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Personality and Individual Differences 44 (2008) 833–841

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The relationship between the Maudsley Violence

Questionnaire and official recordings of violence
in mentally disordered offenders
Emma Warnock-Parkes a,*, Gisli Gudjonsson b, Julian Walker c
a
East CMHT, Salcot Crescent, New Addington, Croydon, CR0 0JJ, United Kingdom
b
Institute of Psychiatry, The Addiction Sciences Building, P.O. Box 78, Windsor Walk, Denmark Hill,
SE5 8AF, United Kingdom
c
Fromeside, Blackberry Hill, Stapleton, Bristol, BS16 1ED, United Kingdom

Received 8 March 2007; received in revised form 19 July 2007; accepted 12 October 2007
Available online 3 December 2007

Abstract

The Maudsley Violence Questionnaire (MVQ; Walker, 2005) measures cognitions relating to violent
behaviour. Although the measure has been found to relate to self-report delinquency in an adolescent sam-
ple, it is yet to be used in a clinical or forensic sample. Therefore, this paper investigates the relationship
between the cognitive style of Machismo and Acceptance of violence (assessed by the MVQ) and objective
measures of violence, within an adult forensic sample. Sixty-four male forensic inpatients completed the
MVQ and their violent criminal convictions and documented incidents of institutional violence were
recorded from medical records. In concordance with predictions, the Machismo scale was significantly
related to both the number of past violent criminal convictions and institutional violence. The Acceptance
of violence scale was significantly related to institutional violence only. A number of theoretical and clinical
implications are discussed and future study into this growing area of research is encouraged.
Ó 2007 Elsevier Ltd. All rights reserved.

Keywords: Violence; Cognitive style; Machismo; Acceptance of violence; Secure units

*
Corresponding author. Tel.: +44 1689 308423; fax: +44 1689 800874.
E-mail address: emma.warnock-parkes@slam.nhs.uk (E. Warnock-Parkes).

0191-8869/$ - see front matter Ó 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.paid.2007.10.013
834 E. Warnock-Parkes et al. / Personality and Individual Differences 44 (2008) 833–841

1. Introduction

Violence is a significant problem in society, psychiatric and correctional institutions, impact-

ing detrimentally on both individuals and society at large (e.g. Howells & Hollin, 1989). If we
can further advance our understanding of the causes of violent behaviour, we can enhance
treatment programmes and inform preventative interventions to deal with this epidemic prob-
lem more effectively. Cognitive behavioural models, and their associated interventions, have
had impressive efficacy in dealing with a number of debilitating psychiatric problems (Butler,
Chapman, Forman, & Beck, 2006). However, an adequate and empirically tested cognitive
model specifically of violence is yet to be fully developed. Furthermore, as Walker (2005) high-
lights, there is a paucity of research into the relationship between cognitive style and violence.
Thus Walker’s Maudsley Violence Questionnaire (MVQ: Walker, 2005) was developed to ad-
dress this problem. The use of violent action in response to embarrassment and to protect
threatened self-esteem (Gilligan, 1996; Salmivalli, 2001) was a key theme in the development
of the questionnaire.
The MVQ, unlike other measures of offending in general, is specific to violence and designed for
use across a spectrum of violent offenders and non-violent individuals (Walker, 2005). According
to Walker (2005), the MVQ is the only measure of violent thoughts that has been factor analysed
using a large, normally distributed sample. Following factor analysis 56 items remained loading
on two factors: (1) Machismo (42 items loaded on this factor), and (2) Acceptance of violence (14
items loaded on this factor).
The MVQ provides a measure of a ‘macho’ belief system linked to violence and of beliefs about
the legitimacy of violence. In the initial validation study (Walker, 2005), Machismo and Accep-
tance of violence were significantly positively correlated with self-reported violent delinquency
for both men and women. For men both factors predicted both violent and non-violent delin-
quency, but for women this was only true of Acceptance of violence. Walker (2005) concluded
that the cognitive style more likely to put men at risk for future violence is the endorsement of
both Machismo and Acceptance of violence items.
In a second publication from the same study Walker and Gudjonsson (2006) provided strong
support for the validity of the MVQ, by comparing it with existing measures of personality (Ey-
senck Personality Scales: EPS: Eysenck & Eysenck, 1991) and self-esteem (Culture Free Self-Es-
teem Inventory-2: Battle, 1992). This study found that the best predictor of self-report violence for
men was Machismo.
A further study has used the MVQ in a student population investigating the role of cognition in
the involvement of violent films and computer games (Sigurdsson, Gudjonsson, Bragason, Krist-
jansodottir, & Sigfusdottir, 2006). The rationale of this study was based on evidence that exposure
to such media presentations of violence can impact upon aggressive behaviour (Anderson, 2004;
Anderson & Bushman, 2001). The study found that Acceptance of violence (from the MVQ) was
the strongest predictor of violent media use. The authors concluded that the violent cognitions
have an important role in behaviours such as violent media utilisation.
Despite the interesting results the use of this questionnaire has generated, studies completed
using the MVQ have been conducted within a non-offender/non-clinical population so ‘‘the per-
formance of the measure in clinical and forensic settings remains to be evaluated” (Walker, 2005:
198).
 E. Warnock-Parkes et al. / Personality and Individual Differences 44 (2008) 833–841 835

Therefore, this paper presents the results of a study using the MVQ with 64 forensic inpatients. It
was predicted that individuals with higher Machismo and Acceptance of violence scores would show
elevated rates of criminal convictions and institutional violence as noted in their medical records.

2. Method

2.1. Participants

Participants were 64 males residing in seven different secure forensic mental health units, across
four NHS trusts. Inclusion criteria for participants were that they should be male, over 18 years of
age, have a previous conviction for a criminal offence and that they were not acutely unwell at the
point of participation. Furthermore, participants had to be settled in behaviour for 24 h prior to
the research session, i.e. no violent or sexually disinhibited behaviour exhibited. Participants were
also required to have adequate intellectual ability to respond to the questionnaire (approximately
IQ > 70). Any individuals that did not meet these criteria were excluded from participating in the
study.
Of a potential sample of 208 individuals on the units, 142 people that were assessed to be men-
tally and physically able to take part in the project by their clinical team (based on the inclusion
criteria above) were approached, and 64 consented to take part (representing 45% of those
approached).
Participants were found to have a mean age of 35.2 years (SD = 10.4). There was a large range
of ages in the study (19–69 years). The majority of participants described themselves as either
White British (29; 45%) or Black British (12; 19%). The majority of participants (52; 81.1%) were
diagnosed with a form of schizophrenic illness (schizophrenia or schizoaffective disorder); 43 indi-
viduals (67.2% of the total sample) had a primary diagnosis of paranoid schizophrenia. All par-
ticipants were taking prescribed medication, but data was not collected on each participant’s
medication. In terms of their current psychiatric admission, the mean length of stay was 22.2
weeks (SD = 28.0, range = 1–154). The majority of participants were held under a section 37/
41 restriction order (42; 65.6%). Only a small minority of participants had been assigned a civil
section, such as Section 3 (2; 3.1%).
In total 56 (87.5% of the 64 participants) had committed violent crimes. Approximately a third
of the individuals who had committed a violent index offence (19; 34%) had been convicted for a
serious crime that led to either the death of the victim, including: murder (9; 16.1%) and man-
slaughter (7; 12.5%), or the attempted murder of the victim (3; 5.3%). Furthermore, 23% (15)
of the sample had committed a violent offence of Grievous Bodily Harm (GBH). Of the 56 indi-
viduals who committed a violent offence against another person, half had attacked a stranger (28;
50%). In addition, approximately a third attacked a friend or acquaintance (18; 32.1%).

2.2. Materials

2.2.1. The Maudsley Violence Questionnaire (MVQ: Walker, 2005)

This 56-item questionnaire measures a number of cognitions (including: beliefs, rules, distor-
tions and attributions) that are related to violence. Walker (2005) factor analysed the question-
836 E. Warnock-Parkes et al. / Personality and Individual Differences 44 (2008) 833–841

naire using a large ‘normal’ sample (n = 785, adolescents); 56 items remained loaded on two fac-
tors: (1) Machismo and (2) Acceptance of violence; these are the two scales included in the mea-
sure. Both scales were found to have adequate internal consistency (Machismo: Cronbach
a = 0.91, Acceptance: Cronbach a = 0.76, Walker, 2005).

2.3. Procedure

To gain initial access to the units, senior managers and clinicians were approached about the
study. Appropriate participants were identified by staff working clinically with the patients (based
on the inclusion criteria outlined above), and were then approached by the clinician and the study
discussed. Each participant was required to give written informed consent before completing the
questionnaires.
Participants were also asked for their written consent to access their medical records. These re-
cords were then analysed to record participants’ history of past violence. For the sake of this study
the following operational definition of violence was adopted:
‘‘Aggression refers to the intention to hurt or gain advantage over other people, without nec-
essarily involving physical injury; violence involves the use of strong physical force against
another person, sometimes impelled by aggressive motivation” (Howells & Hollin, 1989: 4).
Therefore, non-contact aggression was not included as a violent offence. As within the litera-
ture, violent sexual crimes were also included in the analyses (Blackburn, 1993).
The following information was recorded from medical records:

1. The total number of violent (including sexually violent) criminal convictions (allegations of
violence were not included in this outcome measure).
2. The total number of violent (including sexually violent) incidents that took place whilst an
individual was an inpatient/inmate (recorded in medical notes or incident forms).

As the main outcome variable was highly dependent on the quality of analysis completed on
participants’ medical records, 20% of the case notes were chosen at random and the number of
violent incidents and severity of violence ratings were recorded by a second researcher (a qualified
clinical psychologist working in a forensic setting). Subsequently, inter-rater reliability was
checked between the two sets of data (see Results section).

2.4. Statistical considerations

A power calculation was conducted using data from Walker’s (2005) initial validation study of
the MVQ. This study found that Acceptance of violence and Machismo were both positively cor-
related with self-reported violence (Machismo: r = 0.49. Acceptance: r = 0.35). The power calcu-
lation indicated that a sample size of 59 would have 80% power to detect a correlation of r = 0 .35
with a 0.05 two tailed significance level.
Examination of Q–Q plots of the data revealed that the data was not normally distributed, and
there were outliers outside the range of 2 and +2. In view of this, non-parametric tests (Spear-
 E. Warnock-Parkes et al. / Personality and Individual Differences 44 (2008) 833–841 837

man’s rank correlation coefficients) that do not rely on the assumption of normally distributed
data were utilised to analyse the results.

3. Results

3.1. Reliability analysis on the history of violence measures

In order to check the reliability of the researcher’s rating of the frequency of violent incidents,
approximately 20% of case notes (12 participants’ medical records) from one unit were randomly
selected and the number of violent events was independently rated by a second researcher. As data
was continuous, intraclass correlation coefficients were employed (Fleiss & Cohen, 1973). Total
agreement was found between the two raters when recording the number of violent convictions.
Despite some small discrepancies, intraclass correlation coefficients were also significantly high for
recording of the number of violent incidents in institutions (intraclass correlation coeffi-
cient = 0.98, p < 0.01).

3.2. The Maudsley Violence Questionnaire (MVQ)

The mean scores for the Machismo and Acceptance of violence scales were 10.4 (SD = 8.7,
range 0–32) and 7.2 (SD = 3.3, range 0–13), respectively.
In order to explore how related the two cognitive styles of the MVQ (Machismo and Accep-
tance of Violence) are, a correlation was completed between the two scales and they were found
to be significantly correlated with each other (q = 0.52, p < 0.001).

3.3. MVQ scores and official recordings of violence

Table 1 shows the correlations (q) between Machismo and Acceptance of violence scores and
both the number of violent criminal convictions and number of institutional violent events. The
mean number of criminal convictions and institution violent incidents is also shown.
The prediction that higher rates of Machismo and Acceptance of violence would indicate indi-
viduals have elevated incidents of institutional violence was supported by the data. The Machismo
scale only was found to be significantly related to number of criminal convictions.

Table 1
Mean number of violent incidents (convictions and institutional) and correlations of MVQ factors with the official
recordings of violence
Criminal convictions Institutional violent incidents
M and SD 3.4 (3.04) 4.3 (7.3)
Correlation (q) with Machismo scale (and p value) 0.25* (p = 0.045) 0.36**(p = 0.004)
Correlation (q) with Acceptance of violence scale (and p value) 0.072 (p = 0.57) 0.29* (p = 0.019)
*
p > 0.05
**
p > 0.01.
838 E. Warnock-Parkes et al. / Personality and Individual Differences 44 (2008) 833–841

4. Discussion

The study demonstrated that the cognitive styles of Machismo and Acceptance of violence are
indeed, as proposed by Walker (2005), related to official recordings of violence in forensic inpa-
tients’ medical records. A significant correlation between Machismo and both history of convic-
tions and institutional violence was found. The study also found a significant correlation between
Acceptance of violence and history of institutional violence, but not with number of convictions.
Machismo appeared to have a better relationship with the violence outcome measures than
Acceptance of violence. The effect sizes (correlations) found for the relationship between Machis-
mo and history of violence were slightly higher than the relationship between Acceptance of vio-
lence and history of violence.
Previous studies have found the MVQ to relate to self-reported offending in adolescents (Walk-
er, 2005; Walker & Gudjonsson, 2006), and Acceptance of violence specifically to media use of
high violent content (Sigurdsson et al., 2006). This is the first study that has found a relationship
between these concepts and objective measures of violence in a forensic sample. In view of the age
difference between the current sample and Walker’s (2005) normative adolescent data no compar-
ison in the mean scores is attempted.
This study provides some support for the notion that cognitions are involved in violent behav-
iour (Beck, 1999; Dodge, 1993; Farrington, 1998). Furthermore, the findings promote the impor-
tance of future research into this area; for example whether Walker’s work could inform a general
cognitive model whereby Machismo and Acceptance of violence represent dysfunctional assump-
tions activated in certain situations that then trigger an emotional response (such as anger) and/or
violent behaviour.
Interestingly, both Machismo and Acceptance of violence were related to violence in institu-
tions, but Acceptance of violence was not related to number of convictions. It is likely that this
result is due to problems with the outcome measures (see below). However, in contradiction to
the discussion above, one possibility is that Machismo and Acceptance of violence are styles of
thinking common in the culture of institutions and prisons (Walker, 2005). Anecdotally, a culture
of ‘honour and respect’ may be especially relevant in prison/forensic units.
There are a number of issues to consider when interpreting the data here. For example, a large
proportion of people approached who were asked to take part in the study declined (45%). Unfor-
tunately, data was not kept on those who did not agree to participate and as such this could have
implications for the generalizability of the study’s findings. The sample were also highly variable
and included a large variety in the type and severity of index offences, such as a high proportion of
individuals with serious crimes such as murder and also many individuals with lower level convic-
tions such as common assault. This could be problematic if, for example, Machismo and Accep-
tance of violence related to different types (or aspects) of violence, respectively. Due to the large
variability in the data there were also problems with distribution of the sample that could not be
statistically corrected for using transformations.
There were also a number of factors that were not controlled for, such as the general level of
disturbance individuals were experiencing (Link & Stueve, 1994; Swanson, 1994). Although it is
recognised within the literature that only a small proportion of violent crimes are caused by peo-
ple with mental health problems (Monahan, 1992; Taylor & Gunn, 1999), the level of psychotic
disturbance an individual is displaying is likely to impact on their level of violence (Arseneault,
 E. Warnock-Parkes et al. / Personality and Individual Differences 44 (2008) 833–841 839

Moffitt, Avshalom, Taylor, & Silva, 2000; Swanson, Borum, Swartz, & Monahan, 1996; Taylor &
Monahan, 1996; Wessely, 1998), particularly certain symptoms, such as delusions (Taylor, 1985)
and paranoia (McNeil & Binder, 1994). As the study had a high proportion of individuals with a
diagnosis of paranoid schizophrenia, it is possible that their history of violence and cognitive
styles might have been influenced by their history of mental illness. However, all the participants
were in a stable mental state when completing the questionnaires and their consultant had consid-
ered them to have the necessary capacity to participate in the study. None had a history of learn-
ing disability.
Most importantly, when considering the research findings there were a number of problems with
the violence outcome measures that should be considered. As other studies have noted, psychiatric
patients can spend some considerable time in institutions when, as they are not living in the com-
munity, they are less likely to get a criminal conviction (Wessely, 1998). Therefore, ideally the total
time spent in institutions during an individual’s adult life would be recorded and controlled for in
the analyses. A major limitation of the study was that data could not be reliably recorded on the
total amount of time that individuals had been either incarcerated or an inpatient, as this informa-
tion was available for only a very small minority of people. Therefore, a major issue in interpreting
the findings is the differing amount of time that participants will have had to either be violent in
institutions, or in the community. By recording both community convictions and violent incidents
from medical records this to some extent covers violence across the adult life span. However, this is
not a particularly rigorous method, and thus the results should be treated with caution.
In this study a relatively weak correlation was found between the number of convictions and
the number of violent incidents in institutions. Notably, Acceptance of violence was related to
institutional violence and not number of convictions. It is possible that this non-significant effect
could be explained by problems with data collection. Research has found that people with a psy-
chiatric disorder are more likely to be violent in their place of residence against a family member
(Erb, Hodgins, Freese, Muller-Isberner, & Jockel, 2001; Steadman et al., 1998). Therefore, it is
likely that following such an incident of violence in the community the individual might be less
likely to be arrested and convicted for the offence, rather put on a civil or criminal section and
taken to hospital. In this study the criteria for recording a criminal conviction was that the indi-
vidual had to be actually convicted of the crime. Therefore, there were many occasions when alle-
gations or incidents were noted in medical records, but could not be included in the ‘criminal
convictions’ outcome measure. Therefore, perhaps institutional violence is a more reliable presen-
tation of an individual’s likelihood to be violent in this study.
Nevertheless, a limitation is that institutional violence is reliant on accurate recording of violent
incidents by staff in either the health service or in prisons. However, other authors have also re-
ported little relationship between institutional violence and number of convictions (Drinkwater &
Gudjonsson, 1989; Mills & Kroner, 2003). A self-report measure of violence might have ac-
counted for some of the difficulties in using the more objective measures, and some authors have
recommended that multiple sources of information be used when measuring community violence
(Douglas, Ogloff, Nicholls, & Grant, 1999; Mulvey, Shaw, & Lidz, 1994; Steadman et al., 1998).
However, self-report data has many limitations and a key strength of this study is that official and
objective measures of violence were used.
This is an area of research in an early stage and there are many opportunities for future work,
for example, administering the MVQ to a non-forensic adult male sample. In addition, exploring
840 E. Warnock-Parkes et al. / Personality and Individual Differences 44 (2008) 833–841

the relationship between certain personality disorders and traits with the MVQ would be interest-
ing, for example, one might expect Narcissistic Personality Disorder (NPD) to share some simi-
larities with a ‘macho’ cognitive style as NPD includes a number of traits theoretically linked to
machismo. In addition, the potential impact of the setting in which an individual resides on these
cognitive styles (e.g. does length of stay in prison, reduce or increase scores on the MVQ?). Fur-
thermore, the existing literature on gang violence highlights the role of machismo and a culture of
honour and respect (Branch, 1999; Jankowski, 1991); these concepts are key in the MVQ, and it
would be interesting to use this measure within a gang population.
In spite of its limitations this study provides some evidence for a significant relationship be-
tween Walker’s MVQ and official recordings of violence in a male forensic inpatient sample. In
order to further develop much needed clinically applicable models and interventions for violence,
further empirical investigations into the role of cognitions such as Machismo and Acceptance of
violence in both anger and violent behaviour is fundamental.
An important issue in future work is how improved understanding of patients’ cognitive style,
such as Machismo, may influence how violent incidents within forensic (Gudjonsson, Rabe-Hesk-
eth, & Wilson, 2000) and general hospital ward settings (Gudjonsson, Rabe-Hesketh, & Szmukler,
2004) can be prevented and successfully managed.

Acknowledgement

Many thanks to all the staff and participants from all of the units involved. Furthermore, to Dr.
Helen Miles for her valuable time as a second-rater.

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