To cite this article: Julian S. Walker & Jenifer A. Bright (2009) False inflated self-esteem and
violence: a systematic review and cognitive model, The Journal of Forensic Psychiatry &
Psychology, 20:1, 1-32, DOI: 10.1080/14789940701656808
RESEARCH ARTICLE
False inflated self-esteem and violence: a systematic review and
cognitive model
Julian S. Walkera* and Jenifer A. Brightb
a
Fromeside (Avon & Wiltshire Mental Health Partnership), Bristol, UK;
b
Maudsley Hospital, London, UK
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Welsh (1989) maintain: [W]hile anger is neither necessary nor sucient for
aggression to occur, it is nonetheless a central activator of both individual
and collective violence and is significantly involved in a range of mental
health disturbances (p. 39). They go on to propose that problems with anger
control and regulation are important risk factors in relation to harming
others. One important aspect of anger in relation to violent behaviour is that
it may be identified and described by the aggressor and is seen as a central
factor in the loss of control and subsequent violence. Furthermore, there are
now recognized ways of treating the problem through anger management
training (Williams & Barlow, 1998). However, a more detailed evaluation of
the literature suggests that anger management may be less potent as an
intervention for violence than it initially appears (Walker & Bright, 2008).
Violent beliefs and thinking (cognitions) have received less research
attention than cognitions in sex oenders (Abel, Gore, Holland, & Camp,
1989; Blumenthal, Gudjonsson, & Burns, 1999; Hayashino, Wurtele, &
Klebe, 1995; McGrath, Cann, & Konopasky, 1998; Vanhouche & Vertom-
men, 1999; Ward et al., 1997). The majority of the studies of violence and
aggression have focussed on risk factors (Bjrkly, 1997; Monahan, 1984,
1997; Monahan & Steadman, 1994) and anger (Greene, Coles, & Johnson,
1994; Novaco, 1997; Novaco & Welsh, 1989). The factors relevant to
violence are exceptionally complex (Monahan & Steadman, 1994), and
include multiple causal and exacerbating factors, ameliorating or protective
factors, individual dierences, and the influences of other unique factors
such as the environment and the victim at the time the violent act took place.
This problem has lead McGuire and Priestly (1995) to suggest that the whole
focus of risk assessment needs to shift towards understanding what makes a
particular person commit a particular violent act at a particular time.
In the cognitive behavioural literature this approach formulating the
antecedent causes and maintaining factors in a persons thinking and
behaviour has long been considered important. Cognitive models (e.g.,
Beck, Freeman et al., 1990; Beck, Freeman, Davis et al., 2004) suggest that
adaptive and maladaptive deeply held beliefs (schemas) are laid down in
4 J.S. Walker and J.A. Bright
childhood through various processes including modelling, the result of
trauma and abuse, and other positive and negative significant events or
patterns in upbringing. The second layer to the model comprises rules
(dysfunctional assumptions) that govern when and how strongly these
deeply held beliefs are activated. The triggering of these rules results from
everyday experiences which may link to automatic thoughts that are fleeting,
often aect-laden, and relate strongly to the corresponding rule and schema.
Dierent constellations of beliefs, rules, and thoughts together with their
related symptoms correspond to dierent disorders such as depression
and anxiety disorders. These negative constellations can be enduring and
damaging, producing chronic self-defeating behaviour patterns such as
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aggression and violence does not seem to have been adequately addressed by
contemporary authors in the same way that the core beliefs of worthlessness
in depression and vulnerability in anxiety are focussed upon in general adult
psychological formulations.
Psychodynamic approaches place deeply held (unconscious) ideas at the
core of formulation and treatment, and one of the most influential and
respected writers on this topic in recent years (Gilligan, 1996) has presented
a compelling psychodynamic formulation for violence which puts shame,
poor self-esteem, and humiliation at the centre of formulating violence-
proneness. Gilligan (1996) starts with the proposition that psychoanalyti-
cally, all behaviour, including violent behaviour, whether it is labelled as
bad or mad, is psychologically meaningful (p. 9) and therefore can be
understood. He goes on to suggest that violence is a means to an end, used
to attain justice by punishing those whom they feel have punished them,
unjustly (p. 18); thus, violence is seen by the perpetrator as revenge for
being wronged unjustly by the victim. What constitutes the wrong in
Gilligans view is usually a personally meaningful insult of some kind that
causes an overwhelming sense of shame. The violent person cannot cope
with this shame due to a lack of self-love, self-esteem, or a healthy sense of
pride which would enable them to survive the inevitable rejections and
humiliations which even the most fortunate people cannot avoid (p. 47).
When this happens to someone lacking the non-violent skills to restore their
damaged sense of self-esteem, violence becomes a way of restoring that
pride. Gilligan adds that these preconditions dramatically increase the
likelihood of violent impulses being acted upon, particularly when the
feelings that would normally inhibit the acting out of those feelings, such as
love and/or guilt, are absent (p. 114).
The characteristics of a potentially violent confrontation can gradually
be pieced together. Information processing is important in that it strongly
influences how the environment is perceived; thus when an insult, rejection,
humiliation, or verbal attack is experienced as deeply shaming, and
inhibition of guilt and empathy are absent (or disabled at the crucial
moment in some way), violence becomes a way of restoring the balance for
The Journal of Forensic Psychiatry & Psychology 7
the violent person pride for themselves and punishment for the victim.
Cognitive behavioural therapy (CBT) and anger management approaches
have traditionally dealt with triggers, information processing, and elevated
arousal, without necessarily working at the level of personal meaning,
humiliation, and damaged pride (or low self-esteem).
The definition and dierentiation of shame, humiliation, and guilt are
taken up by Gilbert (1998). Internal shame is defined as shame which relates
to negative self-evaluations; external shame relates to being scorned,
ridiculed, judged, or disgraced in front of others. Shame can have numerous
foci including ones body, feelings, failures, and belonging to a discredited
social group. From an evolutionary perspective, Gilbert relates shame to
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research into the relationship between self-esteem and other variables such
as aggression and violence.
Individually, self-esteem and violence are two commonly researched
topics in the psychological literature, but perhaps less frequently researched
is the relationship between the two. In order to answer the question of how
self-esteem relates to aggression and violence, a systematic review of the
1986 2006 literature was undertaken. In all, 365 articles were identified
from a search of the Psychinfo, Embase, and Medline databases using self-
esteem combined with aggression, violence, or anger as search terms (a
recent extensive systematic review in forensic psychiatry revealed that
almost 100% of published articles can be located via these three databases
without complicating or extending the search further; see Amos et al., in
press). The search was limited to original journal articles that involved some
form of comparison or controlled study. The titles of these 365 articles were
reviewed and the results narrowed to 92 articles; the 92 abstracts were
reviewed for relevance to the research question. The 28 papers left following
this process were retrieved in full (from the original authors where possible),
which resulted in the receipt of an additional eight papers from the
originating authors (two of which were in press and thus excluded). Three
additional papers were located through cross-referencing. This left 37
articles to be reviewed in full. Of these, seven were excluded because self-
esteem was not an independent variable; four did not have violence as a
dependent variable; and in five the age (or mean age) of participants was
below 13 years. A further two articles were excluded for being a case study
series and a small pilot study respectively. This left 19 articles where
inclusion criteria were met (published journal studies, with adolescents or
adults, reporting a relationship between self-esteem and violence/
aggression).
The results are reported in Table 1 in order of descending sample size.
Sample size was chosen as one indication of quality, but it is recognized that
there are numerous other indices of quality, and the results could have been
presented in alphabetical or date order; sample size was chosen as a simple
way to convey at least some information about the relationship of one study
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11
(continued)
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12
Table 1. (Continued).
(continued)
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Table 1. (Continued).
Study Sample Design Conclusions
3) 217 female and 183 aggression scores for males and females.
male students and their Self-esteem was the strongest predictor for
acquaintances, females and social desirability for males.
Germany, mean age
(continued)
13
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14
Table 1. (Continued).
Study Sample Design Conclusions
(continued)
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Table 1. (Continued).
Study Sample Design Conclusions
2) 35 male and 39 female 2) Cross-sectional self-perceived mate value emerged as a
college students, USA, experimental design (positive) predictor of aggression. Global
(continued)
15
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16
Table 1. (Continued).
(continued)
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Table 1. (Continued).
17
18 J.S. Walker and J.A. Bright
to the next, but this order does not indicate decreasing quality. Indeed many
of the larger studies were conducted with students, who are not likely to be
comparable to the clinical populations found in forensic settings.
The majority of studies (12 of 19) suggested that low self-esteem rather
than high self-esteem was associated with violence. This was true of the
seven largest studies, many of which were conducted with American
undergraduate students; however, this group also included the only two
longitudinal cohort studies. Five studies found no association between self-
esteem and violence, the largest of these with a total sample of 785 (Walker
& Gudjonsson, 2006). Only one study indicated that high self-esteem was
related to violence, in a sample of 391 white American prison inmates
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Cognition/emotion/
thinking error Description Reference
Anger Negatively toned emotion, risk Novaco (1994)
factor for aggression and
violence
Information Issues include: attentional Williams and Barlow
processing cuing, perceptual matching, (1998), DZurilla,
attribution error, false Chang and Sanna
consensus, anchoring eects, (2003), Novaco and
cognitive scripts, Welsh (1989)
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dichotomous thinking,
perfectionism, and poor
social problem-solving
Embarrassment, Intense feelings which also Gilbert (1998), Gilligan
shame, and include negative self- (1996)
humiliation evaluation and relate to
core beliefs of vulnerability
(cf. anxiety) and worthlessness
(cf. depression)
Feeling diminished The assault on self-esteem Baumeister (1997), Beck
(through some form of (1999), Gilligan (1996)
perceived threat or insult) is
experienced as diminishing,
and highly provoking if also
experienced as intentional by
someone responsible for their
actions who is deserving of
punishment
Machismo Presentational and behavioural Walker (2005), Walker
eects of the rule To be and Gudjonsson
strong and respected you must (2006)
fight results in tough, hard
exterior and behaviour;
dysfunctional assumptions or
rules mitigate the relationship
between core beliefs and
aggressive behaviour (e.g.,
To be respected you must
fight; If I let people get
the better of me and I dont
retaliate it means that I am
weak and pathetic)
Acceptance of Acceptance of violence relates to Walker (2005), Walker
violence false consensus and validates and Gudjonsson
violence as a response to the (2006)
strength of insult/humiliation
felt
(continued)
The Journal of Forensic Psychiatry & Psychology 21
Table 2. (Continued).
Cognition/emotion/
thinking error Description Reference
Empathy (lack of) Anger and humiliation cause a Gilligan (1996)
bypass in empathy because all
self-related feelings at the
point of conflict are so strong,
negative, and unpleasant
Low self-esteem Underpins susceptibility to Fennel (1997), Gilbert
(core beliefs) humiliation and relates to (1998), Salmivalli
depressive core beliefs or (2001)
worthlessness; however, such
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are reinforced and maintained even when they may seem undesirable to the
individual on face value. Furthermore, the core beliefs are maintained
whether the person resists or complies with the urge to act in a schema-
congruent way. These aspects of the self-esteem model reflect exactly the
vicious cycle of behaviour seen in violent individuals who may wish to stop
behaving violently but who seem unable to give up fighting and regard it as
the only way of dealing with certain threatening (or potentially threatening)
situations.
Violent behaviour is an attempt to protect the self from further injury
(humiliation) and thus against a perceived lowering of self-worth. By standing
22 J.S. Walker and J.A. Bright
and fighting, some level of self-esteem and self-respect is maintained, as is
some level of physical respect from the victim being fought. This physical
respect from the other is developed when it is seen that the aggressor will not
back down or run away, but will stand and fight whatever the cost to
themselves (i.e., even if the odds are not in the aggressors favour). This sense
of physical respect is increased by the victims apparent fear.
Interestingly, many patients seem able to dierentiate between the
physical respect gained by refusing to back down or run away, and causing
fear in the other person, and a more interpersonal or psychologically-based
respect gained through being a good person, having positive personal
qualities, being looked up to by others, and getting on well with people. This
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the embarrassing or highly charged violent act. Socratic dialogue was used
to uncover the meaning of behaviours (verbal, physical, facial, observed,
and imagined) at the time of the incident, and the emergent themes began to
support the old proverb that it is harder to walk away than to stand and
fight.
Many patients reported that, despite resisting the urge to fight, the
excruciating embarrassment from not asserting themselves violently would
eventually lead to an assault. Following the assault, feelings of relief and
control, and the dissipation of feelings of fear, anxiety, pain, or
embarrassment would serve to reinforce the response. On the rare occasions
that violence was avoided, patients reported feeling as if they had let
themselves down and feeling weird or uncomfortable for some time after
(sometimes up to weeks later); this would lead to tension and increase the
likelihood of other confrontations. Conversely, when violence occurred, the
relief was immediate but then eventually marred by self-recrimination
often minimized because the end justified the means. It was interesting to the
authors that non-violence was not immediately associated with pride or self-
praise, thus maintaining inner low self-esteem.
The formulation in Figure 1 was designed in line with these clinical
observations. The first stages of the formulation outline possible paths for
the development of low self-esteem, vulnerability to embarrassment, and
lack of options such that violence becomes the default option and doesnt
allow the development of alternative skills (e.g., verbal skills and self-
assertion). The traumatic roots of destructiveness are well covered by de
Zulueta (2006) and will not be described in detail here: suce it to say that
histories of abuse (particularly violent and sexual) and neglect (the absence
of a warm, compassionate, containing attachment figure) lie at the source of
many troublesome psychological sequelae, not least of all aggression and
violence. As a child, the consequence of trauma, abuse, and neglect is not to
demean ones abusers (often trusted adults), which would result in
unthinkable helplessness, disempowerment, and a recognition of the danger
of ones bad parents, but rather to look for meaning and control through
assuming responsibility and therefore concluding that one is in some way
The Journal of Forensic Psychiatry & Psychology 25
bad and therefore deserving in some way of the abusive treatment. Thus the
theoretical bottom line for the individual comprises a belief that they are
vulnerable, weak, stupid, or mad. These beliefs are well hidden, painful to
access, and often well covered with a veneer of confidence and aggression,
giving the appearance of an arrogant exterior.
However, in dicult social situations further evidence for these negative
self-beliefs becomes available in the form of fear and anxiety which on the
one hand reinforce those beliefs, and on the other hand must be got rid of at
all costs, through conversion to anger and violence. Embarrassment is
particularly crucial in dicult social situations because it combines many of
the more painful elements of fear and anxiety with powerful negative
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individual feels worse privately for having lost control and been aggressive.
The alternative, resisting the urge to attack, simply allows fear and self-
critical thinking to reinforce those same negative core beliefs.
This formulation, as far as the authors are aware, is the first attempt to
explain not only the mechanism for the link between self-esteem and
violence found in the literature, but also to explain, through a cognitive
behavioural approach, the links between the hypothesized core beliefs, rules,
and behaviour which seem to reinforce themselves so powerfully in violent
individuals. The importance of such a formulation is that it links with
measurable phenomena (rules as measured by the Maudsley Violence
Questionnaire; Walker, 2005; Walker & Gudjonsson, 2006) and oers
solutions for treatment thus far not generated in the literature (see Walker &
Bright, 2008).
violence that does not take account of the cognitive mechanisms proposed
here may result in important information being overlooked without which
an accurate formulation could be impossible. Walker and Bright (2008)
demonstrate how central these issues were to a patient who also seemed to
be suering both mental state and personality disturbance who sought
therapy for longstanding violent behaviour.
The authors acknowledge that there is only anecdotal evidence that a
particular set of core beliefs may combine to produce low self-esteem and
then link with a macho thinking style (designed to hide low self-esteem) to
result in violent behaviour. Some of the support for this formulation model
comes from data gathered in other studies, and the model itself has not been
empirically validated so far. Furthermore, some of the most extreme
violence (perhaps occurring during wartime or in the context of sadistic
killings and torture) probably does not conform to the model presented
here this model has been designed to help with conceptualization of more
common forms of violence in everyday situations. Such situations cannot
simply be explained by an inability to manage anger. Additional work is
required, both clinical and research, to develop our models for formulation;
the model presented is intended to encourage this process.
Future work in this area may need to begin with a review of the way self-
esteem is measured, and discuss how existing conceptual models can be
integrated into assessment. Given the importance of these issues to forensic
settings, studies will need to focus both on normal and forensic groups.
There is further work to be done to develop the best way of assessing the
complicated interaction between self-esteem, narcissism, and ego threat,
along with related concepts such as shame and humiliation. It may be that
rules such as those measured by the Maudsley Violence Questionnaire
(Walker, 2005) are easier and more reliable to assess than core self-
concepts, and that having been evaluated they are then easier to challenge
in therapy. However, we argue that, as therapy progresses, the evalua-
tion of the individuals self-concept, and its development, maintenance,
and influence on violent behaviour, should be addressed rather than
underestimated.
The Journal of Forensic Psychiatry & Psychology 29
Acknowledgements
Professor Gisli Gudjonsson at the Institute of Psychiatry for his supervision of my
research at the Maudsley Hospital.
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