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Intimate partner violence: A narrative review of

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Contents lists available at SciVerse ScienceDirect

Aggression and Violent Behavior

Intimate partner violence: A narrative review of the biological and

psychological explanations for its causation
Parveen Azam Ali a,, Paul B. Naylor b
a
Faculty of Health and Social Care, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
b
Faculty of Social Sciences, The Open University, UK

a r t i c l e i n f o a b s t r a c t

Article history: Intimate partner violence (IPV) is a major social and public health problem that affects men and women
Received 2 September 2012 across the globe regardless of their culture, religion and other demographic characteristics. During the last
Received in revised form 31 December 2012 100 years many different theories have been proposed to explain the phenomenon of IPV. Much research
Accepted 15 January 2013
is been conducted using these theories as a guiding or underlying framework. However, it is difcult to
Available online 9 February 2013
nd a single account that provides a succinct and up-to-date overview of these theories. As a result consid-
Keywords:
erable effort is required to identify and retrieve relevant papers to understand the various theories which at-
Intimate partner violence (IPV) tempt to explain IPV. This article attempts to provide a succinct and up-to-date integrative review of the
Domestic violence biological and psychological explanations of IPV. Both perspectives have been critically evaluated in the
Theoretical perspective light of the available literature and an attempt has been made to discuss the strengths and limitations of
Biological explanations each perspective in shedding light on the causation of IPV.
Psychological explanations 2013 Elsevier Ltd. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
3. Findings and discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
3.1. The biological perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
3.1.1. Head injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
3.1.2. Neurotransmitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
3.1.3. Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
3.2. The psychological perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
3.2.1. Psychopathology and personality theories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
3.2.2. Attachment theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
3.2.3. Anger/hostility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
3.2.4. Self-esteem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
3.2.5. Communication skills and assertiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
3.2.6. Substance and alcohol abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
4. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379

1. Introduction between intimate partners is dened as intimate partner violence

The word violence is derived from the Latin word vis, referring
to the use of force and physical supremacy against another person
(Casique & Furegato, 2006). Violence or patterns of abusive behaviors
Corresponding author.
E-mail addresses: p.ali@hull.ac.uk (P.A. Ali), p.b.naylor@open.ac.uk (P.B. Naylor).
(IPV) (Toro-Alfonso & RodrIguez-Madera, 2004). IPV is often thought
to be violence against women (VAW) perpetuated by men. The rst
term used for such violence was wife beating in the 1856 campaign
for divorce reform in the UK (Heru, 2007, p. 376). Subsequently,
domestic violence became a popular term for such violence perpe-
trated by men against women in intimate relationships.
Today, the terms IPV and domestic violence are often used inter-
changeably, but other terms for such behavior are also used. These

1359-1789/$ see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.avb.2013.01.003
374 P.A. Ali, P.B. Naylor / Aggression and Violent Behavior 18 (2013) 373382

terms include: domestic abuse, intra-family violence, wife abuse, spousal
abuse, wife battering, dating violence, courtship violence, battering,
violence against women and intimate partner abuse (Gelles, 1993;
Saltzman, Fanslow, McMahon, & Shelley, 1999). Use of the term IPV is
not only a recognition of the fact that violence can be perpetuated by
both men and women with no limitation on their marital status or the
heterosexual or homosexual nature of their relationship, but it
also helps to distinguish it from other types of violence such as child
abuse and elderly abuse. Interestingly the World Health Organization
(WHO) (1997) originally did not use such a broad denition of IPV
describing it as the range of sexually, psychologically, and physically
coercive acts used against adult and adolescent women by current or
former male intimate partners. Since then WHO (2002) has broadened
its denition of IPV by acknowledging that it can be perpetrated by
women as well as men as argued in many studies (Anderson, 2002;
Archer, 2000, 2002; Brown, 2004; Capaldi, Kim, & Shortt, 2007;
Capaldi & Owen, 2001; Carney, Buttell, & Dutton, 2007; Hamberger &
Potente, 1994; Straus & Gelles, 1986).
Many explanations for understanding and explaining IPV have been
proposed. These explanations come from a wide range of perspectives
including the biological, psychological, feminist, social learning, and
ecological. However, it is very difcult to nd evidence related to each
of these different perspectives any one article. This paper is an attempt
to present a brief integrative account of biological and psychological
theories that have been proposed to explain IPV. The remaining per-
spectives will be the subject of a further article. Both perspectives
in the present study have been critically evaluated in the light of the
available literature and the strengths and limitations of each perspec-
tive are discussed.
needs, attachment, attachment problems, self-esteem, self-worth, com-
munication, communication skills, communication abilities, interper-
sonal skills, interpersonal abilities, interpersonal communication,
assertiveness, and assertive were used. These terms were used in com-
bination with the terms violence, domestic violence and alternative
terms for IPV including intimate partner violence, intimate partner
abuse, wife abuse, spousal abuse, women abuse, marital violence, and
marital abuse. Table 1 presents examples of key words used, numbers
of articles retrieved and numbers of articles included in the review.
A search was also conducted using Google to identify studies not
published in indexed journals. In addition, the reference list of each
article was also reviewed to identify studies that may not be listed
in databases. Through literature searching 1134 sources (including
primary and secondary sources) were retrieved and scanned, 324
sources (including primary and secondary sources) were reviewed
and 216 sources have been used in this study. Journal articles pub-
lished in English in any journal during the period 19902011 were in-
cluded to obtain only current and relevant literature. However, where
needed classical work from previous years was also incorporated.
Among 216 sources included in this study, 40 sources were published
prior to 1990 (19431989). In addition, secondary sources such as
books were also referred to and included in the review where needed.
The review was conducted section-by-section. Each article and book
was closely read and the main points and ndings, strengths and
limitations of each document were summarized.
3. Findings and discussion
3.1. The biological perspective

The biological perspective of IPV centers on genetic, congenital,

2. Methods
and organic causes of behavior. Consequently, the focus of biological
research is the role of ethology, genetic defects, brain injury, neuropa-
A search was undertaken of four databases: Medline, CINHAL,
thology, brain infections, and medical illnesses affecting brain and
Google Scholar, and PsychInfo. To identify studies related to biological
structural or functional changes in the brain secondary to trauma in
perspective various search terms were used including biological causes,
the development of violent and aggressive behavior (Cunningham
head injury, brain injury, neurotransmitters, androgens, testosterone,
et al., 1998; Johnson, 1996).
serotonin, genetics, genes, genetic factors, genes, and aggression. To
identify studies mentioned under psychological perspective various
search terms including mental disorder, depression, psychopathology, 3.1.1. Head injury
personality disorder, psychological problems, attachment, attachment Head injury is known to have distressing consequences for the sur-
needs, attachment problem, attachment problems, attachment theory, vivor and the family members. While survivors report facing difcul-
anger, aggression, aggressor, aggressiveness, hostility, attachment ties with behavior, anger management, and self-monitoring (Hanks,

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

Terms Alternative terms Articles identied Articles reviewed

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

Explanation of IPV
Biological perspective Biological causes, head injury, brain injury, neurotransmitters, 150 53
androgens, testosterone, serotonin, genetics, genes, genetic factors,
genes and aggression
Psychological perspective Mental disorder, depression, psychopathology, personality disorder, 680 146
psychological problems,
Attachment, attachment needs, attachment problem, attachment 60 26
problems, attachment theory,
Anger, aggression, aggressor, aggressiveness, hostility 30 15
Attachment needs, attachment, attachment problems, 30 10
Self esteem, self worth, self-esteem 26 14
Communication, communication skills, communication abilities, 58 14
interpersonal skills, interpersonal abilities, interpersonal
communication, assertiveness, assertive
Alcohol, alcohol abuse, substance abuse, substance addiction, 100 46
substance misuse, alcohol use, addiction,
Total
 P.A. Ali, P.B. Naylor / Aggression and Violent Behavior 18 (2013) 373382
Temkin, Machamer, & Dikmen, 1999), spouse and family members re-
port changes in the survivor's personality, irritability, rage outbursts
and reduced impulse control as long term consequences of head injury
(Parsons, Carpenter-Hyland, Burright, & Donovick, 1995; Wood, Liossi,
& Wood, 2005). The possible link between head injury and IPV was not
investigated until Rosenbaum and Hoge (1989) found that head injury
was implicated in the 61.3% of their participants (N = 31) who perpe-
trated partner violence. Subsequently, Rosenabum and colleagues,
and others, published numerous studies (Gosling & Oddy, 1999;
Rosenbaum et al., 1994; Warnken, Rosenbaum, Fletcher, Hoge, &
Adelman, 1994) on the association between head injury and IPV.
Collectively, these studies concluded that head injury cannot be the
cause of IPV, but that it might impair the impulse control mechanism
which in turn may increase the risk of aggressive behavior. In addition,
personality changes resulting from head injury may have an impact
on relationship quality which consequently may lead to aggressive
behavior in the head injury survivor.
Research on the impact of brain injury on violent behavior has
limitations since it is severely limited in the extent to which it can ex-
plain all causes of IPV (Holtzworth-Munroe, Smutzler, & Bates, 1997).
For example, it fails to explain why all violent men do not necessarily
have a history of head injury, and why not all men with a history
of head injury are violent towards their intimate partners. Further
research is warranted to better understand the phenomenon and to
testify the association between head injury and IPV.
3.1.2. Neurotransmitters
Understanding the role of androgens, particularly testosterone, is crit-
ical to understand aggression and aggressive behavior (Meyer-Bahlburg,
1981). Researchers have, therefore, tried to link various neurotrans-
mitters, such as testosterone and serotonin, with deviant behaviors.
Testosterone plays an important role in developing and maintaining
masculine attributes in many species (Mazur & Booth, 1998). A positive
association between testosterone and aggression has already been
established in animals, but remains under-investigated and inconclu-
sive in humans (Albert, Walsh, & Jonik, 1993; Archer, 1991). Elevated
testosterone levels have been found in more violent compared with
less violent male prisoners arrested for wife abuse and other crimes
(Archer, 1991, 1994; Bergman & Brismar, 1994; Dabbs, Carr, Frady, &
Riad, 1995; Mazur, 1995). Men with high testosterone levels tend
to be more aggressive, have difculty in maintaining good marital rela-
tionships, are more prone to having extra marital affairs and have lower
quality marital interactions than men with low testosterone levels
(Booth & Dabbs, 1993). Testosterone has also been found to be positive-
ly associated with verbal and physical aggression (Meyer-Bahlburg,
1981; Soler, Vinayak, & Quadagno, 2000), dominance (Gray, Jackson,
& McKinlay, 1991), sensation seeking (Daitzman & Zuckerman, 1980),
depressed occupational achievement (Dabbs, 1992) and criminal, vio-
lent and/or antisocial behavior (Dabbs, Frady, Carr, & Besch, 1987;
Dabbs & Morris, 1990; Dabbs, Ruback, Frady, Hopper, & Sgoutas,
1988). At the same time, a lower level of serotonin is identied as pre-
dictive of impulsive and violent behavior (Badawy, 2003; Burrowes,
Hales, & Arrington, 1988; Tuinier, Verhoeven, & van Praag, 1995;
Virkkunen & Linnoila, 1993). Decreased serotonin levels have also
been found to have a negative effect on mood and behavior whereas
increased serotonin levels have been found to result in improved social
interaction and decreased aggression (Young & Leyton, 2002). Howev-
er, only one study suggested a positive association between serotonin
levels and aggression (Lesch et al., 1996).
Studies examining at the relationship between these neurotrans-
mitters and IPV are not only scarce, but have produced inconsistent
ndings (Archer, 1991; Book, Starzyk, & Quinsey, 2001; Booth &
Dabbs, 1993; Carr, McCormick, & Hariri, 2011). For instance, some
studies report a strong positive association (Soler et al., 2000), some
a moderate or weak association (Archer, 2006; Book et al., 2001;
McKenry, Julian, & Gavazzi, 1995) while some could not identify a
375
relationship at all (Archer, 1991; Archer, Birring, & Wu, 1998;
Campbell, Muncer, & Odber, 1997; Carr & McCormick, 2008). It has
also been noted that there are discrepant ndings within some stud-
ies (Book et al., 2001). For instance, a study reported a positive link
with aggressive behavior in 1213-year-old boys, but could not iden-
tify any association for 1516-year-old boys (Turner, 1994). There-
fore, caution is needed when interpreting ndings, particularly since
many of studies on neurotransmitters have been conducted on ani-
mals. More research is needed to understand the role of neurotrans-
mitters in causing violent and aggressive behavior generally and
IPV, specically. The reciprocal association between testosterone
and aggression noticed in animals needs to be explored in humans
as well (Archer, 1991; Book et al., 2001; Mazur, 1985).
3.1.3. Genetics
Researchers interested in biological mediators of IPV have suggested
a possible genetic contribution to the perpetuation of violence (Hines &
Saudino, 2002; Saudino & Hines, 2007). Though many researchers have
recommended exploring this issue (DiLalla & Gottesman, 1991;
Herzberger, 1996; Widom, 1989), research related to the role of genet-
ics in IPV is almost non-existent. Our comprehensive literature search
only identied one study investigating the extent to which genetic
and environmental factors contribute to individual differences in inti-
mate aggression (Hines & Saudino, 2002, p. 701). This study involved
134 monozygotic and 41 dizygotic twins revealed familial resemblance
in psychological and physical intimate partner aggression attributable
to shared genes. Genetic inuence was able to explain 16% and 15% of
the variance in the perpetration and receipt of physical aggression re-
spectively. Likewise, 22% and 25% of the variance in the perpetration
and receipt of psychological aggression was attributable to genetic
factors (Hines & Saudino, 2004). In another study, Saudino and Hines
(2007) suggested that genetic inuences are probabilistic, not deter-
ministic (p. 128). These authors also suggested that there is a genetic
inuence on victims of violence or aggression due to evocative or active
genotype environment correlation. The evocative genotype-environment
correlation refers to the victim's genetically inuenced behaviors
that could induce aggressive reaction from others, whereas, the active
genotype-environment correlation refers to victim's tendency to
select aggressive partners due to a congruency between genetically
inuenced traits (Saudino & Hines, 2007).
With the exception of the studies presented so far, behavioral
genetic research on IPV is unavailable. However, behavioral genetic
research in related areas can serve as a guide to possible genetic inu-
ences on IPV. Most of this evidence is based on twin and adoption
studies looking at delinquent behavior in children/adolescents and
criminal/antisocial behavior in adults. These studies support the
notion that aggression and the ability to control aggression are genet-
ically inuenced characteristics (Plutchik & Van Praag, 1989; Tellegen
et al., 1988). Certain people, due to their genotype, may act more ag-
gressively than others (Carey & Goldman, 1997; Coccaro, Bergeman,
Kavoussi, & Seroczynski, 1997). Evidence also suggests that genetic
factors combined with environmental inuences increase the risk of
aggressive, antisocial, and criminal behavior (Cadoret, Cain, &
Crowe, 1983; Miles & Carey, 1997; Rutter, 1997). As mentioned earli-
er, there is a severe dearth of literature related to genetics and IPV.
Researchers, such as Hines and Saudino (2002), call for behavioral
genetic research to understand the mechanism of IPV better and
thereby identify preventive strategies. There is hope that advances
in genetic research, such as DNA research may facilitate future inves-
tigations of IPV.
Evidence, although there is very little, suggests that there is an
association between some infections/illnesses, such as encephalitis,
meningitis, syphilis, herpes simplex, tuberculosis, AIDS, and violent
behavior (Tardiff, 1992). In summary, very little attention has been
paid to looking at the biological determinants of IPV. One reason for
this could be the fear of providing men with an excuse for their
376 P.A. Ali, P.B. Naylor / Aggression and Violent Behavior 18 (2013) 373382
violent behavior. Much research is needed to determine the links
between biological factors and IPV. In the next section, theory and
evidence from the psychological perspective on IPV are reviewed.
3.2. The psychological perspective
The psychological perspective on IPV focuses on various factors
that affect the individual perpetrator or the target or victim. The re-
searchers have tried to explore the role of various psychological and
psychiatric difculties and disorders such as psychopathology, per-
sonality disorders, attachment needs, anger/hostility, substance and
alcohol abuse, low self-esteem, and individual abilities such as excessive
or weak assertiveness, communication difculties, and poor problem
solving skills.
3.2.1. Psychopathology and personality theories
The initial theories related to IPV were based on the psychopatho-
logical orientation of violence. Based on studies conducted on known
violent men in prisons, community based settings or victim women in
shelters, some theorists believed that men who perpetuate violence and
women who experience violence suffer from mental health problems
such as depression (Hastings & Hamberger, 1994; Julian & McKenry,
1993; Murphy, Meyer, & O'Leary, 1993; Pan, Neidig, & O'Leary, 1994),
personality disorders including antisocial personality, borderline per-
sonality disorder (BPD) (Edwards, Scott, Yarvis, Paizis, & Panizzon,
2003; Ehrensaft, Cohen, & Johnson, 2006a; Holtzworth-Munroe et al.,
1997; Levy, Meehan, Weber, Reynoso, & Clarkin, 2005; Mauricio, Tein,
& Lopez, 2007; Porcerelli, Cogan, & Hibbard, 2004), borderline personal-
ity organization (BPO) (Dutton & Starzomski, 1993, 1994; Dutton,
Starzomski, & Ryan, 1996; Tweed & Dutton, 1998), and psychopathology
(Danielson, Moftt, Caspi, & Silva, 1998; Kessler, Molnar, Feurer, &
Appelbaum, 2001; McKenry et al., 1995; Stueve & Link, 1997; Swanson
et al., 1997).
Initial studies in this area were often criticized for lacking a compar-
ison group, small sample size, and for their descriptive nature in merely
reporting percentages of violent men diagnosed for psychiatric ill-
nesses, or comparing violent husbands' scores on standardized tests to
norms. In response to such criticisms, more recent studies usually
have large sample sizes ranging from 29 participants (Maiuro, Cahn,
Vitaliano, Wagner, & Zegree, 1988) to 11,870 participants (Pan et al.,
1994). Researchers now usually include a comparison or control
group of non-violent husbands/partners. The number of groups com-
pared in these studies varies depending on the objective and scope of
the study ranging from a minimum of two groups to a maximum of
four (Hamberger & Hastings, 1991; Maiuro et al., 1988). Most of these
studies have used self-report questionnaires including the Minnesota
Multiphasic Personality Inventory (Hathaway & McKinley, 1943) (Else,
Wonderlich, Beatty, Christie, & Staton, 1993; Greene, Coles, & Johnson,
1994; Valliant, De Wit, & Bowes, 2004), the Million Clinical Multiaxial
Inventory (MCMI: Millon, 1983; MCMI-II 1987) (Dutton, 1995; Dutton
& Starzomski, 1994; Hamberger & Hastings, 1991; Hamberger, Lohr,
Bonge, & Tolin, 1996; Hastings & Hamberger, 1988; Murphy et al.,
1993; Porcerelli, Cogan, & Hibbard, 1998; Sugihara & Warner, 1999),
the California Psychological Inventory (CPI: Barnett & Hamberger,
1992; Gough, 1975), the Beck Depression Inventory (BDI: Beck,
Ward, Mendelson, Mock, & Erbaugh, 1961; Boyle & Vivian, 1996;
Feldbau-Kohn, Heyman, & O'Leary, 1998; Hanson, Cadsky, Harris, &
Lalonde, 1997; Rankin, Saunders, & Williams, 2000; Vivian & Malone,
1997), the test of Borderline Personality Organization (Dutton, 1994;
Oldham et al., 1985) and various versions of the Conict Tactic Scale
(CTS: Straus, 1979) (Saunders, 1996; Tjaden & Thoennes, 2000).
Among all psychopathological conditions, personality disorders,
especially borderline personality organization, have been found to
be more prevalent in violent husbands or male partners compared
with less violent controls. Dutton and Golant (1995) believe that
the prevalence of borderline personality organization ranges from
11 to 15% in the general population. However, Else et al. (1993)
found that 33% of their abusive men participants fullled the criteria
for borderline-antisocial personality traits. Similarly, Dutton and
Starzomski (1994) examined 40 self-referred and 38 court-referred
men to a treatment program for wife assaulters. Findings suggested
that 79% of the study participants had personality disorders with
37% of them suffering from BPD. Dutton and Starzomski (1993) also
compared wives' reports of their husbands' abusive behavior with
the men's responses on various questionnaires on BPO. A signicant
association was identied between reported BPO scores by men and
women's reports of male abusiveness. In addition, violent intimates
also reported signicantly more anger of greater frequency, magni-
tude, and duration (Dutton, 2002, p. 195), feelings of jealousy, trau-
ma symptoms including dissociation, sleep disturbances, anxiety,
depression, and post-sexual abuse trauma than non-violent intimates
(Dutton, 1994, 1995). A signicant positive correlation was also noted
between men's self-report of anger and verbal abuse of wives' with
wives' reports of emotional abuse by their husbands (Dutton, 1995).
Studies have also been conducted to determine if there is a link
between psychopathology in men and the victimization of women. It
has been reported that female victims of violence suffer from borderline
personality symptomology (BPS) (Sansone, Chu, & Wiederman, 2006;
Sansone, Reddington, Sky, & Wiederman, 2007), depressive disorders
(Cascardi, Daniel O'Leary, & Schlee, 1999; Coker et al., 2002; Golding,
1999; Nixon, Resick, & Nishith, 2004; Stuart, Moore, Gordon, Ramsey,
& Kahler, 2006; Zlotnick, Kohn, Peterson, & Pearlstein, 1998), anxiety
and post-traumatic stress disorder (PTSD) (Cascardi et al., 1999; Coker
et al., 2002; Golding, 1999; Nixon et al., 2004; Scheffer & Renck, 2008;
Stuart et al., 2006), psychological distress (Romito, Molzan Turan, &
De Marchi, 2005), substance dependence, or suicidality (Vitanza,
Vogel, & Marshall, 1995). A meta-analysis of the effects of IPV on the
mental health of women reported that the odds ratios of depression,
PTSD, alcohol abuse or dependence, and drug abuse or dependence
in the group of victimized women were 3.80, 3.74, 5.56, and 5.562
times higher respectively, than in the control group (Golding, 1999). A
cross-sectional study reported a rate of 75% and 54% of PTSD and
major depressive disorders (MDD) respectively in female victims of
IPV (Nixon et al., 2004).
It is important to note here that no study was able to show any
causal relationship between psychopathology and violence (Heru,
2007). However, results of a longitudinal study (Ehrensaft, Moftt,
& Caspi, 2006b) suggest that intimate partner abuse contributes to
the development of psychiatric disorders among females as opposed
to males. Moreover, people with psychiatric disorders regardless of
gender are prone to becoming involved in abusive relationships
(Ehrensaft et al., 2006b). Evidence also suggests that people who
have been treated for IPV report a decline in their depressive symp-
toms (Kernic, Holt, Stoner, Wolf, & Rivara, 2003). Behavioral couple
therapy treatment for alcoholism dependence has also been reported
as effective in lowering IPV rates and improving relationships
(O'Farrell, Murphy, Stephan, Fals-Stewart, & Murphy, 2004). Another
study suggests that an integrated treatment approach to substance
abuse, mental health, and trauma may be helpful for women victims
of violence (Morrissey et al., 2005).
Opponents argue that the studies establishing a psychopathological
basis of VAW have been conducted on either people arrested for such
crimes, court referred cases, people attending treatment programs, or
women in shelters. Therefore, ndings of these studies cannot be gener-
alized to the general population. Psychopathological theory has also
failed to acknowledge and address other issues, notably, why all people
with psychopathology do not react violently towards their intimates
and why some violent individuals do not suffer from psychopathologi-
cal disorders. Some studies have found that men charged with battering
were not psychopathic, but presented with a history of alcohol or sub-
stance abuse, a feeling of hostility and jealousy towards women, affec-
tive instability, impulse control disorder, or intermittent explosive
 P.A. Ali, P.B. Naylor / Aggression and Violent Behavior 18 (2013) 373382 377

disorder (Echeburua & Fernandez-Montalvo, 2007). Opponents also
argue that considering psychopathology as the sole cause of VAW
distracts society from examining and dealing with other factors, such
as societal attitudes, cultural norms, and structural inequalities, that
condone VAW. Finally, it is suggested that the theory of BPO needs
further exploration and testing to conrm the reliability of diagnosis
or any valid predictors about treatment outcomes (Cunningham
et al., 1998, p. 9).
3.2.2. Attachment theory
Attachment theory (Bowlby, 1988) postulates that IPV could be a
result of disturbed attachment to the partner. Attachment theory
attempts to explain the relationship between an infant and his/her
mother (or mother substitute). Bowlby (1977) stressed that attach-
ment behavior is held to characterize human beings from cradle to
grave (p. 203). It is a process by which an infant seeks proximity to
an identied attachment gure (mostly mother or her substitute)
specically in perceived distressing situations. An infant attaches to
an adult who remains a constant caregiver in the initial months of
his/her life (6 months to 2 years) and who is responsive and sensitive
to the infant in social interactions. Bowlby (1988) believed that trust
in the attachment gure and an assurance about the availability and
accessibility of the attachment gure or vice versa develops slowly
during infancy and continues to build in childhood and adolescence
in its various forms. Expectations developed during those years
tend to persist relatively unchanged throughout the rest of life
(Bowlby, 1973, p. 235). These expectations and the response of the
attachment gure to the expectations lead to the development of
internal working models that direct the individual's feelings, beliefs,
and expectations in later relationships. Bowlby (1988) believed that
disturbed or unmet attachment needs result in the development
and provocation of interpersonal anger, and a feeling of rage. A per-
ceived threat of separation or loss of attachment gures generates
feelings of terror, grief and rage in the infant (Bowlby, 1969, 1973).
Repeated experiences of unmet attachment needs during childhood
may lead to the development of disturbed attachment patterns in
adult relationships.
Hazan and Shaver (1987) were the rst to apply attachment
theory to the adult relationship. They proposed romantic love as an
attachment process and developed an instrument to measure the
adult version of the infantile attachment patterns (secure, ambiva-
lent, and anxious-avoidant) described by Ainsworth, Blehar, Waters,
and Wall (1978). Subsequent studies conrmed that the attachment
patterns of children and adults are similar and romantic and intimate
relationship are the most signicant attachment relationships in
adult life (Hazen & Zeifman, 1994; Shaver & Hazan, 1993). Extending
attachment theory, Bartholomew (1990) developed a four category
model of attachment which is frequently used in studies of IPV.
The model was created by dichotomizing Bowlby's two dimensions
of positivity of representation of self (the degree of the sense of an
individual's own self-worth) and others (the degree to which others
are seen as supportive and trustworthy, or rejecting or unreliable)
(see Fig. 1). The derived four attachment patterns are named secure,
dismissing, fearful, and preoccupied. A secure person's views are
positive about self and others (low dependence/anxiety and low avoid-
ance), whereas a dismissing person's views are positive for self, but neg-
ative for others (low dependence/anxiety and high avoidance). On the
other hand, a fearful person holds negative views of self and others
(high dependence/anxiety and high avoidance) and a preoccupied
person holds negative views of self, but positive views for others
(high dependence/anxiety and high avoidance) (Bartholomew &
Horowitz, 1991; Henderson, Bartholomew, & Dutton, 1997).
These researchers proposed that the disturbed attachment to the
intimate partner could explain the phenomenon of IPV. Parentchild
relationships act as a prototype for adult relationships. Experiencing
ongoing abuse and unmet or disturbed attachment needs leads to
the development of working models of relationship characterized
by rejection, role reversal, and fear. Such people expect others to be
hostile, rejecting, and unavailable; therefore, they themselves behave
in the same manner in their intimate relationships (Egeland, 1993;

Model of Self (Dependence)

Positive (low) Negative (High)

SECURE PREOCCUPIED
Model of others (Avoidance)

Positive (low)
Preoccupied with
Comfortable with intimacy and
relationships
autonomy

DISMISSING FEARFUL
Negative
Fearful of intimacy or attachment
(High) Dismissing of intimacy or attachment

Fig. 1. Bartholomew's Model of adult attachment. Source: Bartholomew, K., & Horowitz, L. (1991). Attachment styles among young adults: A test of a four-category model. Journal of
Personality and Social Psychology, 61, 226244.
378 P.A. Ali, P.B. Naylor / Aggression and Violent Behavior 18 (2013) 373382
Hines & Saudino, 2002; Zeanah & Zeanah, 1989). Research suggests
that violent men or women usually have preoccupied, fearful and anx-
ious attachment styles (Bond & Bond, 2004; Henderson, Bartholomew,
Trinke, & Kwong, 2005; Schumacher, Feldbau-Kohn, Smith Slep, &
Heyman, 2001; Stith, Smith, Penn, Ward, & Tritt, 2004). These men
and women report frustrated attachment needs, excessive dependence
on their partners, fear of rejection and abandonment, discomfort with
closeness, jealousy (Babcock, Jacobson, Gottman, & Yerington, 2000;
Dutton, 1995; Dutton, Saunders, Starzomski, & Bartholomew, 1994;
Levy et al., 2005; Mauricio et al., 2007), and feeling less related to others
(Julian & McKenry, 1993). The preoccupied and fearful attachment
styles have also been found more prevalent among the victims of IPV
(Bond & Bond, 2004; Henderson et al., 1997; Henderson et al., 2005).
Researchers believe that research related to attachment theory
can help identify people at risk of becoming abusive, why they act
in such a way, which behaviors to expect, what circumstances force
them to behave in this manner; and what might be the consequences
(Gormley, 2005). Attachment theory, however, does not seem to pro-
vide a comprehensive explanation of IPV. It fails to explain the role of
biological factors or to address why siblings from one family do not all
behave in the same way (McClellan & Killeen, 2000). Further research
related to this topic, especially on the role of attachment insecurity
and on women's perpetration of or victimization through IPV is
needed.
3.2.3. Anger/hostility
Researchers have also investigated a link between anger/hostility
and IPV. Findings of the majority of such studies conducted in clinical
and community settings conrmed that violent husbands/intimate
partners experience more anger and hostility towards their spouses
than non-violent husbands/partner (Baron et al., 2007; Boyle &
Vivian, 1996; Dutton et al., 1996; Feldbau-Kohn et al., 1998;
Hanson et al., 1997; Holtzworth-Munroe, Rehman, & Herron, 2000;
Holtzworth-Munroe et al., 1997; McKenry et al., 1995; Norlander &
Eckhardt, 2005; Schumacher et al., 2001; Stith et al., 2004). A critical
examination of the literature shows that ndings about the relation-
ship between anger, hostility and IPV are inconsistent. In an examina-
tion of eight studies, Schumacher et al. (2001) identied anger and
hostility as consistent predictors of IPV, though, with varying degrees
of effect size ranging from very small (r = 0.18) to large (r = 0.52).
This variation was attributed to design and measures used in the stud-
ies. In another meta-analysis, Stith et al. (2004) examined 11 studies
and reported anger and hostility as a moderate risk factor for IPV
(r = 0.26). Similar ndings were reported by a later meta-analytic
review of 33 studies by Norlander and Eckhardt (2005).
Evidence suggests that anger is one of the contributing factors
to IPV (Norlander & Eckhardt, 2005; Schumacher et al., 2001; Stith
et al., 2004). However, there are several points that need attention.
The concept or construct of anger remains poorly dened in studies
and is under-researched. The distinction or difference between the
constructs of anger and hostility is not always clearly stated
(DiGiuseppe, Tafrate, & Eckhardt, 1994; Eckhardt, Barbour, & Stuart,
1997; Norlander & Eckhardt, 2005). Likewise, the methods of
assessing anger and their psychometric appropriateness have also
been questioned (Eckhardt, Norlander, & Deffenbacher, 2004;
Eckhardt et al., 1997). Similar concern was expressed by Norlander
and Eckhardt (2005) about the denitions of anger and hostility and
their relationships to aggressive behavior; they concluded that it
would seem likely that methods of assessing these constructs are sim-
ilarly unclear (and so) the conceptual status of the angerIPV
relationship will continue to be limited by the inadequacies sur-
rounding anger assessment (p. 121). Others too have challenged
the relationship between anger and IPV. For instance, Gondolf and
Russell (1986), while making a case against anger management
programs, suggested that considering anger as the cause of IPV partly
blames the woman for arousing anger and, therefore, requires her to
change her behavior to reduce abuse. It also helps abusers to deny
responsibility for abuse and to use anger as an excuse for their abuse,
as is often the case with alcohol or substance use. Moreover, considering
anger as the cause of IPV distracts attention from other important con-
tributing factors such as issues of power and control and wider societal
and cultural issues.
In conclusion Norlander and Eckhardt (2005) say that despite the
seemingly obvious connection between feeling angry and acting ag-
gressively, serious gaps exist regarding our ability to make a condent
statement about whether anger matters with regard to IPV(p. 144)
Therefore, there is a need to explore this issue further to understand
its importance, consequences, and how it might be managed in rela-
tion to IPV.
3.2.4. Self-esteem
Low self-esteem is also considered to be another psychological risk
factor that contributes to IPV. However, ndings of various studies in
this respect are inconsistent. It is suggested that violent partners suffer
from low self-esteem and perpetrate violence towards their partners in
an attempt to defend or cover up their feelings of inferiority and shame
and to improve their own feeling of self-worth (Crocker, Thompson,
McGraw, & Ingerman, 1987; Papadakaki, Tzamalouka, Chatzifotiou, &
Chliaoutakis, 2009; Tracy & Robins, 2003). Some studies have identied
violent partners as suffering from low self-esteem (Cowan & Mills,
2004; Donnellan, Trzesniewski, Robins, Moftt, & Caspi, 2005;
Echeburua & Fernandez-Montalvo, 2007; Murphy, Meyer, & O'Leary,
1994), whereas, some others were unable to identify self-esteem as a
signicant variable (Russell, Lipov, Phillips, & White, 1989; Sugarman
& Hotaling, 1989; Telch & Lindquist, 1984).
3.2.5. Communication skills and assertiveness
Some literature postulates a relationship between social skills,
such as communication, assertiveness, and problem-solving, and IPV
(Holtzworth-Munroe et al., 1997; Schumacher et al., 2001). Evidence
suggests that violent men tend to suffer from poor communication
skills and display aversive behavior (Cordova, Jacobson, Gottman,
Rushe, & Cox, 1993), are offensive and negative (Burman, John, &
Margolin, 1992; Margolin, John, & Gleberman, 1988) or are defensive
and negative (Burman et al., 1992) and engage in less positive or
constructive communication (Berns, Jacobson, & Gottman, 1999;
Holtzworth-Munroe, Smutzler, & Stuart, 1998) during interactions
with their intimate partners, compared with non-violent men. It has
been suggested that violent partners tend to lack these skills and
use violence when they are unable to resolve marital conicts with
other less destructive options (Holtzworth-Munroe et al., 1997).
Researchers have investigated two types of assertiveness including
general assertiveness (being able to behave assertively generally in
any situation) and spouse- specic assertiveness (an ability to behave
assertively with one's spouse). However, results of these studies are
not consistent as some of them reported a lack of less spouse specic
assertiveness only (Dutton & Strachan, 1987; O'Leary & Curley, 1986;
Telch & Lindquist, 1984); a lack of spouse specic assertiveness and
general assertiveness abilities (Rosenbaum & O'Leary, 1981); or a
lack of general assertiveness abilities only (Morrison, VanHasselt, &
Bellack, 1987). Maiuro, Cahn, and Vitaliano (1986) found differences
between violent husbands and their non-violent controls in relation
to initiation assertiveness (ability to request or demand). However,
they could not identify any differences between the two groups in
relation to refusal assertiveness.
Studies have also found victims of violence as unassertive especially
while interacting with their spouses (Morrison et al., 1987; O'Leary &
Curley, 1986; Rosenbaum & O'Leary, 1981). However, such unassertive
behavior could be an adaptive response to the husband's violence, as
behaving assertively or disagreeing with one's husband is identied as
a risk factor for physical abuse of women (O'Leary, Curley, Clarke, &
Rosenbaum, 1985).
 P.A. Ali, P.B. Naylor / Aggression and Violent Behavior 18 (2013) 373382
3.2.6. Substance and alcohol abuse
The relationship between alcohol use or abuse and IPV remains con-
troversial and debatable (Foran & O'Leary, 2008; Klostermann, 2006;
Leonard, 2001; O'Leary & Schumacher, 2003). Research studies in this
area can be categorized into three groups: those supporting a link
between perpetration of IPV and alcohol or substance abuse; those
supporting a link between victimization and alcohol or substance
abuse; and those which identify a reciprocal relationship between alco-
hol abuse and both the perpetration of IPV and victimization.
Despite the controversy, research has clearly reected a positive and
predictive association between alcohol problems and IPV (Chase,
O'Farrell, Murphy, Fals-Stewart, & Murphy, 2003; Fals-Stewart, 2003;
Fals-Stewart, Golden, & Schumacher, 2003; Kantor & Straus, 1987,
1989; Pan et al., 1994; Russell et al., 1989; Schumacher, Fals-Stewart,
& Leonard, 2003; Schumacher et al., 2001; Stith et al., 2004; Thompson
& Kingree, 2006). Violent husbands and male partners have been
reported to have signicant drinking problems compared with
non-violent controls or the general population (Barnett, Fagan, &
Booker, 1991; Hamberger & Hastings, 1991; Julian & McKenry, 1993;
Kyriacou et al., 1999; Leonard & Blane, 1992; Leonard & Senchak,
1993; Murphy et al., 1993; Oriel & Fleming, 1998; Rosenbaum &
O'Leary, 1981; Stith & Farley, 1993; Telch & Lindquist, 1984). O'Farrell
and Murphy (1995) found that alcoholic men were six times more
likely to be violent towards their wives than non-alcoholics. Violence
perpetrated by alcoholic men was more frequent and severe than that
perpetrated by non-alcoholic men. Although these studies have been
conducted in various settings, such as emergency rooms of hospitals,
primary health care settings, and family practice clinics, in general
population and minority samples, results have consistently supported
a link between alcohol and IPV.
Women's perpetration of IPV has also been reported to have an
association with substance or alcohol abuse (Chase et al., 2003;
Cunradi, Caetano, Clark, & Schafer, 1999; Drapkin, McCrady,
Swingle, & Epstein, 2005; Stuart, Moore, Ramsey, & Kahler, 2003).
Studies also suggest a direct association between female victimization
and substance abuse by women (Berenson, Stiglich, Wilkinson, &
Anderson, 1991; El-Bassel, Gilbert, Schilling, & Wada, 2000; Kyriacou
et al., 1999; McCauley et al., 1995; Miller, Downs, & Panek, 1993;
Miller, Wilsnack, & Cunradi, 2000; Parks & Fals-Stewart, 2004;
Roberts, Lawrence, O'Toole, & Raphael, 1997; Stewart & Cecutti,
1993). These studies have also been conducted in a variety of settings
such as emergency rooms, primary care setting, prenatal clinics, alco-
hol treatment programs, and in the general population (Leonard,
2001). Alcohol or substance use or abuse in many such studies is
identied as the consequence of experiencing violence rather than a
cause. Some researchers suggest that victims use alcohol or substance
abuse as a strategy for coping with violence perpetrated against them
(Barnett & Fagan, 1993; Clark & Foy, 2000; Simmons, Lehmann, &
Cobb, 2008).
Results from two meta-analytical studies suggest signicant but
only small to moderate effect sizes for an association between alcohol
use or abuse and IPV (Foran & O'Leary, 2008; Stith et al., 2004).
Another meta-analysis suggested that there is only a weak relationship
between alcohol use or abuse and IPV (Gil-Gonzalez, Vives-Cases,
Alvarez-Dardet, & Latour-Perez, 2006). Tolman and Bennett (1990), in
a narrative review of quantitative studies on battering men, suggested
that chronic alcohol abuse is a better indicator of IPV than acute intoxi-
cation. Other researchers (Kilpatrick, Acierno, Resnick, Saunders, & Best,
1997; Polusny & Follette, 1995) believe that alcohol or substance abuse
and IPV has a reciprocal relationship which works cyclically. Substance
abuse is directly related to the physical and sexual assault which results
in an increased risk of subsequent alcohol or substance abuse. Based on
the evidence it is difcult to establish a causal link between alcohol
abuse and IPV. However, it is likely to be an important contributing or
facilitating factor and so is worthy of further research. Feminists are
especially reluctant to accept the link between alcohol abuse and IPV.
379
The reason could be that endorsing such association means taking
away the responsibility of violence from men and providing them with
an excuse for justifying their violence. This feminist account remains
an avenue for further research (Fals-Stewart, Leonard, & Birchler,
2005; Klostermann, 2006; Leonard, 2001).
Various theories are presented under the umbrella of psychological
perspectives. Evidence suggests that various factors, such as psychopa-
thology, personality disorders, attachment needs, anger/hostility, sub-
stance and alcohol abuse, self-esteem and individual abilities such as
assertiveness, communication, and problem-solving skills, play an im-
portant role with respect to IPV. Opponents of each of the theories
reviewed have questioned why not all men behave the same. Another
major criticism is that accounting for violent and aggressive behavior
in terms of, for example, psychopathology, psychiatric issues, anger
and hostility and justifying the behavior of the batterer, does not very
helpful to women. It is important to note here that none of the factors
is identied as the sole cause, as the ndings of the studies remains in-
consistent. Nonetheless, all of these factors are important to consider
while examining IPV.
4. Conclusion
An examination of the literature on the dynamics of IPV reveals that
the factors discussed above are helpful in explaining IPV. The biological
perspective sees the issue of IPV as being caused by secondary to ag-
gression, which results from structural and chemical changes in the
brain due, for example, to trauma or head injury. Psychopathological
theories consider that IPV results from psychopathology, mental illness,
attachment problems, inability to manage anger and hostility, decien-
cy in various skills and abilities such as management of anger and
hostility, lack of assertiveness, low self-esteem, and communication
skill difculties. It is clear that no single theory explored in this article
fully explains the phenomenon of IPV. However, both the biological
and psychological perspectives make an important contribution to
our understanding of violence in intimate relationships. It is clear, how-
ever, that further research from these perspectives still needs to be
conducted which attempts to ensure that the criticisms of the extant
studies are avoided.
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