Murphy, Meyer, & O'Leary, 1993; Stuart et al., 2008).
4. Psychopathology and battering
In attempting to understand the correlates and potential causes of
battering, numerous studies have been conducted comparing violent
men with nonviolent men in order to investigate the relationship between psychopathology and IPV (e.g. Danielson et al., 1998, Hastings
& Hamberger, 1988, Murphy et al., 1993). Even though early research
reported high levels of psychopathology in batterers, the majority of
these studies did not include comparison groups, and instead researchers either reported the percentage of batterers who received
various psychiatric diagnoses or compared violent batterer scores on
standardized tests to test norms (Holtzworth-Munroe, Bates, et al.,
1997). In more recent studies, researchers have compared batterers
with non-batterers administering self-report measures of psychopathology mostly the Millon Clinical Multiaxial Inventory in its three editions (MCMI, MCMI-II, MCMI-III; Millon, 1983, 1987, 1994), and the
Minnesota Multiphasic Personality Inventory in its two editions
(MMPI; Hathaway & McKinley, 1967; MMPI-2; Butcher, Dahlstrom,
Graham, Tellegen, & Kaemmer, 1989) indicating that, as a group, violent men evidence more psychopathological symptoms than do their
nonviolent counterparts.
Hastings and Hamberger (1988), using the MCMI (Millon, 1983)
scores, compared the personality proles of 29 alcoholic batterers, 35
32
33
used violence to sustain and reinforce their self-image and selfesteem, whereas the defenders were dependent on their wives and
overprotected them, mixing love and hate. The incorporators saw
their partners as part of their self and needed them to dene themselves, while the controllers viewed their wives as objects and used violence to control them.
Several subsequent studies have factor or cluster analyzed batterers'
scores on standardized tests, particularly the MCMI (Millon, 1983) and
the MMPI (Hathaway & McKinley, 1967), to identify subgroups of
batterers on the basis of the psychopathology/personality disorders reported by the violent men.
The rst typology derived by employing this method was developed
and replicated by Hamberger and Hastings (1985, 1986) in two empirical studies that used factor analysis to examine batterers' scores on the
MCMI (Millon, 1983), and then compared the subtypes on measures of
depression and anger. On the basis of the key personality features reported by batterers on the MCMI, the authors identifying three batterer
subtypes: passive-dependent/compulsive, schizoidal/borderline, and
narcissistic/antisocial. The passive-dependent/compulsive men were
anxious, depressed, and rigid individuals who lacked self-esteem and
depended on others, becoming hostile when others did not meet their
needs. Schizoidal/borderline men were withdrawn, asocial, moody, volatile, hypersensitive to interpersonal affronts, and likely to overreact to
trivial interpersonal disputes. Further, the men in this group had high
levels of anxiety, depression, and anger proneness, and may have had
alcohol problems. Narcissistic/antisocial men showed tendencies for alcohol and drug abuse, and had a self-centered approach to life using
others to meet their own needs and believing to deserve others appreciation and love.
In 1992 Saunders performed a cluster analysis of self-report data
gathered from 165 maritally violent men entering treatment for spouse
abuse, identifying three subtypes of batterers. Family only aggressors,
who represented more than 50% of the sample, perpetrated violence exclusively within their romantic relationships and largely in association
with alcohol abuse, were overall satised with their marriages, and reported low levels of anger, depression, and jealousy. Conversely, emotionally volatile aggressors reported high levels of anger, depression,
and jealousy, and had the most suicidal ideation and guilt. These men
were the least satised with their marriages and the most psychologically abusive. Finally, generally violent aggressors engaged in the
highest levels of violence both within their romantic relationships and
outside the family, and reported the most severe abuse as children.
Their violence was often associated with alcohol abuse, and they
showed moderate to low levels of anger, depression, marital satisfaction, and marital conicts.
5.1. Batterer typologies identied from 1994 to the present
In 1994, Holtzworth-Munroe and Stuart conducted a comprehensive
review of 15 existing batterer typologies (e.g. Hamberger & Hastings,
1985, 1986, Saunders, 1992), including some using deductive approaches like subgroups formed using clinical observations or a priori
hypotheses, and others using inductive approaches such as factor or
cluster analysis of participants' scores on various instruments
(Holtzworth-Munroe & Meehan, 2002, 2004). Summarizing data across
these studies, the authors observed that batterer subtypes could be classied along three descriptive dimensions namely (1) the severity and
frequency of IPV, (2) the generality of violence, marital only or also
extra-familial, and (3) the batterer's psychopathology or personality
disorder traits. According to the authors, using these dimensions,
three subtypes of batterers would be identied namely family only
(FO), borderline or dysphoric (BD), and generally violent or antisocial
(GVA).
FO batterers were predicted to engage in the least marital violence
and the least violence outside the home. Men in this group were expected to show little or no psychopathology since they were not
34
characterized by either BPD or ASPD. Conversely, BD batterers were predicted to engage in moderate or severe IPV, but only in low or moderate
levels of extra-familial violence. This group would be the most psychologically distressed, presenting depression and anxiety, and the most
likely to evidence borderline personality traits. GVA batterers were expected to engage in the highest level of violence both within and outside
the intimate relationship, and would be the most likely to display features of ASPD.
The authors then integrated several interpersonal theories of aggression into a developmental model of these three different batterer typologies. The model emphasized the role of numerous correlates of male
violence as risk factors for specic batterer subtypes, including distal
or historical correlates such as violence in the family of origin and association with delinquent peers, and proximal correlates such as attachment style, dependency, impulsivity, social skills, and attitude toward
women and toward violence.
Consistent with this model, the authors predicted that among maritally violent men, FO batterers would report the lowest levels of risk
factors. The violence of these men was assumed to result from a combination of stress, marital and/or personal, and low level risk factors such
as exposure to IPV as a child and lack of relationship skills, such that on
some occasions of marital conict escalations these men use physical
aggression to manage a situation otherwise experienced as uncontrollable. Following the episode of violence, the low levels of psychopathology and related problems that distinguish this group such as low
impulsivity and low attachment dysfunctions, combined with a lack of
hostility toward women and a lack of positive attitude toward violence,
would led these men to experience remorse preventing their aggression
from escalating.
Conversely, BD batterers were expected to report a history of parental abuse and rejection resulting in a difculty to construct a stable,
trusting attachment to an intimate partner and in high levels of jealous,
dependency, and fearful of loosing their wives. These men are impulsive, they lack marital skills, and show attitudes that are hostile toward
women and supportive of violence.
Finally, the batterers included in the GVA group were predicted to
show the highest levels of involvement with deviant peers and of family
of origin violence, and to resemble the main characteristics of the antisocial aggressive personality. These men would exercise IPV as a part
of a more general pattern of aggression and antisocial behavior also extended outside the family context since they view violence as an acceptable way to achieve their goals and to solve conicts, lack general social
skills, and express hostile attitudes toward women.
In a more recent work, Holtzworth-Munroe, Meehan, Herron,
Rehman, and Stuart (2000) tested this tripartite batterer typology
among a community sample of 102 physically violent men conducting
a series of cluster analyses and assessing borderline and antisocial personality traits employing two scales appositely derived from the
MCMI-III (Millon, 1994) and labeled fear of abandonment and
antisociality, respectively. The author detected the three expected typologies namely FO, BD, and GVA, along with one additional subgroup
labeled low-level antisocial (LLA). Men included in the fourth unexpected cluster, the LLA batterers, scored moderately on measures of
antisociality, marital violence, and general violence, falling intermediate
on most of the measures compared to the FO batterers and the GVA
batterers. Therefore, conceptualizing the FO, LLA, and GVA groups as
falling along a continuum of antisociality and given that it is unreasonable to place the BD group along this continuum, the authors' data suggest that two personality dimensions are still needed in order to
describe completely the four batterer typologies, namely borderline
and antisocial.
In a subsequent study (Holtzworth-Munroe, Meehan, Herron,
Rehman, & Stuart, 2003), the same authors tested the validity and the
predictive value of the four-typology groups gathering longitudinal
data at an 18 month follow-up and again after another 1 to 2 years
and, obtaining information from 95 of the 102 batterers, they veried
Psychopathic
Antisocial
Proactive
Reactive
Borderline/dysphoric Borderline/dependent
Hostile/controlling
Non-pathological
Low personality
dysfunction
Severe personality
dysfunction (borderline)
Moderate personality
dysfunction (antisocial)
Generally
violent
Generally violent antisocial
(GVA)
Type 2 Impulsive
(pitbulls)
Type 1 antisocial
(cobras)
Non-pathological
group
Passiveaggressivedependent group
Antisocial group
Type 1
instrumental
Type 2 impulsive
Pathological
Normal/non-pathological
(fake good)
seriously disturbed
(fake bad)
Psychopathic/deviance
Family only
Waltz et al.
(2000)
Tweed and
Dutton (1998)
Hamberger et al.
(1996)
Gottman et al.
(1995)
Holtzworth-Munroe
and Stuart (1994)
Table 1
Comparison of batterer typologies in studies published from 1994 that examined personality disorder characteristics.
Langhinrichsen-Rohling
et al. (2000)
Chase et al.,
2001 + Ross &
Babcock, 2009
35
dependent men reported the highest frequency of physical violence toward the intimate partner. Moreover, while antisocial batterers showed
the highest levels of generalized violence outside the family and the
greater number of police contacts, the passiveaggressive-dependent
batterers reported the highest levels of depression and were the most
likely to be abused as children.
Tweed and Dutton (1998) employed measures of marital violence
and personality characteristics and used a cluster analysis to group personality traits of 79 physically abusive men referred to treatment for DV.
Subsequently, they associated each personality trait cluster to the most
common attachment style identied in the participants (Relationship
Styles Questionnaire [RSQ]; Bartholomew & Horowitz, 1991) and to
their average anger level, reporting also if the men in each cluster
showed trauma symptoms. The authors identied two subtypes of
batterers: an instrumental group, or Type 1 (comparable to the GVA)
and an impulsive group, or Type 2 (resembled the BD). Batterers in the
instrumental subtype showed an antisocialnarcissisticaggressive prole on the MCMI-II (Millon, 1987) and reported more severe physical
violence toward their partners. Batterers in the impulsive subtype
showed a mixed prole to the MCMI-II with passiveaggressive, borderline, and avoidant elevations, high scores on the BPO scale, higher
chronic anger, and fearful attachment style. Further, both types of abusive men reported a preoccupied attachment style, but only the impulsive group showed an associated fearful attachment style. Despite the
small sample size, Tweed and Dutton's work is remarkable because it
extended the knowledge on battering typologies including into the
analyses a measure of attachment that allowed them to connect each
specic typology of batterers to particular attachment styles.
Waltz et al. (2000) examined a sample of 75 domestically violent
men and their partners, and 32 maritally distressed nonviolent comparison couples adopting measures of all three descriptive dimensions
identied by Holtzworth-Munroe and Stuart (1994) that is marital violence, general violence, and psychopathology. Furthermore, the authors
assessed the batterers' attachment style using the Adult Attachment
Scale (AAS; Collins & Read, 1990). Mixed analyses led to the identication of three batterer subtypes largely resembling the HoltzworthMunro and Stuart taxonomy. The rst group, labeled family only, engaged in the least levels of violence and reported only few psychopathological symptoms and high levels of compulsive care seeking. Generally
violent batterers showed the greatest levels of violence both within and
outside the intimate relationship, scored highest on alcohol and drug
dependence scales and within the clinical range on antisocial and narcissistic scales, and displayed mainly an avoidant attachment pattern.
Conversely, pathological batterers, comparable to the BD group except
that they reported the highest antisocial scores, displayed mostly an
anxiousambivalent attachment pattern combined with self-reliance
and angry withdrawal. They engaged in moderate levels of violence
within and outside the family context, and scored highest on the aggressivesadistic and narcissistic scales, and within the clinical range on the
schizotypal scale. Further, batterers in the generally violent and pathological groups reported exposure to the most frequent and severe IPV
as children.
In an attempt to test the clinical utility of the batterer typologies distinguished by Holtzworth-Munroe and Stuart (1994); LanghinrichsenRohling et al. (2000) gathered data from 49 male batterers in treatment
for DV administering the BDI (Beck et al., 1961) and the MMPI
(Hathaway & McKinley, 1967). Employing cluster analysis in order to
derive the empirical batterer subtypes, the author identied three subgroups of batterers labeled normal/non-pathological/fake good, seriously
disturbed/fake bad, and psychopathic-deviant. Contrary to the researchers' expectations, the ve mental health professionals expressed
considerable disagreement about how to classify batterer proles. However, when they compared the three empirically derived clusters to the
three theoretical typologies, FO, BD, and GVA, they placed three-fourths
of the sample into the FO, BD, and GVA groups and the three subgroups
observed clearly reected the psychopathology traits identied in these
36
subgroups of batterers. Indeed, the proles of batterers in the nonpathological subgroup showed no clinical elevations of any of the clinical or validity scales, while the prole of the psychopathic-deviance
subgroup was characterized by a clinical elevation on the psychopathic
deviant scale. Finally, the prole of the seriously disturbed cluster had
elevations on almost all of the clinical scales and an unusual validity pattern. Further, these men reported the most frequent suicidal ideation,
while the other two clusters showed the highest levels of alcohol and
drug abuse.
In order to examine the treatment needs of batterers, White and
Gondolf (2000) drew a stratied random subsample of 100 cases from
a larger sample of 840 men in treatment for battering, and grouped
the proles of the 100 batterers using the exclusive criterion of severity
of personality pathology. The interpretation of the MCMI-III (Millon,
1994) proles produced three levels of personality pathology referred
to as low dysfunction (56%), moderate dysfunction (29%), and severe dysfunction (15%) associated to specic personality traits. The personality
proles of men in the low dysfunction group did not indicate elevation
on personality disorder scales or clinical personality traits, while the
proles of men in the moderate dysfunction group suggested the presence of moderate symptoms of narcissistic and antisocial personality
disorders not associated with any Axis I condition. Lastly, the proles
of batterers with severe personality dysfunction included men who presented severe symptoms of paranoid and borderline personality disorders, accompanied by Axis I conditions such as thought disorder and
major depression. The authors further divided these three proles into
six groupings based on the specic personality traits detected, and provided recommendations for treatment.
Chase et al. (2001) used descriptions of episodes of male violence
among a sample of 60 couples seeking marital therapy for IPV to categorize men as perpetrating either proactive or reactive violence. Proactively violent men, similar to GVA men, planned how to use violence in an
instrumental way, and were goal oriented. They were more dominant
and angry during the marital discussion, reported higher scores on measures of antisocial and aggressivesadistic personality, and were more
frequently classied as psychopathic. On the other hand, similar to BD
men, batterers who used violence reactively were more dependent
reacting emotionally to perceived threats and frustrations, and showed
borderline and dysphoric personality traits.
In a more recent work, Ross and Babcock (2009) administered the
Structured Clinical Interview for DSM-IV (SCID-II; First, Spitzer,
Gibbon, & Williams, 1997) to 124 men recruited from the community
that reported to be physically abusive toward their partners, and their
female partners were interviewed to investigate the reactive or proactive nature of the violence sustained. The ndings, consistent with previous research, showed that personality-disordered batterers were
signicantly more violent toward their partners and inicted more
injuries than the non-diagnosed men, and that the violence of men
with different personality disorders appeared to differ in its function.
Specically, while batterers with BPD appeared to engage largely in reactive violence, batterers with ASPD tended to use violence both proactively and reactively. Surprisingly domestically violent men reporting
BPD did not differ from their counterpart showing ASPD with regard
to number of incarcerations, partner injury, and the severity and frequency of IPV.
In 2003, Lawson and his colleagues conducted a study in order to examine the differences among FO, BD, and GVA batterers, and a group of
generally violent men in a sample of 153 participants who were on probation for either IPV or non-intimate violence. The authors conducted a
cluster analysis on MMPI-2 (Butcher et al., 1989) proles of the subsample of 91 domestically violent men identifying three clusters of psychopathology, namely non-pathological (62%), borderline/dysphoric (14.3%),
and antisocial (24.2%). The rst cluster of non-pathological batterers
was comprised of men who scored within normal limits on the MMPI2 scales. The borderline/dysphoric cluster identied a psychopathological pattern often associated with borderline personality disorder and
37
hold negative images of themselves, while, even though not fully consistent, data on infants classied as avoidant suggest the presence of
negative images of others (Cassidy, 1988; Kaplan & Main, 1985). A considerable body of research also links the attachment style of children at
12 or 18 months to their social and emotional adjustment through
childhood (e.g., Bretherton, 1985).
6.2. Adult romantic attachment and personality disorders
A central principle of attachment theory is that attachment relationships continue to be signicant and to inuence individuals throughout
the life span (Ainsworth, 1982, 1989; Bowlby, 1977, 1980, 1982).
Although attachment processes have been extensively investigated in
parentchild relationships (Bartholomew & Horowitz; Benware, 2014;
Zhao, 2013), scholars have only recently started to examine the
relationships between internal working models and adjustment in
adulthood.
Hazan and Shaver (1987) conceptualized romantic love as an attachment process and developed a self-report instrument to classify adults
into three categories that correspond to the three attachment styles of
childhood secure, anxiousambivalent, and avoidant. Their work
showed that compared with the secure group, the two insecure groups
reported higher adverse romantic experiences and more negative beliefs about love (see also Collins & Read, 1990). They had a history of
shorter romantic relationships, and provided less favorable descriptions
of their relationships with parents in childhood. Subsequent research
has indicated that enduring romantic relationships are the most important attachment relationships in adult life (Hazan & Zeifman, 1994), and
that adult attachment patterns are associated with a range of relationship outcomes including satisfaction, trust, communication, and conict
resolution (Bartholomew, 1993; Hazan & Shaver, 1994; Shaver & Hazan,
1993).
Building on the work of Hazan and Shaver (1987), Bartholomew and
Horowitz (1991) developed a fourth-category model of adult attachment that denes attachment patterns according to specic combinations of positive or negative representations of the self and others, or
in other words, specic internal working models (see Table 2). Models
of the self describe the degree to which individuals have internalized a
sense of their own self-worth and if negative may be associated with excessive anxiety and dependency, while models of others indicate the degree to which people expect signicant others to be supportive and
trustworthy and are associated with the tendency to seek out or avoid
intimacy in relationships.
The secure pattern is dened in terms of a positive self-model and
positive other model, and is expected to be negatively associated with
emotional reactivity and abuse in intimate relationships since secure individuals are both condent and comfortable with intimacy. The
dismissing attachment pattern is described in terms of a positive selfmodel and negative other model that lead individuals to maintain a positive self-image by defensively devaluating the importance of attachment needs and maintaining emotional distance in their relationships.
People with a dismissing pattern of attachment are described as
counter-dependent and deny their need for intimacy. Although the frustration of attachment needs may give rise to anger (Kobak & Sceery,
1988), due to deactivation of the attachment system, dismissing
Table 2
Attachment styles continuity from childhood throughout adulthood.
Childhood
Adulthood
Secure
Anxious-resistant
Avoidant
Disorganizeddisoriented
(Main & Solomon, 1990)
38
Given the body of research highlighting the signicance of attachment styles in the quality of adult romantic relationships, researchers
and clinicians have turned their attention to exploring the role of attachment patterns in the perpetration of IPV, with strong evidence suggesting that insecurely attached persons, dismissed, preoccupied, and
fearful, exhibit greater relational abuse than securely attached persons.
6.3. Attachment insecurity, personality disorders, and battering
Over the years a body of research has identied the association between insecure attachment and perpetration of IPV by employing two
main research strategies that are the direct assessment of batterers' attachment patterns, and the indirect evaluation of personality characteristics theoretically linked to insecure attachment styles such as intimacy
anger, interpersonal dependency, and jealousy. Moreover, attachment
insecurity has often been found to correlate with personality disorder
traits, specically borderline and antisocial (e.g., Brennan & Shaver,
1998; Dutton, 1995d, 1995e; Dutton & Starzomski, 1993; Dutton et al.,
1996; Edwards et al., 2003; Holtzworth-Munroe, Stuart, et al., 1997;
Kesner, Julian, & McKenry, 1997; Mauricio & Gormley, 2001; Murphy
et al., 1994; Scott, Levy, & Pincus, 2009).
In a series of studies, Dutton and his colleagues (Dutton, 1994a,
1994b, 1995d, 1995e, 2000; Dutton & Starzomski, 1993, 1994; Dutton
& White, 2012; Dutton et al., 1994; Dutton et al., 1996) employed the
concept of functional anger theorized by Bowlby (1988) in examining
proles of assaultive men in order to demonstrate the existence of an
abusive personality. Bowlby states that anger is the natural response
of the child when the expectation of safety and physical proximity to
the attachment gure is jeopardized. During a separation when the
child perceives that the attachment gure is unavailable, angry behavior
is a way to communicate that the attachment behavioral system has
been activated and that attachment needs are not being met. Bowlby
termed this mode of expressing displeasure to the attachment gure
functional anger because if the attachment gure responds appropriately to it, this expression of anger will facilitate the development of a
secure relationship. Thus, Bowlby viewed interpersonal anger as arising
from frustrated attachment needs and functioning as a form of protest
behavior directed at regaining contact with an attachment gure. However, when the caregiver shows pervasive insensitivity and the child
needs are constantly and repetitively neglected, a consistent history of
insecure attachment experiences may distort this functional anger
into aggression (see also Fonagy, 1999; Kesner et al., 1997).
According to this conceptualization, when men with an insecure attachment style perceive that their attachment needs are not met, they
may use physical violence toward their intimate partners as a dysfunctional coping mechanism in the attempt to deal with their partners' perceived unresponsiveness or rejection. In adulthood, psychological
availability of the attachment gure replaces the need for physical
closeness that is important in childhood, and therefore the batterer's
perception of the relational support provided to him by his intimate
partner may impact the perpetration of violence within the relationship.
Grounded on previous studies showing that anger, jealousy, and affective instability were all strongly and signicantly associated to the
frequency of abuse in intimate relationships (Dutton, 1994b; Dutton &
Starzomski, 1993), Dutton et al. (1994) tested the hypothesis that
attachment insecurity, chronic anger, and affective instability are
produced by chronically frustrating attachment needs and are risk factors for increased abusiveness in romantic relationships. The authors
administered self-report measures to a sample of 120 men referred for
treatment for wife assault and 40 nonviolent men matching on demographic variables, assessing adult attachment patterns the RSQ
(Bartholomew & Horowitz, 1991), BPO, anger, jealousy, trauma symptoms, and abuse in romantic relationships. This constellation of variables was found to represent a prole related signicantly to the
frequency of both physical and verbal abuse. Moreover, secure attachment correlated signicantly but negatively with the constellation
variables, while fearful attachment was positively and signicantly correlated with the measures, and the dismissing pattern was not associated to any variable considered. Specically, violent men scored on the
BPO scale similar to those with a diagnosis of BPD and were signicantly
more likely than nonviolent men to show a fearful attachment pattern.
They reported signicantly more anger of greater magnitude, frequency, and duration, higher levels of jealousy, and more trauma symptoms
in comparison to non-batterers. Notably, participants not enrolled in the
IPV intervention program the control group were signicantly more
likely to show a secure pattern of attachment.
In a subsequent study, Dutton et al. (1996) examined the same constellation of variables in a sample of 140 men referred for wife assault
and 45 demographically matched controls nding further validation of
an abusive personality grounded in the early experiences of batterers
within the family of origin. Findings showed that a composite of BPO,
anger, trauma symptoms, and fearful attachment was positively and
signicantly correlated with perpetration of violence in romantic relationships. Moreover, the abusive personality was predicted by paternal
rejection, physical abuse, and absence of maternal warmth in childhood,
suggesting that the experience of a neglecting and abusive family of origin environment plays a key role in the development of batterers'
personalities.
In a more recent work, Dutton (2000) included parental shaming
and exposure to IPV as a child in his model and found that insecure attachment combined with parental shaming and rejection acts as the
mediator of the relationship between abuse and/or exposure to IPV during childhood and the perpetration of violence in romantic relationships
in adulthood.
Parallel to the research conducted by Dutton and his colleagues
(see for instance Dutton, 2000, Dutton et al., 1996, and Dutton et
al., 1994), Murphy et al. (1994) compared 24 married or cohabitant
men in treatment for partner abuse with 24 maritally discordant
non-violent men, and 24 happily married nonviolent men using
two measures of dependency. Findings revealed that men who had
physically assaulted female partners reported greater interpersonal
dependency as well as spouse-specic dependency combined with
higher perceived personal inadequacy and higher emotional investment in the romantic relationships.
Attachment is also investigated by using the Anxious Romantic Attachment Test (ARAT; White, 1984). Barnett, Martinez, and Bluestein
(1995) applied the ARAT to investigate attachment patterns of batterers
as compared to unhappily and happily married men, nding that domestically violent men were signicantly more jealous and insecurely
attached than their nonviolent counterparts.
Holtzworth-Munroe, Stuart, et al. (1997) further investigate attachment in domestically violent men conducting two studies to compare
the attachment patterns, dependency, and jealousy of violent and maritally distressed husbands with that of nonviolent-distressed and
nonviolent-non-distressed husbands. The combined sample of 103
batterers consisted of two subgroups of 55 violent-distressed men
recruited from the community (n1 = 36, n2 = 19) and 48 violentdistressed men attending marital violence treatment (n1 = 22, n2 =
26), while the two comparison groups of nonviolent men were both
recruited from the community (nT = 109). The authors administered
a wide range of self-report attachment measures including the Adult Attachment Scale (AAS; Collins & Read, 1990) and the RSQ (Bartholomew
& Horowitz, 1991). The semi-structured Adult Attachment Interview
(AAI; George, Kaplan, & Main, 1985) was also used to assess the state
of mind of batterers regarding their childhood attachment. Findings of
both studies were generally consistent with hypotheses showing that
relative to nonviolent men, batterers demonstrated more insecure, preoccupied, and disorganized attachment as shown by anxiety about
abandonment, discomfort with closeness, and difculty in classifying attachment (AAI). In addition, violent men displayed more dependency
on and preoccupation with their wives, and more jealousy and less
trust in their marriages.
39
40
antisocial or borderline personality characteristics when all three mediators were included in the path analyses. There are, however, two additional factors that should be taken into account when interpreting these
mixed ndings; the sample characteristics and the self-report instruments employed in assessing both psychopathology of personality and
attachment styles. Indeed, while Mauricio and colleagues recruited men
attending a batterer intervention program and used the PDQ-R (Hyler
et al., 1988) and the ECR to evaluate attachment patterns and personality
disorders traits, respectively, Lawson and Brossart recruited men on probation for IPV perpetration and, for the same purpose, employed the AAS
(Collins & Read, 1990) and the MCMI-III (Millon, 1994). These divergences imply distinct motivations of the batterers to participate in the
studies and dissimilar validity and reliability of the instruments
employed for their evaluation.
Given the potential prevention and treatment relevance of individuating the specic psychological factors that explain the relationship between insecure attachment patterns and perpetration of violence in
romantic relationships, this inconsistency of ndings across studies
should capture the attention of researchers and be the starting point
for future research.
8. Discussion
Research that examines attachment styles and personality disorders
in batterers can be an extremely valuable resource that both scholars
and clinicians can use to interpret and better understand the distinctive
ndings reviewed here on batterer typologies. The variability in the
number of batterer typologies identied across studies is probably due
to a set of peculiarities concerning the research methods specically
used in each study. Particularly, the different and unique purposefully
recruited samples of male batterers employed in each analysis, the
broad variety of standardized measures and techniques used to classify
them across different studies, and the specic personality characteristics assessed in each investigation, represent methodology features
that provide a unique standpoint on batterers and affect the reliability
of comparisons across studies. The samples used in the reviewed studies
on battering typologies were recruited from different settings, such as
clinical, forensic, and community, in most of the cases the severity and
chronicity of violence were not systematically assessed for example
using the Conict Tactic Scale (CTS2; Straus, Hamby, Boney-McCoy, &
Sugarman, 1996) as well as the unidirectionality or bidirectionality
of the violence because no information were provided regarding the
batterers' intimate partners. Across studies different instruments were
employed to assess personality traits such as self-reported standardized
measures, clinical evaluations, and intimate partner reports, and each
study examined a peculiar set of dysfunctional personality characteristics that even though can be considered personality traits, do not represent the specic DSM criteria (American Psychiatric Association, 2013)
employed to diagnose personality disorders in clinical settings.
Given these characteristics of the investigations on batterer typologies and considering the ndings of research on attachment styles and
personality disorders in batterers, it is likely that male batterers follow
in two broad categories characterized by borderline and antisocial personality traits, respectively, as well as by insecure attachment. These
men suffer from severe personality dysfunctions that reach the DSM-V
(American Psychiatric Association, 2013) cut-offs for a diagnosis of personality disorders often in comorbidity with other mental disorders of
Axis I, they tend to be violent in a number of settings that go beyond
their intimate relationships, and perpetrate severe and chronic physical
and psychological violence toward their intimate partners. It is expected
that the third group of male batterers identied in some of the studies
on battering typologies, characterized by a non-pathological or low
dysfunctional personality and insecure attachment, includes men who
perpetrate intimate partner violence in the context of the less severe situational couple violence (Johnson, 1995). These men are characterized
by a personality showing some clinical indicators that however do not
41
42
43
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