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<p class="ltrs-br-ltr-br-title"><span class="bold">A Survey of Self-Directed Physical Aggression Among Perpetrators of Partner Violence</span></p>
<p class="ltrs-br-ltr-br-body-text"><span class="semibold">To the Editor:</span> The characterization of partner-violent behavior is potentially relevant in terms of anticipating psychiatric diagnoses, treatment needs, and outcomes. One unaddressed issue is the relationship, if any, between externalized aggressive behavior (ie, partner violence) and self-directed physical aggression. Beyond the literature on murder followed by suicide (eg, references <span class="htmreg-cite"><a href="#ref1">1</a></span><span class="htm-cite"> and </span><span class="htmreg-cite"><a href="#ref2">2</a></span>) and a report of suicidal ideation or attempts in perpetrators of bullying (22%),<span class="htm-cite"><a href="#ref3">3</a></span> associations between person-directed violence and self-directed physical aggression remain unclear, despite the documented presence of negative self-schemas among batterers.<span class="htm-cite"><a href="#ref4">4</a></span> We explored among a sample of batterers 5 self-directed physically aggressive behaviors.</p>
<p class="ltrs-br-ltr-br-body-text">Participants were adult men and women who were court-referred to 1 of 4 treatment facilities because of perpetration of partner violence. Of the 235 individuals approached, 193 agreed to participate (82.1%): 170 men and 23 women. All respondents were between ages 18 and 65 years, with most (71.5%) between 21 and 40 years. The majority was white (43.0%), followed by black (19.7%), Native American (14.5%), Hispanic (11.4%), other (10.9%), and Asian (0.5%).</p>
<p class="ltrs-br-ltr-br-body-text">At the 4 sites, a recruiter met with 24 different treatment groups and reviewed the project focus and elements of informed consent. Participants signed consent forms and completed self-report surveys onsite. In addition to demographic queries, surveys contained the Self-Harm Inventory (SHI),<span class="htm-cite"><a href="#ref5">5</a></span> which is a 22-item, yes/no, self-report inventory that explores participants’ lifetime histories of self-harm behavior. In this study, we were interested in a subset of 5 queries related to self-directed physical aggression: cut self, burned self, hit self, banged head, and scratched self. This project was approved by a university institutional review board.</p>
<p class="ltrs-br-ltr-br-body-text">Of the 193 participants, 19.7% reported cutting self, 15.5% burning self, 34.7% hitting self, 33.7% banging one’s head, and 10.9% scratching self. In addition, 101 participants (52.3%) endorsed none of the 5 self-directed physical aggression items; 92 (47.7%) endorsed at least 1 item; 66 (34.2%), 2 or more items; 37 (19.2%), 3 or more items; 18 (9.3%), 4 or more items; and 8 (4.1%), all 5 items. The total number of items endorsed was weakly, but statistically significantly negatively correlated with age (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>–0.18, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.05). The mean (SD) number of items endorsed by men (1.09 [1.46]) compared to women (1.57 [1.62]) was not statistically significantly different, <span class="italic">F</span><span class="subscript">1,191</span><span class="thinspace"> </span>=<span class="thinspace"> </span>2.12, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.15. Similarly, the percentages of men (45.9%) and women (60.9%) who endorsed at least 1 item were not statistically significantly different, <span class="italic">χ</span><span class="superscript">2</span><span class="thinspace"> </span>=<span class="thinspace"> </span>1.82, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.14.</p>
<p class="ltrs-br-ltr-br-body-text">Limitations of the study include the self-report nature of the data, small sample size, and unknown ability to generalize findings to individuals with less severe histories of battering. However, findings indicate that a significant subgroup of perpetrators of partner violence, with no differences between men and women, also engage in self-directed physical aggression—a relatively novel finding in this literature. This finding may be particularly meaningful in teasing out associations with underlying psychopathology (eg, borderline personality disorder, depression), treatment (medications, psychotherapy), and long-term outcome (suicide).</p>
<p class="ltrs-br-ltr-br-references-head"><span class="smallcaps">References</span></p>
<p class="references-references-text-1-9"><a name="ref1"></a><span class="htm-ref"> 1.	</span>Galta K, Olsen SL, Wik G. Murder followed by suicide: Norwegian data and international literature. <span class="italic">Nord J Psychiatry</span>. 2010;64(6):397–401. <a href="
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=20380549&dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a> <a href="
http://dx.doi.org/10.3109/08039481003759201"><span class="pubmed-crossref">doi:10.3109/08039481003759201</span></a></p>
<p class="references-references-text-1-9"><a name="ref2"></a><span class="htm-ref"> 2.	</span>Roma P, Pazzelli F, Pompili M, et al. Mental illness in homicide-suicide: a review. <span class="italic">J Am Acad Psychiatry Law</span>. 2012;40(4):462–468. <a href="
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=23233465&dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a></p>
<p class="references-references-text-1-9"><a name="ref3"></a><span class="htm-ref"> 3.	</span>Borowsky IW, Taliaferro LA, McMorris BJ. Suicidal thinking and behavior among youth involved in verbal and social bullying: risk and protective factors. <span class="italic">J Adolesc Health</span>. 2013;53(suppl):S4–S12. <a href="
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=23790200&dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a> <a href="
http://dx.doi.org/10.1016/j.jadohealth.2012.10.280"><span class="pubmed-crossref">doi:10.1016/j.jadohealth.2012.10.280</span></a></p>
<p class="references-references-text-1-9"><a name="ref4"></a><span class="htm-ref"> 4.	</span>McKee M, Roring S, Winterowd C, et al. The relationship of negative self-schemas and insecure partner attachment styles with anger experience and expression among male batterers. <span class="italic">J Interpers Violence</span>. 2012;27(13):2685–2702. <a href="
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=22829210&dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a> <a href="
http://dx.doi.org/10.1177/0886260512436395"><span class="pubmed-crossref">doi:10.1177/0886260512436395</span></a></p>
<p class="references-references-text-1-9"><a name="ref5"></a><span class="htm-ref"> 5.	</span>Sansone RA, Wiederman MW, Sansone LA. The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. <span class="italic">J Clin Psychol</span>. 1998;54(7):973–983. <a href="
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9811134&dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a> <a href="
http://dx.doi.org/10.1002/(SICI)1097-4679(199811)54:7%3c973::AID-JCLP11%3e3.0.CO;2-H"><span class="pubmed-crossref">doi:10.1002/(SICI)1097-4679(199811)54:7<973::AID-JCLP11>3.0.CO;2-H</span></a></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">Randy A. Sansone, MD</span></p>
<p class="ltrs-br-ltr-br-author"><a href="
mailto:Randy.sansone@khnetwork.org">
Randy.sansone@khnetwork.org</a></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">Kenneth Elliott, MEd</span></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">Michael W. Wiederman, PhD</span></p>
<p class="ltrs-br-ltr-br-endmatter-fieldnotes"><span class="semibold-ital">Author affiliations:</span> Departments of Psychiatry and Internal Medicine, Wright State University School of Medicine, Dayton, and Department of Psychiatry Education at Kettering Medical Center, Kettering, Ohio (Dr Sansone); Violence Prevention Program, University of Central Oklahoma, Edmond (Mr Elliott); and Department of Psychology, Columbia College, Columbia, South Carolina (Dr Wiederman).</p>
<p class="ltrs-br-ltr-br-endmatter-fieldnotes"><span class="semibold-ital">Potential conflicts of interest: </span>None reported.<span class="semibold-ital"> </span></p>
<p class="ltrs-br-ltr-br-endmatter-fieldnotes"><span class="semibold-ital">Funding/support:</span> None reported.</p>
<p class="ltrs-br-ltr-br-endmatter-fieldnotes"><span class="semibold-ital">Published online:</span> March 5, 2015.</p>
<p class="ltrs-br-ltr-br-copyright-doi"><span class="italic">Prim Care Companion CNS Disord 2015;17(2):</span><span class="doi">doi:10.4088/PCC.14l01703</span></p>
<p class="ltrs-br-ltr-br-copyright-doi"><span class="italic">© Copyright 2015 Physicians Postgraduate Press, Inc.</span></p>
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