759977

research-article2018
JIVXXX10.1177/0886260518759977Journal of Interpersonal ViolenceLoinaz et al.

Original Research
Journal of Interpersonal Violence
1­–24
Understanding Empathy, © The Author(s) 2018
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DOI: 10.1177/0886260518759977
https://doi.org/10.1177/0886260518759977
Attachment in Sexual journals.sagepub.com/home/jiv

Offenders and
Partner-Violent Men

Ismael Loinaz,1   Luis Miguel Sánchez,2

and Andrea Vilella1

Abstract
The assessment and treatment of emotional variables is a priority in the
rehabilitation of offenders. Although theoretical proposals suggest a clear
relationship between violence and self-esteem, attachment, and empathy, the
research carried out to date has reached contradictory results due mainly to
differences in the measurements used, the reliability of self-reports, or even
to problems with the definition of the constructs. The present study analyzed
these three variables in a prison sample of sexual offenders (n = 48) and
partner-violent men (n = 68), using the Interpersonal Reactivity Index, the Rape
Empathy Measure, the Rosenberg Self-Esteem Scale, and the Adult Attachment
Questionnaire. Results confirmed the low utility of nonspecific empathy, the
predominance of high self-esteem, and the difficulty of identifying an insecure
attachment. The implications of the use of these variables in the treatment
of offenders, and the need to improve the assessment tools, are discussed.

Keywords
empathy, self-esteem, adult attachment, sexual offenders, partner-violent men

1University of Barcelona, Spain

2Alhaurín de la Torre prison, Málaga, Spain

Corresponding Author:
Ismael Loinaz, University of Barcelona, Passeig Vall d’Hebron 171, 08035 Barcelona, Spain.
Email: ismael.loinaz@gmail.com
2 Journal of Interpersonal Violence 00(0)

The analysis of affective dimensions such as empathy, self-esteem, or adult

attachment is common in the assessment of offenders before they enter or
during cognitive-behavioral programs (see Bowen, 2011; Craig, Dixon, &
Gannon, 2013). Despite the relevance of these variables, as we will see later,
controversy persists regarding the reliability of the tools used for their mea-
surement, the existence of any differences with respect to the general popula-
tion, the one-dimensionality of the constructs used, and context dependence
or stability over time. Research seems unable to confirm the theoretical pro-
posals put forward, and the improvement in some variables does not seem to
be associated with changes in recidivism rates.

Empathy
Broadly speaking, empathy may be defined as the ability to put oneself in
the place of another person on an emotional level (see Davis, 1994). It is a
multidimensional construct with at least two components: A cognitive
component, which involves recognizing the feelings of the other person
and identifying with them, and an emotional component, which involves
experiencing such feelings oneself (Day, Casey, & Gerace, 2010; Day,
Mohr, Howells, Gerace, & Lim, 2012; Marshall, Marshall, Serran, &
O’Brien, 2009). Barnett and Mann (2013a, 2013b) proposed that empathy
has five components (perspective taking, the ability to experience emo-
tion, a belief that others are worthy of compassion and respect, situational
factors, and an ability to manage personal distress) and that certain risk
factors present in the offender (i.e., offense-supportive beliefs, grievance
thinking, lack of concern for others, poor problem solving, self-regulation)
lead to a lack of empathy during the offending. Moreover, a consistent
definition is still a challenge, and affects research and practice (Cuff,
Brown, Taylor, & Howat, 2016).
It is generally agreed that empathy is a protective factor that inhibits vio-
lent behavior and motivates altruism, while an empathic deficit is related to
violent behavior (Day et al., 2010, 2012; Jolliffe & Farrington, 2004).
However, problems with its measurement, the existence of different dimen-
sions, and its context dependence have made it difficult to empirically dem-
onstrate a clear relationship between low empathy and violence (Day et al.,
2012; Loinaz, Echeburúa, & Ullate, 2012; Marshall et al., 2009; Martínez,
Redondo, Pérez, & García-Forero, 2008). For example, a subject may have
general empathy, or empathy toward specific targets such as animals or chil-
dren, but not toward his or her victim.
Research with sex offenders has shown that they have less empathy toward
their own victims than toward other victims of sexual assault (Fernandez &
Loinaz et al. 3

Marshall, 2003; Fernandez, Marshall, Lightbody, & O’Sullivan, 1999;

Marshall & Moulden, 2001). In the case of intimate partner violence (IPV),
several studies have reported the absence of differences between aggressors
and controls (Buck, Leenaars, Emmelkamp, & van Marle, 2012; Loinaz
et al., 2012), and have proposed the same explanation as in sexual offenders:
Empathy is a multidimensional construct and attempts to assess it globally
may miss the influence of important facets (Covell, Huss, & Langhinrichsen-
Rohling, 2007). Others conclude that improvements in empathy are related to
reduction in violence (Zosky, 2016), or that poor empathy skills mediate
recidivism in some type of offenders (Romero-Martínez, Lila, & Moya-
Albiol, 2016). A recent meta-analysis (Vachon, Lynam, & Johnson, 2014) of
the absence of a relationship between empathy and violence presents two
alternative explanations: (a) the true association between the two variables is
weak (we cannot assume that having cognitive empathy, that is, knowing the
emotions of others, implies prosocial behavior, or that those with less emo-
tional resonance, or emotional affection, will act in a violent way) and (b) the
association between variables is affected by measurement problems (poor
reliability, small groups, and the use of self-reports). It is essential to take into
account at least these two explanations.

Self-Esteem
Self-esteem is related to different psychological problems and can be
described as the feeling of satisfaction that a person has with himself or her-
self. Research has associated both low and high self-esteem with violent
behavior (Ostrowsky, 2010; Perez, Vohs, & Joiner, 2005). Broadly speaking,
low self-esteem has been associated with greater frequency and severity of
violent behaviors (Walker & Bright, 2009b), which has favored its inclusion
in treatment programs. However, high or falsely inflated self-esteem (Walker
& Bright, 2009b), self-reported but not real high self-esteem with feelings of
insecurity (Salmivalli, 2001; Thomaes & Bushman, 2011), or even violence
motivated by a perceived ego threat in cases of high narcissism (Baumeister,
Bushman, & Campbell, 2000; Bushman et al., 2009) may also be found. So,
the relationship between violence and self-esteem is U-shaped: both low and
very high (inflated) levels can promote violence (Thomaes & Bushman,
2011). As with empathy, different types of self-esteem have been described—
specific self-esteem (referring to specific aspects of oneself), global self-
esteem (general opinion), or competence-centered self-esteem (Sakellaropoulo
& Baldwin, 2007)—and the instability of the dimension has also been ana-
lyzed as a possible confounding variable (Ostrowsky, 2010). Therefore, even
this apparently simple variable cannot be clearly linked to violence.
4 Journal of Interpersonal Violence 00(0)

Sexual abuse during childhood and low self-esteem during adolescence

have been found to be strong predictors of sexual violence in adulthood
(Reckdenwald, Mancini, & Beauregard, 2014). One possible explanation is the
rejection and social perception of sexual offenders (Levenson, Brannon,
Fortney, & Baker, 2007), which may influence their self-esteem, discomfort,
and consequent aggression. Marshall et al. (2009) proposed an explanatory
model that not only links low levels of self-esteem with shame, violent, and
nonempathic responses but also associates the same type of response with high
self-esteem. Shame may be caused by the act of carrying out a sexual assault
and may be related to cognitive distortions aimed at denying or minimizing the
facts. In their therapeutic model, Marshall, Marshall, Serran, and Fernandez
(2006) linked the increase in self-esteem with changes in cognitive distortions
and increases in empathy toward victims, all of which reduce recidivism.
In IPV, self-esteem is also a part of many treatment programs. Theoretically,
partner-violent men (PVM) with low self-esteem are more likely to perceive
situations as threatening and to react violently to confront their feelings of
inferiority and improve their sense of self-worth (Ali & Naylor, 2013). Self-
esteem has also been related to taking responsibility, with more acceptance of
the crime in offenders with higher self-esteem (Lila, Oliver, Galiana, & Gracia,
2013). Significantly, lower self-esteem has been reported in adolescents who
use violence in their relationships (Díaz-Aguado & Martínez, 2015), and even
in the general population, it has been found that for every point that self-
esteem is reduced on a scale of 1 to 10, the risk of committing IPV increased
by 2.8% (Papadakaki, Tzamalouka, Chatzifotiou, & Chliaoutakis, 2009).
However, recent studies have raised doubts about this relationship. Regardless
of the possibility mentioned above that the subject may have narcissistic ten-
dencies or falsely inflated self-esteem, sometimes, the instruments used do not
show differences between offenders and the general population, due either to
a lack of sensitivity, to a distortion in the answers, to the existence of different
forms of self-esteem or simply to the lack of any relationship between vari-
ables (Loinaz et al., 2012).

Adult Attachment
Finally, attachment reflects the type of affective connection that we have with
people who are close to us (either family members or not). This variable is
expressed from the earliest childhood in maternal-filial bonds (the topic that
originated its study), but develops and is modified in the different stages of
an individual’s evolution (Mikulincer & Shaver, 2007). In general, we talk
about security or insecurity in relationships, with insecurity being expressed
in the form of anxiety by worried or fearful subjects and in the form
Loinaz et al. 5

of avoidance by rejecting subjects. Attachment influences our response to

interactions with other people and, therefore, the expression of different types
of IPV (Mikulincer & Shaver, 2011). Many studies have assessed the rela-
tionship between attachment and violence (Ansbro, 2008; Beech & Mitchell,
2009; Ross & Pfäfflin, 2007), especially regarding insecure style (Ogilvie,
Newman, Todd, & Peck, 2014).
Theories of attachment have explained IPV as a reaction to a real or per-
ceived threat of separation and abandonment (Bartholomew & Allison,
2006). The most frequently described style in PVM is insecurity (Chiffriller
& Hennessy, 2010; Holtzworth-Munroe, & Meehan, 2004; Lawson, 2008;
Waltz, Babcock, Jacobson, & Gottman, 2000), insecure people being more
vulnerable to feelings of abandonment (Mikulincer & Shaver, 2011) and
more likely to distrust their partners (Buck et al., 2012). Fearful and preoc-
cupied styles, characterized by avoidance and concern, respectively, are com-
monly described (Dutton, Saunders, Starzomski, & Bartholomew, 1994;
Fournier, Brassard, & Shaver, 2011; Mauricio & Gormley, 2001) more often
than the dismissive style characterized by defensiveness. Buck et al. (2012)
linked separation anxiety, mistrust in the intimate partner, and insecure
attachment to IPV and low self-esteem, describing the dismissive style as
more frequent (and present in the antisocial aggressor subtype). Attachment
insecurity is also linked with anger and jealousy (Wright, 2017).
Research on sexual offender’s attachment problems has pointed out its
potential role as predisposing and precipitating factor, even in the onset of their
offending behavior (McKillop, Smallbone, Wortley, & Andjic, 2012). Although
attachment does not explain sexual violence (there is a wide variety of offend-
ers, motivations, or risk factors), and attachment problems have not been con-
sistently found or even are common in general population, sexual offenders
may be more likely to report insecure adult attachment styles compared with
nonoffenders or other offenders (Craissati, 2009). These attachment problems
are related to failures in managing intimacy that increase the risk for sexual
behavior to be expressed with violence or abuse, in impersonal circumstances,
or with less threatening sexual partners like children (Craissati, 2009; McKillop
et al., 2012). Regarding specific sexual offenders, rapists tend to have avoidant
or dismissive attachment, and child molesters preoccupied or fearful patterns
(Craissati, 2009). In turn, attachment problems may explain the connection
between adverse developmental experiences in childhood victimization or
trauma in the backgrounds of sexual offenders and sexual violence (Abracen &
Looman, 2016; Grady, Levenson, & Bolder, 2017; McKillop et al., 2012).
Although less frequently, the modification of attachment also forms part
of some treatment programs. Among PVM, achieving secure attachment
may increase comfort in relationships, as well as the establishment of
6 Journal of Interpersonal Violence 00(0)

healthy patterns in closeness and dependence (Lawson, Barnes, Madkins,

& Francois-Lamonte, 2006), improvements that would help to reduce vio-
lence (Lawson & Brossart, 2009). Its treatment has been described in juve-
nile sex offenders (Rich, 2006), and has been related to reduced recidivism
in adults (Marshall & Marshall, 2010). For example, Marshall and Marshall
(2017) included attachment theory in the treatment of child molesters,
pointing out that the development of a secure attachment could allow
offenders to believe that it is possible to have relationships with other adults
and that other people can see attractive features in them (attending some
interpersonal problems described in sexual offenders).

Current Study
Based on the theoretical framework and available research findings, the aim
of the study was to describe the assessment of empathy, self-esteem, and
adult attachment in sexual offenders and PVM in Spain. The main research
question was whether offenders have low self-esteem, empathy deficits, or a
dysfunctional attachment style. We hypothesized the following:

Hypothesis 1: Scores in unspecific empathy (measured with the

Interpersonal Reactivity Index [IRI]) would be comparable with those of
general population.
Hypothesis 2: Offenders would have lower scores in specific empathy
scenario (measured with the Rapist Empathy Measure [REM]) for their
own victim compared with other types of victim’s scenarios.
Hypothesis 3: Scenario of an accident victim would be more related to
general empathy (IRI) than violence victim’s scenarios.
Hypothesis 4: High levels of self-esteem would be obtained according to
cutoff scores established in general population.
Hypothesis 5: An insecure attachment style is expected in both types of
offenders.

Findings will contribute to our understanding not only of the relevance of

these variables but also of the utility of the currently used assessment tools in
daily practice.

Method
Participants
A total of 116 male offenders serving sentences in Alhaurín de la Torre Prison
(Spain) participated in the study. Forty-eight were sexual offenders and 68
Loinaz et al. 7

were PVM according to their main crime. Sexual offenders had an average
age of 39.73 (SD = 14.96; range = 19-81) and most of them (n = 44; 91.7%)
were Spanish. PVM had an average age of 38.07 (SD = 10.36; range = 22-61)
and also most of them were Spanish (n = 62; 91.6%). There were no signifi-
cant differences in age (t = 0.663; p = .509), nationality (χ2 = 1.469; p = .336),
or educational level (χ2 = 4.482; p = .701).
Among sexual offenders, the most common types of crime were sexual
abuse (41.7%; n = 20), sexual aggression (35.4%; n = 17), and exhibitionism
(12.5%; n = 6) to victims more than 13 years (the age of sexual consent until
2015 in Spain) in all three cases. Rape (2.1%; n = 1), sexual assault of children
below 13 (8.3%; n = 4), or sexual abuse of children below 13 (6.3%; n = 3)
were less common. Among PVM, the most frequent types of crime were mal-
treatment (44.1%; n = 30), protection order violations (17.6%; n = 12), and
threats (16.2%; n = 11). Injuries (7.4%; n = 5), homicide, and murder (both
with 1.5%; n = 1) were less frequent. The same offender in each group could
have committed more than one type of crime. Regarding criminal history,
10% of sex offenders and 24% of PVM were recidivists (prior conviction).

Measures
Interpersonal Reactivity Index (IRI).  The IRI consists of 28 items, rated on a
5-point scale ranging from 0 (does not describe me well) to 4 (describes me
very well; Davis, 1980, 1983). It measures four components of general empa-
thy: (a) perspective taking (capacity to understand the psychological point of
view of others), (b) fantasy (ability to get into fictional situations and identify
with fictitious characters in books, movies, and so on), (c) empathetic con-
cern (ability to show compassion and concern for others), and (d) personal
distress (self-oriented feelings of discomfort when observing negative expe-
riences in others). The Spanish adaptation by Mestre, Frías, and Samper
(2004) was used, which presented an internal consistency of between .56 and
.62 in male samples. Test–retest reliability of the original version ranged
from .62 to .71 (Davis, 1980).

Rapist Empathy Measure (REM).  Designed specifically to assess empathy in

sexual offenders, this self-report describes three scenarios: (1) a sexually
assaulted woman, (2) a female victim of a traffic accident, and (3) the offend-
er’s own sexual assault victim. Respondents answer 30 items about the wom-
an’s feelings (measuring the cognitive facet of empathy), and 20 items about
his own feelings regarding what happened to the woman (measuring the emo-
tional facet) for each scenario (Fernandez & Marshall, 2003). The Spanish
adaptation was used (Martínez et al., 2008), with an internal consistency
between .83 and .91.
8 Journal of Interpersonal Violence 00(0)

Rosenberg Self-Esteem Scale. This 10-item self-report scale assesses one’s

overall feeling of satisfaction or worth (Rosenberg, 1965). Items are rated on
4-point scale ranging from 1 (strongly disagree) to 4 (strongly agree). The
suggested ranges are up to 25 (low self-esteem), 26 to 29 (medium self-
esteem), and 30 or more (high self-esteem). In a Spanish clinical sample
(Vásquez, Jimenez, & Vázquez-Morejon, 2004), the scale produced an inter-
nal consistency of .87, and a test–retest reliability of .74.

Adult Attachment Questionnaire (AAQ).  This self-report created in a Spanish

sample comprises 40 items (rated on a 6-point scale) divided into four scales:
(a) low self-esteem, need for approval, and fear of rejection; (b) hostile reso-
lution of conflicts, resentment, and possessiveness; (c) expression of feelings
and comfort with relationships; and (d) emotional self-sufficiency and dis-
comfort with intimacy (Melero & Cantero, 2008). It follows the model of
Bartholomew and Horowitz (1991) classifying the subjects into two (inse-
cure or secure attachment) or four types (fearful, worried, safe, and dismis-
sive) according to centile scores and values assigned to them (low, moderate,
high). Its internal consistency ranges from .68 to .89.

Procedure
All respondents participated in the assessment in a pretreatment phase carried
out by one of the authors (a prison psychologist) as part of standard procedure
during penitentiary treatment. In the case of PVM, the REM was modified to
describe a victim of IPV rather than of sexual violence in Scenario 3. There
were some incomplete answers and, therefore, some cases are missed depend-
ing on the measure analyzed.

Statistical Analyses
Data were analyzed using the SPSS 22 statistical package, using descriptive
statistics and frequencies, comparison of means using the Student’s T para-
metric test for independent samples, chi-square frequency comparison, and
bivariate correlations. Cohen’s d was used to analyze the effect size of the
significant differences for quantitative variables.

Results
Empathy
General empathy (Table 1), measured with the IRI, showed statistically signifi-
cant differences on the perspective taking (15.08 vs. 18.20; t = –3.277; p = .001),
 Table 1.  Scores on the IRI.

Sexual Partner-Violent
Full Sample Offenders Men General Population
(N = 110) (n = 44) (n = 68) (k = 5a)

  M SD M SD M SD t p d M Range
Perspective taking 16.93 5.03 15.08 4.50 18.20 5.34 −3.277 .001 −0.63 16.26 14.38-19.19
Fantasy 11.30 4.75 9.91 5.03 12.26 4.33 −2.673 .009 −0.50 15.28 13.45-17.17
Empathic concern 19.88 4.60 18.70 4.32 20.69 4.64 −2.319 .021 −0.44 17.64 16.73-19.04
Personal discomfort 9.27 5.10 8.91 5.05 9.50 5.16 −0.633 .528 — 10.36 9.46-10.91

Note. Full sample is 110 cases because six cases had missing data on the IRI. IRI = Interpersonal Reactivity Index.
aReferences used: Braun, Rosseel, Kempenaers, Loas, and Linkowski (2015); Chrysikou and Thompson (2016); Davis (1983); De Corte et al. (2007);

Mestre et al. (2004).

9
10 Journal of Interpersonal Violence 00(0)

Table 2.  Score on the REM.

Full Sample Sexual Offenders Partner-Violent
(N = 110) (n = 44) Men (n = 68)

  M SD M SD M SD t p d

Scenario 1 352.89 56.01 337.48 69.36 363.17 42.54 −2.197 .032 −0.45
Scenario 2 317.29 58.90 315.41 64.10 318.55 55.64 −0.272 .786 —
Scenario 3 323.26 76.28 308.36 84.33 333.20 69.30 −1.687 .095 —

Note. Full sample is 110 cases because six cases had missing data on the REM. Scenario 1: woman victim
of crime (victim of sexual offense or intimate partner violence in case of partner-violent men); Scenario 2:
woman victim of car accident; Scenario 3: the offender’s victim. REM = Rapist Empathy Measure.

fantasy (9.91 vs. 12.26; t = –2.673; p = .009), and empathic concern (18.70 vs.
20.69; t = –2.319; p = .021) scales, with higher scores among PVM. The magni-
tude of the difference was moderate for the fantasy (d = 0.50) scale and large for
perspective taking (d = 0.63). Offender’s scores were similar to those of general
population samples, except for the fantasy scale, lower among offenders.
Table 2 shows empathy measured by the REM, with only significant dif-
ferences between groups in Scenario 1 (generic victim of sexual assault), in
which PVM scores were higher (t = –2.197; p = .032). In spite of this, the
magnitude of the difference was only moderate (d = –0.45). In Scenarios 2
and 3, PVM also presented higher scores, although the differences were not
significant. Sexual offenders showed the lowest level of empathy toward
their own victim, and PVM toward the victim of the traffic accident but had
higher empathy toward the generic crime victim than toward their own
victim.
As shown in Table 3, IRI and REM were significantly and positively cor-
related among sexual offenders, with the highest correlation between REM
Scenario 1 (generic victim of sexual aggression, r = .483; p < .001) and total
IRI, followed by Scenario 2 (car accident, r = .479; p < .001) and Scenario 3
(offender’s own victim, r = .362; p < .05). Among PVM, there were no statis-
tically significant correlations. Thus, general empathy correlated less with
empathy toward offenders’ own victims than with empathy toward other
people’s victims or traffic accidents.

Self-Esteem
Table 4 shows the scores on the self-esteem scale. There were no differences
between the two groups: PVM had a mean of 31.59, and sexual offenders had
a mean of 31.26. According to the cutoff scores, most of the subjects (more
than 65%) had high self-esteem (score ≥ 30). The self-esteem scale, on the
 Table 3.  Intercorrelations for Scores on All Scales as a Function of Offender Group.
Measure 1 2 3 4 5 6 7 8 9 10 11 12 13

 1.  IRI_PT — .323** .447** −.058 .638** .319** −.045 .118 −.162 −.404** .407** −.335** .154
 2.  IRI_F −.026 — .460** .289* .725** .003 −.102 −.062 .249* .107 .102 −.046 −.073
 3.  IRI_EC .270 .114 — .370** .818** .210 .164 .143 .193 .116 .172 .080 .027
 4.  IRI_PD −.041 .330* .063 — .585** .059 .224 −.019 .410** .533** −.194 .327** −.216
 5.  IRI_TOTAL .483** .642** .583** .616** — .224 .091 .070 .241 .119 .178 .005 −.036
 6.  REM_VIOLENCE .480** .298* .351* .040 .483** — .454** .314* −.058 −.122 .240 −.224 .224
 7.  REM_ACCIDENT .478** .316* .186 .158 .479** .697** — .220 .223 .159 .001 .071 −.183
 8.  REM_VICTIM .437** .263 .190 −.011 .362* .655** .596** — −.090 −.097 .283* −.029 .241
 9.  AAQ_1 −.097 .020 .075 .255 .120 −.165 −.123 −.200 — .553** −.282* .517** −.597**
10. AAQ_2 −.109 .187 .090 .270 .195 −.088 .021 .000 .800** — −.370** .628** −.471**
11. AAQ_3 .000 .084 −.216 .018 −.044 −.153 −.111 −.086 −.249 −.228 — −.366** .309*
12. AAQ_4 .149 .280 −.050 .191 .251 −.164 .053 −.121 .390* .550** −.140 — −.360**
13. SE .106 −.238 −.156 −.177 −.200 −.209 −.033 .071 −.532** −.324* .298 −.132 —

Note. Intercorrelations for partner-violent men are presented above the diagonal and intercorrelations for sexual offenders are presented below the diagonal.
IRI = Interpersonal Reactivity Index (PT = perspective taking; F = fantasy; EC = empathic concern; PD = personal discomfort); REM = Rapist Empathy Measure
(violence = victim of sexual violence or IPV depending on the sample type; accident = victim of an accident; victim = offender’s own victim); AAQ = Adult Attachment
Questionnaire (Scale 1: low self-esteem, need for approval and fear of rejection; Scale 2: hostile resolution of conflicts, resentment and possessiveness; Scale 3:
expression of feelings and comfort with relationships; Scale 4: emotional self-sufficiency and discomfort with intimacy); SE = Rosenberg Self-Esteem Scale.
*p < .05. **p < .01.

11
12 Journal of Interpersonal Violence 00(0)

Table 4.  Scores on Rosenberg Self-Esteem Scale.

Full Sample Sexual Offenders Partner-Violent

(N = 111) (n = 43) Men (n = 68)

  M SD M SD M SD t p

Total 31.40 4.94 31.26 4.49 31.59 5.24 −0.344 .732

Categories χ2  
Low (%) 11.4% 11.6% 14.7% 0.407 .816
Medium (%) 21% 23.3% 19.1%
High (%) 67.6% 65.1% 66.2%

Note. Full sample is 111 cases because five cases had missing data on the Self-Esteem Scale.

contrary, was negatively correlated (p = .000) with Scale 1 on the AAQ (see
Table 3). The correlation between the two variables was high and significant
among PVM (–.597) and sexual offenders (–.532). In both cases, higher lev-
els of self-esteem on the Rosenberg Scale gave a lower score on Scale 1 of the
attachment questionnaire, thus suggesting its convergent validity.

Attachment
Scores in the AAQ are presented in Table 5. Both groups showed similar pat-
terns of scores, but PVM had significantly higher scores on Scale 3 that mea-
sure expression of feelings and comfort with relationships (the desirable
interpersonal style). The AAQ Scales are not homogeneous with regard to the
number of items, which decreases from Scale 1 to Scale 4; therefore, centiles
proposed in the original tool to assess the score on each scale were used.
According to these centiles, most of the scores were moderate. The difference
between sex offenders and PVM, identified by the Scale 3 raw score, was
reflected in low/moderate values in sexual offenders and moderate/high val-
ues in PVM.

Discussion
Do offenders have low self-esteem, empathy deficits, or a dysfunctional
attachment style? These are some of the questions that motivated this study.
Understanding the utility of these variables in the assessment of risk and
recidivism in violent subjects is essential (see Barnett, Wakeling, Mandeville-
Norden, & Rakestrow, 2011), but there remain many controversies.
 Table 5.  Mean Scores and Classification According to Percentiles on the AAQ.

Full Sample Sexual Offenders Partner-Violent Men

(N = 105) (n = 41) (n = 68)

  M SD M SD M SD t p d
Scale 1 37.18 12.69 38.05 13.36 36.63 12.32 0.559 .577 —
Scale 2 29.39 10.78 30.29 11.81 28.81 10.12 0.662 .510 —
Scale 3 41.59 6.79 39.32 6.04 43.05 6.88 −2.839 .005 −0.58
Scale 4 17.30 7.39 17.68 6.86 17.06 7.75 0.418 .677 —

  Centile Values Centile Values Centile Values  

Scale 1 40-60 Mod. 40-60 Mod. 25-39 Low/mod.  
Scale 2 40-60 Mod. 40-60 Mod. 40-60 Mod.  
Scale 3 40-60 Mod. 25-39 Low/mod. 61-74 Mod./high  
Scale 4 40-60 Mod. 40-60 Mod. 40-60 Mod.  

Note. Full sample is 105 cases because 11 cases had missing data on the AAQ. Scale 1: low self-esteem, need for approval and fear of rejection;
Scale 2: hostile resolution of conflicts, resentment and possessiveness; Scale 3: expression of feelings and comfort with relationships; Scale 4:
emotional self-sufficiency and discomfort with intimacy. AAQ = Adult Attachment Questionnaire; Mod. = moderate.

13
14 Journal of Interpersonal Violence 00(0)

Regarding empathy, among PVM, IRI scores were similar to or even

higher than those of the general population (Braun, Rosseel, Kempenaers,
Loas, & Linkowski, 2015; Chrysikou & Thompson, 2016; Davis, 1983; De
Corte et al., 2007), including the Spanish adaptation scores (Mestre et al.,
2004), except for the Fantasy scale, lower among offenders. In the case of
sexual offenders, scores were similar to or lower than those of general popu-
lation, and slightly lower than those of previous sexual offender samples
(e.g., Brown, Harkins, & Beech, 2012; Webster, Bowers, Mann, & Marshall,
2005). This confirms partially our first hypothesis.
Previous reports of a higher level of empathy toward the victims of others
than toward one’s own victims (Fernandez & Marshall, 2003) are confirmed
among sexual offender (the Scenario 3 has the lower score). Although, among
PVM, Scenario 2 has the lowest score, they had also less empathy toward their
own victimim compared with victims of others. Hypothesis 2 is fully con-
firmed among sexual offenders, and partially among PVM. We must take into
account that REM was not created originally for PVM. In addition, the corre-
lation between IRI (nonspecific) and REM (specific) was greater in the sce-
nario corresponding to the accident or victims of others than in the scenario
related to the own victim among sexual offenders. There were no significant
relationships among PVM. This confirms partially the existence of different
types of empathy, and the Hypothesis 3. Therefore, the measurement of empa-
thy with generalist tools may be of little utility in some offenders. This rela-
tionship should be analyzed with more detail in future research among PVM.
This result corroborates those found with dimensional models and in
studies indicating that empathy is specific to the object to which it refers
(Day et al., 2012). Therefore, we cannot make inferences in aggressors
based on the assessment of a kind of empathy that is unrelated to the prob-
lem for which they are in prison. Having empathy for general issues such as
“less fortunate people” or identifying with “the feelings of the characters in
a novel” does not mean that an aggressor is able to put himself in the place
of his victim. In fact, in previous studies, the assessment of general empathy
has not distinguished aggressors from controls (Loinaz et al., 2012). It has
even been suggested that traditional techniques used to improve empathy in
offenders may be useless. During the treatment, offenders may learn to have
some empathy with their past victim, but that does not necessarily mean that
they successfully develop the skill of perspective taking and are able to
apply it in the future (Barnett & Mann, 2013a,b). New developments for the
assessment of empathy associated with aggression, as the recently proposed
Affective and Cognitive Measure of Empathy (ACME) Scale (Vachon &
Lynam, 2016) or the Empathy Index (Grady & Rose, 2011), may solve some
of these problems.
Loinaz et al. 15

Our prediction that self-esteem would be high (Hypothesis 4) was sup-

ported in both groups of offenders, not only because of their mean scores but
also because the cutoff points established in the general population classified
more than 65% of the cases in both samples as having high self-esteem (≥30).
The results do not support the theory exposed by some authors that explains
aggression as a way of improving low self-esteem (e.g., Ali & Naylor, 2013);
in fact, they endorse those of others who have concluded that self-esteem
levels in violent offenders may be high (Loinaz et al., 2012; Thomaes &
Bushman, 2011; Walker & Bright, 2009a).
The results do not confirm the Hypothesis 5 regarding insecure attachment
indicated by previous studies (Ansbro, 2008; Babcock, Jacobson, Gottman,
& Yerington, 2000; Beech & Mitchell, 2009; Forbes & Reilly, 2011; Ross &
Pfäfflin, 2007; Timmerman & Emmelkamp, 2005; Waltz et al., 2000). The
mean scores of the total sample were similar to those of the general popula-
tion (Melero & Cantero, 2008). Recent results regarding attachment security
in sex offenders (Ogilvie et al., 2014) and PVM (Chiffriller & Hennessy,
2010; Lawson, 2008) have also been inconsistent, and subtypes of offenders
must be taken into account (see Cameranesi, 2016; Loinaz, 2014).
All the results show the persistence of a long-standing debate in offender
assessment which can be summarized in three main ideas: (a) subjects’
responses are unreliable and, therefore, the results do not demonstrate their real
psychological state; (b) the tools are not useful for measuring the dimensions
that we are trying to describe in offenders (because they are nonspecific, are
static, or do not consider specific contexts); and (c) the variables described in
studies or theoretical models may not be relevant in practice or may not be
homogeneous in all subjects; theory may be useful in some cases, but not in all.
Whichever assessment option we choose, the implications for daily practice are
very important. If the subjects’ responses are not reliable either in experimental
contexts (in which inmates respond to questions from a person from outside the
penitentiary center and in which there are no possible consequences; for exam-
ple, Loinaz et al., 2012) or in a real context as in this study (in which inmates
responded to their therapist), the measurement of therapeutic change, the suit-
ability of the programs to respond to specific needs, and the reliability of our
recidivism forecasts are all problematic. How can we assess whether partici-
pants are responding to treatment and modifying risk factors if we cannot trust
the answers they give us? If the tools are not able to assess dimensions or are
unsuitable in specific samples, we are using inadequate criteria to make
assumptions about the respondents’ psychological state. Finally, if the ongoing
research does not confirm the theoretical postulates or the results of previous
studies and raises doubts about the interest of the variables, we may be devot-
ing substantial therapeutic and preventive efforts to inadequate goals.
16 Journal of Interpersonal Violence 00(0)

In accordance with recent research, our study highlights three major prob-
lems of assessment. First, the possibility that the dimensions assessed may not
apply to the specific problems of violent offenders (e.g., with regard to general
vs. victim-specific empathy). Second, that the influence of the variables may
not be the same in all offenders (e.g., those who attack due to deficits in self-
esteem, those who have high narcissism, and those in whom there is no rela-
tion between their aggression and their self-esteem). And, finally, that the
specificity and temporality of the variables mean that they cannot be measured
transversally with the self-reports available at present (which assume that the
respondent is able to abstract from the general questions, imagining that they
also allude to the specific problem of violence that has occurred). We can
advance here something that could be also a limitation, the fact that the data
were drawn from a cross-sectional design, which cannot determine the real
functioning of the variables at the time of committing the crime.
The instruments used are also in need of improvement. In samples of this
kind, it is vital to establish reference scores and numerical criteria for com-
paring offenders, regardless of whether we can also compare them with the
general population. In the case of AAQ, raw scores are not useful for describ-
ing the type of attachment (the content of the scales is not homogeneous in
terms of the number of items), and the comparison of centiles (which accord-
ing to the recommendations of the questionnaire’s authors requires clinical
considerations) makes it difficult to establish the specific type of attachment.
These complications could be solved by simultaneously comparing the utility
of other tools available in Spanish to assess adult attachment, such as the
Experience in Close Relationships (ECR; Alonso-Arbiol, Balluerka, &
Shaver, 2007) or the Relationship Questionnaire (RQ; Alonso-Arbiol, Shaver,
& Yarnoz, 2002). In the case of empathy, IRI scores can be interpreted in the
light of the general population’s scores because the scale measures generic
empathy, but in the case of the REM, specific criteria are needed to define
what counts as adequate empathy and what does not; the simple current indi-
cation of “the higher the score the higher the empathy” is inadequate.
Furthermore, Beven, O’Brien-Malone, and Hall (2004) found that the
Personal Distress subscale was not reliable when used in an offender popula-
tion, and principal components analysis did not confirm the four-subscale
structure of the IRI. In relation to self-esteem, we need to consider other
comparable dimensions or constructs measured with other tools, such as self-
concept, using more complex response scales than the Rosenberg Scale. As
far as some of the tools used in this article are common in daily practice, we
should take into account all of these problems, and make new proposals.
Future research lines could assess how items perform with this population to
see ways to improve the accuracy of the tools (see Baker, Beech, & Tyson,
2006, regarding validity of self-reported attachment).
Loinaz et al. 17

The study also has some limitations that may have affected the results. First,
social desirability was not controlled, and so its influence is unknown. There are
no comparable samples with the AAQ among sexual offenders or using the
REM in nonsexual offenders. Moreover, as the research was carried out in daily
practice in a prison setting, it was impossible to use another attachment tool to
compare convergent validity. Comparisons between groups treated the two
types of offenders as homogeneous, even though the existence of different
typologies is known (Carbajosa, Catalá-Miñana, Lila, & Gracia, 2017; Loinaz,
Marzabal, & Andrés-Pueyo, 2018; Martínez-Catena, Redondo, Frerich, &
Beech, 2016; Robertiello & Terry, 2007). Therefore, future studies should seek
to group offenders according to their scores rather than according to the crime
committed. Regarding diversity, although it was a Spanish-speaking sample,
results are not necessarily applicable to all Spanish-speaking countries. On the
contrary, all offenders were male. It was impossible to reach a sample from
female offenders; so, future research must afford the gender perspective regard-
ing the understanding of emotional variables among female sexual offenders
and batterers. Variables such as socioeconomic status, ethnicity, gender identity,
sexual orientation, or religion, were not included in the assessment procedure.
As a final recommendation, one of the main challenges facing research
and clinical practice is the use of homogeneous and comparable constructs
that reflect current knowledge, and for which useful tools are available in
forensic samples. The definitions should consider the multidimensionality of
the variables, and tools should be able to measure this characteristic and also
reflect the rationale of the assessment and treatment (in our case, violence).

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publi-
cation of this article.

ORCID iD
Ismael Loinaz   https://orcid.org/0000-0002-6307-6518

References
Abracen, J., & Looman, J. (2016). Combining attachment theory and complex post-
traumatic stress disorder and theories of sexual offending. In J. Abracen & J.
Looman (Eds.), Treatment of high-risk sexual offenders (pp. 83-96). Chichester,
UK: John Wiley.
18 Journal of Interpersonal Violence 00(0)

Ali, P. A., & Naylor, P. B. (2013). Intimate partner violence: A narrative review of
the biological and psychological explanations for its causation. Aggression and
Violent Behavior, 18, 373-382. doi:10.1016/j.avb.2013.01.003
Alonso-Arbiol, I., Balluerka, N., & Shaver, P. R. (2007). A Spanish version of the
Experiences in Close Relationships (ECR) Adult Attachment Questionnaire.
Personal Relationships, 14, 45-63. doi:10.1111/j.1475-6811.2006.00141.x
Alonso-Arbiol, I., Shaver, P. R., & Yarnoz, S. (2002). Insecure attachment, gen-
der roles, and interpersonal dependency in the Basque Country. Personal
Relationships, 9, 479-490. doi:10.1111/1475-6811.00030
Ansbro, M. (2008). Using attachment theory with offenders. Probation Journal, 55,
231-244. doi:10.1177/0264550508092812
Babcock, J. C., Jacobson, N., Gottman, J. M., & Yerington, T. P. (2000). Attachment,
emotional regulation, and the function of marital violence: Differences between
secure, preoccupied, and dismissing violent and nonviolent husbands. Journal of
Family Violence, 15, 391-409. doi:10.1023/a:1007558330501
Baker, E., Beech, A., & Tyson, M. (2006). Attachment disorganization and its rele-
vance to sexual offending. Journal of Family Violence, 21, 221-231. doi:10.1007/
s10896-006-9017-3
Barnett, G. D., & Mann, R. E. (2013a). Empathy deficits and sexual offending: A
model of obstacles to empathy. Aggression and Violent Behavior, 18, 228-239.
doi:10.1016/j.avb.2012.11.010
Barnett, G. D., & Mann, R. E. (2013b). Cognition, empathy, and sexual offending.
Trauma, Violence & Abuse, 14(1), 22-33. doi:10.1177/1524838012467857
Barnett, G. D., Wakeling, H., Mandeville-Norden, R., & Rakestrow, J. (2011). Does
change in psychometric test scores tell us anything about risk of reconviction
in sexual offenders? Psychology, Crime & Law, 19, 85-110. doi:10.1080/10683
16x.2011.607820
Bartholomew, K., & Allison, C. J. (2006). An attachment perspective on abusive
dynamics in intimate relationships. In M. Mikulincer & G. S. Goodman (Eds.),
Dynamics of romantic love: Attachment, caregiving and sex (pp. 102-127). New
York, NY: Guilford Press.
Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults:
A test of a four-category model. Journal of Personality and Social Psychology,
61, 226-244.
Baumeister, R. F., Bushman, B. J., & Campbell, W. K. (2000). Self-esteem, nar-
cissism, and aggression: Does violence result from low self-esteem or from
threatened egotism? Current Directions in Psychological Science, 9, 26-29.
doi:10.1111/1467-8721.00053
Beech, A. R., & Mitchell, I. J. (2009). Attachment difficulties. In M. McMurran &
R. Howard (Eds.), Personality, personality disorder, and violence: An evidence-
based approach (pp. 213-228). Chichester, UK: John Wiley.
Beven, J. P., O’Brien-Malone, A., & Hall, G. (2004). Using the Interpersonal
Reactivity Index to assess empathy in violent offenders. International Journal of
Forensic Psychology, 1(2), 33-41.
Loinaz et al. 19

Bowen, E. (2011). The rehabilitation of partner-violent men. Chichester, UK: Wiley

Blackwell.
Braun, S., Rosseel, Y., Kempenaers, C., Loas, G., & Linkowski, P. (2015). Self-report
of empathy: A shortened French adaptation of the Interpersonal Reactivity Index
(IRI) using two large Belgian samples. Psychological Reports, 117, 735-753.
doi:10.2466/08.02.PR0.117c23z6
Brown, S., Harkins, L., & Beech, A. R. (2012). General and victim-specific empa-
thy: Associations with actuarial risk, treatment outcome, and sexual recidi-
vism. Sexual Abuse: A Journal of Research and Treatment, 24, 411-430.
doi:10.1177/1079063211423944
Buck, N. M. L., Leenaars, E. P. E. M., Emmelkamp, P. M. G., & van Marle, H. J.
C. (2012). Explaining the relationship between insecure attachment and partner
abuse: The role of personality characteristics. Journal of Interpersonal Violence,
27, 3149-3170. doi:10.1177/0886260512441258
Bushman, B. J., Baumeister, R. F., Thomaes, S., Ryu, E., Begeer, S., & West, S. G.
(2009). Looking again, and harder, for a link between low self-esteem and aggres-
sion. Journal of Personality, 77, 427-446. doi:10.1111/j.1467-6494.2008.00553.x
Cameranesi, M. (2016). Battering typologies, attachment insecurity, and personality
disorders: A comprehensive literature review. Aggression and Violent Behavior,
28, 29-46. doi:10.1016/j.avb.2016.03.005
Carbajosa, P., Catalá-Miñana, A., Lila, M., & Gracia, E. (2017). Differences in treat-
ment adherence, program completion, and recidivism among batterer subtypes.
The European Journal of Psychology Applied to Legal Context, 9, 93-101.
doi:10.1016/j.ejpal.2017.04.001
Chiffriller, S. H., & Hennessy, J. J. (2010). An empirically generated typology of
men who batter. Victims & Offenders, 5, 1-24. doi:10.1080/15564880903048552
Chrysikou, E. G., & Thompson, W. J. (2016). Assessing cognitive and affective
empathy through the Interpersonal Reactivity Index. Assessment, 23, 769-777.
doi: 10.1177/1073191115599055
Covell, C. N., Huss, M. T., & Langhinrichsen-Rohling, J. (2007). Empathic deficits
among male batterers: A multidimensional approach. Journal of Family Violence,
22, 165-174. doi:10.1007/s10896-007-9066-2
Craig, L., Dixon, L., & Gannon, T. A. (Eds.). (2013). What works in offender reha-
bilitation: An evidence-based approach to assessment and treatment. Chichester,
UK: Wiley Blackwell.
Craissati, J. (2009). Attachment problems and sex offending. In A. Beech, L. Craig,
& K. Browne (Eds.), Assessment and treatment of sex offenders: A handbook (pp.
13-35). Chichester, UK: John Wiley.
Cuff, B. M. P., Brown, S. J., Taylor, L., & Howat, D. J. (2016). Empathy: A review of
the concept. Emotion Review, 8, 144-153. doi:10.1177/1754073914558466
Davis, M. H. (1980). A multidimensional approach to individual differences in empa-
thy. JSAS Catalog of Selected Documents in Psychology, 10(4), 85.
Davis, M. H. (1983). Measuring individual differences in empathy: Evidence for a mul-
tidimensional approach. Journal of Personality and Social Psychology, 44, 113-126.
20 Journal of Interpersonal Violence 00(0)

Davis, M. H. (1994). Empathy: A social psychological approach. Boulder, CO:

Westview Press.
Day, A., Casey, S., & Gerace, A. (2010). Interventions to improve empathy aware-
ness in sexual and violent offenders: Conceptual, empirical, and clinical issues.
Aggression and Violent Behavior, 15, 201-208. doi:10.1016/j.avb.2009.12.003
Day, A., Mohr, P., Howells, K., Gerace, A., & Lim, L. (2012). The role of empathy in
anger arousal in violent offenders and university students. International Journal
of Offender Therapy and Comparative Criminology, 56, 599-613. doi:10.1177/0
306624x11431061
De Corte, K., Buysse, A., Verhofstadt, L. L., Roeyers, H., Ponnet, K., & Davis, M. H.
(2007). Measuring empathic tendencies: Reliability and validity of the Dutch ver-
sion of the Interpersonal Reactivity Index. Psychologica Belgica, 47, 235-260.
doi:10.5334/pb-47-4-235
Díaz-Aguado, M. J., & Martínez, R. (2015). Types of adolescent male dating violence
against women, self-esteem, and justification of dominance and aggression. Journal
of Interpersonal Violence, 30, 2636-2658. doi:10.1177/0886260514553631
Dutton, D. G., Saunders, K., Starzomski, A., & Bartholomew, K. (1994). Intimacy-
anger and insecure attachment as precursors of abuse in intimate relationships.
Journal of Applied Social Psychology, 24, 1367-1386.
Fernandez, Y. M., & Marshall, W. L. (2003). Victim empathy, social self-esteem, and
psychopathy in rapists. Sexual Abuse: A Journal of Research and Treatment, 15,
11-26. doi:10.1177/107906320301500102
Fernandez, Y. M., Marshall, W. L., Lightbody, S., & O’Sullivan, C. (1999). The
child molester empathy measure: Description and examination of its reliability
and validity. Sexual Abuse: A Journal of Research and Treatment, 11, 17-31.
doi:10.1177/107906329901100103
Forbes, D., & Reilly, S. (2011). ‘Using attachment theory with offenders’ by Maria
Ansbro. Probation Journal, 58, 167-171. doi: 10.1177/0264550510389535
Fournier, B., Brassard, A., & Shaver, P. R. (2011). Adult attachment and male aggres-
sion in couple relationships: The demand-withdraw communication pattern and
relationship satisfaction as mediators. Journal of Interpersonal Violence, 26,
1982-2003. doi:10.1177/0886260510372930
Grady, M. D., Levenson, J. S., & Bolder, T. (2017). Linking adverse childhood effects
and attachment: A theory of etiology for sexual offending. Trauma, Violence, &
Abuse, 18, 433-444. doi:10.1177/1524838015627147
Grady, M. D., & Rose, R. A. (2011). The Empathy Index: An evaluation of the psy-
chometric properties of a new empathy measure for sex offenders. Journal of
Interpersonal Violence, 26, 3790-3814. doi:10.1177/0886260511403755
Holtzworth-Munroe, A., & Meehan, J. C. (2004). Typologies of men who are mari-
tally violent: Scientific and clinical implications. Journal of Interpersonal
Violence, 19, 1369-1389. doi:10.1177/0886260504269693
Jolliffe, D., & Farrington, D. P. (2004). Empathy and offending: A systematic review
and meta-analysis. Aggression and Violent Behavior, 9, 441-476. doi:10.1016/j.
avb.2003.03.001
Loinaz et al. 21

Lawson, D. M. (2008). Attachment, interpersonal problems, and family of origin

functioning: Differences between partner violent and nonpartner violent men.
Psychology of Men and Masculinity, 9, 90-105. doi:10.1037/1524-9220.9.2.90
Lawson, D. M., Barnes, A. D., Madkins, J. P., & Francois-Lamonte, B. M.
(2006). Changes in male partner abuser attachment styles in group treat-
ment. Psychotherapy: Theory, Research, Practice, Training, 43, 232-237.
doi:0.1037/0033-3204.43.2.232
Lawson, D. M., & Brossart, D. F. (2009). Attachment, interpersonal problems, and
treatment outcome in group therapy for intimate partner violence. Psychology of
Men & Masculinity, 10, 288-301. doi:10.1037/a0017043
Levenson, J. S., Brannon, Y. N., Fortney, T., & Baker, J. (2007). Public perceptions
about sex offenders and community protection policies. Analyses of Social Issues
and Public Policy, 7, 137-161. doi:10.1111/j.1530-2415.2007.00119.x
Lila, M., Oliver, A., Galiana, L., & Gracia, E. (2013). Predicting success indicators
of an intervention programme for convicted intimate-partner violence offend-
ers: The Contexto Programme. The European Journal of Psychology Applied to
Legal Context, 5(1), 73-95.
Loinaz, I. (2014). Typologies, risk and recidivism in partner-violent men with the
B-SAFER: A pilot study. Psychology, Crime & Law, 20, 183-198. doi:10.1080/
1068316x.2013.770854
Loinaz, I., Echeburúa, E., & Ullate, M. (2012). Estilo de apego, empatía y autoes-
tima en agresores de pareja [Attachment style, empathy and self-esteem in
partner-violent men]. Terapia Psicológica, 30, 61-70. doi:10.4067/S0718-
48082012000200006
Loinaz, I., Marzabal, I., & Andrés-Pueyo, A. (2018). Risk factors of female intimate
partner and non-intimate partner homicides. The European Journal of Psychology
Applied to Legal Context, 10(2), in press. doi: 10.5093/ejpalca4
Marshall, W. L., & Marshall, L. E. (2010). Attachment and intimacy in sex-
ual offenders: An update. Sexual and Relationship Therapy, 25, 86-90.
doi:10.1080/14681991003589568
Marshall, W. L., & Marshall, L. E. (2017). An attachment-based theory of the aeti-
ology of affiliative child molestation. In D. P. Boer (Editor in chief) and A. R.
Beech & T. Ward (Eds.), The Wiley handbook on the theories, assessment and
treatment of sexual offending (Vol. I: Theories, pp. 3-24). Chichester, UK: John
Wiley.
Marshall, W. L., Marshall, L. E., Serran, G. A., & Fernandez, Y. M. (2006). Treating
sexual offenders: An integrated approach. New York, NY: Routledge.
Marshall, W. L., Marshall, L. E., Serran, G. A., & O’Brien, M. D. (2009). Self-
esteem, shame, cognitive distortions and empathy in sexual offenders: Their
integration and treatment implications. Psychology, Crime & Law, 15, 217-234.
doi:10.1080/10683160802190947
Marshall, W. L., & Moulden, H. (2001). Hostility toward women and victim empathy
in rapists. Sexual Abuse: A Journal of Research and Treatment, 13, 249-255.
doi:10.1177/107906320101300403
22 Journal of Interpersonal Violence 00(0)

Martínez, M., Redondo, S., Pérez, M., & García-Forero, C. (2008). Empatía en una
muestra española de delincuentes sexuales [Study of empathy in a Spanish sex
offender sample]. Psicothema, 20, 199-204.
Martínez-Catena, A., Redondo, S., Frerich, N., & Beech, A. R. (2016). A dynamic
risk factors–based typology of sexual offenders. International Journal of
Offender Therapy and Comparative Criminology, 61, 1623-1647. doi:10.1177/
0306624x16629399
Mauricio, A. M., & Gormley, B. (2001). Male perpetration of physical violence against
female partners: The interaction of dominance needs and attachment insecurity.
Journal of Interpersonal Violence, 16, 1066-1081. doi:10.1177/088626001016010006
McKillop, N., Smallbone, S., Wortley, R., & Andjic, I. (2012). Offenders’ attachment
and sexual abuse onset: A test of theoretical propositions. Sexual Abuse: A Journal
of Research and Treatment, 24, 591-610. doi:10.1177/1079063212445571
Melero, R., & Cantero, M. J. (2008). Los estilos afectivos en la población española:
un cuestionario de evaluación del apego adulto [Affective styles in a Spanish
sample: A questionnaire for the assessment of adult attachment]. Clínica y Salud,
19, 83-100.
Mestre, M. V., Frías, M. D., & Samper, P. (2004). La medida de la empatía: análi-
sis del Interpersonal Reactivity Index [Measuring empathy: The Interpersonal
Reactivity Index]. Psicothema, 16, 255-260.
Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynam-
ics, and change. New York, NY: The Guilford Press.
Mikulincer, M., & Shaver, P. R. (2011). Attachment, anger, and aggression. In P.
R. Shaver & M. Mikulincer (Eds.), Human aggression and violence: Causes,
manifestations, and consequences (pp. 241-257). Washington, DC: American
Psychological Association.
Ogilvie, C. A., Newman, E., Todd, L., & Peck, D. (2014). Attachment and violent
offending: A meta-analysis. Aggression and Violent Behavior, 19, 322-339.
doi:10.1016/j.avb.2014.04.007
Ostrowsky, M. K. (2010). Are violent people more likely to have low self-esteem or
high self-esteem? Aggression and Violent Behavior, 15, 69-75. doi:10.1016/j.
avb.2009.08.004
Papadakaki, M., Tzamalouka, G. S., Chatzifotiou, S., & Chliaoutakis, J. (2009).
Seeking for risk factors of intimate partner violence (IPV) in a Greek national
sample: The role of self-esteem. Journal of Interpersonal Violence, 24, 732-750.
doi:10.1177/0886260508317181
Perez, M., Vohs, K. D., & Joiner, T. E. (2005). Discrepancies between self- and other-
esteem as correlates of aggression. Journal of Social and Clinical Psychology,
24, 607-620. doi:10.1521/jscp.2005.24.5.607
Reckdenwald, A., Mancini, C., & Beauregard, E. (2014). Adolescent self-image as a
mediator between childhood maltreatment and adult sexual offending. Journal of
Criminal Justice, 42, 85-94. doi:10.1016/j.jcrimjus.2013.12.007
Rich, P. (2006). Attachment and sexual offending: Understanding and applying
attachment theory to the treatment of juvenile sex offenders. Chichester, UK:
John Wiley.
Loinaz et al. 23

Robertiello, G., & Terry, K. J. (2007). Can we profile sex offenders? A review
of sex offender typologies. Aggression and Violent Behavior, 12, 508-518.
doi:10.1016/j.avb.2007.02.010
Romero-Martínez, Á., Lila, M., & Moya-Albiol, L. (2016). Empathy impairments
in intimate partner violence perpetrators with antisocial and borderline traits:
A key factor in the risk of recidivism. Violence and Victims, 31, 347-360.
doi:10.1891/0886-6708.VV-D-14-00149
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton
University Press.
Ross, T., & Pfäfflin, F. (2007). Attachment and interpersonal problems in a prison
environment. The Journal of Forensic Psychiatry & Psychology, 18, 90-98.
doi:10.1080/14789940601063345
Sakellaropoulo, M., & Baldwin, M. W. (2007). The hidden sides of self-esteem:
Two dimensions of implicit self-esteem and their relation to narcissistic reac-
tions. Journal of Experimental Social Psychology, 43, 995-1001. doi:10.1016/j.
jesp.2006.10.009
Salmivalli, C. (2001). Feeling good about oneself, being bad to others? Remarks on
self-esteem, hostility, and aggressive behavior. Aggression and Violent Behavior,
6, 375-393. doi:10.1016/S1359-1789(00)00012-4
Thomaes, S., & Bushman, B. J. (2011). Mirror, mirror, on the wall, who’s the most
aggressive of them all? Narcissism, self-esteem, and aggression. In P. R. Shaver &
M. Mikulincer (Eds.), Human aggression and violence: Causes, manifestations,
and consequences (pp. 203-219). Washington, DC: American Psychological
Association.
Timmerman, I. G. H., & Emmelkamp, P. M. G. (2005). The effects of cognitive-behav-
ioral treatment for forensic inpatients. International Journal of Offender Therapy
and Comparative Criminology, 49, 590-606. doi: 10.1177/0306624x05277661
Vachon, D. D., & Lynam, D. R. (2016). Fixing the problem with empathy. Assessment,
23, 135-149. doi:10.1177/1073191114567941
Vachon, D. D., Lynam, D. R., & Johnson, J. A. (2014). The (non)relation between
empathy and aggression: Surprising results from a meta-analysis. Psychological
Bulletin, 140, 751-773. doi:10.1037/a0035236
Vásquez, J., Jimenez, R., & Vázquez-Morejon, R. (2004). Escala de Autoestima de
Rosenberg: fiabilidad y validez en población clínica española [Rosenberg Self-
Esteem Scale: Reliability and validity in Spanish clinical sample]. Apuntes de
Psicología, 22, 247-255.
Walker, J. S., & Bright, J. A. (2009a). Cognitive therapy for violence: Reaching the
parts that anger management doesn’t reach. The Journal of Forensic Psychiatry
& Psychology, 20, 174-201. doi:10.1080/14789940701656832
Walker, J. S., & Bright, J. A. (2009b). False inflated self-esteem and violence: A
systematic review and cognitive model. The Journal of Forensic Psychiatry &
Psychology, 20, 1-32. doi:10.1080/14789940701656808
Waltz, J., Babcock, J. C., Jacobson, N. S., & Gottman, J. M. (2000). Testing a
typology of batterers. Journal of Consulting and Clinical Psychology, 68,
658-669.
24 Journal of Interpersonal Violence 00(0)

Webster, S. D., Bowers, L. E., Mann, R. E., & Marshall, W. L. (2005). Developing
empathy in sexual offenders: The value of offence re-enactments. Sexual Abuse: A
Journal of Research and Treatment, 17, 63-77. doi:10.1177/107906320501700107
Wright, M. F. (2017). Intimate partner aggression and adult attachment insecurity:
The mediation of jealousy and anger. Evolutionary Behavioral Sciences, 11, 187-
198. doi:10.1037/ebs0000097
Zosky, D. L. (2016). “I feel your pain”: Do batter intervention programs impact per-
petrators’ empathy for victims? Partner Abuse, 7(1), 70-86. doi:10.1891/1946-
6560.7.1.70

Author Biographies
Ismael Loinaz, PhD, psychologist and criminologist, is member of the Group of
Advanced Studies (GEAV) on Violence of the University of Barcelona. He is teacher
of criminology at the same university and focused in research related to violent
offender’s assessment and treatment. He is specialized in violence risk assessment.
Luis Miguel Sánchez is a psychologist in the Alhaurín de la Torre prison, working in
the treatment of partner-violent men and sexual offenders.
Andrea Vilella is a psychologist and master in forensic and criminal psychology
from the University of Barcelona- Institute of Lifelong Learning (IL3), with experi-
ence as volunteer with sexual offenders in Circles of Support and Accountability
(CoSA).