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 follows
1,
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. First, they may fear retaliation from their
partner. They may have been directly threatened that if they
tell anyone they will be killed, or they may just fear the
worst. Second, there is shame associated with choosing a
partner who could be violent, and there is shame associated with
staying with a violent partner. 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 Herbert
4 and Tjaden and Thoennes,
3 shed light on the prevalence of domestic violence
(statistics are for the U.S. only):
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. 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. The abused person therefore
becomes increasingly dependent on the abuser. The second key
factor in traumatic bonding is the intermittent and unpredictable
abuse. 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. 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 Marshall
10 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 Tollerud
5 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
National toll-free Domestic Violence hotline:
1-800-799-SAFE (7233)
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). 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.