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Neuropsychological And Psychological Correlates Of Marital Violence In A Clinical Sample

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Neuropsychological And Psychological Correlates Of Marital Violence In A Clinical Sample

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NEUROPSYCHOLOGICAL AND PSYCHOLOGICAL CORRELATES
OF MARITAL VIOLENCE IN A CLINICAL SAMPLE
by
Virdette Laura Brumm
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(Counseling Psychology)
December 1994
UNI Dumber: 9600956
OKI Microform 9600956
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UNIVERSITY OF SOUTHERN CALIFORNIA
THE GRADUATE SCHOOL
u n iv e r s it y p a r k
LOS ANGELES, CALIFORNIA 90007
This dissertation, written by
under the direction of Dissertation
Committee, and approved by all its members,
has been presented to and accepted by The
Graduate School in partial fulfillment of re
quirements for the degree of
DOCTOR OF PHILOSOPHY
D n n of Graduate Studies
Date .Ei. ...
DISSERTATION COMMITTEE
• 1 — ' Choirpmon
Abstract
Marital violence is a serious national health
problem. Few studies have examined the
neuropsychological factors which may relate to marital
violence. The present investigation examined whether
male subjects with a history of domestic violence had
deficits in impulse control corresponding with
neuropsychological impairments in executive control
functioning and its relationship to self-reported
impulsivity and conflict resolution strategies.
Subjects were 40 self- and court-referred to the
Men's Educational Workshop at the University of
Massachusetts Medical Center for treatment of marital
violence. The nature and frequency of their
aggressive/violent behavior varied. Subjects were
interviewed by a psychologist specializing in marital
violence. Subjects completed a number of
questionnaires and were administered a battery of
standard neuropsychological tests (e.g., Continuous
Performance Test, Trail Making Test, and Wisconsin Card
Sorting Test.)
A series of stepwise multiple regression analyses
were performed to examine whether neuropsychological
measures of executive control functioning were
predictive of self-reported impulsivity and conflict
resolution tactics. Results revealed that components
representing neuropsychological measures of executive
control functions predicted self-reported impulsivity
and verbal aggression. However, performance on
neuropsychological measures did not predict head injury
status.
The results of this study indicated that although
subjects did not demonstrate overall neuropsychological
deficits, their pattern of response on certain measures
of executive control functioning predicted self-
reported impulsivity and self-reported aggressive
behavior as indicated by scores on the Conflict Tactics
Scales and the Barratt Impulsivity Scale. Theoretical
implication and applications will be discussed.
ii
Table of Contents
LIST OF T A B L E S........................* ............iv
INTRODUCTION ....................................... 1
significance ................................... 2
Statement of the Problem ...................... 3
Definitions ................................... 3
REVIEW OF THE LITERATURE .......................... 7
Marital violence .............................. 7
Biological Contributions to Marital
Aggression...............* .................. 10
Relationship Between Biological Factors
and Generalized Violence ................... 11
Neuropsychological Factors ................... 19
Related Research .... * .....................21
Limitations.................................... 24
Hypotheses...................................... 26
Relationship Among Predictor Variables . . . 26
Relationshp Between Predictor and
criterion Variables ...................... 26
METHOD AND PROCEDURES .............................. 28
Subjects........................................ 28
Procedures...................................... 29
Measures........................................ 31
Normative Measures .......................... 31
General Cognitive Functioning ........... 31
Overall Executive Control Functioning . .31
Predictor variables............ 36
Head Injury Status......................... 36
Neuropsychological Evaluation of ...........
Impulse Control ........................ 38
Self-Report Impulsivity Scale ........... 42
Criterion Variable .......................... 42
Research Design................................43
RESULTS...............................................44
Normative Data..................................44
Results of Regression Analyses ............... 50
Relationship Among Predictor Variables .... 50
Relationship Between Predictor and .............
Criterion Variables ................. . . . 52
Supplementary Analyses ........................ 59
ill
DISCUSSION...........................................62
Summary and Integration of Results ........... 62
Explanation for Relationship Among ...........
Predictor Variables ........................ 62
Explanation for Relationship Between ...........
Predictor and Criterion Variables ......... 63
Implications of the Present Study ........... 67
Limitations of the Present Study ............. 69
Future Directions ............................ 72
REFERENCES 75
List of Tables
iv
Table Page
1 Cognitive Variables ........................ 45
2 Overall Executive Function Measures .... 46
3 Impulse Control Measures.................... 47
4 Components and Corresponding Impulsivity . .
Measures.................................51
5 Correlation Matrix of Impulsivity ...........
Components and the Barratt Impulsivity . . .
Scale..................................... 53
6 Correlation Matrix of Head Injury and . . .
the Conflict Tactics Scale ................. 60
1
CHAPTER I
INTRODUCTION
In the last decade, marital violence has emerged as a
significant national health issue. Recent studies
indicate that marital violence affects one of every three
households (Straus & Gellee, 1986). Many variables must
be considered in the analysis of violence, including the
individual, the family system, and society. Gelles &
Haynard (1987) observe that:
Two decades of empirical research in child
abuse, wife beating, and domestic violence
are conclusive on one point— the causes of
violence are multi•dimensional. There is
no one cause— not poverty, not stress, not
mental illness or psychopathology, not
being raised in a violent home, and not
alcohol and/or drugs (p.270).
In the last decade, research has been driven
primarily by psychosocial conceptualizations of abuse
(Rosenbaum & Hoge, 1989). Amidst the impressive volume of
research conducted on marital violence, few studies have
examined biological factors which may contribute to
marital violence. Hotaling and Sugarman (1986) emphasized
that researchers have made an enormous effort to explain
male partner violence by examining the characteristics of
women rather than by revealing more about the factors that
promote violent behavior in men.
Recent research on biological explanations for
violent behavior has come under considerable criticism out
2
of concern that such work promotes the view of violence as
a disease, that it removes such behavior from its context
and absolves the perpetrator of responsibility.
Nevertheless, it is apparent that researchers increasingly
are studying aggressive behavior as a medical symptom with
specific brain substrates and treatment modalities (Brown
et al., 1989) and that evidence has emerged supporting
physiological bases of violent behavior (DiLalla &
Gottesman, 1991).
Significance
Few investigations have been conducted on the ways in
which biological factors may contribute to domestic
violence. One promising way in which to investigate the
relationship between biological factors and domestic
violence is by way of neuropsychological assessment, which
purports to examine the relationship between brain
functioning and behavior.
In one of the few studies that have addressed the
relationship between brain functioning and marital
violence, Rosenbaum et al. (in press) administered
neuropsychological tests and did not find general
neuropsychological deficits. However, their assessment of
neuropsychological impairment did not specifically address
frontal lobe functioning which generally is believed to be
related to impulse control. The present investigation
3
focused on executive control measures and self-reported
impulse control.
Statement of the Problem
This Btudy focused upon the role of
neuropsychological factors among men with a history of
marital aggression. The central research question of this
investigation was: do neuropsychological deficits
specific to impulse control predict self-reported marital
aggression.
Definitions
Typically, "violence" refers to the use of
interpersonal aggression with the intent to harm or
destroy (Elliott, 1992). With respect to the present
investigation, "violence" was not assessed directly.
Instead, self-reported indices of violent behavior were
used to assess marital violence.
For purposes of this study, references to
"biological" factors are used generally to describe
aspects of brain functioning as possible explanations for
aggressive behavior. This terminology is consistent with
that used in the literature on violent and aggressive
behavior.
According to Stuss (1992), "executive control
functions relate to the psychological concept of frontal
system function. These functions are commonly labeled
4
'frontal lobe functions' and include abilities such as
planning, decision making, directed goal selection, and
monitoring of ongoing behaviors". These higher order
activities frequently are divided into specific functions
such as anticipation, goal selection, plan formulation,
evaluation and monitoring of behavior. However, Stuss
(1992) also emphasized that his review of pertinent
research on the development of "frontal abilities"
reflects "the present inadequacy of the definition of
•frontal' abilities."
Published definitions of head injury employ different
diagnostic criteria and are not uniform in the inclusion
criteria for determining mild closed head injury. This
makes it especially difficult to determine head injury
status (Williams, Levin & Eisenberg, 1990). The specific
details as to the way in which head injury status was
assessed in this study follows in Chapter Three: Methods.
"Measures."
The term "impulsivity" is not clear, particularly
when applied to criminal acts (Volavka, Martel1 & Convit,
1992). For example, Linnoila and Virkkunen (1992) studied
the biological correlates of suicidal risk and aggressive
behavior traits and used the following definition of
impulsivity: if the victim was previously unknown to the
offender, and there was no apparent premeditation, only
5
verbal provocation, and no economic motivation (e.g.
robbery), the offense was termed impulsive. All other
cases were considered nonimpulsive. It is important to
note, however, that offenses involving domestic violence
were excluded as a result of the definition. For the
purposes of this study, impulsivity was defined more
inclusively as Nthe tendency to deliberate less than most
people of equal ability before taking action" (Dikman,
1990, p.95).
In summary, the present investigation explored
neuropsychological factors related to marital violence.
Specifically, it examined relationship between
neuropsychological deficits in executive control and self-
reported marital violence. Neuropsychological assessment
was used to evaluate batterers for possible deficits in
executive control functioning and poor impulse control.
The Conflict Tactics Scales, a self-report instrument,
were used to access frequency and severity of marital
violence. The Barratt Impulsivity Scale, a self-report
instrument, was used to measure degree of impulsivity.
Chapter Two, Review of the Literature, provides a context
in which to consider the problem and proposed research
project. Chapter Three sets forth a description of the
subjects, procedures, psychological and neuropsychological
assessment measures, and questionnaires which were
utilized. Results are presented in Chapter Four.
Chapter Five, the results of the investigation are
discussed.
7
CHAPTER II
REVIEW OF THE LITERATURE
This review first will provide an overview of the
research on marital violence and, thereby, a context
within which to consider the findings of this research.
Second, research on biological factors related to marital
violence will be presented. Third, relevant research on
the relationship between biological factors and
generalized violence will be briefly outlined. Lastly,
relevant literature in the field of neuropsychology will
be discussed.
Marital Violence
Previous psychological research has investigated the
problem of domestic violence from psychoanalytic,
behavioral, sociological, and feminist perspectives.
Early conceptualizations of the problem were based on
psychoanalytic theory and focused primarily on the
personality characteristics of battered women. Masochism
was perceived as an aspect of the feminine personality and
particularly relevant in the case of battered women.
According to Walker (1988), these early studies implied
that the pathology resided in the victim and essentially
ignored the initiation and effect of violence by the
perpetrator. There is little research applying
psychoanalytic theory to domestic violence.
8
Research based on social learning theory has
emphasized the relationship between physical and emotional
abuse and the batterer's mismanagement of anger and
frustration. Batterers learn that violence is a way in
which to gain their partner's compliance. Stimuli elicit
abusive behaviors and responses of the abused partner
maintain those behaviors (Jacobson 6 Margolin, 1979).
Learning theory also has emphasized the role of
interactional styles modeled in the family of origin as a
contributing factor to maladaptive learning.
The literature pertaining to the intergenerational
transmission of violence has established that violence in
the family of origin is frequently the most consistent
factor characterizing abusive families (Kalmuss, 1984;
MacEwen & Barling, 1988; Straus, Gelles & Steinmetz,
1980). Consequently, in recent years, researchers have
begun to focus on how marital violence affects children,
witnessing violence in one's family has been found to have
both short- and long-term developmental effects
(Forsstrom-Cohen & Rosenbaum, 1985; Hotaling & Sugarman,
1986; Kalmuss, 1984; Rosenbaum & O'Leary, 1981).
Furthermore, courtship violence has been viewed as a link
between experiences with violence in the family of origin
and those in the family of procreation (Makepeace, 1981;
Cate, Henton, Koval, Christopher, & Lloyd, 1982; Roscoe &
Benaske, 1985; Flynn, 1987).
Although there is considerable research in support of
the intergenerational transmission hypothesis, various
authors have cautioned that such a view is
wdeterministicn:
Caution should be used in interpreting the
cycle-of-violence literature, for
deterministic statements can lead
individuals from physically aggressive
homes to believe that they are programmed
to become aggressive . . . Attributing
aggression of anv kind to a single cause
simply does not fit the facts of
reasonable theoretical conceptualizations
of spousal aggression (Halone, Tyree, &
O'Leary (1989), p.696, emphasis added).
Other authors whose work is based on learning theory
place less emphasis on the experience in the family of
origin. Walker (1979) has applied Seligman's theory of
"learned helplessness" in order to explain how women
become caught in the cycle of violent relationships:
Once we believe we cannot control what
happens to us, it is difficult to believe
we can ever influence it, even if later we
experience a favorable outcome. This
concept is important for understanding why
battered women do not attempt to free
themselves from a battering relationship
(p.47).
Sociological and feminist theories have emphasized
the role of cultural norms in perpetuating conjugal
violence. Straus (1979) argued that cultural norms have
permitted conjugal violence:
The subordinate status of women in
American society, and in most of the
world's societies, is well documented.
Since physical force is the ultimate
recourse to keep subordinate groups in
their place, women in the history of Euro-
American society have often been the
victims of physical assault (p.465).
One distinction, however, between feminist and
sociological theorists is the feminist view that conjugal
violence is yet another example of violence against women
rather than a subtype of family violence. From the
feminist perspective, violence against women is the result
of an inherently patriarchal social structure which
facilitates the battering of women by their partners. In
the 1970s, feminists were among the first authors to
address the problem of violence against women and to argue
that women abuse should be studied in its own right.
Feminists were also instrumental in developing the shelter
movement and related treatment programs (Okun, 1986).
Thus, over the last several decades, research has
progressed from an individual/psychopathological
conceptualization of domestic violence to a
multidimensional view of etiological factors. However,
this research has focused principally on psychosocial
dimensions of the problem.
Biological Contributions to Marital Aggression
Despite considerable research on psychosocial
factors, little is known about other variables such as the
11
contribution of biological factors to marital aggression.
Rosenbaum et al. (in press) examined the relationship of
head injury and marital violence among S3 partner abusive
males, 32 maritally discordant, nonviolent males, and 45
maritally satisfied males. They found that 53% of abusive
males had a history of significant head injury compared to
25% of discordant males and 16% of maritally satisfied,
nonviolent males. Despite the finding that batterers had
a high rate of head injury, the authors emphasized that at
the present time there are still no data on what
proportion of male batterers have physical brain disorders
(Rosenbaum & Hoge, 1969). Statistics on the incidence of
head injury in the United States vary. Beers (1992)
reported that 3 million people sustain closed head injury
annually and approximately 140,000 to 280,000 have
resident deficits as a result of their injury. According
to McAllister (1992), head injuries are estimated to
affect close to 2 million people in the U.S. each year.
Relationship Between Biological Factors and Generalized
Violence
Due to the scarcity of research on biological factors
which may relate to marital violence, a review of the
research related to general violence is briefly set forth
in order to demonstrate the theoretical rationale for this
study. Researchers increasingly have demonstrated that
12
violent behavior is determined by the complex interaction
of psychosocial and biological variables (Mungas, 1988;
Elliott, 1982). Hungas (1988) suggested that longstanding
behavioral and psychosocial abnormalities distinguish
violent from non-violent individuals and that while brain
dysfunction contributes to the development of such
problems, it does not appear to be Ma necessary or
sufficient etiological factor causing violence" (p. 186).
According to Volavka et al. (1992), some antecedents
of violent crime are; childhood victimization; deviant
rearing environment (i.e., substance abuse, psychiatric
hospitalization); medical and neuropsychiatric history
(heart disease, epilepsy, severe head injury); alcohol;
and, anti-social personality disorder. Volavka et al.
(1992) also listed neurobiological findings in violent
offenders such as: diffuse brain dysfunction; drug abuse;
psychosis; localized brain dysfunction (i.e., temporal
lobes, frontal lobes, lateralized hemispheric
dysfunction); neurochemical findings (i.e. serotonin); and
serum glucose.
The above-referenced studies indicate that brain
damage is one possible antecedent of violent crime. Head
injury is one of the major causes of acquired brain damage
(Martel1, 1988) and has consistently been related to
organic deficits and violent behavior (Elliott, 1982;
13
McKinlay, Brooks, & Bond, 1981; Silver & Yudofsky, 1987).
In a study of 15 death row inmates, Lewis, Pincus,
Feldman, Jackson, and Bard (1986) found that all had a
history of severe head injury. There are approximately 1
million new cases of brain injury per year in the United
States and these events may damage the frontal lobes and
deep structures (i.e., frontal lobe syndrome), a component
of which is the inability to control angry affect (Silver
6 Yudofsky, 1987). McKinlay et al. (1981) reported that
70% of patients with traumatic brain injury were shown to
have aggression and irritability that was part of
significant distress to patients and families.
An important aspect of the theoretical rationale for
this study is that injury to the frontal area of the brain
is related to variables ultimately having their major
impact on impulse control (Mungas, 1983). Elliott (1982)
argued that 1 4 Investigations have disclosed that organic
deficits are much more common in patients with behavior
disorders than in the general population" (p.680).
Therefore, Elliott (1982) studied 286 patients with a
history of head injury, and found that "episodic
dyscontrol had developed in 102 formerly stable
individuals after a specific brain insult" (p.685). Based
on these findings, Elliott (1982) argued that aggressive
behavior may have neurological correlates and that not all
14
aggressive or violent behavior can be explained in terns
of psychological or social factors.
Many authors have postulated that damage to the
frontal area of the brain increases the risk of violent
behavior as the result of impaired inhibition of violent
impulses or excess impulsivity (Levin, Grafman, &
Eisenberg, 1987; Lezak, 1983; Martell, 1988; Tancredi &
Volkow, 1988). Impulsivity and behavioral dyscontrol are
variables which are central to this investigation as well
as their relationship to violence as the result of
possible deficits in the area of executive control due to
frontal lobe damage. Lezak (1983) has described executive
control functions as having four components: (1) goal
formulation; (2) planning; (3) carrying out goal-directed
plans; and (4) effective performance.
Frontal lobe functioning involves ’ "executive
control' and regulation of behavior. However, our
understanding of the role of the frontal cortex in violent
behavior is limited" (Volavka et al., 1992, p. 242). It
has been postulated that the frontal lobes are involved in
the process of cognition, abstraction, learning and
problem-solving behavior (Tancredi & Volkow, 1988).
Tancredi and Volkow (1988) emphasized the interaction of
various cerebral processes in order to understand brain
defects as they relate to violent behavior. Stuss, Gow,
15
and Hetherington (1992) concluded that symptoms of frontal
lobe damage labeled as "emotional disturbance" may be
classified as disorders of drive, mood, and affect and
suggest that the primary change after frontal lobe damage
is disorder of personality "with a disorder of self-
reflective awareness as a key deficit" (p. 349).
Caplan and Schechter (1990) also explored the high
incidence of impulsivity after injury to the brain.
According to Caplan and Shechter (1990), whatever the
observable behavior, the fundamental phenomenon is the
same: specifically, a tendency to initiate behavior
before a situation has been analyzed adequately (p. 60).
Caplan and Shechter (1990) noted that despite frequent
observation of impulsivity among brain-damaged patients,
it has received relatively little empirical attention in
the adult literature. The authors studied the incidence
of impulsivity after lateralized cerebral lesions using
the Kagan Hatching Familiar Figures Test (MFFT) and
reported that response latency scores of brain-damaged
groups were slightly lower than controls. It was noted
that these differences might have been due to incomplete
visual scanning characteristics of neglect rather than
impulsivity. Caplan and Shechter*s work highlights
potential problems inherent in trying to operationalize
the construct/concept of impulsivity and the limited
16
number of acceptable measures. For example, Dickman and
Heyer (1988) explored the association between individual
differences in personality trait of impulsivity and
differences in willingness to sacrifice accuracy for speed
of information processing. Dickman and Heyer (1988)
concluded that there are problems in "a simple speed*
accuracy tradeoff model of impulsive cognitive
functioning" (p. 274). Messer (1976) described
reflection-impulsivity as "the tendency to reflect on the
validity of problem solving under a very specific
condition, namely, when several possible alternatives are
available and there is some uncertainty over which one is
the most appropriate" (p. 1026).
Further evidence of the effect of injury to the
frontal area of the brain upon impulse control is
demonstrated by Prigatano (1992) which demonstrated that
specific personality and motivational disturbances are
associated with traumatic brain injury. Prigatano (1992)
found that agitation, irritability, anger, and episodic
dyscontrol were among commonly reported affective
disturbances. In addition, the study indicated that
patients seemed to show less spontaneous control of
affective states: some patients reportedly responded too
quickly (i.e., impulsivity) or very slowly (Prigatano,
1992). Prigatano stated that a long term problem of some
17
patients is anger and cited the findings of Elliott (1982)
and Rosenbaum and Hoge (1989), which provided
correlational but not experimental evidence that brain
injury is associated with a greater incidence of violence.
Prigatano (1992) also emphasized that because there may be
many effects of brain damage on emotion and motivational
responding, it has been difficult to conceptualize and
measure personality problems of patients with mild,
moderate, and severe injury.
The literature on violence also indicates that
impulsivity is emerging as an important concept connecting
assaultiveness and serotonergic dysfunction (Volavka,
Kartell, 6 Convit, 1992; Stein, Hollander, & Liebowitz,
1993; Apter et al., 1990) and only recently have
psychometric measures emerged (Apter et al., 1990). Stein
et al. (1993) reviewed research on impulsivity as a
dimension of personality or behavior from a biological
perspective and argued that MDespite the disagreement on
how best to classify and measure impulsive symptoms, there
has been notable convergence on the conclusion that
impulsive aggression and autoaggression correlate with
serotonergic hypofunction. . (p.15).
Evidence of impairment in executive control functions
due to frontal lobe damage may manifest itself in a
variety of ways. Heilman and Valenstein (1985) indicated
18
that dysfunction of the frontal lobes is reflected in a
number of specific behavioral manifestations, but argue
that the notion that frontal lobe lesions are associated
with a single characteristic picture such as "frontal lobe
syndrome" is not supported by clinical experience.
Heilman and Valenstein (1985) stated that the
contradiction between the claim that the frontal lobes
control the highest forms of behavior in humans and the
finding that intelligence test performance is not affected
after extensive frontal damage is a manifestation of the
problem of what to measure and how. Levin in a comment to
Stuss (1985) observed that recent studies indicate
usefulness of measures that stress information processing
under conditions of time or divided attention as well as
tests which measure flexibility of problem solving. Levin
emphasized that it is becoming increasingly clear that
head-injured patients frequently exhibit subtle
alterations of attention, memory and cognitive efficiency
despite recovery to a normal level of intellectual
functioning as measured by standard psychometric tests
(WAIS-R).
Knowledge regarding the functions of the frontal
lobes is limited when compared to other regions of the
brain (Mattson & Levin, 1990). Although deficits in
functioning vary, there is agreement that frontal lobe
19
disorders affect how a person responds, which in turn
affects the content of the response (Lezak, 1983).
Failures on test items are more likely to result from
approach to problems than from lack of knowledge or
perceptual or language incapacities (Lezak, 1983). Lezak
(1983) has classified behavioral disturbances associated
with frontal lobe damage in five groups with considerable
overlap: (1) problems of starting; (2) difficulties in
making mental or behavioral shifts; (3) problems in
stopping; (4) deficient self-awareness; and (5) a concrete
attitude.
Neuropsychological Factors
The present study focused upon the neuropsychological
parameters of violent behavior that may have significance
for understanding the brain mechanisms underlying marital
violence. In research on neuropsychological
discrimination between violent and nonviolent men,
Spellacy (1978) argued that psychological tests of
cognitive, motor, and perceptual abilities in the
identification of brain injury equals or exceeds medical
techniques and found neuropsychological differences
between violent and nonviolent men. Furthermore, Spellacy
(1978) argued that Mif poor impulse control shown by
violent persons is due in part to impaired or atypical
20
brain function, this should be reflected in generally poor
performance on such behavioral tests" (p. 50).
Neuropsychological research indicates that
significant progress has been made as the result of
studies on the effect which head injury may have upon
behavior (Bryant, Scott, Golden, 6 Tori, 1984). Dikmen,
Reitan, and Temkin (1983) suggested that head injury
occurs with high frequency and is a leading cause of brain
damage in young people. Among common sequelae,
"cognitive, intellectual, and emotional problems appear to
be more persistent and socially disabling than sensory and
motor disabilities" (Dikmen et al. 1983, p.333). These
studies provide a useful background for the present
investigation given that it focuses on the relationship
between brain function or impairment and violent behavior.
Neuropsychological measures have been used as
correlates with biological deficits (Kartell, 1992;
Hungas, 1988). Martell (1992) has noted the importance of
neuropsychological impairment in relation to violent
crime. Hungas (1988) has emphasized the value of a
neuropsychological model "for providing a better
theoretical understanding of the relationship between the
complexity of brain function and the extremely complex
phenomenon of violent behavior" (p. 186). in his study,
three groups of neuropsychiatric outpatients, homogeneous
21
according to parameters of violent behavior, were
identified and compared to each other on
neuropsychological measures and found that impulsively
violent individuals were shown to manifest an increased
incidence of neurological abnormalities. The author
argued that brain dysfunction impacts violent behavior in
various ways e.g., impaired impulse control.
Related Research
The study of violence necessitates that researchers
cross disciplinary boundaries in developing theories and
in designing research (Widom, 1991). Related areas of
research include: emotional processing, neuroanatomical
theories of impulse control, personality, and emotion as
well as biochemical theories of aggression. Haaland
(1992) has argued that "the study of emotional responses
may be one way of elucidating critical neural substrates
of emotion and the interaction of cognitive and non-
cognitive factors" (p.327). For example, Borod (1992)
reported that emotional processing has been traditionally
linked to limbic system structures, but more recently has
also been attributed to neocortical structures.
Borod (1992) described two general classes of
theories of emotion: cognitive theories which emphasize
cognitive processes mediating emotional experience and (2)
biologically based theories which postulate separate
22
systems for cognition and emotion yet include interaction
between the two systems. As Borod (1992) has suggested,
the biologically based theories are more germane to the
neuropsychological study of emotion and, thus, may have
relevance here as part of the rationale and theoretical
underpinning of this investigation.
Research on current neuroanatomical theories of
impulse control, personality and emotion is also relevant
to this investigation. Derryberry and Tucker (1992)
reviewed the neural substrates of emotion and described
the interdependence of the multiple levels of the neural
hierarchy in the brain. A noteworthy observation was that
this interdependence may be particularly important to
motivational and emotional processes, which combine bodily
feelings, a postural set, and a certain quality of
alertness together with complex mental representations of
the self and the social environment (Derryberry & Tucker,
1992).
They described the brain's architecture through an
analysis of the evolutionary progression through which
certain primitive control systems of the brain-stern were
overlaid by more complex elaborations of the limbic and
cortical networks (Derryberry 6 Tucker, 1992). They
postulated that "self-control in this hierarchy of
multiple networks may require a kind of negotiation
23
between the external constraints of the environmental
context and the Internal constraints at the core of the
bodily self (Derryberry & Tucker, 1992, p. 336).
There are several alternative biological explanations
for aggression which are prominent in the literature on
violence, but are not within the scope of this
investigation. These theories include genetic lines of
evidence which are relevant to the study of violence
(Plutchik & van Praag, 1989). In addition, the literature
on biochemical theories of aggression includes a
substantial number of scientific reports indicating that
serotonin functions may be altered in individuals with
aggressive/impulsive behaviors (Brown & Linnoila, 1990;
Linnoila & Virrkkunen, 1992; Plutchik & van Praag, 1989).
These reports constitute one of the most highly replicated
findings in biologic psychiatry (Brown & Linnoila, 1990).
Apter, van Praag, Plutchik, Sevy, Korn, and Brown (1990)
explored the interrelationship among anxiety, aggression
impulsivity, and mood as "a serotonergically linked
cluster" (p. 191). Brown et al. (1988) found a
correlation between uptake of serotonin and episodic
aggression and rating scales of impulsivity (Barratt
Impulsivity Scale). The authors hypothesized that the
relationship of low uptake to violence and aggression may
24
relate to Impulsiveness or "anger control" rather than
simply the presence of anger.
Limitations
Limitations in previous research on biological
factors related to marital violence are listed below.
Some of these limitations also apply to the present study
given the practical and theoretical limitations common to
this area of research:
1. Small sample sizes have precluded generalization
to all perpetrators;
2. Absence of a control groups;
3. Margolin, John, and Gleberman (1988) emphasized
that in previous research the labeling of subjects makes
them different from the large number of persons who,
despite experience with violence, have not been labeled as
batterers. Those who come to the public attention are a
small and potentially nonrepresentative sample of the
larger group of batterers.
4. Previous studies used subjects who all were from a
specific geographical area;
5. It may be that a significant relationship between
neuropsychological functioning and marital aggression was
not found in previous research because it did not assess
functioning of the relevant domains such as executive
control functions;
25
6. Research has been limited by a failure to
recognize qualitatively distinct but empirically and
clinically important subgroups and by use of single
measures or multiple measures sharing the same method of
measurement, limiting the scope of theoretical
explanations (Hungas, 1988, p. 180);
7. Experimenter bias in the assessment of head injury
has affected findings. For example, in Lewis et al.
(1986) and Rosenbaum and Hoge (1989), the investigator
making the assessment of head injury was aware of the
subject's history of aggression. The investigator should
be blind to group membership and aggression history; and
8. Quantification of head injury.
To summarize, violent behavior is related to the
complex interaction of psychosocial and biological
variables. The literature on violent behavior indicates
that brain damage is one possible antecedent of violent
crime and that head injury is a major cause of acquired
brain damage. A relationship between head injury and
marital violence was demonstrated in one study. Various
authors have postulated that injury to the frontal area of
the brain increases the risk of violent behavior as the
result of impaired inhibition of violent impulses or
excess impulsivity. Further research is required to
determine the relationship, if any, between biologically
26
related deficits, impaired impulse control, and marital
violence.
This study employed subjects with a history of
marital aggression. Thus, the investigation was
restricted to a clinical sample. The rationale for doing
so was because the focus of the investigation was on
within group differences germane to males with a history
of marital aggression and not the general population.
Hypotheses
Two types of hypotheses were tested: (1) those which
pertain to the relationship between predictor variables;
and, (2) those which pertain to the relationship between
predictor and criterion variables.
Relationship Among Predictor Variables
1. Neuropsychological measures of impulse control
(predictor variable 1) would be significantly related to
impulsivity as measured by the Barratt Impulsivity Scale
(predictor variable 2) among men who physically abuse
their partners.
2. Deficits in performance on neuropsychological
measures of impulse control (predictor variable 1) would
be positively related to history of head injury (predictor
variable 3) among men who physically abuse their partners.
Relationship Between Predictor and Criterion Variables
27
3. Neuropsychological measures of impulse control
(predictor variable 1) would be predictive of increased
verbal aggression (criterion variable lb) and violence
(criterion variable lc) and decreased reasoning (criterion
variable la).
4. Impulsivity as measured by the Barratt Impulsivity
Scale (predictor variable 2) would be predictive of
increased verbal aggression (criterion variable lb) and
violence (criterion variable lc) and decreased reasoning
(criterion variable la) among men who physically abuse
their partners.
5. Head injury (predictor variable 3) would be
predictive of increased verbal aggression (criterion
variable lb) and violence (criterion variable lc) and
decreased reasoning (criterion variable la) among men who
physically abuse their partners.
28
CHAPTER III
METHOD AND PROCEDURES
Subjects
Subjects in this study were 40 males (one subject was
deleted as he was a psychologist and had previously
administered a number of the measures which might have
invalidated the procedures). The 40 subjects used in this
study were obtained from a pool of 45 potential subjects;
five subjects declined to participate. Demographic data
are as follows; age ({{Age ■ 32.9, SD “ 9.58); education
({{Educational level - 12.23 years, SD - 2.52); occupation
({{Occupational level based on the Hollingshead scale ■
36.75, SD - 15.59).
Subjects were obtained from referrals to a group
treatment program for batterers at the University of
Massachusetts Medical Center (UMMC) in Worcester,
Massachusetts. This program, the Men’s Educational
Workshop, evaluates and treats individuals with a history
of aggression in marital or dating relationships.
Participants were referred from Central Massachusetts and
from neighboring states; 72.5% were court referred to the
Men's Educational Workshop and 27.5% were self-referred.
Research methods took into account the contribution
of head injury in explaining disparities in performance.
29
Thus, the criteria by which head injury was determined
required careful consideration. The criteria included:
a) Self- or court-referral for treatment of marital
violence;
b) No evidence of psychiatric disturbance; and
c) Consent to participate (see Appendix E).
This project was approved by the Committee for the
Protection of Human Subjects in Research at the University
of Massachusetts Medical Center and by the University Park
Institutional Review Board at the University of Southern
California.
Procedures
Subjects who were referred to UMMC for treatment of
marital aggression were scheduled for a three hour intake
interview assessment. Subjects were informed of the
project and asked if they wish to take part in the
research component. Participation in the research
component involved agreement to neuropsychological
assessment and permission to utilize intake data for
research. The neuropsychological assessment added
approximately 1.5 to 2.0 hours to the intake process.
Intake fees were waived as compensation for participation.
Subjects were informed prior to participation that intake
fees would be reduced in the case of financial need,
regardless of participation. Prior to any participation.
30
the nature of the investigation was described and informed
consent obtained.
Following consent procedures, all subjects were given
an intake interview for approximately one hour at UMMC by
the director of the program who is a nationally known
expert in the area of marital aggression. This semi
structured interview (see Appendix A) covered: family
history, with an emphasis upon parental marital
aggression; abuse of the subject by parents; marital
history; school and vocational history; alcohol and
substance abuse history; psychiatric history; police
record; and aggression history (involving partners and
others). Personality assessment was not part of the
screening.
Following the psychological interview, subjects were
asked to complete the Medical History Questionnaire (see
Appendix B), the Husband Form of the Conflict Tactics
Scales (see Appendix C), and the Barratt Impulsivity Scale
(see Appendix D). Twelve neuropsychological assessment
measures were then administered to all subjects. The
primary emphasis of the assessment was on impulse control.
A co-investigator administered these assessment measures
and was blind as to the subjects' medical history and
status regarding head injury in order to control for
experimenter bias.
31
Measures
Normative Measures
General Cognitive Functioning. The importance of
moderating cognitive variables in studies of violence and
impulsiveness has been demonstrated (Heilbrun, 1979). In
order to control for variability in the subjects' level of
global intelligence the Wechsler Adult Intelligence Scale-
Revised (WAIS-R) was administered. Specifically, a
modified Satz-Mogel administration was employed. Seven
subtests were administered (Comprehension, Similarities,
Vocabulary, Digit Span, Block Design, Digit Symbol, and
Picture Completion) and scores were prorated accordingly.
The validity and reliability of the WAIS-R as a measure of
global intelligence have been demonstrated (Wechsler,
1955).
This study examined the way in which impulse control
was related to type and severity of marital violence by
measuring neuropsychological functioning in men who
batter. Measures are presented below. There were three
predictor variables (impulse control measures and head
injury) and three criterion variables (methods of conflict
resolution).
Overall Executive Control Functioning. General
executive control functions were measured with the
32
following standard neuropsychological instruments (Lezak,
1983).
1. The Continuous Performance Test (CPT). A
modification of the CPT test based on the original version
described by Rosvold, Mirsky, Sarason, Bransome and Beck
(1956) was administered. This test has been widely used
to study attention deficits in patients with neurological,
metabolic, or psychiatric disorders (Mirsky & Orrin,
1977). It is a computer-generated task which requires
that the subject identify target combinations (the letter
"A" followed by the letter "X"). When the target is
identified, the subject responds by pressing a key on the
computer keyboard. The measure provides an estimate of
deviations of attention that extend beyond the normal
range. Several sets of norms have been developed. Norms
developed at UMMC (Cohen & Swearer, in press) will be
used;
2. The Wisconsin card Sorting Test (WCST). The WCST
is a widely used test devised to study "abstract behavior"
and "shift of set" (Lezak, 1983). Impairment on the WCST
is one of the most consistent findings in humans after
frontal lobe damage (Levin, Grafman, & Eisenberg, 1987).
Subjects were presented with 64 cards on which one to four
symbols are printed in four different colors. They were
then asked to place the cards one by one under four
33
stimulus cards according to a principle which the
individual deduced from the pattern of the examiner's
responses to placement of the cards (Lezak, 1983). A
computer-generated version of the test was used in this
study. Subjects were compared to standard normative data
for the WCST (Heaton, 1981; Spreen & Strauss, 1991);
3. The Stroop Test (Stroop, 1935) is a widely used
measure of focused attention (Levin et al., 1987) and the
ease with which an individual can shift perceptual set to
confirm to changing demands (Lezak, 1983). Subjects were
required to name a sequence of colors. Distraction was
created by disparity between the color and the word that
was presented which identifies a different color. Test-
retest reliability using a one month interval between
tests was estimated at *90, .83, and .91 for the three
parts (Spreen & Strauss, 1991). A computerized version
from the Walter Reed Performance Assessment Battery was
also used;
4. Trail Making Test. This measure is a widely used
test of visual conceptual and visuomotor tracking which
measures motor speed and attention functions. It is
highly vulnerable to the effects of brain injury (Lezak,
1983). It was administered in two parts (A and B).
Subject were asked to draw lines to connect consecutively
numbered circles on Part A and connected the same number
34
of consecutively numbered and lettered circles by
alternating betveen the two sequences on Part B (Lezak,
1983). Reliability as measured by the coefficient of
concordance was reported as .98 for Part A and .67 on
Part B (Spreen & Strauss, 1991). More detailed
information on reliability and validity is set forth by
Spreen and Strauss (1991). Means and standard deviations
for Trail Making Test were based on normative data
developed by Bornstein (198S);
5. Paced Auditory Serial Addition Test (PASAT). The
PASAT (Gronwall, 1977) is a measure of the efficiency of
information processing and is sensitive to deficits in
information processing ability (Levin et al., 1987; Lezak,
1983). Subjects were asked to add 60 randomized digits so
that each digit was added to the digit immediately
preceding it. The test was administered by taped
presentation at four rates of speed. Subjects were
compared to standard normative data (Lezak, 1983; Spreen &
Strauss, 1991);
6. controlled Oral Word Generation Test is a measure
of verbal fluency. Subjects were asked to say as many
words as possible within one minute beginning with a given
letter of the alphabet. Word fluency, as measured by FCL
and similar techniques calling for generation of word
lists, has proven to be a sensitive indicator of brain
35
dysfunction (Lezak, 1963; Spreen & Strauss, 1991).
Subjects' performance was compared to standard normative
data (Benton and Hamsher, 1976);
7. The Forteus Mass Test was "designed to yield data
about the highest levels of mental functioning involving
planning and foresight." (Lezak, 1983). The eight-maze
Porteus Haze Extension was administered. Each of the
eight Haze Tests were scored according to instructions
outlined by Stanley Porteus (1965). According to Lezak,
the Porteus Haze Test is sensitive to brain damage and has
successfully predicted severity of brain damage;
8. Oo-Ho-Oo and Double Alternating Kovements (Lezak,
1983; Benton et al., 1983). Hotor impersistence has been
defined by Benton (1983) as the inability of some
individuals to sustain a movement which they were able to
initiate on command. (Benton et al., 1983, p. 126).
Questions have been raised regarding reliability and
validity. Hore detailed information may be obtained in
Benton et al. (1983). No normative data is available;
however, the number of errors for each subject was
calculated;
9. Time Estimation (Thorne, Genser, Sing & Hegge,
1985). This computerized task is part of the Halter Reed
Performance Assessment Battery. An object moving at a
certain velocity on a computer monitor passes behind a
36
barrier. The subject must estimate the moment when it
will reappear. Normative data in Thorne, Genser and Hegge
(1983) was used;
10. Interval Production. This is a computerized
task from the Halter Reed Performance Assessment Battery
which was used to determine the temporal consistency of
interbeat interval of subjects' motor production.
Subjects were compared on this test to norms for young
adults derived from studies by Irving and Keele (1989) and
Cohen, Barns and Albers (1993); and,
11. Two-Letter Search. This is a computerized task
from the Halter Reed Performance Assessment Battery
involving visual search and recognition. Two target
letters are presented at the top of the computer monitor,
along with a string of 20 letters in the middle of the
monitor. The Bubject determines as quickly as possible
whether or not both target letters are present in the
string. The search string and target letters change with
each trial (Thorne, et al., 1985).
Predictor Variables
Head Inlurv Status. With regard to the determination
of head injury status, several studies referenced above
provide relevant discussions on the complexity involved in
measuring this variable, on how head injury has been
37
measured in the past and provide a rationale for how the
variable was measured in present investigation.
Subjects were evaluated for history of head injury.
Head injury status was determined by a neurologist at
UMMC, from information based on the Medical History
Questionnaire (see Appendix B). The questionnaire was
completed by the subjects during the intake interview.
This questionnaire was prepared with the assistance of the
above noted neurologist, and a neuropsychologist at Brown
University School of Medicine.
A point score was calculated based on the
questionnaire which provided information regarding
previous loss of consciousness due to head injury and
duration of post traumatic amnesia. More specifically,
subjects with scores of one or greater classified as
having a history of head injury and those with scores of
one or below were classified as having no history of head
injury based on the following cutoffs for post-traumatic
amnesia (Levin et al., 1987):
< 1 hour - mild head injury (1 point)
1-24 hours » moderate head injury (2 points)
>24 hours - severe head injury (3 points)
The questionnaire was named and constructed so that
subjects would be unaware of the focus of the
investigation. Questions regarding medical illness and
38
substance use were included as these variables may also
influence executive control functioning.
Neuropsychological Evaluation of Impulse Control.
Neuropsychological evaluation consisted of 13
measures focusing on executive control functions. Various
studies referenced above have addressed the problems
inherent in defining and measuring executive control
functions (Heilman and Valenstein, 1985; Stuss, 1985);
yet, in spite of these difficulties, certain features such
as subtle changes in alertness, affect, emotional
response, and appropriate control of regulatory behaviors
are commonly identified as the most telling signs of
frontal damage (Heilman & Valenstein, 1985, p.340).
For the purpose of this investigation,
impulsivity/impaired inhibition measures were derived from
executive control measures which correspond to Lezak
(1985). Given that there are no definitive categories of
executive control functions set forth in the literature, a
rationale for selecting impulse control measures was
required. Three highly experienced neuropsychologists
were asked to identify measures of impulse control from a
list of executive control measures. A measure was
included if there was 100% agreement among all three
raters.
39
The following impulse control measures were employed
to assess problems in stopping (breaking or modulating
behavior) which have been described as another type of
behavior associated with frontal lobe damage (Lezak,
1983). These problems are also manifested in impulsivity,
overreactivity, disinhibition, and problems in holding
back a wrong or unwanted response (Lezak, 1983).
Impulsivity or impaired inhibition may be reflected by the
failure to maintain set or incorrect responses to
distracting stimuli. The following indices were used:
1. CPT (number of false alarms). False alarm
responses were defined as incorrect responses to
distractors and also included impulsive responses to any
stimulus (Ringholz, ARCPT, Research Addition). The number
of false alarms indicated overreactivity or problems in
holding back an incorrect response;
2. CPT (response bias [b11]). This value indicated
whether the subject was cautious and chose not to respond
very often or whether the subject was impulsive and
responded more readily than he should;
3. Controlled Word Generation (FCL) (the number of
intrusions [i.e., wrong letter)). The number of
intrusions was used to assess ability to maintain set;
4. Interval Production. A standard one-second time
estimation task. It was predicted that subjects with
40
impulse control disorders would have a bias toward
increasingly short interbeat intervals as they fail to
delay response;
5. Lurie 3-8tep Motor Task (number of errors).
Mental inflexibility was reflected in the subjects'
ability to regulate motor acts;
6. Porteus Meies (number of errors by orossing over
lines). Qualitative errors were errors in execution
rather than planning. Wherever the pencil mark touched a
printed line in a maze, other than in turning a corner, it
was scored as a crossed line. According to qualitative
scoring guidelines, the score is intended to reveal
haphazard, impulsive, or overconfident habits of action,
or a tendency to become absorbed in the task so as to
neglect other directions (Porteus, 1965);
7. Porteus Mssss (number of errors by cutting
corners). The number of errors in cutting corners was
revealed haphazard or impulsive behavior. These are
errors of execution rather than planning (Porteus, 1965);
8. Stroop Test-Manual Version (number of correct
responses). The number of correct responses reflected
ability to shift perceptual set;
9. Stroop Test-Manual Version (number of breaks in
response set). Number of errors in naming color print of
color words indicated the ease with which subjects shifted
41
perceptual set to conforming demands and suppressed a
habitual response In favor of an unusual one (Spreen &
Strauss, 1991). This variable suggested a failure to
inhibit response;
10. Stroop Test-Computer Version (mean reaction time
on ineongruent trials);
11. Time Estimation (mean estimate overall response
time). Overall response time reflected a tendency to
react prematurely;
12. Two Letter Search (number of errors). The
number of errors on this visual search and recognition
task indicated a failure to delay response;
13. Wisconsin card Sorting Test (number of times
failed to maintain set);
14. Trail Making Test (Part B - time to completion).
The number of seconds to complete Trails B reflected
ability to shift course during ongoing activity, and the
ability to deal with more than one stimulus at a time
(Spreen & Strauss, 1991); and
15. Trail Making Test (Part B - number of errors).
Number of errors indicated the subject's ability to shift
course during ongoing activity and to deal with more than
one stimulus at a time (Spreen & Strauss, 1991).
A principal components analysis of the 15
neuropsychological measures of impulse control was
42
conducted to empirically summarize them as predictor
variables. The specific results are presented in the
Results section. For methodological purposes, it should
be noted that five components were derived. In subsequent
statistical analyses, the neuropsychological predictor
variables were represented by these five components.
Self-Report Impulsivitv Scale. The Barrett
Impulsivity Scale Version 11 (BI8) (Barratt, 1985, 1991)
is a 34 item self-report questionnaire consisting of three
subscales which measure motor impulsiveness, cognitive
impulsiveness and impulsive nonplanning. A score of
general impulsiveness is obtained by summing the three
subscales. The author of the BIS was consulted with
regard to scoring and normative data.
Criterion Variable
All subjects were asked to complete the Husband Form
of the Conflict Tactics Scales (CT6) (Straus, 1979). The
CTS is a self-report instrument consisting of 18 items.
CTS is used to measure self-reported violence. This
instrument has been used and refined in numerous studies
of family violence (Straus, 1979). The author of the CTS
was consulted with regard to administration and scoring of
the instrument. The scales were scored according to
guidelines and norms set forth in the Manual for the CTS
(1990) and a score were calculated for each subject on
43
three scales: reasoning; verbal aggression; and violence.
In order to assess the frequency and the severity of
violence, each CT item was weighted in accordance with the
frequencies indicated by the response categories presented
to the respondent. With respect to the scores on the
three scales of the CTS, subjects scored in the following
range: (1) Reasoning 0-65, H - 24.03; (2) Verbal
Aggression 0-130; M « 39.38; and (3) Violence 0-72, M -
5.38. Subjects' scores on the CTS were compared with
information regarding their history of aggression which
was gathered during the intake interview in order to check
for underreporting of aggressive/violent behavior.
Research Design
The hypotheses of this study were evaluated by
multivariate analysis of three predictor variables and one
criterion variable. The predictor variables were: (1)
head injury status and (2) impulse control. The
criterion variables were tactics in conflict resolution.
44
CHAPTER IV
RESULTS
Normative Data
Results of the Wechsler Adult Intelligence Scale-
Revised (WAIS-R) (Satz-Mogel Administration) are presented
in Table 1. The mean full scale IQ (94.98) and all
subtest scores were within one standard deviation of the
mean. Thus, there were no deficits noted in global
intelligence compared to the general population.
Performance on the measures of general executive
control suggested no significant deficits. Subjects
scored within 1.5 standard deviation of the mean on normed
measures. With regard to the measures for which no norms
exist, performance was analyzed qualitatively.
Results of the head injury assessment were as
follows: 24 subjects did not report a history of head
injury and 14 did report a history of concussion. Of the
subjects who reported a history of head injury, seven had
a history of concussion, six had a history of mild head
injury, none of the subjects had a history of moderate
head injury, and one had a history of severe head injury.
Results are presented in Table 2.
Descriptive statistics (i.e., mean and standard
deviation) derived for each impulse control measure are
presented in Table 3.
45
Table 1.
Cognitive Variables (Means and Standard Deviations)
Mean
WAIS-R Verbal IQ 94.95 (12.72)
WAIS-R Performance IQ 96.48 (11.94)
WAIS-R Full Scale IQ 94.98 (12.05)
Digit Span 10.54 (2.51)
Digits Forward 7.08 (1.05)
Digits Backward 5.55 (2.31)
Vocabulary 8.10 (1.91)
Comprehension 8. 38 (2.71)
Similarities 9.85 (3.97)
Picture Completion 10.28 (2.96)
Block Design 9.90 (2.74)
Digit Symbol 8.80 (2.09)
Footnote 1. Numbers In parentheses are standard
deviations.
46
Table 2.
Overall Executive Function Measures fMeans and Standard
Deviations)
Measure Mean
Continuous Performance Test
No. of hits
D'
Final ISI (msec)
Inconsistency index
Controlled word Generation (FCL)
No. of words/minute
Animals H
Shopping H
No. perseverative errors
Interval Production
Mean average beeps per tap
Porteus Mases
Test quotient
No. times lifted pencil
No. times changed directions
No. tracing errors
Motor Programs
Reciprocal programs (errors)
Go-No-Go (errors)
Double Alternating Movements
(errors)
Paced Auditory Serial Addition Task
Total no. errors
Proportion error responses
49.12 (3.96)
2.73 (.41)
60.99 (27.30)
6.88 (3.84)
37.54 (10.36)
19.85 (4.79)
21.49 (6.23)
1.13 (1.45)
0.94 (0.27)
104.51 (14.03)
1.64 (2.07)
2.28 (2.44)
.44 (.72)
.46 (.56)
.62 (.96)
.89 (1.48)
10.78 (7.96)
.13 (.12)
Table Continues
47
Table 2. (continued)
Measure Mean
Stroop Test (Computer Version)
Errors on incongruent trials
Errors on neutral trials
Mean reaction time on
neutral trials
1.00
.08
.90
(2.12)
(.27)
(.24)
Tiae Wall
Standard deviation in seconds
around estimate
.82 (1.07)
Trail Making Test (A)
Seconds to complete
No. of errors
33.40
0.35
(13.26)
(0.66)
T«o Letter Search
Mean overall reaction time
Reaction time for correct
responses
6. 04
6.14
(2.06)
(1.95)
Wisconsin card Sorting Test
Errors
Perseverative errors
Categories completed
Learning to learn
32.10
16.85
4.97
-2.13
(20.49)
(14.67)
(1.65)
(8.09)
Footnote 1. Numbers in parentheses
deviations.
are standard
48
TABLE 3.
Impulse Control Measures (Means and Standard Deviations!
Measure Mean
Continuous Performance Test
False alarms 2.32 (1.85)
Beta .59 (.27)
Controlled Word Generation
Errors l.ie (1.45)
interval Production
SD (1 sec) around estimate .20 (.63)
Luria Motor Test (Pist/Edge/Pain)
Errors 3.67 (3.69)
Errors crossing lines 8.44 (6.48)
Errors cutting corners 5.21 (4.21)
Btroop Test (manual version)
Color/Word score 46.55 (8.07)
Errors 1.25 (1.27)
Btroop Test (computer version)
Mean reaction time
incongruent trials .99 (.31)
Time Wall
Mean Estimated Overall
Response Time 9.89 (1.00)
Trails Making Test B
Seconds to complete 82.70 (36.95)
Errors .78 (1.41)
Two Letter Search
Errors .87 (1.03)
Table Continues
49
Table 3. (Continued)
Measure Mean
Wisconsin Card sorting Test
Failure to maintain set 1.36 (1.48)
Footnote 1. Numbers in parentheses are
deviations.
standard
50
Results of Reqresaion Analyses
Because there were a large number <15) of
neuropsychological measures of Impulse control, a
principal components analysis (PCA) was used to
empirically reduce the number of variables. Results of
the PCA showed that the 15 neuropsychological measures
were reduced to five independent components, which
accounted for 70% of the total variance. The five
components were identified as measuring the following
aspects of impulsivity: (1) focused attention; (2) motor
impulsivity; (3) cognitive tempo; (4) cognitive
inflexibility; and (5) disinhibition. The measures which
comprise each component are presented in Table 4.
The five components were then used as predictor
variables in subsequent stepwise multiple regression (SMR)
analyses. In order to justify separate SNR analyses using
the criterion measures, intercorrelations of the Conflict
Tactics Scales and Barratt Impulsivity Scale were
calculated. Intercorrelations were very low and ranged
from -.12 to .19.
Relationship Among Predictor Variables
Hypothesis 1: Neuropsvchological measures of impulse
control (predictor variable l) will be positively related
to impulsivity as measured bv the Barratt Impulsivity
Scale fpredictor variable 2). To evaluate this
Table 4.
Componentb and Corresponding Impulsivity Measures
Component 1 tFocused Attention)
Trail Making Test B
Continuous Performance Test
Time Estimation
Component 2 fMotor Control)
Porteus Mazes
Controlled Word Generation
Component 3 (Cognitive Tempo1
Interval Production
Two Letter Search
Component 4 (Cognitive Flexibility)
Wisconsin Card Sorting Test
The Stroop Color Word Test
Component 5 (Disinhibitionl
The Stroop Color Word Test
52
hypothesis, a series of 20 Pearson correlation
coefficients were conducted. Results are presented in
Table 5. Specifically, the following relationships
between the Barratt Impulsivity Scale and the components
were significant: (1) the cognitive impulsivity scale and
Component 3 (cognitive tempo); £ * .45 p < .01 and (2) the
Barratt motor impulsivity scale and Component 2 (motor
control) £ - -.38, p < .03. There was no significant
correlation between the Barratt nonplanning scale and any
of the five components.
Hypothesis 2: Deficits in performance on
neuropsychological measures of impulse control (predictor
variable 1) will be positively related to history of head
iniurv fpredictor variable 3). To evaluate this
hypothesis a series of five Pearson correlation
coefficients were conducted. The correlation between head
injury and Components 1 through 5 was not significant;
thus, there was not a significant relationship between
head injury and any of the five components.
Relationship Between Predictor and Criterion Variables
Hypothesis 3:__Neuropsychological measures of impulse
control fpredictor variable 11 will be predictive of
increased verbal aggression tcriterion variable lb) and
violence (criterion variable lc) and decreased reasoning
(criterion variable lal. To evaluate the relationship
53
Table 5.
Correlation Matrix of Impulsivity Components and the
Barratt Impuleivitv Scale
Pearson Correlation Matrix
BIS Components
Total
(1)
(2) (3)
BIS Total 1.0
Component 1 -0.06 1.0
Component 2 -0.32 -0.0 1.0
Component 3 0.31 0.0 -0.0 1.0
Component 4 0. 09 -0.0 0.0 0.0
Component 5 -0.05 0.0 0.0 0.0
Matrix of Probabilities
BIS
Total
(1)
Components
(2) (3)
BIS Total 0.0
Component 1 0.75 0.0
Component 2 0.07 1.0 0.0
Component 3 0.08 1.0 1.0 0.0
Component 4 0.59 1.0 1.0 1.0
Component 5 0.80 1.0 1.0 1.0
Table Continues
(4) (5)
1.0
0.0
0.0
1.0
1.0
(4) (5)
0.0
54
Table 5 (continued)
Pearson Correlation Matrix
BIS Cognitive
BIS
Cognitive (1) (2)
1.0
Components
(3) <4)
Component 1
CO
o
»
0
1
1.0
Component 2 -0.18 -0.0 1.0
Component 3 0.42 0.0 -0.0 1.0
Component 4
\
O
•
o
o
-0.0 0.0 0.0 1.0
Component 5 -0.04 0.0 0.0 0.0 0.0
Matrix of Probabilities
BIS
Cognitive (1)
Components
(2) (3) (4)
BIS Cognitive 0.0
Component 1 0. 66 0.0
component 2 0.33 1.0 0.0
Component 3 0.01 1.0 1.0 0.0
Component 4 1.0 1.0 1.0 1.0 0.0
Component 5 0.84 1.0 1.0 1.0 1.0
Table Continues
(5)
1.0
(5)
0.0
55
Table 5. (Continued)
Pearson correlation Matrix
BIS
Motor
(1)
Components
(2) (3) (4)
BIS Motor 1.0
Component 1 0.11 1.0
Component 2 -0.42 -0.0 1.0
Component 3 0.21 0.0 -0.0 1.0
Component 4 -0.03 -0.0 0.0 0.0 1.0
Component 5 -0.24 0.0 0.0 0.0 0.0
Matrix of Probabilities
BIS
Motor
(1)
Components
(2) (3) (4)
BIS Motor 0.0
Component 1 0.56 0.0
Component 2 0.02 1.0 0.0
Component 3 0.25 1.0 1.0 0.0
Component 4 0.89 1.0 1.0 1.0 0,0
Component 5 0.19 1.0 1.0 1.0 1.0
Table Continues
56
Table 5. (Continued)
Pearson Correlation Matrix
BIS
Non* Components
Planning (1) (2) (3) (4) (5)
BIS Non-Planning 1.0
Component 1 -0.2 1.0
Component 2 -0.09 -0.0 1.0
Component 3 0.12 0.0 -0.0 1.0
Component 4 0.26 -0.0 0.0 0.0 1.0
Component 5 0.21 0.0 0.0 0.0 0.0
Matrix of Probabilities
BIS
Non-
Planning
Components
(1) (2) (3) (4)
BIS Non-Planning 0.0
Component 1 0.27 0.0
Component 2 0.62 1.0 0.0
Component 3 0.52 1.0 1.0 0.0
Component 4 0.14 1.0 1.0 1.0 0.0
Component 5 0.24 1.0 1.0 1.0 1.0
1.0
(5)
0.0
57
between neuropsychological measures of impulse control and
reasoning, verbal aggression and violence, three SMRs were
performed. The five components derived from the principal
components analysis served as predictor variables. The
criterion variables were factor scores on the three scales
of the Conflict Tactics Scale: (1) Reasoning; (2) Verbal
Aggression; and (3) violence.
Results of the first SKR indicated that Component 5
(disinhibition) emerged as a significant predictor of
self-reported reasoning, £(1,31) “ 5.40, p < .03, and
accounted for 12% of the total variance in the prediction
of reasoning.
In the second SMR, the criterion variable was the
score on the Conflict Tactics Verbal Aggression Scale.
None of the predictor variables contributed significantly
to the prediction of verbal aggression as a conflict
resolution strategy.
In the third SMR, the criterion variable was the
score on the Conflict Tactics Violence Scale. None of the
predictor variables emerged as significant predictors of
self-reported violence.
Hypothesis 4: Impulsivity as measured bv the Barratt
Impulsivity Scale (predictor variable 2) will be
predictive of increased verbal aggression fcriterion
variable lb) and violence fcriterlon variable lc\ and
58
decreased reasoning fcriterion variable la). To evaluate
the relationship between impulsivity and reasoning, verbal
aggression and violence, four SMRs were conducted using
the overall score and the three scale scores (motor
impulsiveness, cognitive impulsiveness, and nonplanning
impulsiveness) on the Barratt Impulsivity Scale as the
predictor variables. The criterion variables were factor
scores on the three scales of the Conflict Tactics Scale:
(1) Reasoning; (2) Verbal Aggression; and (3) Violence.
In the first SMR, the criterion variable was the
score on the reasoning scale. Results indicated that none
of the predictor variables were significant predictors of
reasoning.
In the second SMR, the criterion variable was the
score on the Conflict Tactics Verbal Aggression Scale.
The motor impulsiveness scale significantly predicted
verbal aggression as a conflict resolution strategy,
£(1,38) - 15.53; p < .01, and accounted for 29% of the
total variance.
In the third SMR, the criterion variable was the
score on the Conflict Tactics Violence Scale. Two
predictor variables (Cognitive Impulsiveness and the
overall score) contributed significantly to the prediction
of violence, £,(2,37) - 8.34; p < .001.
59
Hypothesis 5: Head injury I predictor variable 31
will be significantly related to increased verbal
aggression fcriterion variable lb) and violence fcriterion
variable lcl and decreased reasoning fcriterion variable
lal. To evaluate this hypothesis a series of three
Pearson correlation coefficients were conducted. Results
are presented in Table 6. Specifically, the following
results were significant. Head injury status was
significantly correlated with the verbal aggression, r *
.44, p < .01. Head injury was not significantly
correlated with the reasoning or the violence scales.
Supplementary Analyses
Supplementary analyses were conducted to evaluate the
relationship between the five components derived from the
PCA and the Barratt Impulsivity Scale. Four stepwise
multiple regression (SMR) analyses were performed. The
predictor variables were the five components. The
criterion variables were the overall score on the Barratt
Impulsivity Scale and the factor scores on the three
scales: (1) motor impulsiveness; (2) cognitive
impulsiveness; and (3) nonplanning impulsiveness.
Results of the first SMR indicated that Component 2
(motor impulsivity) and Component 3 (cognitive tempo)
significantly predicted the overall score on the Barratt
Impulsivity Scale, E(2,30) * 3.76, p < .03, and accounted
60
Table 6.
Correlation Matrix of Head Injury and the Conflict Tactics
Scales
Pearson Correlation Matrix
Head Verbal
Injury Reasoning violence Aggression
Head Injury 1.00
Reasoning -.03 1.0
Violence .26
H
O
*
0
1
1.0
Verbal
Aggression
.44 -0.16 0. 62
Matrix of Probabilities
Head Verbal
Injury Reasoning Violence Aggression
Head Injury 0.0
Reasoning 0.84 0.0
Violence 0.11 0.97 0.0
Verbal o.oi 0.32 0.0 o.o
61
Aggression for almost 15% of the total variance in
predicting self-reported impulsivity.
In the second SNR, the criterion variable was the
score on the cognitive impulsiveness scale. Component 3
(cognitive tempo) contributed significantly to the
prediction of cognitive impulsiveness, £(l,3l) - 6.72, p
<.01, and accounted for 15% of the total variance in
predicting self-reported cognitive impulsivity.
In the third SNR, the criterion variable was the
score on the motor impulsiveness scale. Component 2
(motor control) emerged as a significant predictor of
self-reported motor impulsivity, £(1,31) - 6.71, p < .02.
In the fourth SNR, the criterion variable was the
score on the nonplanning impulsiveness scale. None of the
components emerged from the regression equation as
predictors of nonplanning.
62
CHAPTER V
DISCUSSION
Summary and Integration of Results
This study examined whether neuropsychological
assessment profiles would predict self-reported
impulsivity and conflict resolution strategies among men
who batter their partners. Specifically, this study
attempted to provide increased understanding of violent
men and the ways in which they may differ with regard to
executive control functions and their patterns of self-
reported abusive behavior. In general, the results of
this study demonstrated that while the subjects did not
demonstrate deficits in general cognitive or executive
control functioning, some neuropsychological measures of
impulse control measures were predictive of scores on the
Conflict Tactics Scales and the Barratt Impulsivity Scale.
Explanation for Relationship Among Predictor Variables
Two hypotheses were specific to the predictor
variables utilized in this study. First, it was
hypothesized that there would be a significant
relationship between self-reported impulsivity and the
neuropsychological measures as represented by the five
components derived from the PCA. Of the five correlations
that were conducted, only Component 3 (cognitive tempo)
was significantly related to self-reported impulsivity.
63
Secondly, it was hypothesized that there would be a
significant relationship between head injury status and
the neuropsychological measures as represented by the five
components. There was no significant relationship between
head injury status and neuropsychological functioning as
represented by the five components.
There are several possible explanations as to why the
neuropsychological profiles were not significantly related
to head injury status. First, frontal lobe dysfunction
resulting from prior head injury may have resolved.
Second, of the 40 subjects in this study, only 14 subjects
met the criteria for head injury (35%) and seven had
significant head injury (i.e., seven mild and one severe).
Assessment of head injury based on self report resulted in
the inclusion of subjects who in actuality had sustained
very mild injury in the form of concussion, the sequelae
of which is often difficult to detect on
neuropsychological assessment.
Explanation for Findings For the Relationship Between
Predictor and Criterion Variables
Two hypotheses examined the prediction of conflict
resolution strategies, and one hypothesis examined the
relationship between head injury and conflict resolution
strategies. In the first hypothesis (hypothesis 3), it
was postulated that scores on impulse control measures
64
would be predictive of Increased verbal aggression and
violence and decreased reasoning as measured by the
Conflict Tactics Scales. Results of the three separate
stepwise multiple regressions (SMR) using the five
components as predictor variables demonstrated that
component 5 (disinhibition) was predictive of reasoning.
No other components were predictive of verbal aggression
or violence.
The finding that component 5 was a significant
predictor of reasoning is interesting and suggests that
subjects who demonstrated decreased use of reasoning as a
conflict resolution strategy performed poorly on measures
which are sensitive to behavioral disinhibition. A
failure to inhibit or delay responses suggests a tendency
to respond before a situation has been analyzed and may
preclude more adaptive verbal mediation in emotionally
charged situations. The fact that the five components
were not predictive of increased verbal aggression or
violence may be due to the fact that subjects did not
demonstrate overall deficits on measures of executive
control functioning.
In the second hypothesis (hypothesis 4), it was
postulated that scores on self-reported impulsivity would
be predictive of increased verbal aggression and violence
and decreased reasoning as measured by the Conflict
65
Tactics Scales. The score on the motor impulsiveness
scale significantly predicted verbal aggression.
Additionally, the overall score on the Barratt Impulsivity
Scale and the score on the cognitive impulsiveness scale
significantly predicted violence.
The finding that the motor impulsiveness scale
predicted verbal aggression suggested that subjects who
reported impulsive habits of action also reported
increased verbal aggression as a conflict resolution
strategy. Both of these variables reflect an individual's
ability to regulate behavior. Thus, one would expect to
find a positive relationship between them.
The finding that the overall score on the Barratt
Scale and the Barratt cognitive impulsiveness scale
significantly predicted violence suggests that subjects
who reported difficulty in planning and decreased
cognitive flexibility were prone to report more violent
behavior. Therefore, this result is consistent with
previous studies which have reliably demonstrated that
decreased cognitive flexibility has been associated with
difficulties in planning and monitoring of behavior
(Lezak, 1983).
In the third hypothesis (hypothesis 5), it was
postulated that head injury would be related to increased
verbal aggression and violence and decreased reasoning as
66
measured by the CTS subscales. Although head Injury
status was significantly related to increased verbal
aggression, it was unrelated to either decreased reasoning
or increased violence. These findings suggest that there
is a true relationship between self-reported head injury
status and self-reported increased verbal aggression, but
not an increase in self-reported violence and decreased
reasoning. This result, i.e., head injury was not related
to increase violence, is consistent with previous findings
(see page 67) which demonstrated that none of the five
components were related to head injury status. As
reported, this also differs from the literature in which
head injury has been related to violence (Volavka et al.,
1992).
That self-reported verbal aggression was
significantly related to reported head injury, and
violence and reasoning were not, is intriguing, and
difficult to explain. Nonetheless, one possible
explanation is that the significant correlation between
head injury and verbal aggression was spuriously high, in
that with a sample size of 40 one would expect a higher
correlation coefficient which in turn would account for a
larger percentage of the variance than 19%. To remedy
this, future work might employ a larger sample size or a
more heterogenous population.
67
Supplementary analyses revealed that some of the
components of impulsivity predicted self-reported
impulsivity. Several findings are of Interest: (1) motor
control (Component 2) and cognitive tempo (Component 3)
predicted overall self-reported impulsivity; (2) cognitive
tempo (Component 3) was also predictive of cognitive
impulsiveness; and (3) motor control (Component 2) was
predictive of motor impulsiveness. These findings suggest
that the neuropsychological measures employed in this
study are sensitive to self-reported impulsivity and may
be useful in predicting self-reported impulsive
behavior.
Implications of the Present Study
In summary, some of the findings from the present
study are consistent with neuropsychological models as
discussed in Hungas (1988) which focus on the way in which
brain dysfunction (i.e., frontal lobe dysfunction and head
injury) may be related to violent behavior. Previous
investigations have demonstrated that brain dysfunction
increases the risk of violent behavior by impaired
inhibition of violent impulses and/or stimulating
behavioral dyscontrol (Levin, Grafman, & Eisenberg, 1987;
Lezak, 1983; Martell, 1988; Tancredi & Volkow, 1988). The
results of the present study indicate that
neuropsychological assessment of executive control
68
functions (specifically impulse control) were predictive
of self-reported impulsivity, but not aspects of marital
aggression such as self-reported verbal aggression and
violence.
These neuropsychological findings suggest that
batterers have certain response patterns which are related
to impulsive behavior. For example, they demonstrated a
failure to inhibit or delay response as indicated by the
number of false positive responses on the Continuous
Performance Test. Furthermore, performance on the
Wisconsin Card Sorting Test indicated a failure to
maintain cognitive set. In addition, performance on Trail
Making Test B revealed difficulties shifting cognitive
set.
Therefore, the neuropsychological profiles of
batterers reflect a pattern of responses on measures of
overall executive control function which may have direct
bearing on their ability to regulate their own behavior.
For example, a failure to inhibit or delay responses
suggests a tendency to respond before a situation has been
analyzed adequately (Caplan 6 Shechter, 1990). The
ability of these measures to predict responses on self-
reported impulsivity suggests that this is in fact the
case.
69
Although there were no significant differences in
performance on the neuropsychological measures between
subjects who had a history of head injury and those who
did not, 35% of the group had a history of some type of
head trauma. The prevalence of head injury in this group
may be another reflection of a tendency toward impulsive
behavior among the group rather than head injury as a
cause of impulsive behavior.
It has been argued that there is a lack of base rates
for neuropsychological disorders across all settings
(Duncan 6 Snow, 1987 in Martell, 1992). Although studies
have examined the prevalence of brain dysfunction in
various forensic populations, there have been few studies
examining the neuropsychological functioning of batterers.
Thus, these findings contribute data to understanding
neuropsychological profiles of this population.
The results of this study also highlight the ongoing
need for greater ecological validity in neuropsychological
research (Franzen, 1989; Heinricks, 1990 in Martell,
1992). More specifically, one may have expected that
neuropsychological performance would be more reflective of
actual behavior, e.g. their spousal abuse.
Limitations of the Present Study
Interpretation of these results should be made with
caution given the limitations of the study. Several
70
limitations exist with regard to design and internal
validity. First, subjects were not selected via random
sample, but were selected as a result of their
participation in the UMMC Men's Educational Workshop.
Second, the labeling of subjects makes them different from
the large number of persons who, despite experience with
violence, have not been labeled as batterers. Those who
come to the public attention are a small and potentially
nonrepresentative sample of the larger group of batterers
(Margolin, John & Gleberman, 1988).
There were two limitations related to external
validity and generalizability. First, there was a limited
sample size (n-40). A greater case to variable ratio
would increase the power of the study and reduce the
probability for chance results. Second, subjects were
drawn from a limited geographical area. The subjects in
this study were all from central Massachusetts rather than
from various geographical sections of the country.
Therefore, these factors must be carefully considered
before generalizing the results to other batterers.
Still other limitations pertained to the statistical
analyses which were employed. Because of the large number
of variables, principal components analysis was selected
in order to provide an empirical summary of the data set,
which resulted in five independent components. These five
71
components were then used In subsequent step wise multiple
regression analyses as predictor variables. Despite the
apparent utility in summarizing the large number of
neuropsychological measures, the components might have
masked potentially significant contribution of individual
neuropsychological measures.
A series of stepwise multiple regression analyses
were performed. With this statistical procedure, the
researcher does not have control over the order of entry
of each predictor variable. Thus, predictor variables are
chosen as a function of statistical consideration as
opposed to theory. Additionally, this procedure
capitalizes on chance and overfitting of data which make
it controversial, particularly when the procedure is used
for explanatory interpretations of the data* However, in
exploratory research such as this, stepwise regression is
less controversial. Nevertheless, variability of beta
weights may produce a misleading subset of variables
(Tabachnick & Fidel1, 1983). In the case of the present
study, several neuropsychological variables might increase
R2, but any one alone might not have added a significant
proportion of the variance.
Another limitation to the investigation was the
restriction of range on both predictor and criterion
variables. For example, subjects' neuropsychological
72
profiles (predictor variable) generally were all within
normal limits. Additionally, on the Conflict Tactics
Scales (criterion variable), scores on the verbal
aggression and violence scales all fell at the low end of
the distribution. Thus, the lack of variability on both
predictor and criterion variables may have contributed to
the lack of findings.
Finally, several limitations must be addressed with
regard to measurement. Due to significant expense,
neuroimaging techniques such as Magnetic Resonance Imaging
(MRI), Computerized Axial Tomography (CT Scan), Positron
Emission Tomography (PET) were not utilized to confirm the
presence and location of brain lesions. Furthermore,
absent access to anatomical data derived from CT Scan,
discharge or operative notes, the history or severity of
head injury was based on the Medical History Questionnaire
which is a self-report measure and relies on memory of
past events. It was also necessary to rely on self-report
measures of impulsivity and conflict resolution
strategies.
Future Directions
The relationship between biological, environmental
and learning variables in the etiology of violent behavior
remains complex and unresolved. Therefore,
multidisciplinary studies which examine the multiplicity
73
of variables involved are required. First, future
neuropsychological research will be useful in exploring
the role of the frontal cortex in violent behavior
(Volavka, Martell f c Convit, 1992). In the effort to
increase knowledge of frontal lobe dysfunction and the
impact this type of dysfunction may have upon impulse
control, a next step might be to expand the range of
violent behavior by comparing batterers, normals and
subjects from the prison population on these measures. A
more violent population may demonstrate greater deficits
on impulse control measures. Furthermore, more attention
might be directed to the relationship between test scores
and activities of daily living and criminal legal
standards of behavior in the effort to increase ecological
validity in neuropsychological research (Martell, 1992).
In addition, a multimodal approach to the measurement
of the criterion variables would be helpful in addressing
the limitations of the present study. For example, this
investigation relied upon self-report measures of
impulsivity and patterns of violent behavior. Future
research might incorporate data from other sources such as
partners, family members, or clinicians involved in
treatment.
Finally, future research might employ a group design
format comparing the responses of subjects on the Conflict
74
Tactics Scales, the Barratt Impulsivity Scale and the
neuropsychological measures used in the present study
using head injury as an independent variable in order to
examine head injury more closely. A study of this nature
would necessitate the use of a control group as well as
precise assessment of head injury through neuroimaging
techniques and documentation in medical records.
In summary, this study provides initial data on the
ability of neuropsychological profiles to predict self-
reported methods of conflict resolution and impulse
control. Multidisciplinary research on violent behavior
continues to explore the various factors which contribute
to violent behavior. Future research as to the way in
which biological and psychosocial factors interact will be
important to increased understanding of domestic violence
as a significant problem.
75
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Creator Brumm, Virdette Laura (author)

Core Title Neuropsychological And Psychological Correlates Of Marital Violence In A Clinical Sample

Degree Doctor of Philosophy

Degree Program Counseling Psychology

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,psychology, clinical,sociology, criminology and penology

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Polkinghorne, Donald E. (committee chair), Goodyear, Rodney K. (committee member), Margolin, Gayla (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c20-567873

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Legacy Identifier 9600956.pdf

Dmrecord 567873

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Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

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