Reducing Interpersonal Violence A Psychological

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Dedication: For Will Davies, admirable applied psy-
chologist, dinner companion and cricket enthusiast
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CONTENTS

List of tables viii

Acknowledgements ix
Preface x

1 Interpersonal violence: A psychological perspective 1

2 Principles of reducing behaviour 11
3 Reducing ‘everyday violence’ 19
4 Reducing violence at home 36
5 Reducing sexual violence 55
6 Reducing criminal violence 78
7 Could we do better? 111

References 139
Index 191
TABLES

1.1. Summary of DSM-5 Diagnostic Criteria for APD 7

3.1. Illustrative items from the Children and Animals
Assessment Instrument (CAAI; Ascione, Thompson, &
Black, 1997) and the Cruelty to Animals Inventory
(CAI; Dadds et al., 2004) 21
5.1. Organisational scheme for preventative strategies for
reduction of child sexual abuse (after Mendelson &
Letourneau, 2015) 60
5.2. MAPPA categories and levels of management (after
Ministry of Justice, 2016) 62
5.3. Strategies to reduce the likelihood of sexual assault 76
6.1. Principles of effective practice to reduce reoffending 93
6.2. Assessment Domains in the LSI-R 94
7.1. Pros and cons in the press regarding the Minimum Price
per Unit (MPU) debate; after Katikireddi and Hilton
(2015) 116
ACKNOWLEDGEMENTS

I do try not to but I know that I can moan just a little bit, well quite a lot
actually, when the day’s writing is not going as well as I’d like. My partner
in life, Flick Schofield, has after many years habituated to my groaning and
pacing about and tells me just to get on with it. Sound advice for any
writer. I’ve also noticed that in my not-too-happy phases our latest dog,
Toby, relinquishes his chair in my study and heads for the less fraught
environment of his bed in the kitchen. At which point I feel really, really
guilty and resolve in future to behave in a better fashion. Anyway, I can
reveal that everyone is pleased that this book is finally written and peace
now reigns in our household.
PREFACE

I think of this book as a companion to my previous book The Psychology of

Interpersonal Violence. Indeed, this book started life as Chapter 8 of The
Psychology of Interpersonal Violence before I realised it was expanding expo-
nentially and taking on a life, now realised, of its own. In agreement with
others, it is my view that interpersonal violence is one of the great public
health issues of our times, bringing about harm and distress on a global scale.
I hope that the ideas and research covered in these pages will act as a
resource for both students and practitioners.
1
INTERPERSONAL VIOLENCE
A psychological perspective

The World Report on Violence and Health published by the World Health
Organization (Krug et al., 2002) was unequivocal in “Declaring violence a
major and growing health problem across the world” (p. ix). However,
despite the seriousness of the matter, there is some debate in the literature
regarding a satisfactory definition of violence. Lee (2015) suggests a wide-
ranging definition:

The intentional reduction of life or thriving of life in human being(s) by

human being(s), through physical, structural, or other means of force, that
either results in or has a high likelihood of resulting in deprivation, mal-
development, psychological harm, injury, death, or extinction of the species.
(p. 202)

Lee’s definition speaks to the widespread nature of violence and its many
adverse physical, sometime fatal, and psychological consequences for the
victim. The WHO report attempted to manage the diversity of acts that fall
under the rubric of violence by forming the three categories of self-directed
violence, interpersonal violence, and collective violence. The term interpersonal vio-
lence is used here in the same sense as in the World Report on Violence and
Health. Thus, interpersonal violence covers of acts of principally face-to-face
violence, excluding violence in the wider context of war and terrorism,
between people either within the same family or wider community. In
2 Interpersonal violence

addition, many forms of interpersonal violence are punishable by law and

may therefore be described as criminal violence.
Kazdin (2011) makes the point that interpersonal violence can be considered
in two ways. The molecular view, to use Kazdin’s terminology, conceives of
interpersonal violence as a set of different types of violent act, categorised by
setting, type of perpetrator, the nature of the act and so on. Thus, for example, a
meaningful distinction can be drawn between physical child abuse and the
sexual assault of an adult. In contrast, Kazdin’s molar view takes interpersonal
violence as a complex phenomenon, with no neat divisions between its many
forms, which is embedded in a nest of other social, political, and economic
problems such as inequality and poverty.
The sheer complexity of the molar view, Kazdin argues, means there can
be no “silver bullet” that will make interpersonal violence disappear. This
view resonates with the view of archaeologists such as LeBlanc (2003) who
see warfare as an intractable aspect of human existence. There have been
wars between nations and within nations since time immemorial, there are
wars being fought as you read this sentence, and there will undoubtedly be
wars to be fought in the future. Wars may start and wars may end; warfare
is for ever. In contrast to the enormity of conflict between nations, some
forms of interpersonal violence, such as violence in the context of sport, are
generally accepted as commonplace “everyday” violence.
The scale of the problem of violence, alongside its dynamic, shifting and
changing, complex nature means that the evidence base will always be
incomplete. A World Health Organization Report (WHO, 2014) laments
the gaps in the data which act to hinder progress in developing evidence-
based violence prevention strategies. The lack of contemporaneous evidence
acts to compound the difficulties of knowing which strategies to apply to
reduce violence most effectively.
The broad understanding of interpersonal violence used here, which will be
used as a springboard for considering strategies to reduce violence, is that
interpersonal violence is a social act. This is not to discount non-social influ-
ences on behaviour (Fox, 2017), rather to say that the actions of those engaged
in the violence are to be considered in their social and situational context. The
notion of a person–situation interaction is, of course, highly familiar within
mainstream psychology (e.g., Bandura, 1977) and has been applied specifically
to violent behaviour (e.g., Allen, Anderson, & Bushman, 2018; Anderson &
Bushman, 2002; Bandura, 1978; Nietzel, Hasemann, & Lynam, 1999).
A person–situation approach has three component parts. Thus, as applied to
interpersonal violence, the first part is the setting in which the violence takes
 Interpersonal violence 3

place. The setting has several characteristics, any and all of which may be present
in a given incident, which include the type of place (home, public bar, street,
etc.), the presence and numbers of other people, the physical temperature, and
whether weapons are present (see Hollin, 2016; Krahé, 2013).
The second part lies in qualities of the individual in the given setting;
these qualities will be a combination of static and dynamic factors. Static
factors include the person’s age, gender, and whether they have a history of
violence. Dynamic factors relate to the individual’s functioning during the
incident which may fluctuate and change as events unfold. Thus, dynamic
factors include the individual’s cognition and emotion as well as their
mental health and use of drugs and alcohol. Finally, the third part concerns
the nature of the interactions between those involved in the incident.
In many cases an act of interpersonal violence is the product of a series of
exchanges between those involved. Luckenbill (1977) called these exchanges a
situated transaction. In an analysis of incidents which had culminated in murder,
although the sequence applies equally well to other types of interpersonal
violence, Luckenbill described six stages in the build-up to the final act.
In the first stage the eventual victim makes the first move in the form of
spoken words, an act, or a refusal to comply with a request from the other
person. At stage two the eventual offender sees a personal insult in the other
person’s words or actions leading, at stage three, to the offender seeking
confirmation of the perceived insult and reacting with an insult of their own.
This insult offers a challenge to the victim to continue the exchanges thereby
placing the victim, at stage four, in the same position as the offender in stage
two: their options are to respond to the challenge, to apologise, or to leave
and “lose face”. If the victim responds, so accepting the challenge, a “work-
ing agreement” is in place such that violence becomes highly likely.
At stage five the physical battle commences with, in some instances, the
use of weapons; Luckenbill reports that in just over one-third of cases the
offender was carrying a gun or a knife while in other cases the offender
either left and returned with a gun or knife or they seized whatever was at
hand, such as a broken glass, to use as a weapon. The use of weapons is
culturally bound: Luckenbill’s analysis was based on cases in California,
USA. In about one-half of the incidents the victim was killed quickly with
a single shot or stab; in the other cases the fight was two-sided, with both
protagonists armed, and it was after an exchange of blows that the victim
was killed. In the final stage about one-half of offenders ran from the scene,
about one-third voluntarily waited for the police, and the remainder were
prevented from leaving by bystanders until the police arrived.
4 Interpersonal violence

It is implicit in the description of the social exchanges that, for both

offender and victim, the perceptions of the other person’s actions and
intentions are driving the sequence of interactions. However, as Luckenbill
notes, these perceptions are not necessarily accurate and, given the context,
situational factors may lead to misperceptions. The exchanges may take
place in front of other people, both acquaintances and strangers, who may
encourage the protagonists’ increasingly aggressive behaviour. In addition, as
the transaction progresses so emotions are likely to become heightened with
one or both of those involved becoming angry, excited, or anxious as vio-
lence draws close.
A myriad of factors may influence the outcome of these social exchanges.
Individuals will act differently because of variations in their perception and
appraisal of the situation and those involved. There will also be variations in
each individual’s values, morals, social problem-solving skills, and experi-
ence of violence. In addition, factors such as the effects of alcohol, the use
of weapons, the presence of mental disorder, and high levels of emotionality
may influence interpersonal exchanges, making violence more or less likely
to occur. As these factors are potentially active across different types of
interpersonal violence a brief overview of each is given below.

The effects of alcohol

The association between alcohol and violence is firmly established in the research
literature (e.g., Boden, Fergusson, & Horwood, 2013; Parrott & Eckhardt, 2018)
and is recognised around the globe (World Health Organization, 2008). The
Institute of Alcohol Studies (2010) have summarised some key statistics about the
alcohol–crime relationship: (1) approximately one-third of violent offenders
have a drink problem, including binge-drinking; (2) alcohol use is prevalent in
close to one-half of convicted domestic violence offenders; (3) about 20 per cent
of those arrested by the police test positive for alcohol; (4) alcohol is common in
many different types of violent crimes against the person, including homicide,
wounding, affray, and domestic violence, as well as property crime (Cordilia,
1985); (5) a high proportion of both offenders and victims of violent crime are
under the influence at the time the offence occurs.
Of course, the setting in which the violence takes place is also important:
violent incidents cluster around the immediate vicinity of bars and clubs, so it
is highly likely that all those involved, offender, victim, and bystanders, will
have consumed alcohol (Ratcliffe, 2012). It follows that alcohol problems are
widespread among convicted violent offenders (MacAskill et al., 2011) and
 Interpersonal violence 5

victims of violent crime (Branas et al., 2009). Yet further, the alcohol-crime
relationship is found for males and females, adolescents and young adults
(Popovici, et al., 2012).

The use of weapons

The presence of a weapon in a potentially violent situation acts to prime hostile
thoughts among those involved, in turn making it more likely that the weapon
will be used (Bartholow, et al., 2005; Benjamin & Bushman, 2018; Cukier &
Eagen, 2018). If a weapon is used, with some weapons more lethal than others,
the risk of serious injury and death is substantially increased. Brennan and
Moore (2009) note that in both America and the UK weapons are used in
about one-quarter of violent incidents. A person may have a weapon for several
reasons: (i) the weapon may be for self-protection; (ii) to threaten other people;
(iii) deliberately to harm another person; (iv) to act as a status symbol; (v) to
bolster self-image.

Mental disorder
Another factor to consider lies in the quality of the violent individual’s
mental health. The relationship between mental health and violence, mainly
criminal violence, has concentrated upon the disorders of psychosis, mainly
schizophrenia, and personality disorder.
There is research evidence to indicate that, compared with the general
population, men and women with psychosis have an elevated risk of
conviction for violent offences (e.g., Bonta, Blais, & Wilson, 2014; Douglas,
Guy, & Hart, 2009; Fazel & Yu, 2009; Hodgins, 2008; Witt, van Dorn, &
Fazel, 2013). It appears that people with a mental disorder are overly
represented among perpetrators of homicide. In a typical study, Meehan et
al. (2006) reviewed 1,594 cases of homicide in England and Wales com-
mitted between 1996 and 1999. They reported that 85 (5%) of the sample
had a formal diagnosis of schizophrenia: this figure stands in contrast to an
incidence of schizophrenia of 1 per cent in the general population.

Violence and schizophrenia

Schizophrenia is characterised by delusions, hallucinations, and confused
speech which can be of sufficient severity to bring about changes in beha-
viour which precipitate social or occupational difficulties. Bo et al. (2011)
6 Interpersonal violence

described two trajectories to explain the association between schizophrenia

and violence. In the first trajectory, the primary explanation lies in the
presence of psychopathic and antisocial personality disorder with the
psychotic symptoms of secondary concern. Those individuals in this trajec-
tory had a history of antisocial behaviour which preceded the onset of
schizophrenia. In the second trajectory, the primary explanation is a high
occurrence of symptoms – including persecutory delusions, “threat control
override” symptoms, and command hallucinations – often without a history
of antisocial behaviour. Threat control override symptoms, often implicated
in violence (Braham, Trower, & Birchwood, 2004; Bucci et al., 2013), may
be experienced as a delusion that other people are trying to cause personal
harm or control one’s thoughts and actions. These specific aspects of
schizophrenia associated with violence should be seen in the larger context
of social conditions and other physiological and psychological aspects of the
disorder (Steinert & Whittington, 2013).
An individual may have concurrent, or comorbid, mental health problems.
A large proportion, perhaps half, of people with schizophrenia have a
comorbid substance use disorder (Volkow, 2009). Given the association
between alcohol and violence, a combination of schizophrenia and alcohol
misuse potentially raises the risk of violence (Fazel et al., 2009).

Violence and personality disorder

There are several types of personality disorder (PD) defined by diagnostic systems
such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American
Psychiatric Association, 2013). Yu, Geddes, and Fazel (2012) conducted a sys-
tematic review of the evidence and concluded that as compared to the general
population PD was associated with a threefold higher risk of violence. The risk of
violence associated with PD was similar to the risk levels for those with other
mental disorders such as bipolar disorder and schizophrenia. However, if the PD
was specifically Antisocial Personality Disorder (APD) the risk of violence rose
significantly to levels comparable to the risks associated with drug and alcohol
abuse. In addition, APD increased the probability of reoffending to a higher level
than other psychiatric conditions. In a British survey using DSM-IV, Coid et al.
(2017) found that APD was the personality disorder most strongly associated with
violence and was three times more prevalent in men than in women.
DSM-5 specifies four diagnostic criteria for APD (see Table 1.1): (1) a
disregard for the rights of other people which is longstanding and may have been
evident from childhood; (2) the individual has reached 18 years of age; (3) there is
 Interpersonal violence 7

TABLE 1.1. Summary of DSM-5 Diagnostic Criteria for APD

A. Disregard for and violation of the rights of other people since 15 years of age
as seen by:
(i) Breaking the law;
(ii) Lying and manipulation for profit or fun;
(iii) Impulsive behaviour;
(iv) High levels of aggression evinced by frequent involvement
in fights and assaults;
(v) Deliberate disregard for own and other people’s safety;
(vi) A pattern of irresponsibility;
(vii) An absence of remorse.
B. The individual is at least 18 years of age.
C. Conduct disorder was present before 15 years of age.
D. The individual was not diagnosed with schizophrenia or bipolar disorder when
the antisocial behaviour occurred.

evidence of Conduct Disorder before the age of 15 years; (4) the antisocial
behaviour is evident not only during an episode of schizophrenia or mania.
DSM-5 presents several specific instances by which the first criterion, a
callous disregard for the rights of others, may be seen which illustrate the
essence of APD. These instances are: (a) failing to follow accepted social
norms as seen by a repetition of behaviours that give grounds for criminal
arrest; (b) deceit for gain or personal pleasure through consistent lying or
cheating; (c) impulsive behaviour; (d) belligerence leading to involvement
in numerous fights or assaults; (e) an irresponsible disregard for the safety of
self or others; (f) repeatedly losing employment and failure to maintain
financial responsibilities; (g) failure to show remorse for victims.
It is evident that APD is strongly associated with criminal behaviour,
particularly when it is comorbid with substance use disorders (Roberts & Coid,
2010; Walter et al., 2010). This association applies to offenders in both the
criminal justice and mental health care systems. Similarly, psychopathic dis-
order, which has features in common with personality disorder, is also strongly
associated with the likelihood of violent conduct (Lestico et al., 2008).

Emotional arousal
Anger is the emotion most readily associated with interpersonal violence. A
person typically becomes angry when cues from their immediate environment,
8 Interpersonal violence

such as the words or actions of other people, provoke physical feelings and
thoughts which, influenced by experience, they label as “anger”. This
emotional state may lead to an expression of anger in the form of verbal or
physical violence directed at another person (Novaco & Welsh, 1989). The
way in which an individual expresses their anger depends upon factors such as
attribution of hostility and perception of provocation (both of which may be
inaccurate), experience and memories of similar situations, and ability to cope
with the situation and with feelings of anger. When it is under control, anger
can have a positive aspect in that it signals to others the effect of their actions
and it can prompt the individual into positive action to protect themselves or
others. However, a failure to regulate anger effectively can lead to the emotion
becoming dysfunctional in nature.
Anger regulation refers to the ability to remain in a calm state when one
perceives provocation. The level of anger control of which an individual is
capable may be dependent upon factors such as the way in which they label
their internal state, from irritation through to rage, and the appraisal of level
of emotional control, from keeping control to “losing it”.
While most people will occasionally have been roused to anger, for
others anger and aggression can become an established behavioural pattern
from an early age (Lemerise & Dodge, 2008). When anger is habitual it may
become dysfunctional with adverse consequences for the individual and
other people they encounter. Dysfunctional anger may take the form of
intermittent explosive disorder (Coccaro, 2000) and alongside an increased
likelihood of acts of interpersonal violence, chronic levels of anger can
precipitate serious psychological and health problems (Miller et al., 1996).
The hostile processing of social information leading to anger may be
exacerbated by qualities of the physical environment such as high tempera-
ture and over-crowding. In addition, anger arousal can be intensified
through interactions with other conditions, such as alcohol use and mental
health problems, which serve to heighten the risk of hostile perception and
appraisal of other people.

Payoffs from reducing interpersonal violence

Why is it important to reduce interpersonal violence? What payoffs would
there be if the levels of interpersonal violence could be reduced?
The first payoff would be a reduction in the human costs of victimisation.
The exact effects of violent victimisation vary across several factors such as the
victim’s age and gender, the nature of the assault in terms of the degree of force
 Interpersonal violence 9

used and sexual intent, and the victim’s relationship with the perpetrator.
Given these variations, victim surveys (e.g., Tan & Haining, 2016) show the
fourfold effects of victimisation. First, there is a high probability of physical
harm ranging from the effects of slaps, bites, and punches, through severe tissue
damage, broken bones, and internal injuries, to life-threatening conditions.
These injuries may require medical attention. Second, the psychological
sequelae of victimisation include loss of self-confidence, fear and anxiety for
self and others, panic attacks, post-traumatic stress disorder, depression, and
thoughts of suicide. Third, the victimisation may precipitate behavioural
change as seen with alcohol and drug use, smoking, disrupted sleep patterns,
reliance on prescription medication, and appetite change. Finally, the social
consequences can include withdrawal from social activities resulting in
diminished quality of life and loss of friendships, absences from work causing
financial problems, and strains on family life threatening the quality and
stability of relationships with relatives including partner and children.
While some of these consequences may be short-term, in that cuts and
bruises heal, they all have the potential to have long-term effects from
physical scarring to financial instability and breakdown of the family home.
As Kazdin (2011) comments, while the adverse consequences of
interpersonal violence can be categorised as physical, psychological, and so
on, it is likely that these will occur concurrently bringing misery and despair
potentially over a period of years. A reduction in the levels of victimisation
from interpersonal violence has the potential to alleviate these consequences
for the benefit of not just the victim but also their family and friends, as well
as helping to maintain their wider social and economic contribution to
society.
A second payoff lies in the long-term benefits realised by diminishing the
perpetuation of violence across generations. Widom described the continuity
of violence across generations within a family as a “cycle of violence” (Widom,
1989a, 1989b). If the familial influences which reinforce and perpetuate such
cycles can be ameliorated, there is the possibility of a significant reduction in
interpersonal violence.
The third payoff of a reduction in interpersonal violence is a reduction in
the financial burden caused by the consequences of interpersonal violence. It
is not a simple task to estimate the financial costs of crime: first, as not all
crimes, perhaps a minority, are reported, estimates based on recorded crime
can only be a sample of the true costs; second, estimating costs for all the
agencies immediately involved in the crime – police, courts, medical services,
probation, and prison – is not straightforward; third, there are more distal