Staff members’ evaluation of inpatients’ motivation for aggression – the roles of staff restrictions and aggression severity

Improved understanding of inpatient aggression can come from systematic assessment of motivation for aggressive incidents. This study investigates staff members’ evaluation of motivation for aggressive incidents, and how such evaluations are influenced by staff restrictions and aggression severity. Staff reports of aggressive incidents in a secure psychiatric unit were collected in clinical practice over a ten-year period (2006–2015). Motivation for aggression was assessed with the Aggressive Incident Motivation Evaluation Scale, measuring irritable, instrumental, and defensive dimensions. Information about staff restrictions was collected with the Staff Observation Aggression Scale – Revised, and severity was rated with the Visual Analog Scale. Multilevel analyses of 2649 aggressive incidents, committed by 67 inpatients, revealed greater variation in aggression motivation across incidents than between individual patients. Staff restrictions preceding the aggressive incident and rating of severity were positively related to staffs’ evaluation of motivation for aggression, but their impacts differed across motivational dimensions. Staff reports of motivation provide important additional information beyond current standard report forms. Systematically evaluating motivation is essential to risk management, and may contribute to develop more fine-tuned interventions for preventing and managing aggression in inpatient settings.     

The predictive validity of the Depression Hopelessness Suicide screening form for self-harm among prisoners

The Depression Hopelessness Suicide Screening Form (DHS) includes 12 ‘critical items’, which have not been validated for the prospective prediction of self-harm. We conducted a retrospective cohort study (N = 4196) to validate the ability of the DHS critical items to prospectively predict inmates with at least one incident of self-harm during the first six months of imprisonment. While the critical items were highly sensitive (89.5%) at predicting incidents of self-harm, 51.3% of the inmates endorsed at least one item. Five items reflecting more recent and specific risk factors reduced the referral rate to 17.7%, while maintaining high sensitivity (84.2%). While the DHS has high sensitivity to predict inmates at risk of self-harm, treating all items as equally critical results in excessive numbers of false positives that likely exceed the capacity of prison resources for professional assessment and intervention. Referral rules based on recency and specificity of risk factors are proposed.     

Context for specific episodes of marital violence: Gender and severity of violence differences

The present study was designed to evaluate the context of marital violence through husbands' and wives' accounts of the worst violent episode in the year prior to assessment. The primary objective was to examine severity (mild or severe) and gender (husbands or wives) differences in reports of the worst episode of marital aggression using a functional analysis conceptualization. That is, within the specific episode, current stressors, setting events, outcome, and function of aggressive behavior(s) and victimization experiences were evaluated. Sixty-two couples, who presented for marital treatment over a three year period and also reported at least one episode of physical aggression in the past year, participated. In most cases, marital aggression appeared to reflect an outgrowth of conflict between both partners. However, wives consistently reported that their aggressive husbands had engaged in more psychological coercion and aggression than they as a marital conflict escalated to physical violence. Further, there was a tendency for wives to use severe physical aggression in self-defense more often than husbands.     

The Timeline Followback Interview to Assess Children’s Exposure to Partner Violence: Reliability and Validity

This study evaluated psychometric properties of the Timeline Followback interview—Children’s Exposure to Partner Violence (TLFB-CEPV), an event history calendar interview designed to assess children’s exposure to daily patterns of intimate partner violence. Participants were men (N = 107) entering batterer’s treatment, their female partners, and a custodial child (6–16 years). The TLFB-CEPV asked about days of partner physical aggression and children’s exposure to these episodes, and was administered to partners at pretreatment, posttreatment, 6 and 12 months. At each assessment, the percentage of days of any child exposure (PAE) and of children’s direct exposure (PDE) to violence were calculated. Parents completed measures of partner aggression and social desirability; parents, teachers, and children completed measures of children’s adjustment. TLFB-CEPV scores had excellent temporal stability and strong evidence of concurrent, discriminant, and criterion validity. Interrater agreement for TLFB-CEPV scores was moderate at initial assessment, but high at subsequent follow-up interviews. This project was supported, in part, by grants from the National Institute on Drug Abuse (R01DA12189, Fals-Stewart), the Alpha Foundation, and Old Dominion University.     

Repeating the errors of our parents? Parental violence in men's family of origin and conflict management in dating couples

Within a social learning model, family-of-origin violence places men at risk for developing negative communication in their adult relationships. Thirty young men exposed to family-of-origin violence (exposed group) and 30 unexposed young men were videotaped discussing a conflict topic with their female dating partners. Relative to the unexposed group, the exposed men and women reported higher relationship aggression and during discussion showed more negative communication, were more domineering, and the men reported more negative affect. There were no differences between the groups on cognition or heart rate. The conflict management deficits and aggression evident in the exposed group suggest that these partners are at high risk for future relationship aggression and distress.     

Interactive and Unique Risk Factors for Husbands' Emotional and Physical Abuse of Their Wives

Predisposing risk factors of husband to wife physical and emotional abusiveness were assessed in 175 community volunteer couples. Negative life events, marital dissatisfaction, attitudes regarding aggression, and employment status accounted for unique variance in the prediction of husbands' total abusiveness. Alcohol impairment, while not in itself a significant predictor, moderated the effects of life stress and marital dissatisfaction. Men reporting alcohol impairment, combined with high negative life events or with high marital dissatisfaction, exhibited greater abusiveness than predicted by the additive effects of these individual risk factors. Men exhibiting emotional abuse, compared to those without emotional abuse, scored higher on hostility and attitudes condoning aggression, whereas men exhibiting severe physical aggression, compared to those without severe physical aggression, reported more negative life events, more marital dissatisfaction, more hostility, and more exposure to abuse in their family of origin. The present data highlight the importance of variables that fluctuate over time, as well as the co-occurrence of such variables in understanding husband to wife abusiveness.     

Genius is 1% inspiration and 99% perspiration … or is it? An investigation of the impact of motivation and feedback on deception detection

Purpose . Although most people perform around the level of chance in making credibility judgments, some researchers have hypothesized that high motivation and the provision of accurate feedback could lead to a higher accuracy rate. This study examined the influence of these factors on judgment accuracy and whether any improvement following feedback was related to social facilitation, a gradual incorporation of successful assessment strategies, or a re‐evaluation of ‘tunnel vision’ decision‐making. Methods . Participants (N = 151) were randomly assigned to conditions according to motivation level (high/low) and feedback (accurate, inaccurate or none). They then judged the credibility of 12 videotaped speakers either lying or telling the truth about a personal experience. Results . Highly motivated observers performed less accurately (M = 46.0%), but more confidently, than those in the low‐motivation condition (M = 60.0%). Although there was no main effect of feedback, the provision of any feedback (accurate or inaccurate) served to diminish the motivational impairment effect. Further, high motivation was associated with a relatively low ‘hit’ rate and high ‘false‐alarm’ rate. This suggested that in the absence of feedback the judgments of highly motivated participants were made through tunnel vision. Conclusions . The results suggest that it is important for lie‐catchers to monitor their motivation level to ensure that over‐enthusiasm is not clouding their judgments. It may be useful for professionals engaged in deception detection to regularly discuss their judgments with colleagues as a form of feedback in order to re‐evaluate their own decision‐making strategies.     

Screening offenders for risk of drop‐out and expulsion from correctional programmes

Purpose. The goal of the present research was to develop a screening measure to assist in identifying offenders at risk for drop‐out or expulsion from correctional programmes. Methods. Non‐Aboriginal male offenders (N = 5,247) were randomly divided into a development sample (N = 2,617) and a validation sample (N = 2,630). In the development sample, individual predictors were identified through univariate and multivariate analyses, weighted based on their relationship with drop‐out/expulsion, and combined into a composite measure we called the drop‐out risk screen (DRS). Results. The DRS consists of five items, including static and dynamic risk factors for recidivism as well as motivation for intervention. It significantly predicted drop‐out/expulsion in the development sample (area under the receiver operating characteristic curve [AUC]= .72) and performed similarly in the validation sample (AUC = .70). Conclusions. The results indicate that the DRS is a valid screening instrument for risk of drop‐out/expulsion. Prior to commencement of a treatment programme, offenders with high scores on the DRS could be more thoroughly assessed and, if necessary, targeted with pre‐treatment efforts to increase their motivation and general readiness for treatment.     

Changes in Intimate Partner Violence During Pregnancy

Women's experiences of partner violence, both before and during pregnancy, are described using a convenience sample of women recruited from prenatal clinics. Included were an index group of women who told their clinicians that they had been physically abused during pregnancy, and a comparison group of women who told their clinicians that they had not been physically abused during pregnancy (even though later more detailed assessment found that some of these comparison women had experienced such violence). The women averaged 27 years of age, with 83% being high school graduates, 26% being married, and 66% having had previous children. The Conflict Tactics Scales 2 assessed rates of partner violence victimization of the women and their male partners, including psychological aggression, physical assault, and sexual coercion. Injuries also were assessed. Results showed that comparison men were physically assaulted at significantly higher rates than were their female partners, both before and during pregnancy (even though these victimization rates were much lower than those seen among the index couples). Index women experienced higher rates of psychological aggression, physical assault, and sexual coercion than did their male partners, and these women were significantly more likely than their male partners to be injured. Pregnancy onset was associated with significant increases in the rates of psychological aggression among both the index and comparison couples. In addition, the index women experienced a significantly increased rate of sexual violence victimization during pregnancy. However, pregnancy was not associated with significant increases in the rates of physical assault or violence-related injuries among the index or comparison couples.     

Exposure to Interparental Violence and Childhood Physical and Emotional Abuse as Related to Physical Aggression in Undergraduate Dating Relationships

The present study examined whether witnessing interparental violence and experiencing childhood physical or emotional abuse were associated with college students’ perpetration of physical aggression and self-reports of victimization by their dating partners. Participants (183 males, 475 females) completed the Adult-Recall Version of the Revised Conflict Tactics Scale (CTS2-CA; Straus 2000), the Exposure to Abusive and Supportive Environments Parenting Inventory (EASE-PI; Nicholas and Bieber 1997), and the Revised Conflict Tactics Scale (CTS2; Straus et al. 1996). Results of zero-inflated Poisson (ZIP) regressions demonstrated that being female and having experienced higher levels of childhood physical abuse were associated with having perpetrated physical aggression at least once. Among women, exposure to mother-to-father violence and childhood physical abuse were related to the extent of dating aggression. Among men, witnessing father-to-mother violence and childhood emotional abuse were associated with the extent of dating aggression. Witnessing interparental violence and experiencing childhood physical abuse increased the likelihood that women would report victimization, whereas childhood emotional abuse decreased the likelihood that respondents reported dating victimization. Viewing father-to-mother violence and experiencing childhood emotional abuse increased the extent that men reported being victimized by their dating partners, whereas witnessing mother-to-father violence and experiencing physical abuse decreased the extent that men reported being victimized by their dating partners. Results suggest the importance of parent and respondent gender on dating aggression.     

Experiences with dating aggression and sexual coercion among Polish college students

Dating aggression and sexual coercion were studied in Polish college women (n = 100) and men ( n = 101) using the Revised Conflict Tactics Scales (Straus, Hamby, Boney-McCoy, & Sugarman, 1996). Rates of psychological and physical aggression, sexual coercion, and injury were compared for men and women. Rates of physical aggression, sexual coercion, and injury were compared with preliminary data from 31 universities and 16 countries from the International Dating Violence Study (IDVS; Straus, 2003, 2004). Rates of psychological aggression, physical aggression, and sexual coercion were high with respective rates of 77%, 36%, and 42% for men and 89%, 48%, and 40% for women. Relative to the IDVS samples, Polish men and women had high levels of physical aggression and sexual coercion. Relative to the IDVS samples, women, but not men, had high levels of causing injury to their partner and using threats or actual physical force to obtain oral, anal, or vaginal intercourse. The possible influences of high levels of domestic violence in Polish society and rapid changes in women's roles are discussed.     

The Timeline Followback Spousal Violence Interview to Assess Physical Aggression Between Intimate Partners: Reliability and Validity

The psychometric properties of the Timeline Followback Spousal Violence interview (TLFB-SV), a calendar method used to assess daily patterns and frequency of spousal violence, were evaluated. Men (N = 104) entering a spousal violence treatment program, along with their female partners, were interviewed with the TLFB-SV at pretreatment, posttreatment, and quarterly thereafter for 1 year and asked to identify days of male-to-female and female-to-male physical aggression that had occurred between them. For posttreatment and follow-up interviews, participants maintained a weekly diary, in which they catalogued the days on which acts of spousal violence occurred. The subscale scores derived from the TLFB-SV, the proportion of days of any violence, and proportion of days of severe violence for each partner were calculated for each assessment interval. The TLFB-SV subscales had excellent temporal stability and concurrent and discriminant validity. Interpartner agreement on TLFB-SV subscale scores and agreement between partners on days when spousal violence occurred was low at pretreatment, but was high for the other assessment periods.     

Relationship Abuse and Victims’ Posttraumatic Stress Disorder Symptoms: Associations with Child Behavior Problems

This study examined associations among male-to-female physical and psychological relationship aggression, female partners’ PTSD symptoms, and behavior problems among the children (n = 62) of men enrolled in a treatment program for relationship abuse perpetration. Psychological aggression was a stronger predictor of child behavior problems than physical assault. Restrictive engulfment and hostile withdrawal behaviors evidenced the strongest bivariate associations with child behavior problems, and were the strongest predictors of this outcome when considering four distinct forms of psychological aggression together. Victim PTSD symptoms largely mediated the effects of psychological aggression on child behavior. Findings suggest that male-to-female psychological aggression and victim PTSD symptoms play an important role in understanding behavior problems among children living with male relationship abuse perpetrators. Portions of this work were presented at the annual convention of the Association for the Advancement of Behavior Therapy, New Orleans, Louisiana, November, 2004.     

Trait Anger,Physical Aggression,and Violent Offending in Antisocial and Borderline Personality Disorders

Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are common conditions in forensic settings that present high rates of violence. Personality traits related to the five‐factor model personality domains of neuroticism and agreeableness have shown a relationship with physical aggression in nonclinical and general psychiatric samples. The aim of the present investigation was to examine the association of these personality traits with violence and aggression in ASPD and BPD. Results revealed that trait anger/hostility predicted self‐reported physical aggression in 47 ASPD and BPD subjects (β = 0.5, p = 0.03) and number of violent convictions in a subsample of the ASPD participants (β = 0.2, p = 0.009). These preliminary results suggest that high anger and hostility are associated with physical aggression in BPD and ASPD. Application of validated, self‐report personality measures could provide useful and easily accessible information to supplement clinical risk assessment of violence in these conditions.     

Violence during Pregnancy: Investigating Infanticidal Motives

This study aimed to investigate whether potentially infanticidal violence by men toward their pregnant partners’ is motivated by jealousy, and hence paternity uncertainty. It was predicted that men who used potentially infanticidal violence (directing their physical aggression towards their pregnant partners’ abdominal region) would have younger partners as this is associated with greater reproductive value; would be in relationships of shorter duration as this may indicate less stable relationships; and would be more jealous and restrictive of their partner’s movements and friendships than violent men who directed their aggression to other regions of their pregnant partners’ body. Relationship behaviors were provided from 43 women in domestic violence shelters (n?=?43), using measures of the following: (1) partner physical aggression (2) victim fear and injury, (3) areas of bodily assault (when pregnant and when not pregnant), (4) controlling behaviors, and (5) topics of disagreement. Violence directed towards the fetus was associated with shorter relationships where both partners were younger. In such relationships, there was more physical aggression from the male partner, he used more controlling behaviors to isolate his partner, and the partners had more disagreements arising from his jealousy, compared with when physical aggression was not directed towards the fetus. These findings are consistent with an infanticidal motive for men’s aggression directed towards their pregnant partners. If paternity uncertainty is a primary cause of this dangerous form of domestic violence, it should form an important element in any screening instrument.     

Test–Retest Reliability of the Revised Conflict Tactics Scales (CTS2)

The Revised Conflict Tactics Scales (CTS2) are widely used to measure intimate partner aggression. Various aspects of the CTS2 and its subscales have been examined, e.g. factor structure, internal consistency, and validity, but little or no evidence exists regarding the stability of the self-report of aggression on the CTS2 This study examines the stability of reports of aggression against a partner on the CTS2 among 82 men court-mandated to a batterer intervention program. At both testing times men reported on aggression occurring in the year prior to beginning treatment. Using variety scores, stability of report was strong for psychological aggression (r = 0.69), physical assault (r = 0.76), injury (r = 0.70), and negotiation (r = 0.60), but weaker for sexual coercion (r = 0.30). Implications for the use of the CTS2 in court-mandated populations are discussed.

Attributions for episodes of marital aggression: The effects of aggression severity and alcohol use

This study examined attributions for husband to wife marital agression as a function of aggression severity and husbands' alcohol use. Subjects were a community sample of 117 wives and 109 husbands who reported an episode of serious physical aggression during a structured interview, conducted at one year of marriage. The results showed that husbands' attributions were influenced by both severity and alcohol use. In particular, sober husbands tended to blame their wives for severe aggression, but, unexpectedly, drinking husbands tended to assume responsibility for severe aggression. In contrast, wives' attributions were influenced mainly by severity. Wives also discriminated between the locus and stability dimensions of causal attributions, whereas husbands relied solely on the locus dimension. Specifically, wives held husbands' behavior more responsible for severe aggression than their own behavior and held husbands' character much more responsible than their own character. Additional findings with regard to relationship attributions were discussed.     

Forensic psychiatric inpatients and aggression: An exploration of incidence,prevalence, severity,and interventions by gender

BackgroundPrevious investigations suggest that women judged to be not criminally responsible on account of mental disorder (NCR-MD) differ markedly from their male counterparts in important ways, underscoring the necessity of subsequent study.ObjectiveThe goal of the present study was to inform our understanding of the presenting profile of female forensic psychiatric patients and contrast their risk of inpatient aggression with their male counterparts.MethodThe population of patients assessed and/or treated at a secure Canadian forensic psychiatric hospital were available for study. In total, 527 patients had complete data and were part of intensive retrospective file reviews; inpatient aggression was evaluated using the Overt Aggression Scale.ResultsWomen were no less likely than men to have a violent index offence and to perpetrate inpatient aggression. Examining the range of aggressive behaviours and severity levels did little to increase the relevance of gender to inpatient risk.DiscussionFemale forensic patients represent a highly selected subgroup of women with exceptional clinical and behavioural challenges and associated treatment needs.