Perpetual perpetration: How violence shapes the offender : The interplay between organized and family violence, appetitive aggression and mental health

The present thesis explored how violence shapes the violent offender by investigating the interplay between exposure to and perpetration of organized and family violence and its impact on mental health and aggression. Violence and cruelty seem to be omnipresent in men. Nell (2006) suggested that an affectively positive, dopamine mediated and, therefore, rewarding perception of violence fosters violence among humans. Findings concerning the impact of perpetrating violence on mental health are, however, contradictory, ranging from increasing to buffering the risk for mental disorders. Elbert, Weierstall and Schauer (2010) suggested that an appetitive perception of violence may explain the contradictory findings and thus introduced the term ‘appetitive aggression’. Previous studies have shown that appetitive aggression buffers the risk of developing trauma-related suffering (Weierstall, Schaal, Schalinski, Dusingizemungu, & Elbert, 2011; Weierstall, Schalinski, Crombach, Hecker, & Elbert, 2012). Furthermore, the literature suggests a strong association between exposure to violence and mental health problems (Elbert & Schauer, 2002) as well as aggressive behavior (Weaver, Borkowski, & Thomas, 2008). The present thesis examined the phenomenon of appetitive aggression more closely in former combatants and child soldiers in the eastern provinces of the Democratic Republic of the Congo (DRC). Additionally, the interplay between organized and family violence, mental health, and aggression was investigated.The ‘cycle of violence’ hypothesis (Curtis, 1963; Elbert, Rockstroh, Kolassa, Schauer, & Neuner, 2006), which holds that violence breeds further violence, forms the underlying premise of the first article. This examined the association between exposure to family violence and aggressive behavior in primary school students in Tanzania. Results revealed that in line with the ‘cycle of violence’ hypothesis exposure to family violence, i.e. corporal punishment, was positively related to children’s aggressive behavior.The second article focused on appetitive forms of aggression in a sample of former combatants and child soldiers in the DRC. Results showed that combatants reporting high levels of appetitive aggression are characterized by the perpetration of a high number of violent acts, joining armed groups on their own accord and as children. Joining an armed group voluntarily may indicate an innate appetite for aggression. However, joining young and perpetrating violence on a regular basis seem to intensify the appetite for aggression.The third article examined the same sample, this time investigating whether the perpetration of violence damaged the perpetrator’s mental health. Results revealed that voluntary combatants differed significantly from forcibly recruited combatants, as they reported more perpetrated violence and higher levels of appetitive aggression. Furthermore, we found that perpetrating violence was positively related to posttraumatic stress disorder (PTSD) symptom severity in forcibly recruited combatants, but not in voluntary combatants. Thus, perpetrating violence does not necessarily damage mental health. The combatant’s perception of violence may determine whether perpetrating violence affects their mental health.Previous research suggests that appetitive aggression might buffer the risk of developing trauma related illnesses (Weierstall et al., 2011, 2012). In the fourth article, we investigated the relation between exposure to traumatic stressors, appetitive aggression, and PTSD symptom severity in voluntary combatants in the eastern DRC. The results showed that traumatic events were positively related to PTSD symptom severity and that appetitive aggression correlated negatively with PTSD symptom severity for participants with low to medium PTSD symptom severity. Thus, these findings provide further support for earlier findings that repeated exposure to traumatic stressors cumulatively heightens the risk of PTSD and revealed that appetitive aggression buffers the risk of developing PTSD symptoms under certain circumstances.The fifth article explored the relation between alcohol or drug consumption and the perpetration of violence in former combatants in the eastern DRC from a political science perspective. Prior research revealed a link between substance use and violent behavior. Substance consumption seems to decrease the threshold for using violence, i.e. it removes the learned constraints and thus facilitates aggressive behavior (Moore & Stuart, 2005; Reiss & Roth, 1993). At the same time, specific substances, particularly alcohol, seem to incite violence directly via aggression and rage (Hoaken & Stewart, 2003). Our analyses showed, after controlling for armed group-level and individual-level variables, that drug intake and alcohol consumption boost the amount of perpetrated violent actions by combatants.Earlier findings showed that former child soldiers or ex-combatants often form small groups of outlaws in civil life, performing violent and criminal acts (Elbert et al., 2010; Wessells & Monteiro, 2004). Based on these findings and the prior findings of the present thesis, the last article tested the efficacy of Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET) in a randomized controlled clinical trial. FORNET is a psychological intervention focusing on trauma-related suffering and appetitive forms of aggression to foster the integration of former combatants into civil society and break the cycle of violence. The treatment group reported reduced PTSD symptoms and less contact with combatants. Thus, the study presented for the first time evidence for the feasibility and efficacy of FORNET. We could show that addressing traumatic events and perpetrated violence foster the rehabilitation of violent offenders and thus may help to break the cycle of violence in violent environments.The present thesis has attained further knowledge about the appetitive perception of violence, the interrelation between the exposure to and the perpetration of organized and family violence as well as its impact on mental health and aggression. Clinical implications and directions for future research are discussed. The findings regarding appetitive aggression may provide one explanation at the level of the individual offender for why it is extremely difficult to pacify crisis regions or restrict the risk of violent recidivism in former offenders. However, the successful integration of violent offenders into civil society can help to break the cycle of violence. The findings of the present thesis increase the understanding of the needs and difficulties of violent offenders and can thus improve the rehabilitation process