Domestic Violence
A National Center for PTSD Fact Sheet
By Michelle Rice, Ph.D.
Domestic violence is a prominent public health issue in the United States.
It is the most frequent cause of serious injury to women, more than car accidents,
muggings, and stranger rapes combined.1 This
fact sheet provides information regarding the definition of domestic violence,
the prevalence of domestic violence, the dynamics of abusive relationships,
the effects of domestic violence, treatment for victims and perpetrators, and
resources offering assistance.
What is domestic violence?
Domestic violence is defined as the use or threat of use of physical, emotional,
verbal, or sexual abuse with the intent of instilling fear, intimidating, and
controlling behavior.1 Domestic
violence occurs within the context of an intimate relationship and may continue
after the relationship has ended. The types of domestic violence are as follows1,2:
* Physical
abuse: Verbal threats of violence, pushing, shoving, hitting, slapping,
punching, biting, kicking, holding down, pinning against the wall, choking,
throwing objects, breaking objects, punching walls, driving recklessly to
scare, blocking exits, using weapons
* Emotional/Verbal
abuse: Name calling, coercion and threats, criticizing, yelling, humiliating,
isolating, economic abuse (controlling finances, preventing victim from working),
threatening to hurt children or pets, stalking
* Sexual
abuse: Unwanted touching, sexual name calling, false accusations of sexual
infidelity, forced sex, unwanted pregnancy, sexually transmitted diseases,
HIV transmission
Researchers in the field of domestic violence have compiled characteristics
of batterers, which can be utilized to predict the likelihood of battering.º The
more characteristics present in a person, the greater the likelihood of battering.1 The
most predictive indicators are:
* History
of past battering
* Threats
of violence
* Breaking
objects
* Use
of force during arguments
The following are also warning signs:
* Unreasonable
jealousy
* Controlling
behavior
* Quick
involvement in the relationship
* Verbal
abuse, blaming others for problems
* Cruelty
to children and animals
* Abrupt
mood changes
What is the prevalence of domestic violence?
It is very difficult to estimate the rate of domestic violence because the
majority of victims never disclose that they are involved in partner violence.
It is estimated that, regarding violent behavior toward females within the
context of an intimate relationship, only 20% of all rapes, 25% of all physical
assaults, and 50% of all stalking are ever reported to the police.3 Victims
may be reluctant to come forward for a variety of reasons.º First, they may
fear retaliation from their partner.º They may have been directly threatened
that if they tell anyone they will be killed, or they may just fear the worst.º Second,
there is shame associated with choosing a partner who could be violent, and
there is shame associated with staying with a violent partner.º Finally, some
victims may have tried to seek help from the police, the courts, or others
and been dissatisfied with the help they received. The following statistics
as reported in Fischbach and Herbert4 and
Tjaden and Thoennes,3 shed light
on the prevalence of domestic violence (statistics are for the U.S. only):º
* 20-30%
of American women will be physically abused by a partner at least once in their
lifetimes
* 1.3
million women and 834,732 men are physically assaulted by an intimate partner
annually
* 201,394
women are forcibly raped by an intimate partner annually
* 11%
of women in homosexual relationships and 23% of men in homosexual relationships
report being raped, physically assaulted, and/or stalked by an intimate partner
* 503,485
women and 185,496 men are stalked by an intimate partner annually
* 1-25%
of all pregnant women are battered during pregnancy
* 30-40%
of women’s emergency room visits are for injuries due to domestic violence
* 30%
of women killed in the U.S. are killed by their husbands or boyfriends
* 50%
of men who assaulted their female partners also assaulted their children
* 3.3
million children witness domestic violence each year
What are the dynamics of an abusive relationship?
Research focusing on the dynamics of abusive relationships has resulted in
several ways of understanding the interactions between the batterer and the
victim. The first conceptualization is that of the Cycle of Violence,5 consisting
of three stages: the tension building stage (tension in the relationship gradually
increases over time); the acute battering stage (tension erupts, resulting
in threats or use of violence and abuse); and the honeymoon stage (the batterer
may be apologetic and remorseful and promise not to be abusive again). The
cycle continues throughout the relationship, with the honeymoon stage becoming
shorter and the episodes of battering becoming more frequent or more severe.
The honeymoon stage reinforces the victim's hope that the batterer will change
and contributes to the victim staying in the relationship.
The concept of Traumatic Bonding6 has
also been developed to explain the dynamics of domestic violence relationships.
Essentially, strong emotional connections develop between the victim and the
perpetrator during the abusive relationship. These emotional ties develop due
to the imbalance of power between the batterer and the victim and because the
treatment is intermittently good and bad.º In terms of the power imbalance,
as the abuser gains more power, the abused individual feels worse about him-
or herself, is less able to protect him- or herself, and is less competent.º The
abused person therefore becomes increasingly dependent on the abuser.º The
second key factor in traumatic bonding is the intermittent and unpredictable
abuse.º While this may sound counterintuitive, the abuse is offset by an increase
in positive behaviors such as attention, gifts, and promises. The abused individual
also feels relief that the abuse has ended.º Thus, there is intermittent reinforcement
for the behavior, which is difficult to extinguish and serves instead to strengthen
the bond between the abuser and the individual being abused.
Finally, abusive relationship dynamics can also be understood through the
concepts of Approach and Avoidance.7 The
mix of pros (love and economic support) and cons (fear and humiliation) present
in the battering relationship leads to ambivalence on the part of the victim.
The victim is likely to want to approach the positives in the relationship
but avoid the abuse. This struggle between wanting to keep the relationship
and wanting to remain safe makes it difficult to decide whether to leave or
stay in the relationship. On average, women leave and return to an abusive
relationship five times before permanently leaving the relationship.
What are the effects of domestic violence?
Domestic violence has wide ranging and sometimes long-term effects on victims.
The effects can be both physical and psychological and can impact the direct
victim as well as any children who witness parental violence.
The physical health effects of domestic violence are varied. Victims may experience
physical injury (lacerations, bruises, broken bones, head injuries, internal
bleeding), chronic pelvic pain, abdominal and gastrointestinal complaints,
frequent vaginal and urinary tract infections, sexually transmitted diseases,
and HIV.2,8 Victims
may also experience pregnancy-related problems. Women who are battered during
pregnancy are at higher risk for poor weight gain, pre-term labor, miscarriage,
low infant birth weight, and injury to or death of the fetus.
There are also many psychological effects of domestic violence. Depression
remains the foremost response, with 60% of battered women reporting depression.9 In
addition, battered women are at greater risk for suicide attempts, with 25%
of suicide attempts by Caucasian women and 50% of suicide attempts by African
American women preceded by abuse.4
Along with depression, domestic violence victims may also experience Posttraumatic
Stress Disorder (PTSD), which is characterized by symptoms such as flashbacks,
intrusive imagery, nightmares, anxiety, emotional numbing, insomnia, hyper-vigilance,
and avoidance of traumatic triggers. Several empirical studies have explored
the relationship between experiencing domestic violence and developing PTSD.
Vitanza, Vogel, and Marshall10 interviewed
93 women reporting to be in long-term, stressful relationships. The researchers
looked at the relationships among psychological abuse, severity of violence
in the relationship, and PTSD. The results of the study showed a significant
correlation between domestic violence and PTSD. In each group in the study
(psychological abuse only, moderate violence, and severe violence), women scored
in the significant range for PTSD. Overall, 55.9% of the sample met diagnostic
criteria for PTSD. In further support of the strong relationship between domestic
violence and PTSD, Mertin and Mohr,11 interviewed
100 women in Australian shelters, each of whom had experienced domestic violence.
They found that 45 of the 100 women met diagnostic criteria for PTSD.
Children may develop behavioral or emotional difficulties after experiencing
physical abuse in the context of domestic violence or after witnessing parental
abuse. Children's responses to the violence may vary from aggression to withdrawal
to somatic complaints. In addition, children may develop symptoms of depression,
anxiety, or PTSD.1
How are the effects of domestic violence treated?
Psychological treatment for victims and perpetrators can be helpful in the
aftermath of domestic violence. For battered women, Hattendorf and Tollerud5 recommend
a feminist therapy approach in which traditional gender roles are challenged
and empowerment of the victim is a primary focus. Individual therapy for victims
of domestic violence should begin with a primary focus on safety, particularly
if the woman is currently in an abusive relationship. The therapist should
assess the current level of dangerousness and lethality in the relationship
based on the following factors concerning the batterer: threats of homicide
or suicide, possession of weapons, acute depression, alcohol/drug use, history
of pet abuse, and level of rage.1 The
presence of these factors increases the level of potential lethality in the
batterer.
In addition to assessing lethality, the individual therapist should develop
a safety plan with the victim. A safety plan may contain a strategy for how
to leave a dangerous situation; the preparation of a safety kit (clothing,
medications, keys, money, copies of important documents) to be kept either
near an exit route or at a trusted friend's house; and arrangements for shelter
(made without the batterer's knowledge of the location).1
Once lethality and safety have been addressed, the longer-term goals of treatment
for the battered woman can be addressed. These goals include helping the woman
identify the impact of abuse on her life and helping her work toward empowerment.5 Victims
can be empowered by regaining their independence and reconnecting with supports
and resources that may have been cut off due to the isolation of domestic violence.
In addition, the victim?s children may need their own treatment to address
their responses to witnessing or experiencing abuse.
For some victims, additional treatment may be needed to target symptoms of
depression, PTSD, substance abuse, or other disorders found to occur in the
presence of domestic violence.
Batterers can also benefit from treatment, although it remains unclear exactly
how effective treatment is in breaking the cycle of batterers' violence. Batterers
benefit most from batterer treatment programs, which in part focus on identifying
what domestic violence is. These programs also focus on helping batterers develop
a sense of personal responsibility for one's actions and for stopping the violence.1 Batterers
can also be treated in individual therapy, but the focus of treatment must
be on the violence. While some batterers and victims may seek to engage in
couple's therapy to address the abuse in their relationship, couple's therapy
is not recommended while violence is occurring in the relationship. In addition,
it is recommended that each member of the couple complete their individual
treatment first, before beginning any couple's therapy.1
What resources are available?
National toll-free Domestic Violence hotline: 1-800-799-SAFE (7233)
List of National and State Domestic Violence Hotlines: www.famvi.com/htlines.htm
National Coalition Against Domestic Violence: www.ncadv.org/gettinghelp/help.htm
Family Violence Prevention Fund: http://endabuse.org/gethelp/
Related Fact Sheets
Community
violence
A summary of the research about the effects of community violence on rates
of traumatic stress and PTSD
Domestic
violence and disaster
Summary of empirical findings on the prevalence and impact of domestic violence
in the wake of disasters
Female
sexual assault
Defines sexual assault among females and gives an overview of its immediate
and long-term effects
References
1. Harway, M. & Hansen,
M. (1994). Spouse abuse: Assessing and treating battered women, batterers,
and their children. Sarasota, Florida: Professional Resource Press.
2. Jones, R.F. & Horan,
D.L. (1997). The American college of obstetricians and gynecologists: A decade
of responding to violence against women. International Journal of Gynecology
and Obstetrics, 58, 43-50.
3. Tjaden, P. & Thoennes,
N. (2000). Extent, nature, and consequences of intimate partner violence:
Findings from the National Violence Against Women Survey. National Institute
of Justice/Centers for Disease Control and Prevention.
4. Fischbach,
R.L. & Herbert, B. (1997). Domestic violence and mental health: Correlates
and conundrums within and across cultures. Social Science Medicine, 45, 1161-1176.
5. Hattendorf,
J. & Tollerud, T.R. (1997). Domestic violence: Counseling strategies that
minimize the impact of secondary victimization. Perspectives in Psychiatric
Care, 33, 14-23.
6. Dutton, D.G., & Painter,
S.L. (1981).º Traumatic bonding: The development of emotional attachments in
battered women and other relationships of intermittent abuse. Victimology:
An International Journal, 1, 139-155.
7. Barnett, O.W.
(2001). Why battered women do not leave, part 2: External inhibiting factors?social
support and internal inhibiting factors. Trauma, Violence, and Abuse, 2, 3-35.
8. Bohn, D.K. & Holz,
K.A. (1996). Sequelae of abuse: Health effects of childhood sexual abuse, domestic
battering, and rape. Journal of Nurse-Midwifery, 41, 442-456.
9. Barnett, O.W.
(2000). Why battered women do not leave, part 1: External inhibiting factors
within society. Trauma, Violence, and Abuse, 1, 343-372.
10. Vitanza,
S., Vogel, L.C., & Marshall, L.L. (1995). Distress and symptoms of posttraumatic
stress disorder in abused women. Violence and Victims, 10, 23-34.
11. Mertin, P. & Mohr,
P.B. (2000). Incidence and correlates of posttraumatic stress disorder in Australian
victims of domestic violence. Journal of Family Violence, 15, 411-422.
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