Humiliation, Self-Esteem and Violence

The Journal of Forensic Psychiatry & Psychology
Vol. 22, No. 5, October 2011, 724741
Humiliation, self-esteem and violence

Julian Walkera* and Victoria Knauerb
a
Fromeside and Academic Unit of Psychiatry, School of Social and Community

Medicine, University of Bristol, Oakeld House, Oakeld Grove, Bristol, BS8 6BN,
UK; bFromeside, Avon and Wiltshire Mental Health Partnership NHS Trust,
Blackberry Hill Hospital, Bristol BS16 1ED, UK
(Received 5 January 2011; nal version received 3 April 2011)
Self-conscious emotions such as humiliation and shame, along with
problems of self-esteem, have been related theoretically to aggression,
anger and violence for many years. However, as existing systematic
reviews show, studies with oenders are relatively rare, small in scale
and have conicting ndings. In this article, we have limited our review
and discussion to violence rather than including the full range of
oending, because we consider humiliation and particular self-esteem
patterns to be key triggers and vulnerabilities, respectively, for violence.
We have drawn on existing theories, our own theoretical and research
work, and where evidence is lacking, we have tried to triangulate
information from related studies. We begin with denitions before
discussing possible mechanisms and inevitably refer to narcissistic
personality structures in relation to aggression. We consider particular
groups such as sexual oenders and psychopaths. We describe assessment
methods, both interview and psychometric tests, with reference to
problems of masking and faking good. We conclude with ideas for
treatment, based on the theoretical background presented. However, the
absence of randomised control trial evidence for many forensic interventions means that this largely constitutes a discussion about what could be
tried and evaluated rather than what is known to work.
Keywords: Self-esteem; narcissism; humiliation; self-conscious emotions;
aggression; violence
Introduction
Sticks and stones will break my bones but names will never hurt me. Not true.
Humiliation, embarrassment and shame, and their opposites, pride and selfrespect, are members of a group of self-conscious emotions that are evoked
by self-reection and evaluation. They dier from primary emotions, such as
anger and fear, which are present very early in life, because they are
*Corresponding author. Email: Julian.Walker@awp.nhs.uk
ISSN 1478-9949 print/ISSN 1478-9957 online
2011 Taylor & Francis
http://dx.doi.org/10.1080/14789949.2011.617542
http://www.tandfonline.com
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contingent on the ability to recognise the self as separate from others. Shame
and humiliation are of particular interest to forensic psychology and
psychiatry since they are pertinent to understanding some forms of violence.
It is generally acknowledged that the perception of being insulted, put-down
or disrespected can elicit intense emotion and trigger aggression and
violence in response. It is our understanding that self-conscious emotions
underlie much of this violent behaviour, and in particular that humiliation
and shame are the core trigger and vulnerability for violence.
One of the most compelling overarching theories of violence in relation
to self-conscious emotions is presented by Gilligan (1996), who puts shame,
poor self-esteem and humiliation at the centre of his psychodynamic
formulation of violence proneness. He suggested that violence is used to
attain justice by punishing those whom they feel have punished them,
unjustly (p. 18); thus, violence is seen by the perpetrator as revenge for
being wronged unjustly by the victim. What constitutes a wrong in
Gilligans view is usually a personally meaningful insult (humiliation) of
some kind that causes an overwhelming sense of shame. The violent person
cannot cope with this shame due to a lack of self-esteem or a healthy sense of
pride which would normally allow them to cope with the insult. When this
happens to someone lacking the non-violent skills to restore their damaged
sense of self-esteem, violence becomes a way of restoring their pride.
We take the view that humiliation, respect and self-esteem are complex
but central issues to emotional and psychological wellbeing and that they
are important to mental health generally (e.g. in depression). These concepts
also seem to be central to certain oence types and are also relevant to our
personal and professional responses to oenders (particularly those with
personality disorder). This article sets out to describe some of the
mechanisms through which experiences of shame and humiliation can give
rise to anger and aggression, and in doing so highlights the role of selfesteem and narcissism within this process. These ideas are then drawn
together through the authors cognitive model of violence, humiliation and
self-esteem, and presented in the context of literature which is variable in
quality and coverage but which provides some theoretical bases, some
systematic review evidence and some primary data studies. Our emphasis is
also pragmatic and clinical given that even where evidence is lacking,
clinicians still have to make sensible decisions about what to do.
Key concepts
Self-conscious emotions
The terms embarrassment, shame and humiliation are often used
interchangeably in the literature, however, important dierences between
these emotions have been noted. Embarrassment has been dened by Miller
(1996) as an aversive state of mortication, abashment and chagrin that
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J. Walker and V. Knauer
follows public social predicaments (p. 322). Some theorists believe the key
component in embarrassment is negative evaluation by others, however, this
does not account for all types of embarrassment, for example, feeling
embarrassed about being the centre of attention. Lewis (1992) distinguished
two types of embarrassment: embarrassment due to exposure and
embarrassment due to negative self-evaluation. The latter type (also thought
of as mild shame) emerges later in childhood, once a sense of self has formed
and an internal set of standards and rules have been developed. Although
embarrassment is often equated to shame, the two emotions are thought to
dier in terms of the intensity of aect experienced. It has been suggested
that embarrassment is linked to deciencies in ones publicly presented self,
whilst shame results from perceived deciencies of ones core self.
Embarrassment is marked by more humour, blushing and a greater sense
of exposure, whereas shame is associated with greater feelings of
responsibility, regret and anger (Tangney, Miller, Flicker, & Barlow, 1996).
Humiliation describes the experience of an emotional reaction to feeling
demeaned, put down or exposed; the core issue is the negative down rating
of the victims status particularly in relation to the person humiliating them
or in relation to others present. The feeling of humiliation is subjective and
includes various negative feelings about oneself, in particular feeling small,
insignicant, weak or stupid. These feelings are also common to shame,
however, in shame individuals tend to blame themselves for the damage
brought upon oneself, whereas in humiliation the damage is viewed as
unjustly inicted upon us by others. This distinction is highlighted by Klein
(1991), who states that: Humiliation is what one feels when one is ridiculed,
scorned, held in contempt, or otherwise disparaged for what one is rather
than what one does. People believe they deserve their shame; they do not
believe they deserve their humiliation (p. 117). These feelings of injustice are
often accompanied by feelings of hatred and a desire for revenge against the
person causing the humiliation. This can be seen as an externally focussed or
aggressive response. However, a more internally focussed or depressive
response to humiliation may include self-doubt, self-recrimination and
feelings of worthlessness and disempowerment.
The presence of observers can heighten the humiliation and sense of
injustice, making the insult feel more public and provoking, perhaps leading
to rage and violence in response. This relates to Lazares (1987)
conceptualisation of humiliation as being simultaneously exposed, attacked
and wishing to escape. Violence, which rapidly changes the dynamics of a
situation, is action oriented, and perhaps less aversive than passively
accepting humiliation.
The opposite of shame and humiliation are the more positive selfconscious feelings of pride, healthy self-esteem and self-respect. Pride can be
dened as a personal sense of worth or self-esteem. The concept usually
refers to feelings about the self or ones own achievements, but can also refer
727
to another person such as being proud of ones children or colleagues.

Gilligan (1996) refers to pride as a healthy sense of self-esteem, self-respect
and self-love and notes that the two possible sources of love for the self are
love from others and ones own love for oneself. Children who fail to receive
sucient love from others fail to build those reserves of self-love and the
capability for self-love, which enable them to survive the inevitable
rejections and humiliations which even the most fortunate of people cannot
avoid (p. 47).
Violence and aggression
Violence can be broadly dened as behaviour intended to cause harm.
Howells and Hollin (1989) dene aggression and violence thus:
aggression refers to the intention to hurt or gain advantage over other people,
without necessarily involving physical injury; violence involves the use of
strong physical force against another person, sometimes impelled by aggressive
motivation. (p. 4)
There is a continuum of violent behaviour which includes verbal

behaviour, through direct physical violence, to extreme forms of violence.
Of course, not all violence is criminal or maladaptive; there are situations in
which violence can be seen as an acceptable and legitimate response to
certain situations such as abuse, oppression, or in response to another crime.
In this article, our focus is mainly on violence, in particular criminal
violence, but where there have not been studies we also look at work on
aggression. We also refer mainly to interpersonal violence induced by anger
or rage (reactive) rather than indirect, instrumental or collective violence.
While we recognise the relevance of anger as a precursor to violence
(Novaco, 1994), we also agree with Novaco and Welshes (1989) point that it
is neither necessary nor sucient for violence. As we discuss below, it may
be that dangerous levels of anger only occur with the additional trigger of
humiliation, which is self-referent and more powerful when self-esteem is
compromised.
Self-esteem and self-concept
Self-esteem is usually described as a persons evaluation of themselves or
their attitude towards themselves. Tafarodi and Swann (2001) proposed two
key dimensions of self-esteem, namely self-competence and self-liking.
However, in their comprehensive review, Pyszczynski, Greenberg, Solomon,
Arndt and Schimel (2004) delineated a number of dierent types of selfesteem that various theorists have presented, including: implicit (private or
unconscious) vs. explicit (publically presented); contingent (based on a
particular competence or quality) vs. non-contingent; authentic vs. false;
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stable vs. unstable; global vs. domain specic. They argued that, despite
dierences in how self-esteem is presented by authors, the core underlying
theme is that people are motivated to achieve and maintain high self-esteem
and to defend their self-esteem when it is threatened. The point here is that,
although the term self-esteem is often presented as a unied and simple
dimensional concept, it is actually far more complex, multidimensional and
dynamic than our common usage of the term would suggest, given that we
tend to only talk simplistically about people having high or low self-esteem.
It is this fundamental linguistic error that has led to the false dichotomisation of research questions about the relationship of self-esteem to violence.
Broadly speaking there are two positions, the rst being that low self-esteem
relates to violence (Gilligan, 1996) and the opposite being that high selfesteem relates to violence (Bushman et al., 2009).
Violence and self-esteem
There are two recent reviews of self-esteem and violence. The rst by Walker
and Bright (2009a) reported on 19 studies, 12 of which found low self-esteem
related to violence, ve found no relationship, one found high self-esteem
related to violence and one reported a curvilinear relationship in which both
high and low self-esteem were related to violence. A similar pattern was
found when only studies with oenders were considered, but oender studies
used relatively small samples. Six studies found high narcissism to be related
to violence. Walker and Bright (2009a) noted that there were signicant
problems reliably measuring self-esteem, but nonetheless the low self-esteem
hypothesis prevailed. They suggested that self-esteem may be falsely inated,
as described by Salmivalli (2001), in that self-esteem may actually be low, but
be presented as high, resulting in high scores on simple measures of selfesteem. It is important to distinguish between narcissism (superiority and
thinking you are much better than others) and healthy high self-esteem
(recognising your strengths and qualities and having a good view of yourself).
The second narrative review by Ostrowsky (2010) described the key issues
that have resulted in inconsistent and inconclusive ndings. First, he too
identied problems with measuring self-esteem, noting that self-esteem is a
multidimensional rather than a unitary concept and that self-esteem may be
unstable. Second, he suggested that dierent types of violence are associated
with dierent self-esteem structures; reactive aggression is associated with
lower self-esteem and instrumental aggression with high self-esteem. Finally,
much of the research is cross-sectional, done with university students,
looking for linear relationships and does not disentangle gender dierences.
However, Ostrowsky (2010) seems to conate the idea of narcissism with
high self-esteem, which we believe over-simplies the factors involved.
Baumeister, Bushman and Campbell (2000) have long been proponents
of the view that low self-esteem is not related to violence; they also
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questioned the hidden nature of low self-esteem presented by proponents of

that position. They argue that the emotion processes involved in egotistical
violence also need to be illuminated: How exactly do the shameful feelings of
being criticized transform into aggressive outbursts, and does aggression
genuinely make the aggressor feel better? (p. 29). Bushman et al. (2009)
reanalysed one of their earlier studies on undergraduates, taking into
account not only self-esteem, but also narcissism. They found no evidence of
the independent eect of self-esteem on aggression, but found that students
with high self-esteem combined with high narcissism who had also been
insulted were the most aggressive. Narcissism is discussed in more detail
below, but it may be that the nature of self-esteem measurement and selfpresentation in narcissism, along with the oversimplication of the concept
of self-esteem and the diculty of measuring unconscious defences, explains
why such apparently mixed evidence has emerged over the years and why
experts on the topic seem unable to agree.
The role of narcissism
Theories of narcissism have emphasised two main themes: grandiosity and
vulnerable aects and self-states (see Logan, 2009 for an in-depth review of
narcissism). Research examining the structure of narcissistic personality
traits also consistently nds these two broad factors (Cain, Pincus, & Ansell,
2008). However, vulnerable aects and self-states have been overlooked
within the psychiatric eld, in particular within the DSM-IV criteria for
narcissistic personality disorder. We would argue that this aspect of
narcissism is fundamental to understanding the processes underlying
narcissistic rage and to the mechanisms underlying some forms of violence.
A number of theorists have suggested that narcissism is a form of selfesteem regulation (Kernberg, 1975; Kohut, 1972). A central feature of
narcissism is considered to be the dissociation between an unconscious sense
of inadequacy and conscious feelings of superiority. Self-enhancement and
grandiosity are therefore seen as strategies to regulate inner feelings of
inadequacy (including feelings of embarrassment, shame and humiliation)
by countering these with feelings of superiority, thereby allowing an
individual to maintain a sense of pride and self-esteem. This has more
recently been described as the dierence between low implicit self-esteem
and high explicit self-esteem (Tafarodi & Ho, 2006). Robins, Tracey and
Shaver (2001) suggested that narcissists, more than other individuals, are
motivated to seek out situations in which they can feel pride, and avoid
situations where they might experience shame or humiliation.
Robins et al. (2001) argued that narcissists dier from depressed
individuals with low self-esteem because they actively try to regulate shame
experiences. Narcissists may reappraise an event that is threatening to their
sense of self by projecting the responsibility onto something or someone else,
730
leading to feelings of anger and hostility. The sense that ones status has
gone down in the eyes of another is aversive and damaging to the self, and
generates feelings of anger and hostility which are directed towards the
perceived disapproving other. When one feels humiliated the perceived
humiliator becomes an obvious target for this hostility and aggression. With
shame experiences, internal feelings of shame are projected outward onto an
imagined disapproving or critical other. From a social hierarchy perspective,
anger and aggression can be viewed as a defence against feelings of shame
and humiliation, since they signal power and dominance and move the
individual up the social hierarchy (Gilbert, 1997; Gilbert & McGuire, 1998),
restoring any damage created by the humiliation experience.
Shame, anger and aggression
An early observation of the link between shame and anger was Lewiss
seminal work (1971), in which she reviewed the emotional content of several
hundred psychotherapy transcripts. More recently, Ray, Smith and Wastell
(2004) carried out a detailed analysis of interviews with racist oenders, in
which they examined verbal, visual and paralinguistic markers of shame.
They observed a high number of shame markers during discussions about
the oenders racist violence. Similar ndings have also been reported in
analyses of marital disputes (Retzinger, 1991). Gilligan (1996) interviewed
over a hundred men who had been convicted for violent crimes, and
reported that the majority described their motivation for violence being to
restore their pride and self-esteem after being shamed or disrespected.
Quantitative evidence in this area largely comes from correlational
studies. These have generally examined student populations, with only a
small number of investigations in oending or psychiatric samples.
Tangney, Wagner, Fletcher and Gramzow (1992) investigated shame, anger,
hostility and aggression in a large student sample, and found that shame was
positively correlated with anger arousal and indirect hostility. Similar results
were found in a series of further studies by Tangney, Wagner, Hill-Barlow,
Marschall and Gramzow (1996), however, other researchers have failed to
replicate their ndings (Lutwak, Panish, Ferrari, & Razzino, 2001). In
oending populations, Milligan and Andrews (2005) found a positive
association between levels of shame and anger in a sample of female
oenders, however, this was not detected in a similar study of young male
oenders (Farmer & Andrews, 2009).
A cognitive model of violence
The ideas presented so far are central to our own model of violence (Walker
& Bright, 2009a), which views violent behaviour as an attempt to protect the
self from further injury (humiliation) and against a perceived lowering of
731
self-worth, therefore, restoring a sense of self-worth and pride. We put

forward a cognitive formulation of violence which outlines the possible
paths for the development of low self-esteem, vulnerability to embarrassment, and the use of violence to manage self-esteem and maintain a sense of
pride. We suggested that traumatic experiences in childhood (e.g. violent
and sexual abuse) result in the development of core beliefs that the
individual is vulnerable and weak. These beliefs are well hidden, painful, and
often well covered with a veneer of condence and aggression, giving the
appearance of an arrogant exterior. Social situations which generate
embarrassment are potent, because this emotion combines painful elements
of fear and anxiety with powerful negative self-evaluation; the individual
feels foolish and, more importantly, made to look like a fool by someone
who is then deserving of punishment. Certain dysfunctional assumptions,
exemplied in the machismo items of the Maudsley Violence Questionnaire
(MVQ; Walker, 2005), link with and manage this vulnerability to the eects
of embarrassment, for example: Embarrassment is a sign of weakness if I
feel embarrassed I must show that I am strong; I must not allow people to
show me disrespect as this shows I am not worthy of respect. Thus, when
potentially threatening situations arise and core beliefs of stupidity and
weakness are activated, these rules allow the individual to counteract and
discharge the associated feelings. Furthermore, the threat can be averted by
attacking rst. Violent behaviour allows the perpetrator to express and
discharge unpleasant feelings associated with this threat, whilst simultaneously injuring the victim who provoked the assault, therefore, demonstrating strength to others and restoring some level of pride (saving face).
Walker and Gudjonsson (2006) and Warnock-Parkes, Gudjonsson and
Walker (2008) demonstrated that the dysfunctional assumptions linked to
aggression by Walker and Bright (2009a) were indeed associated with
violence in both general and oender populations. This is perhaps not
surprising given that the dysfunctional assumptions or rules making up the
items of the Machismo scale of the MVQ were derived directly from violent
oenders who were asked during the course of therapy to identify their rules
for the justied use of violence.
Psychopathy and self-conscious emotions
In their chapter on Ten Subtypes of Psychopath, Millon and Davis (1998)
refer to the explosive psychopath discharging pent up feelings of humiliation
through violence. However, this is the only reference in this well-respected
textbook to the psychopaths feelings of humiliation. References to
psychopaths using the humiliation of others for their own satisfaction are
far more commonplace. In fact, Hare (1999) argues that psychopaths are
relatively insensitive to humiliation and more likely to feel pride. Morrison
and Gilbert (2001) conducted one of the only studies of shame and anger in
732
a forensic setting, examining a group of 50 patients detained in high security

under the legal classication of psychopathic disorder. In this study, primary
and secondary psychopaths (Blackburn, 1975) were found to dier. Primary
psychopaths showed unexpectedly high internalised shame but assumed a
dominant and threatening approach, whereas secondary psychopaths
showed even higher internalised shame, more negative self-evaluations and
(despite seeking dominance) were more sensitive to attacks. The importance
of these ndings in the context of the general literature presenting
psychopaths as proud and arrogant is that they are highly sensitive to shame
and humiliation, but counteract this vulnerability through the use of
dominance, threats and aggression. Thus aggression becomes the perfect
macho cover up for negative self-conscious emotions, such as humiliation,
because it appears to show the exact opposite, and can encourage or force
others to back down or become victims (positions associated with shame and
humiliation). Aggression turns the tables for the psychopath from feeling
belittled to gaining dominance without showing weakness or submission. The
prevailing clinical and expert view that psychopaths are impervious to
humiliation warrants review in light of these mechanisms that may not only
explain some forms of psychopathic violence but also suggest possibilities for
intervention.
Sexual violence
There is little emphasis on humiliation within the literature on sexual
oending, however, some consideration is given to the role shame might play
within the cycle of sexual oending. In contrast to the ideas presented so far,
where shame and humiliation have been avoided or regulated through
violence, in sexual oending it is the sense of shame that an individual
experiences following an oence that is thought to be signicant, particularly
in triggering re-oending. In their review of shame and guilt in sexual
oenders, Proeve and Howells (2002) noted that there is a body of literature
(e.g. Bumby, 2000; Roys, 1997) which suggests that shame inhibits empathy,
since the focus on the self reduces the ability for perspective taking and
experiencing the emotions of others. This impairment in empathy may
increase the risk of oending. Bumby, Marshall and Langton (1999) have
oered a theoretical model of the inuence of shame and guilt on sexual
oending. They suggest that the shame experienced following sexual
oending results in decreased self-ecacy, decreased ability to use adaptive
coping strategies, increased personal distress, externalisation of blame,
increased cognitive distortions and decreased victim empathy, all of which
increase the risk of re-oending. They recommended that treatment
approaches should emphasise guilt rather than shame, since experiences of
guilt are thought to result in an examination of the eects of oences on
victims, reparative action and an ability to identify adaptive coping
responses. This can, however, present a paradox in treating sexual oenders,
733
since attending a group in which individuals are expected to publicly

describe their past transgressions may in itself be an acutely painful
experience for some members.
Clinical practice
Assessment interviewing
Walker and Bright (2009b) reviewed assessments of violent oenders and
suggested that, despite having been overlooked in the risk assessment
literature, self-esteem, self-concept and sensitivity to humiliation are key
aspects to assess and understand. In our experience, it is extremely dicult to
assess an individuals experience of or sensitivity to humiliation because of
masking. This means that such issues only become open to assessment after
the development of a trusting therapeutic relationship, which is often not
possible in a couple of assessment sessions. The ability to detect these issues in
assessment relies on the knowledge, experience and calmness of the clinician,
because violent individuals can be anxiety provoking and even threatening
during assessment. The clinician also has to rely on interpretation of covering
emotions such as anger, hostility, frustration and disillusionment, which may
be clues to the oenders underlying self-view. It is potentially unsafe to test
the interviewees sensitivity to humiliation through direct challenge, and this
may also reduce rapport, making assessment more dicult. In our view, a
more subtle approach works best by allowing the respondent to feel
comfortable to express and even show o their ideas and rules for violence,
which will then give some indication about their sensitivity to insults and
threats in social situations. This technique of looking for themes in the
oenders discourse is common to both forensic and clinical psychology and
is helpful for assessing core beliefs that may initially be inaccessible to
conscious reection and discussion (Walker & Bright, 2009b).
If our formulation is correct, the arrogance and aggression seen in social
and clinical situations are the consequences of low self-esteem which is
brittle, unstable and falsely inated in a way that is protective or defensive.
This fragility and brittleness should be observable clinically as someone who
is unable to tolerate criticism or disagreement, particularly when they are
unable to resolve disagreements through dominance. This is dierent to the
ability to build rapport; they may be able to build rapport, and even do this
well, particularly when this is done on their terms or they are given the
respect and admiration they believe they deserve (e.g. allowing them to boast
about past criminal oending to facilitate history taking).
Psychometric assessment
Formal assessment instruments are dicult to recommend for a number of
reasons. The rst and most dicult problem relates to masking and
the tendency of individuals to hide feelings of humiliation, shame and low
734
self-esteem, perhaps even presenting the opposite. Second, despite a number

of measures for self-esteem, shame and narcissism, they have unproven
validity and reliability with forensic populations. Finally, some measures
can prove dicult to understand for respondents who have reading
diculties, which are common in oenders. Any assessment using measures
should take into consideration these threats to the reliability and validity of
assessments.
The MVQ (Walker, 2005) was designed to measure explicit views about
when violence and aggression are acceptable in dicult or potentially
humiliating social situations. The machismo subscale items relate to:
embarrassment over backing down, justication of violence in response
to threat and attack, violence as part of being male and strong and the
weakness associated with fear and non-violence (p. 195). Walker (2005)
suggested that these beliefs potentiate violence as a response in threatening
(including psychologically threatening) situations. Such beliefs (rules or
dysfunctional assumptions) are far easier to assess than core beliefs about
the self because they are explicitly held and most oenders see them as
legitimate rather than beliefs to be hidden or denied.
There is no measure of falsely-inated self-esteem and many popular
self-esteem measures include no measure of socially desirable responding, or
assess self-esteem as a unitary rather than multifaceted concept making them
too simplistic (e.g. Crandal, 1973; Rosenberg, 1965). Salmivalli (2001)
highlighted that a high score on a self-esteem measure can mean several
things: that the person has a genuine acceptance of themselves and feels
worthwhile (genuine high self-esteem); that the person consciously wishes to
convey a high view of themselves despite feeling bad underneath (falsely
inated self-esteem); that they are responding as they believe the researcher
wants them to (social desirability); or that they are defensively keeping up a
sense of high self-esteem despite underlying self-doubts or unconscious low
self-esteem (narcissism). These factors make self-esteem even in the general
population dicult to measure, but particularly so in extreme or unusual
populations.
The assessment of shame (Andrews, Qian, & Valentine, 2002; Tangney,
Wagner, & Gramzow, 1989) and narcissism (Raskin & Terry, 1988) also
requires a balance of insight and honesty which may be lacking in extreme
populations. We would always recommend the concurrent use of validity
scales, such as the Paulhus Deception Scale (Paulhus, 1998) or personality
questionnaires that incorporate a validity prole. The Personality Assessment Inventory (PAI; Morey, 1991) includes several validity scales along
with clinical and treatment scales. The PAIs two interpersonal subscales
(dominance and warmth), a grandiosity subscale (under mania), and a selfesteem proxy in the identity problems subscale (part of borderline
personality disorder features), in conjunction with the aggression subscale
can be useful with forensic patients, especially violent oenders. The Millon
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Clinical Multiaxial Inventory-III (MCMI-III; Millon, Millon & Davis,

1994) includes a subscale specically measuring narcissism, the interpretation of which is modied by the validity scales. The Dimensional Assessment
of Personality Pathology (DAPP; Livesley & Jackson, 2002) also includes a
specic narcissism scale as one of its core dimensions, and is also a selfreport questionnaire.
Engagement techniques
Based on the formulation that arrogance is defensive and a response to low
self-esteem that is not entirely within self awareness, the interviewee is unlikely
to reveal any misgivings or negative evaluations of their self view. This can be
the case even in the context of a trusting relationship, but the development of
a therapeutic relationship over multiple sessions can facilitate the discussion
of more deeply held ideas about the self which cannot be openly disclosed or
thought about during initial sessions. In practice, we often use self-esteem
boosting prefaces to questions that may appeal to the interviewees arrogance
but also allow them to open up about their diculties, for example: You
dont seem to be physically scared of anyone, but sometimes it seems as if you
lack self condence or feel bad about yourself. This can be experienced as
quite a challenging interpretation and should be oered with care, recognising
that the interviewee may struggle to converse about such intimate issues. If the
interviewee does have some verbal uency, then Socratic approaches or
downward arrow techniques are useful and less likely to introduce suggestions
by the interviewer that may inuence the interviewees responses. It is also
worth attending to gaze and body positioning; a person who is talking
aggressively, but not giving eye contact or who is turned away, may be
indicating shame. This does not mean they are not potentially dangerous
quite the contrary but it does mean that the route to helping them to calm
down and reduce the risk of imminent aggression may be to show clear respect
as well as clear boundaries. It should always be taken into consideration that a
person who is experiencing intense anger, shame and/or humiliation will be
unlikely to process information well, and will have a reduced capacity to
process information compared to their baseline state. With an interviewee in
this state, comments to them should be brief, simple, unambiguous, reassuring
and respectful.
With sexual oenders, because their oences are taboo, there is always
the possibility of humiliation during disclosure; this can lead to an increase
in compensatory perverse fantasies and perhaps oending, rather than a
decrease in oending because the perpetrator feels bad. It is important not
to expect oenders to think in the same way as well-educated clinicians do
about crime and abuse. Techniques such as rolling with resistance and
validation should be core clinical skills for assessment and treatment of
oenders as well as the ability to challenge and modify cognitions.
736
Intervention strategies
Elison and Harter (2007) argued that in males whose problematic behaviour
is underpinned by humiliation problems, their early development and
socialisation into the male code (dominance and retaliation versus
weakness and vulnerability) need to be addressed as well as identifying the
precise emotion underpinning the problematic behaviour. Their research on
students suggested that humiliation was a far stronger correlate of
aggression than any other self-conscious emotion and thus warranted
more than the almost absent focus in research to date.
A number of interventions are used for violence where emotion
regulation problems are prominent, including dialectical behaviour therapy
(Linehan, 1993) and mentalisation based therapy (Bateman & Fonagy,
2004). Anger management is used where there are specic problems in
recognising, discharging and coping with anger, with assertiveness training
often being part of anger management (Williams & Barlow, 1998). Any
approach that helps the individual to cope better with negative emotions
and increases their ability to think, reect and tolerate self-conscious
emotions suciently to examine them is likely be an important component
of treatment. However, there are no adequately controlled studies of the
eect of such treatments on oenders and their oending.
There are also specic, often cognitive, approaches for working with selfesteem (see Fennell, 1998), which tend to focus on the modication of
negative perceptual and interpretative self-referent biases in information
processing. Walker and Bright (2009b) also emphasise the importance of
validation as an intervention: Validation of the problem of violence is often
experienced as unusual for patients, who tend to be denigrated by
themselves (privately) and others (publicly), and thus a collaborative
understanding of the problem creates a containing rst stage on which to
build later more challenging interventions (p. 181). A collaborative understanding or formulation is a typical rst step in any cognitive behavioural
intervention, and with violent oenders who are sensitive to humiliation this
needs to be undertaken carefully. The causes of humiliation may have
themes in some cultures (e.g. oenders) but may vary considerably between
genders and cultures and even within cultures. With respect to the building
of positive self-referent or protective structures, Walker and Bright (2009b)
note that with healthy self-esteem, inhibiting factors including guilt and
empathy are not suppressed and can be allowed to aect behaviour. If one
has robust and positive self-esteem, insults are less painful and so there is
less pressure (rage) to respond actively (p. 8).
Gilbert and Ironss (2005) compassionate mind training also ts with the
theoretical underpinnings discussed, although evidence for eectiveness with
oenders is lacking. Compassionate mind training may serve to reduce
dissatisfaction with the self and increase resilience to criticism by others,
thereby reducing anger and aggression. This approach also contributes to the
737
re-evaluation and acceptance of the self with possible consequent improvement in self-esteem. All this has to be undertaken in the context of dealing
with forensic patients who are often diagnosed with personality disorders, so
all the usual caveats about chronicity, rigidity and resistance along with
counteracting techniques from therapists (enthusiasm, collaboration, dimensional thinking, attention to the therapeutic relationship and supervision)
inevitably apply (Allen, 1997; Beck, Freeman, & Davis, 2004; Walker &
Hayward, 2007).
Conclusions
It is perhaps paradoxical that oversensitivity to humiliation can be so
acute that some individuals may cover their experiences with opposites
such as arrogance and aggression. This can make problems with selfconscious emotions particularly dicult to identify and work with. We
have re-evaluated the traditional clinical and expert views that psychopaths
and violent individuals are more resilient than others in the face of
humiliation, but rather take the view that aggression and violence are a
macho cover up for a deeply held vulnerability to humiliation. The
structure that goes with this is false inated self-esteem described by
Salmivalli (2001), which appears as arrogance as opposed to true high selfesteem. The threat of violence coupled with the masking of the true
underlying self-conscious emotions makes this an extremely challenging
area for clinicians and researchers alike, so we have tried to combine some
existing ideas from forensic psychology and approaches to personality
disorder with our own clinical experience and suggested assessment and
intervention strategies.
We agree with Elison and Harters (2007) ndings that humiliation is a
more common trigger for violence than other self-conscious emotions and
that the socialisation of men may be an important factor in the development
of the vulnerability to humiliation and the compensatory strategy of violence.
We also agree with them that this area is neglected by empirical research.
Future work needs to further test the hypothesised mechanisms we have
described, to trial suggested treatments using robust methods (such as
randomised controlled trials) and to nd new and sophisticated ways for
evaluating self-esteem proles and the self-conscious emotions. In assessment
technology, increased research attention could be given to the development
of implicit measures in order to get behind false inated self-esteem to the
underpinning self-referent beliefs. We also take the view that simple scalable
interventions are likely to be more practical, cost eective and equitable than
lengthy specialised forms of therapy and perhaps computer-based approaches may have something to oer in this respect. Finally, we believe
clinicians should be aware of the issues raised in this article in the hope that
this may improve their formulations, the sophistication of their assessments
and the ecacy of their work with violent oenders.
738
References
Allen, D.M. (1997). Techniques for reducing therapy-interfering behavior in patients
with borderline personality disorder: Similarities in four diverse treatment
paradigms. Journal of Psychotherapy Practice and Research, 6, 2535.
Andrews, B., Qian, M., & Valentine, J.D. (2002). Predicting depressive symptoms
with a new measure of shame: The Experience of Shame Scale. British Journal of
Clinical Psychology, 41, 2942.
Bateman, A.W., & Fonagy, P. (2004). Mentalization-based treatment of BPD.
Journal of Personality Disorders, 18, 3651.
Baumeister, R.F., Bushman, B.J., & Campbell, W.K. (2000). Self-esteem, narcissism,
and aggression: Does violence result from low self-esteem or from threatened
egotism? Current Directions in Psychological Science, 9, 2629.
Beck, A.T., Freeman, A., & Davis, D. (2004). Cognitive therapy of personality
disorders (2nd ed). New York, NY: Guilford Press.
Blackburn, R. (1975). An empirical classication of psychopathic personality. British
Journal of Psychiatry, 127, 456460.
Bumby, K.M. (2000). Empathy inhibition, intimacy decits, and attachment
diculties in sex oenders. In D.R. Laws, S.M. Hudson, & T. Ward (Eds.),
Remaking relapse prevention with sex oenders: A sourcebook (pp. 143166).
Thousand Oaks, CA: Sage.
Bumby, K.M., Marshall, W.L., & Langton, C. (1999). A theoretical model of the
inuences of shame and guilt on sexual oending. In B.K. Schwartz (Ed.), The
sex oender: Theoretical advances, treating special populations and legal
developments (pp. 112). Kingston, NJ: Civic Research Institute.
Bushman, B.J., Baumeister, R.F., Thomaes, S., Ryu, E., Begeer, S., & West, S.G.
(2009). Looking again, and harder, for a link between low self-esteem and
aggression. Journal of Personality, 77, 427446.
Cain, N.M., Pincus, A.L., & Ansell, E.B. (2008). Narcissism at the crossroads:
Phenotypic description of pathological narcissism across clinical theory, social/
personality psychology, and psychiatric diagnosis. Clinical Psychology Review,
28, 638656.
Crandal, R. (1973). The measurement of self-esteem and related constructs. In J.P.
Robinson & P.R. Shaver (Eds.), Measures of social psychological attitudes
(pp. 8082). Revised edition. Ann Arbor, MI: Institute for Social Research.
Elison, J., & Harter, H. (2007). Humiliation: Causes, correlates and consequences. In
J. Tracy, R. Robbins, & J. Price Tangney (Eds.), The self-conscious emotions:
Theory and research. New York, NY: Guildford Press.
Farmer, E., & Andrews, B. (2009). Shameless yet angry: Shame and its relationship
to anger in male young oenders and undergraduate controls. Journal of Forensic
Psychiatry and Psychology, 20, 4865.
Fennell, M.J. (1998). Cognitive therapy in the treatment of low self-esteem. Advances
in Psychiatric Treatment, 4, 296304.
Gilbert, P. (1997). The evolution of social attractiveness and its role in shame,
humiliation, guilt and therapy. British Journal of Medical Psychology, 70, 113147.
Gilbert, P., & Irons, C. (2005). Therapies for shame and self-attacking,
using cognitive, behavioural, emotional, imagery and compassionate mind
training. In P. Gilbert (Ed.), Compassion: Conceptualisations, research and use in
psychotherapy (pp. 263325). London: Routledge.
Gilbert, P., & McGuire, M. (1998). Shame, social roles and status:
The psychobiological continuum from monkey to human. In P. Gilbert & B.
Andrews (Eds.), Shame: Interpersonal behavior, psychopathology and culture (pp.
99125). New York, NY: Oxford University Press.
739
Gilligan, J. (1996). Violence: Reections on a national epidemic. New York, NY:

Vintage Books.
Hare, R.D. (1999). Without conscience: The disturbing world of the psychopaths
among us. New York, NY: Guilford Press.
Howells, K., & Hollin, C.R. (1989). Clinical approaches to violence. Chichester, UK:
Wiley.
Kernberg, O. (1975). Borderline conditions and pathological narcissism. New York,
NY: Jason Aronson.
Klein, D.C. (1991). The humiliation dynamic: Viewing the task of prevention from a
new perspective. Journal of Primary Prevention, Part I, 12(2), 93121.
Kohut, H. (1972). Thought on narcissism and narcissistic rage. The Psychoanalytic
Study of the Child, 27, 360400.
Lazare, A. (1987). Shame and humiliation in the medical encounter. Archives of
Internal Medicine, 147, 16531658.
Lewis, H.B. (1971). Shame and guilt in neurosis. New York, NY: International
Universities Press.
Lewis, M. (1992). Shame: The exposed self. New York, NY: Free Press.
Linehan, M.M. (1993). Cognitive-behavioural treatment of borderline personality
disorder. New York, NY: Guildford Press.
Livesley, W.J., & Jackson, D.N. (2002). Manual for the Dimensional Assessment of
Personality Pathology Basic Questionnaire (DAPP-BQ). Port Huron, MI:
Sigma Press.
Logan, C. (2009). Narcissism. In M. McMurran & R.C. Howard (Eds.), Personality,
personality disorder and violence (pp. 85112). Chichester, UK: Wiley.
Lutwak, N., Panish, J.B., Ferrari, J.R., & Razzino, B.E. (2001). Shame and guilt and
their relationship to positive expectations and anger expressiveness. Adolescence,
36, 641653.
Miller, R.S. (1996). Embarrassment: Poise and peril in everyday life. New York, NY:
Guildford Press.
Milligan, R.J., & Andrews, B. (2005). Suicidal and other self-harming behaviour in
oender women: The role of shame, anger and childhood abuse. Legal and
Criminological Psychology, 10, 1325.
Millon, T., & Davis, R.D. (1998). Ten subtypes of psychopathy. In T. Millon, E.
Simonsen, M. Birket-Smith, & R. Davis (Eds.), Psychopathy: Antisocial, criminal
and violent behaviour (pp. 161170). New York, NY: Guildford Press.
Millon, T., Millon, C., & Davis, R.D. (1994). Millon Clinical Multi-Axial Inventory
III. Minneapolis, IL: National Computer Systems.
Morey, L.C. (1991). Personality Assessment Inventory: Professional manual. Lutz,
FL: Psychological Assessment Resources Inc.
Morrison, D., & Gilbert, P. (2001). Social rank, shame and anger in
primary and secondary psychopaths. Journal of Forensic Psychiatry, 12, 330
356.
Novaco, R.W. (1994). Anger as a risk factor for violence among the mentally
disordered. In J. Monahan & H.J. Steadman (Eds.), Violence and mental disorder
(pp. 2159). Chicago, IL: University of Chicago Press.
Novaco, R.W., & Welsh, W.N. (1989). Anger disturbances: Cognitive mediation and
clinical prescriptions. In K. Howells & C. Hollin (Eds.), Clinical approaches to
violence (pp. 3660). Chichester, UK: Wiley.
Ostrowsky, M.K. (2010). Are violent people more likely to have low self-esteem or
high self-esteem? Aggression and Violent Behavior, 15, 6975.
Paulhus, D.L. (1998). Paulhus Deception Scales (PDS): The Balanced Inventory of
Desirable Responding 7. New York, NY: Multi-Health Systems Inc.
740
Proeve, M., & Howells, K. (2002). Shame and guilt in child sexual oenders.
International Journal of Oender Therapy and Comparative Criminology, 46, 657
667.
Pyszczynski, T., Greenberg, J., Solomon, S., Arndt, J., & Schimel, J. (2004). Why do
people need self-esteem? A theoretical and empirical review. Psychological
Bulletin, 130, 435468.
Raskin, R., & Terry, H. (1988). A principal-components analysis of the Narcissistic
Personality Inventory and further evidence of its construct validity. Journal of
Personality and Social Psychology, 81, 524539.
Ray, L., Smith, D., & Wastell, L. (2004). Shame, rage and racist violence. British
Journal of Criminology, 44, 350368.
Retzinger, S. (1991). Violent emotions: Shame and rage in marital quarrels. Newbury
Park: Sage.
Robins, R.W., Tracy, J.L., & Shaver, P.R. (2001). Shamed into self-love: Dynamics,
roots, and functions of narcissism. Psychological Inquiry, 12, 230236.
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ:
Princeton University Press.
Roys, D.T. (1997). Empirical and theoretical considerations of empathy in sex
oenders. International Journal of Oender Therapy and Comparative Criminology, 41, 5364.
Salmivalli, C. (2001). Feeling good about oneself, being bad to others? Remarks on
self-esteem, hostility, and aggressive behaviour. Aggression and Violent
Behaviour, 6, 375393.
Tafarodi, R.W., & Ho, C. (2006). Implicit and explicit self-esteem: What are we
measuring? Canadian Psychology, 47, 195202.
Tafarodi, R.W., & Swann, W.B. (2001). Two-dimensional self-esteem: Theory and
measurement. Personality and Individual Dierences, 31, 653673.
Tangney, J.P., Miller, R.S., Flicker, L., & Barlow, D.H. (1996). Are shame, guilt, and
embarrassment distinct emotions? Journal of Personality and Social Psychology,
70, 12561269.
Tangney, J.P., Wagner, P., Fletcher, C., & Gramzow, R. (1992). Shamed into anger?
The relation of shame and guilt to anger and self-reported aggression. Journal of
Personality and Social Psychology, 62, 669675.
Tangney, J.P., Wagner, P., & Gramzow, R. (1989). The test of self-conscious aect.
Fairfax, VA: George Mason University.
Tangney, J.P., Wagner, P.E., Hill-Barlow, D., Marschall, D.E., & Gramzow, R.
(1996). Relation of shame and guilt to constructive versus destructive responses
to anger across the lifespan. Journal of Personality and Social Psychology, 70,
797809.
Walker, J.S. (2005). The Maudsley Violence Questionnaire: Initial validation and
reliability. Personality and Individual Dierences, 38, 187201.
Walker, J., & Bright, J. (2009a). Self-esteem and violence: A systematic review and
cognitive model. Journal of Forensic Psychiatry and Psychology, 20, 132.
Walker, J., & Bright, J. (2009b). Cognitive therapy for violence: Reaching the parts
that anger management doesnt reach. Journal of Forensic Psychiatry and
Psychology, 20, 174201.
Walker, J., & Gudjonsson, G.H. (2006). The Maudsley Violence Questionnaire:
Relationship to personality and self-reported oending. Personality and
Individual Dierences, 40, 795806.
Walker, J., & Hayward, P. (2007). Treatment of personality disorder. In S. Lindsey &
G. Powell (Eds.), The handbook of clinical adult psychology (pp. 415435).
London: Routledge.
741
Warnock-Parkes, E., Gudjonsson, G., & Walker, J. (2008). The relationship between
the Maudsley Violence Questionnaire and ocial recordings of violence
in mentally disordered oenders. Personality and Individual Dierences, 44,
833841.
Williams, E., & Barlow, R. (1998). Anger control training. Oxford, UK: Winslow
Press Limited.
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