Domestic violence

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Domestic violence
Classification and external resources
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MeSHD017579
 
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Domestic violence
Classification and external resources
eMedicinearticle/805546
MeSHD017579

Domestic violence, also known as domestic abuse, spousal abuse, battering, family violence, and intimate partner violence (IPV), is defined as a pattern of abusive behaviors by one partner against another in an intimate relationship such as marriage, dating, family, or cohabitation.[1] Domestic violence, so defined, has many forms, including physical aggression or assault (hitting, kicking, biting, shoving, restraining, slapping, throwing objects), or threats thereof; sexual abuse; emotional abuse; controlling or domineering; intimidation; stalking; passive/covert abuse (e.g., neglect); and economic deprivation.[1][2] Alcohol consumption[3] and mental illness[4] can be co-morbid with abuse, and present additional challenges in eliminating domestic violence. Awareness, perception, definition and documentation of domestic violence differs widely from country to country, and from era to era.

Domestic violence and abuse is not limited to obvious physical violence. Domestic violence can also mean endangerment, criminal coercion, kidnapping, unlawful imprisonment, trespassing, harassment, and stalking.[5]

Definitions

According to the Merriam-Webster dictionary definition, domestic violence is: "the inflicting of physical injury by one family or household member on another; also: a repeated / habitual pattern of such behavior."[6]

The term "intimate partner violence" (IPV) is often used synonymously with domestic abuse/domestic violence. Family violence is a broader definition, often used to include child abuse, elder abuse, and other violent acts between family members.[7] Wife abuse, wife beating, and battering are descriptive terms that have lost popularity recently for several reasons:

These other forms of abuse have the potential to lead to mental illness, self-harm, and even attempts at suicide.[9][10]

Government definitions

The US Office on Violence Against Women (OVW) defines domestic violence as a "pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner". The definition adds that domestic violence "can happen to anyone regardless of race, age, sexual orientation, religion, or gender", and can take many forms, including physical abuse, sexual abuse, emotional, economic, and psychological abuse.[11]

The Children and Family Court Advisory and Support Service in the United Kingdom in its "Domestic Violence Policy" uses domestic violence to refer to a range of violent and abusive behaviours, defining it as:

Patterns of behaviour characterised by the misuse of power and control by one person over another who are or have been in an intimate relationship. It can occur in mixed gender relationships and same gender relationships and has profound consequences for the lives of children, individuals, families and communities. It may be physical, sexual, emotional and/or psychological. The latter may include intimidation, harassment, damage to property, threats and financial abuse.[12]

Dynamics classification

Violence by a person against their intimate partner is often done as a way for controlling their partner, even if this kind of violence is not the most frequent.[13] Many types of intimate partner violence occur, including violence between gay and lesbian couples,[14] and by women against their male partners.[15]

Intimate partner violence types

Michael P. Johnson argues for four major types of intimate partner violence, which is supported by subsequent research and evaluation.[16][17][18][19] as well as independent researchers.[20][21][22]

Distinctions are made among the types of violence, motives of perpetrators, and the social and cultural context based upon patterns across numerous incidents and motives of the perpetrator. Types of violence identified by Johnson:[15][17][23][24]

Types of male batterers identified by Holtzworth-Munroe and Stuart (1994) include "family-only", which primarily fall into the CCV type, who are generally less violent and less likely to perpetrate psychological and sexual abuse.[35]

Other

Others, such as the US Centers for Disease Control, divide domestic violence into two types: reciprocal, in which both partners are violent, and non-reciprocal violence, in which one partner is violent; it is possible that the former is more common[36][37]

Forms

All forms of domestic abuse have one purpose: to gain and maintain control over the victim. Abusers use many tactics to exert power over their spouse or partner: dominance, humiliation, isolation, threats, intimidation, denial and blame.[38]

Physical

Kalighat Painting, "Woman Striking Man With Broom," Calcutta, India, 1875

Physical abuse is abuse involving contact intended to cause feelings of intimidation, pain, injury, or other physical suffering or bodily harm.

Physical abuse includes hitting, slapping, punching, choking, pushing, burning and other types of contact that result in physical injury to the victim. Physical abuse can also include behaviors such as denying the victim of medical care when needed, depriving the victim of sleep or other functions necessary to live, or forcing the victim to engage in drug/alcohol use against his/her will. If a person is suffering from any physical harm then they are experiencing physical abuse. This pain can be experienced on any level.[39] It can also include inflicting physical injury onto other targets, such as children or pets, in order to cause psychological harm to the victim.[40]

Sexual

Sexual abuse is any situation in which force or threat is used to obtain participation in unwanted sexual activity. Coercing a person to engage in sexual activity against their will, even if that person is a spouse or intimate partner with whom consensual sex has occurred, is an act of aggression and violence.

Sexual violence is defined by World Health Organization as:

Marital rape, also known as spousal rape, is non-consensual sex in which the perpetrator is the victim's spouse. As such, it is a form of partner rape, of domestic violence, and of sexual abuse. In the US spousal rape is illegal in all 50 states.[42][43] In Canada, spousal rape was outlawed in 1983, when several legal changes were made, including changing the rape statute to sexual assault, and making the laws gender neutral.[44] Criminalization in Australia began with the state of New South Wales in 1981, followed by all other states from 1985 to 1992.[45] New Zealand outlawed spousal rape in 1985, and Ireland in 1990.[45] In England and Wales, spousal rape was made illegal in 1991, when the marital rape exemption was abolished by the Appellate Committee of the House of Lords, in the case of R v R.[46]

Categories of sexual abuse include:

  1. Use of physical force to compel a person to engage in a sexual act against his or her will, whether or not the act is completed;
  2. Attempted or completed sex act involving a person who is unable to understand the nature or condition of the act, unable to decline participation, or unable to communicate unwillingness to engage in the sexual act, e.g., because of underage immaturity, illness, disability, or the influence of alcohol or other drugs, or because of intimidation or pressure.

Emotional

Emotional abuse (also called psychological abuse or mental abuse) can include humiliating the victim privately or publicly, controlling what the victim can and cannot do, withholding information from the victim, deliberately doing something to make the victim feel diminished or embarrassed, isolating the victim from friends and family, implicitly blackmailing the victim by harming others when the victim expresses independence or happiness, or denying the victim access to money or other basic resources and necessities. Degradation in any form can be considered psychological abuse.

Emotional abuse can include verbal abuse and is defined as any behavior that threatens, intimidates, undermines the victim’s self-worth or self-esteem, or controls the victim’s freedom.[47] This can include threatening the victim with injury or harm, telling the victim that they will be killed if they ever leave the relationship, and public humiliation. Constant criticism, name-calling, and making statements that damage the victim’s self-esteem are also common verbal forms of emotional abuse. Often perpetrators will use children to engage in emotional abuse by teaching them to harshly criticize the victim as well.[48] Emotional abuse includes conflicting actions or statements which are designed to confuse and create insecurity in the victim. These behaviors also lead the victims to question themselves, causing them to believe that they are making up the abuse or that the abuse is their fault.[40]

Emotional abuse includes forceful efforts to isolate the victim, keeping them from contacting friends or family. This is intended to eliminate those who might try to help the victim leave the relationship and to create a lack of resources for them to rely on if they were to leave. Isolation results in damaging the victim’s sense of internal strength, leaving them feeling helpless and unable to escape from the situation.[48]

People who are being emotionally abused often feel as if they do not own themselves; rather, they may feel that their significant other has nearly total control over them. Women or men undergoing emotional abuse often suffer from depression, which puts them at increased risk for suicide, eating disorders, and drug and alcohol abuse.[49]

Verbal

Verbal abuse is a form of emotionally abusive behavior involving the use of language. Verbal abuse can also be referred to as the act of threatening. Through threatening a person can blatantly say they will harm you in any way and will also be considered as abuse.[50] It may include profanity but can occur with or without the use of expletives.[citation needed]

Verbal abuse may include aggressive actions such as name-calling, blaming, ridicule, disrespect, and criticism, but there are also less obviously aggressive forms of verbal abuse. Statements that may seem benign on the surface can be thinly veiled attempts to humiliate; falsely accuse; or manipulate others to submit to undesirable behavior, make others feel unwanted and unloved, threaten others economically, or isolate victims from support systems.[51]

In Jekyll and Hyde behaviors, the abuser may fluctuate between sudden rages and false joviality toward the victim; or may simply show a very different "face" to the outside world than to the victim. While oral communication is the most common form of verbal abuse, it includes abusive communication in written form.[citation needed]

Economic

Economic abuse is a form of abuse when one intimate partner has control over the other partner's access to economic resources.[52] Economic abuse may involve preventing a spouse from resource acquisition, limiting the amount of resources to use by the victim, or by exploiting economic resources of the victim.[52][53] The motive behind preventing a spouse from acquiring resources is to diminish victim's capacity to support him/herself, thus forcing him/her to depend on the perpetrator financially, which includes preventing the victim from obtaining education, finding employment, maintaining or advancing their careers, and acquiring assets.[52][53][54] In addition, the abuser may also put the victim on an allowance, closely monitor how the victim spends money, spend victim's money without his/her consent and creating debt, or completely spend victim's savings to limit available resources[52][53][54]

Effects

On children

3.3 million children witness domestic violence each year in the US. There has been an increase in acknowledgment that a child who is exposed to domestic abuse during their upbringing will suffer in their developmental and psychological welfare.[55] Because of the awareness of domestic violence that some children have to face, it also generally impacts how the child develops emotionally, socially, behaviorally as well as cognitively.[56] Some emotional and behavioral problems that can result due to domestic violence include increased aggressiveness, anxiety, and changes in how a child socializes with friends, family, and authorities.[55] Depression, as well as self-esteem issues, can follow due to traumatic experiences. Problems with attitude and cognition in schools can start developing, along with a lack of skills such as problem-solving.[55] Correlation has been found between the experience of abuse and neglect in childhood and perpertrating domestic violence and sexual abuse in adulthood.[57] Additionally, in some cases the abuser will purposely abuse the mother[58] or father[citation needed] in front of the child to cause a ripple effect, hurting two victims simultaneously.[58] It has been found that children who witness mother-assault are more likely to exhibit symptoms of posttraumatic stress disorder (PTSD).[59] Consequences to these children are likely to be more severe if their assaulted mother develops posttruamatic stress disorder (PTSD) and does not seek treatment due to her difficulty in assisting her child with processing his or her own experience of witnessing the domestic violence.[60]

Family Violence prevention in Australia and other countries has begun to focus on breaking intergenerational cycles, according to the National (Aust) Standards for Working with Children Exposed to Family Violence it is important to acknowledge that exposing children to Family Violence is child abuse.[61] Some of the effects of Family Violence on children are highlighted in the Queensland Government and SunnyKids awareness raising campaign.[62]

Physical

Bruises, broken bones, head injuries, lacerations, and internal bleeding are some of the acute effects of a domestic violence incident that require medical attention and hospitalization.[63] Some chronic health conditions that have been linked to victims of domestic violence are arthritis, irritable bowel syndrome, chronic pain, pelvic pain, ulcers, and migraines.[64] Victims who are pregnant during a domestic violence relationship experience greater risk of miscarriage, pre-term labor, and injury to or death of the fetus.[63]

Psychological

Among victims who are still living with their perpetrators high amounts of stress, fear, and anxiety are commonly reported. Depression is also common, as victims are made to feel guilty for ‘provoking’ the abuse and are frequently subjected to intense criticism. It is reported that 60% of victims meet the diagnostic criteria for depression, either during or after termination of the relationship, and have a greatly increased risk of suicidality.[65] In addition to depression, victims of domestic violence also commonly experience long-term anxiety and panic, and are likely to meet the diagnostic criteria for Generalized Anxiety Disorder and Panic Disorder. The most commonly referenced psychological effect of domestic violence is Post-Traumatic Stress Disorder (PTSD). PTSD (as experienced by victims) is characterized by flashbacks, intrusive images, exaggerated startle response, nightmares, and avoidance of triggers that are associated with the abuse.[66] These symptoms are generally experienced for a long span of time after the victim has left the dangerous situation. Many researchers state that PTSD is possibly the best diagnosis for those suffering from psychological effects of domestic violence, as it accounts for the variety of symptoms commonly experienced by victims of trauma.

Financial

Once victims leave their perpetrator, they can be stunned with the reality of the extent to which the abuse has taken away their autonomy. Due to economic abuse and isolation, the victim usually has very little money of their own and few people on whom they can rely when seeking help. This has been shown to be one of the greatest obstacles facing victims of DV, and the strongest factor that can discourage them from leaving their perpetrators.[67] In addition to lacking financial resources, victims of DV often lack specialized skills, education, and training that are necessary to find gainful employment, and also may have several children to support. In 2003, thirty-six major US cities cited DV as one of the primary causes of homelessness in their areas.[68] It has also been reported that one out of every three homeless women are homeless due to having left a DV relationship. If a victim is able to secure rental housing, it is likely that her apartment complex will have “zero tolerance” policies for crime; these policies can cause them to face eviction even if they are the victim (not the perpetrator) of violence.[68] While the number of shelters and community resources available to DV victims has grown tremendously, these agencies often have few employees and hundreds of victims seeking assistance which causes many victims to remain without the assistance they need.[67]

Long-term

Domestic violence can trigger many different responses in victims, all of which are very relevant for any professional working with a victim. Major consequences of domestic violence victimization include psychological/mental health issues and chronic physical health problems. A victim’s overwhelming lack of resources can lead to homelessness and poverty.

On responders

Vicarious trauma

Due to the gravity and intensity of hearing victims’ stories of abuse, professionals (social workers, police, counselors, therapists, advocates, medical professionals) are at risk themselves for secondary or vicarious trauma (VT), which causes the responder to experience trauma symptoms similar to the original victim after hearing about the victim’s experiences with abuse.[69] Research has demonstrated that professionals who experience vicarious trauma show signs of exaggerated startle response, hypervigilance, nightmares, and intrusive thoughts although they have not experienced a trauma personally and do not qualify for a clinical diagnosis of PTSD.[69] Researchers concluded that although clinicians have professional training and are equipped with the necessary clinical skills to assist victims of domestic violence, they may still be personally affected by the emotional impact of hearing about a victim’s traumatic experiences. Iliffe et al. found that there are several common initial responses that are found in clinicians who work with victims: loss of confidence in their ability to help the client, taking personal responsibility for ensuring the client’s safety, and remaining supportive of the client’s autonomy if they make the decision to return to their perpetrator.[69] It has also been shown that clinicians who work with a large number of victims may alter their former perceptions of the world, and begin to doubt the basic goodness of others. Iliffe et al. found that clinicians who work with victims tend to feel less secure in the world, become “acutely aware” of power and control issues both in society and in their own personal relationships, have difficulty trusting others, and experience an increased awareness of gender-based power differences in society.[69]

The best way for a clinician to avoid developing VT is to engage in good self-care practices. These can include exercise, relaxation techniques, debriefing with colleagues, and seeking support from supervisors.[69] Additionally, it is recommended that clinicians make the positive and rewarding aspects of working with domestic violence victims the primary focus of thought and energy, such as being part of the healing process or helping society as a whole. Clinicians should also continually evaluate their empathic responses to victims, in order to avoid feelings of being drawn in to the trauma that the victim experienced. It is recommended that clinicians practice good boundaries, and find a balance in expressing empathic responses to the victim while still maintaining personal detachment from their traumatic experiences.[69]

Burnout

Vicarious trauma can lead directly to burnout, which is defined as “emotional exhaustion resulting from excessive demands on energy, strength, and personal resources in the work setting”.[70] The physical warning signs of burnout include headaches, fatigue, lowered immune function, and irritability.[71] A clinician experiencing burnout may begin to lose interest in the welfare of clients, be unable to empathize or feel compassion for clients, and may even begin to feel aversion toward the client.[70] If the clinician experiencing burnout is working with victims of domestic violence, the clinician risks causing further great harm through re-victimization of the client. It should be noted, however, that vicarious trauma does not always directly lead to burnout and that burnout can occur in clinicians who work with any difficult population – not only those who work with domestic violence victims.

Cause

There are many different theories as to the causes of domestic violence. These include psychological theories that consider personality traits and mental characteristics of the perpetrator, as well as social theories which consider external factors in the perpetrator's environment, such as family structure, stress, social learning. As with many phenomena regarding human experience, no single approach appears to cover all cases.

Whilst there are many theories regarding what causes one individual to act violently towards an intimate partner or family member there is also growing concern around apparent intergenerational cycles of domestic violence. In Australia where it has been identified that as many as 75% of all victims of domestic violence are children[72] Domestic violence services such as Sunnykids are beginning to focus their attention on children who have been exposed to domestic violence.[73]

Responses that focus on children suggest that experiences throughout life influence an individuals' propensity to engage in family violence (either as a victim or as a perpetrator). Researchers supporting this theory suggest it is useful to think of three sources of domestic violence: childhood socialization, previous experiences in couple relationships during adolescence, and levels of strain in a person's current life. People who observe their parents abusing each other, or who were themselves abused may incorporate abuse into their behaviour within relationships that they establish as adults. (Kalmuss & Seltzer 1984)

Psychological

Psychological theories focus on personality traits and mental characteristics of the offender. Personality traits include sudden bursts of anger, poor impulse control, and poor self-esteem. Various theories suggest that psychopathology and other personality disorders are factors, and that abuse experienced as a child leads some people to be more violent as adults. Correlation has been found between juvenile delinquency and domestic violence in adulthood.[74] Studies have found high incidence of psychopathy among abusers.[75][76][77]

For instance, some research suggests that about 80% of both court-referred and self-referred men in these domestic violence studies exhibited diagnosable psychopathology, typically personality disorders. "The estimate of personality disorders in the general population would be more in the 15–20% range [...] As violence becomes more severe and chronic in the relationship, the likelihood of psychopathology in these men approaches 100%."[4] Dutton has suggested a psychological profile of men who abuse their wives, arguing that they have borderline personalities that are developed early in life.[78][79] However, these psychological theories are disputed: Gelles suggests that psychological theories are limited, and points out that other researchers have found that only 10% (or less) fit this psychological profile. He argues that social factors are important, while personality traits, mental illness, or psychopathy are lesser factors.[80][81][82]

Jealousy

Many cases of domestic violence against women occur due to jealousy when one partner is either suspected of being unfaithful or is planning to leave the relationship.[83][84] An evolutionary psychology explanation of such cases of domestic violence against a woman is that they represent male attempts to control female reproduction and ensure sexual exclusivity through violence or the threat of violence.[83][84]

Behavioral

Behavioral theories draw on the work of behavior analysts. Applied behavior analysis uses the basic principles of learning theory to change behavior. Behavioral theories of domestic violence focus on the use of functional assessment with the goal of reducing episodes of violence to zero rates.[85] This program leads to behavior therapy. Often by identifying the antecedents and consequences of violent action, the abusers can be taught self control.[86] Recently more focus has been placed on prevention and a behavioral prevention theory.[85]

Social theories

Looks at external factors in the offender's environment, such as family structure, stress, social learning, and includes rational choice theories.[87]

Resource theory

Resource theory was suggested by William Goode (1971).[88] Women who are most dependent on the spouse for economic well being (e.g. homemakers/housewives, women with handicaps, the unemployed), and are the primary caregiver to their children, fear the increased financial burden if they leave their marriage. Dependency means that they have fewer options and few resources to help them cope with or change their spouse's behavior.[89]

Couples that share power equally experience lower incidence of conflict, and when conflict does arise, are less likely to resort to violence. If one spouse desires control and power in the relationship, the spouse may resort to abuse.[90] This may include coercion and threats, intimidation, emotional abuse, economic abuse, isolation, making light of the situation and blaming the spouse, using children (threatening to take them away), and behaving as "master of the castle".[91][92]

Social stress

Stress may be increased when a person is living in a family situation, with increased pressures. Social stresses, due to inadequate finances or other such problems in a family may further increase tensions.[93] Violence is not always caused by stress, but may be one way that some people respond to stress.[94][95] Families and couples in poverty may be more likely to experience domestic violence, due to increased stress and conflicts about finances and other aspects.[96] Some speculate that poverty may hinder a man's ability to live up to his idea of "successful manhood", thus he fears losing honor and respect. Theory suggests that when he is unable to economically support his wife, and maintain control, he may turn to misogyny, substance abuse, and crime as ways to express masculinity.[96]

Social learning theory

Social learning theory suggests that people learn from observing and modeling after others' behavior. With positive reinforcement, the behavior continues. If one observes violent behavior, one is more likely to imitate it. If there are no negative consequences (e. g. victim accepts the violence, with submission), then the behavior will likely continue. Often, violence is transmitted from generation to generation in a cyclical manner.[vague] [97][98][99]

Power and control

In abusive relationships, violence is posited to arise out of a need for power and control of one partner over the other. An abuser will use various tactics of abuse (e.g., physical, verbal, emotional, sexual or financial) in order to establish and maintain control over the partner.

Abusers' efforts to dominate their partners have been attributed to low self-esteem or feelings of inadequacy, unresolved childhood conflicts, the stress of poverty, hostility and resentment toward women (misogyny), hostility and resentment toward men (misandry), personality disorders, genetic tendencies and sociocultural influences, among other possible causative factors. Most authorities seem to agree that abusive personalities result from a combination of several factors, to varying degrees.

A causalist view of domestic violence is that it is a strategy to gain or maintain power and control over the victim. This view is in alignment with Bancroft's "cost-benefit" theory that abuse rewards the perpetrator in ways other than, or in addition to, simply exercising power over his or her target(s). He cites evidence in support of his argument that, in most cases, abusers are quite capable of exercising control over themselves, but choose not to do so for various reasons.[100]

An alternative view is that abuse arises from powerlessness and externalizing/projecting this and attempting to exercise control of the victim. It is an attempt to 'gain or maintain power and control over the victim' but even in achieving this it cannot resolve the powerlessness driving it. Such behaviours have addictive aspects leading to a cycle of abuse or violence. Mutual cycles develop when each party attempts to resolve their own powerlessness in attempting to assert control.

Questions of power and control are integral to the widely utilized Duluth Domestic Abuse Intervention Project. They developed a "Power and Control Wheel" to illustrate this: it has power and control at the center, surrounded by spokes (techniques used), the titles of which include: coercion and threats, intimidation, emotional abuse, isolation, minimizing, denying and blaming, using children, economic abuse, and male privilege.[101] The model attempts to address abuse by challenging the misuse of power by the perpetrator.

The power wheel model is not intended to assign personal responsibility, enhance respect for mutual purpose or assist victims and perpetrators in resolving their differences. Rather, it is an informational tool designed to help individuals understand the dynamics of power operating in abusive situations and identify various methods of abuse.

Critics of this model argue that it ignores research linking domestic violence to substance abuse and psychological problems.[102] Some modern research into the patterns in DV has found that women are more likely to be physically abusive towards their partner in relationships in which only one partner is violent,[36][37] which draws the effectiveness of using concepts like male privilege to treat domestic violence into question; however, it may still be valid in studying severe abuse cases, which are mostly male perpetrated.[37] However, modern research into predictors of injury from domestic violence finds that the strongest predictor of injury by domestic violence is participation in reciprocal domestic violence, and that this pattern of domestic violence is more often initiated by the female in the relationship.[103]

Mental illness

Many psychiatric disorders are risk factors for domestic violence, including several personality disorders: all Cluster B PDs, (especially antisocial), paranoid and passive-aggressive. Bipolar disorder, schizophrenia, drug abuse, alcoholism and poor impulse control are also risk factors.[2][104] It is estimated that at least one-third of all abusers have some type of mental illness.[105]

Marital conflict disorder

The American Psychiatric Association planning and research committees for the forthcoming DSM-5 (2013) have canvassed a series of new Relational disorders which include Marital Conflict Disorder Without Violence or Marital Abuse Disorder (Marital Conflict Disorder With Violence).[106] Couples with marital disorders sometimes come to clinical attention because the couple recognize long-standing dissatisfaction with their marriage and come to the clinician on their own initiative or are referred by an astute health care professional. Secondly, there is serious violence in the marriage which is -"usually the husband battering the wife".[107]

In these cases the emergency room or a legal authority often is the first to notify the clinician. Most importantly, marital violence "is a major risk factor for serious injury and even death and women in violent marriages are at much greater risk of being seriously injured or killed (National Advisory Council on Violence Against Women 2000)."[108] The authors of this study add that "There is current considerable controversy over whether male-to-female marital violence is best regarded as a reflection of male psychopathology and control or whether there is an empirical base and clinical utility for conceptualizing these patterns as relational."[108]

Recommendations for clinicians making a diagnosis of Marital Relational Disorder should include the assessment of actual or "potential" male violence as regularly as they assess the potential for suicide in depressed patients. Further, "clinicians should not relax their vigilance after a battered wife leaves her husband, because some data suggest that the period immediately following a marital separation is the period of greatest risk for the women. Many men will stalk and batter their wives in an effort to get them to return or punish them for leaving. Initial assessments of the potential for violence in a marriage can be supplemented by standardized interviews and questionnaires, which have been reliable and valid aids in exploring marital violence more systematically."[108]

The authors conclude with what they call "very recent information"[109] on the course of violent marriages which suggests that "over time a husband's battering may abate somewhat, but perhaps because he has successfully intimidated his wife. The risk of violence remains strong in a marriage in which it has been a feature in the past. Thus, treatment is essential here; the clinician cannot just wait and watch."[109] The most urgent clinical priority is the protection of the wife because she is the one most frequently at risk, and clinicians must be aware that supporting assertiveness by a battered wife may lead to more beatings or even death.[109]

Gender aspects of abuse

The relationship between gender and domestic violence is a controversial topic. There continues to be debate about the rates at which each gender is subjected to domestic violence and whether abused men should be provided the same resources and shelters that exist for female victims. In particular, some studies suggest that men are less likely to report being victims of domestic violence due to social stigmas.[110][111] Other sources, however, argue that the rate of domestic violence against men is often inflated due to the practice of including self-defense as a form of domestic violence.[112][113]

Both men and women have been arrested and convicted of assaulting their partners in both heterosexual and homosexual relationships. The majority of these arrests have been men being arrested for assaulting women, though since the early-to-mid 1990s the number of women arrested has increased significantly, which is often attributed to the implementation of "Must Arrest" laws. However, the gender neutrality of the enforcement of domestic violence laws remains questionable.[114]

According to a 2004 survey in Canada, the percentages of males being physically or sexually victimized by their partners was 6% versus 7% for women. However, females reported higher levels of repeated violence and were more likely than men to experience serious injuries; 23% of females versus 15% of males were faced with the most serious forms of violence including being beaten, choked, or threatened with or having a gun or knife used against them. Also, 21% of women versus 11% of men were likely to report experiencing more than 10 violent incidents. Women who often experience higher levels of physical or sexual violence from their current partner, were 44% versus only 18% of males to suffer from an injury. Cases in which women are faced with extremely abusive partners, results in the females having to fear for their lives due to the violence they had faced. In addition, statistics show that 34% of women feared for their lives whereas only 10% of males felt this way.[44]

A problem in conducting studies that seek to describe violence in terms of gender is the amount of silence, fear and shame that results from abuse within families and relationships. Another is that abusive patterns can tend to seem normal to those who have lived in them for a length of time. Similarly, subtle forms of abuse can be quite transparent even as they set the stage for further abuse seeming normal. Finally, inconsistent definition of what constitutes domestic violence makes definite conclusions difficult to reach when compiling the available studies.

Violence against women

Although the exact rates are widely disputed, especially within the United States, there is a large body of cross-cultural evidence that women are subjected to domestic violence significantly more often than men.[113][115][116][117] In addition, there is broad consensus that women are more often subjected to severe forms of abuse and are more likely to be injured by an abusive partner.[116][117][118]

According to a report by the United States Department of Justice, a survey of 16,000 Americans showed 22.1% of women and 7.4% of men reported being physically assaulted by a current or former spouse, cohabiting partner, boyfriend or girlfriend, or date in their lifetime.[119] A 2010 survey of over 21,000 residents of England and Wales by the UK Home Office showed that 7% of women and 3% of men were victims of domestic abuse in the last year.[120] A study in the United States found that women were 13 times more likely than men to seek medical attention due to injuries related to spousal abuse.[121]

Women are more likely than men to be murdered by an intimate partner. Of those killed by an intimate partner about three quarters are female and about a quarter are male. In 1999 in the United States 1,218 women and 424 men were killed by an intimate partner,[122] and 1181 females and 329 males were killed by their intimate partners in 2005.[123][124] In England and Wales about 100 women are killed by partners or former partners each year while 21 men were killed in 2010.[125] In 2008, in France, 156 women and 27 men were killed by their intimate partner.[126]

The UN Declaration on the Elimination of Violence against Women (1993) states that “violence against women is a manifestation of historically unequal power relations between men and women, which has led to domination over and discrimination against women by men and to the prevention of the full advancement of women, and that violence against women is one of the crucial social mechanisms by which women are forced into a subordinate position compared with men.”[127][128]

In their study of severely violent couples, Neil Jacobson and John Gottman conclude that the frequency of violent acts is not as crucial as the impact of the violence and its function, when trying to understand spousal abuse; specifically, they state that the purpose of domestic violence is typically to control and intimidate, rather than just to injure.[129]

Violence against men

Determining how many instances of domestic violence actually involve male victims is difficult. Male domestic violence victims may be reluctant to get help for a number of reasons.[130] Some studies have shown that women who assaulted their male partners were more likely to avoid arrest even when the male victim contacts police.[131] Another study examined the differences in how male and female batterers were treated by the criminal justice system. The study concluded that female intimate violence perpetrators are frequently viewed by law enforcement and the criminal justice system as victims rather than the actual offenders of violence against men.[132] Other studies have also demonstrated a high degree of acceptance of aggression against men by women.[133]

A 32-nation study revealed that more than 51% of men and 52% of women felt that there were times when it was appropriate for a wife to slap her husband. By comparison, only 26% of men and 21% of women felt that there were times when it was appropriate for a husband to slap his wife. [134]

Studies have shown many police officers do not treat domestic violence against men as a serious crime, and often will view the male victim as a "pathetic figure". It is for this reason, and also the view among many law enforcement officers that men are inherently "stronger" than women, that male victims are often less likely to report domestic violence than female victims. When and if they do, men are often treated as the aggressor in the situation, and often even placed under arrest.[135]

Some researchers have found a relationship between the availability of domestic violence services, improved laws and enforcement regarding domestic violence, increased access to divorce, and higher earnings for women with declines in intimate partner homicide by women.[136]

Theories that women are as violent as men have been dubbed "gender symmetry" theories.[130][137][138][139][140][141]

Straus and Gelles found that in couples reporting spousal violence, 27% of the time the man struck the first blow; in 24% of cases, the woman initiated the violence. The rest of the time, the violence was mutual, with both partners brawling. The results were the same even when the most severe episodes of violence were analyzed. In order to counteract claims that the reporting data was skewed, female-only surveys were conducted, asking females to self-report, and the data was the same.[142] The simple tally of physical acts is typically found to be similar in those studies that examine both directions, but some studies show that male violence may be more serious. Male violence may do more damage than female violence;[143] women are more likely to be injured and/or hospitalized. Wives are more likely to be killed by their husbands than the reverse (59% to 41% per Department of Justice study), and women in general are more likely to be killed by their spouses than by all other types of assailants combined.[144] From a data set of 6,200 cases of spousal abuse in the Detroit area of USA in 1978-79 found that men used weapons 25% of the time while female assailants used weapons 86% of the time, 74% of men sustained injury and of these 84% required medical care. [145]

Martin S. Fiebert of the Department of Psychology at California State University, Long Beach, has compiled an annotated bibliography of research relating to spousal abuse by women on men. This bibliography examines 275 scholarly investigations: 214 empirical studies and 61 reviews and/or analyses that appear to demonstrate that women are as physically aggressive, or more aggressive, than men in their relationships with their spouses or male partners. The aggregate sample size in the reviewed studies exceeds 365,000.[146] In a Los Angeles Times article about male victims of domestic violence, Fiebert suggests that "...consensus in the field is that women are as likely as men to strike their partner but that—as expected—women are more likely to be injured than men."[118] However, he noted, men are seriously injured in 38% of the cases in which "extreme aggression" is used. Fiebert additionally noted that his work was not meant to minimize the serious effects of men who abuse women.

In a review of the research however Michael Kimmel found that violence is instrumental in maintaining control and that more than 90% of "systematic, persistent, and injurious" violence is perpetrated by men. He points out that most of the empirical studies that Fiebert reviewed used the same empirical measure of family conflict, i.e., the Conflict Tactics Scale (CTS) as the sole measure of domestic violence and that many of the studies noted by Fiebert discussed samples composed entirely of single people younger than 30, not married couples.[147] Kimmel argues that among various other flaws, the CTS is particularly vulnerable to reporting bias because it depends on asking people to accurately remember and report what happened during the past year. Men tend to underestimate their use of violence, while women tend to overestimate their use of violence. Simultaneously men tend to overestimate their partner's use of violence while women tend to underestimate their partner's use of violence. Thus, men will likely overestimate their victimization, while women tend to underestimate theirs.[148]

Similarly, the National Institute of Justice states that some studies finding equal or greater frequency of abuse by women against men are based on data compiled through the Conflict Tactics Scale. This survey tool was developed in the 1970s and may not be appropriate for intimate partner violence research because it does not measure control, coercion, or the motives for conflict tactics; it also leaves out sexual assault and violence by ex-spouses or partners and does not determine who initiated the violence. Furthermore, the NIJ contends that national surveys supported by NIJ, the Centers for Disease Control and Prevention, and the Bureau of Justice Statistics that examine more serious assaults do not support the conclusion of similar rates of male and female spousal assaults. These surveys are conducted within a safety or crime context and clearly find more partner abuse by men against women.[149] However more modern Centers for Disease Control and Prevention and other research reports that female perpetrated domestic abuse, is more common than male [37][103]

In a Meta-analysis, John Archer, Ph. D., from the Department of Psychology, University of Central Lancashire, UK, writes:

The present analyses indicate that men are among those who are likely to be on the receiving end of acts of physical aggression.[130] The extent to which this involves mutual combat or the male equivalent to “battered women” is at present unresolved. Both situations are causes for concern. Straus (1997) has warned of the dangers involved—especially for women—when physical aggression becomes a routine response to relationship conflict. “Battered men”—those subjected to systematic and prolonged violence—are likely to suffer physical and psychological consequences, together with specific problems associated with a lack of recognition of their plight (George and George, 1998). Seeking to address these problems need not detract from continuing to address the problem of “battered women."[150]

Gender roles and expectations can and do play a role in abusive situations, and exploring these roles and expectations can be helpful in addressing abusive situations. Likewise, it can be helpful to explore factors such as race, class, religion, sexuality and philosophy. However, studies investigating whether sexist attitudes are correlated with domestic violence have shown conflicting results.[151][152]

A 1997 report says significantly more men than women do not disclose the identity of their attacker.[153] A 2009 study showed that there was greater acceptance for abuse perpetrated by females than by males.[154] Several studies have confirmed that women’s physical violence towards intimate male partners is sometimes in self-defense.[155][156][157][158]

In Norway, researcher Anja Bredal's opinion is that non-Norwegian men are being assaulted by their wives who are of the same ethnicity—who are Norwegian citizens.[159]

Same-sex relationships

Domestic violence also occurs in same-sex relationships. Gay and lesbian relationships have been identified as a risk factor for abuse in certain populations.[2] In an effort to be more inclusive, many organizations have made an effort to use gender-neutral terms when referring to perpetratorship and victimhood.

Historically, domestic violence has been seen as a family issue and little interest has been directed at violence in same-sex relationships.[160] It has not been until recently, as the gay rights movement has brought the issues of gay and lesbian people into public attention, when research has been conducted on same-sex relationships. A 1999 analysis of nineteen studies of partner abuse concluded that "[r]esearch suggests that lesbians and gay men are just as likely to abuse their partners as heterosexual men,"[161] although the study also noted the uncertain nature of much of the contemporary research in the area. Gays and lesbians, however, face special obstacles in dealing with the issues that some researchers have labeled "the double closet". A recent Canadian study by Mark W. Lehman[162] suggests similarities include frequency (approximately one in every four couples); manifestations (emotional, physical, financial, etc.); co-existent situations (unemployment, substance abuse, low self-esteem); victims' reactions (fear, feelings of helplessness, hypervigilance); and reasons for staying (love, can work it out, things will change, denial). At the same time, significant differences, unique issues and deceptive myths are typically present. Lehman points to added discrimination and fear gays and lesbians can face; dismissal by police and some social services; a lack of support from peers who would rather keep quiet about the problem in order not to attract negative attention toward the gay community; the impacts of HIV status or AIDS in keeping partners together, due to health care insurance/access, or guilt; outing used as a weapon; and encountering supportive services that are targeted and/or structured for the needs of heterosexual women and which may not meet the needs of gay men or lesbians. However Lehman himself noted that "due to the limited number of returned responses and non-random sampling methodology the findings of this work are not generalizable beyond the sample" of 32 initial respondents and final 10 who completed the more in-depth survey.

Cycle of abuse

Frequently, domestic violence is used to describe specific violent and overtly abusive incidents, and legal definitions will tend to take this perspective. However, when violent and abusive behaviours happen within a relationship, the effects of those behaviours continue after these overt incidents are over. Advocates and counsellors will refer to domestic violence as a pattern of behaviours, including those listed above.

Lenore Walker presented the model of a Cycle of abuse which consists of three basic phases:

Tension Building Phase
Characterized by poor communication, tension, fear of causing outbursts. During this stage the victims try to calm the abuser down, to avoid any major violent confrontations.
Violent Episode
Characterized by outbursts of violent, abusive incidents. During this stage the abuser attempts to dominate his/her partner(victim), with the use of domestic violence.
Honeymoon Phase
Characterized by affection, apology, and apparent end of violence. During this stage the abuser feels overwhelming feelings of remorse and sadness. Some abusers walk away from the situation, while others shower their victims with love and affection.

Although it is easy to see the outbursts of the Acting-out Phase as abuse, even the more pleasant behaviours of the Honeymoon Phase serve to perpetuate the abuse.

Many domestic violence advocates believe that the cycle of abuse theory is limited and does not reflect the realities of many men and women experiencing domestic violence.

Management

The response to domestic violence is typically a combined effort between law enforcement, social services, and health care. The role of each has evolved as domestic violence has been brought more into public view.

Domestic violence historically has been viewed as a private family matter that need not involve the government or criminal justice.[163] Police officers were often reluctant to intervene by making an arrest, and often chose instead to simply counsel the couple and/or ask one of the parties to leave the residence for a period of time. The courts were reluctant to impose any significant sanctions on those convicted of domestic violence, largely because it was viewed as a misdemeanor offense.[citation needed]

Medical response

Medical professionals can make a difference in the lives of those who experience abuse. Many cases of spousal abuse are handled solely by physicians and do not involve the police. Sometimes cases of domestic violence are brought into the emergency room,[164] while many other cases are handled by family physician or other primary care provider.[165] Subspecialist physicians are also increasingly playing an important role. For example, HIV physicians are ideally suited to play an important role in managing abuse given the association between abuse and HIV infection as well as their often lifelong relationships with patients.[2]

Medical professionals are in position to empower people, give advice, and refer them to appropriate services. The health care professional has not always met this role, with uneven quality of care, and in some cases misunderstandings about domestic violence.[166]

Washaw (1993) suggests that many doctors prefer not to get involved in people's "private" lives. Clifton, Jacobs, and Tulloch (1996) found that training for general practitioners in the United States about domestic violence was very limited or they had no training. Abbott and Williamson found that knowledge and understanding of domestic violence was very limited among health care professionals in a Midlands, United Kingdom county, and that they do not see themselves as being able to play a major role in helping women in regards to domestic violence.[166] Furthermore, in the biomedical model of health care, injuries are often just treated and diagnosed, without regard for the causes.[167] As well, there is substantial reluctance for victims to come forward and broach the issue with their physicians.[168] On average, women experience 35 incidents of domestic violence before seeking treatment.[169]

In the U. S., the Institute of Medicine recognized the shortcomings of the health care system in its 2002 report entitled Confronting Chronic Neglect and attributed some of the problems cited to a lack of adequate training among health professionals.[170] Health professionals have an ethical responsibility to recognize and address exposure to abuse in their patients, in the health care setting. For example, the American Medical Association's code of medical ethics states that "Due to the prevalence and medical consequences of family violence, physicians should routinely inquire about physical, sexual, and psychological abuse as part of the medical history. Physicians must also consider abuse in the differential diagnosis for a number of medical complaints, particularly when treating women." [171]

Duluth model

In 1981, the Duluth Domestic Abuse Intervention Project became the first multi-disciplinary program designed to address the issue of domestic violence. This experiment, conducted in Duluth, Minnesota, frequently referred to as the "Duluth Project" because it is constantly evolving through the help of an entire community.[172]

It coordinated agencies dealing with domestic situations, drawing together diverse elements of the system, from police officers on the street, to shelters for battered women and probation officers supervising offenders.

This program has become a model for other jurisdictions seeking to deal more effectively with domestic violence. Corrections/probation agencies in many areas are supervising domestic violence offenders more closely, and are also paying closer attention to the victim's needs and safety issues.

There has been controversy as the Duluth framework depends on a strict "patriarchal violence" model and presumes that all violence in the home and elsewhere has a male perpetrator and female victim. Also evidence of success of the model is limited, with scholarly analysis and critique.

Many victims leave their abusers, only to return. Research has shown that a major factor in helping a victim to establish lasting independence from the abusive partner is her or his ability to get legal assistance. Economists at the Brennan Center for Justice analyzed Bureau of Justice Statistics data to determine what accounted for the nationwide reduction in reported abuse. Their findings revealed that one significant factor was the availability of legal services to assist abuse victims. Another major study by economists at Colgate University and the University of Arkansas flatly stated that the only public service that reduces domestic violence in the long term is legal aid. Legal assistance can provide essential safety planning, buttress a family’s economic position through child or spousal support, allay fears planted by the batterer about loss of custody, and help victims to secure needed government benefits.

What the community has done using the Duluth approach:[172]

The Domestic Abuse Intervention Program has federal, state and local funders who support them. This funding allows DAIP to explore strategies to end violence to communities throughout the United States and around the world.[172]

Law enforcement

In the 1970s, it was widely believed that domestic disturbance calls were the most dangerous type for responding officers, who arrive to a highly emotionally charged situation. This belief was based on FBI statistics which turned out to be flawed, in that they grouped all types of disturbances together with domestic disturbances, such as brawls at a bar. Subsequent statistics and analysis have shown this belief to be false.[173][174]

Statistics on incidents of domestic violence, published in the late 1970s, helped raise public awareness of the problem and increase activism.[163][175] A study published in 1976 by the Police Foundation found that the police had intervened at least once in the previous two years in 85% of spouse homicides.[176] In the late 1970s and early 1980s, feminists and battered women's advocacy groups were calling on police to take domestic violence more seriously and change intervention strategies.[177] In some instances, these groups took legal action against police departments, including Los Angeles's, Oakland, California's and New York City's, to get them to make arrests in domestic violence cases.[178] They claimed that police assigned low priority to domestic disturbance calls.[179]

The Minneapolis Domestic Violence Experiment was a study done in 1981–1982, led by Lawrence W. Sherman, to evaluate the effectiveness of various police responses to domestic violence calls in Minneapolis, Minnesota, including sending the abuser away for eight hours, giving advice and mediation for disputes, and making an arrest. Arrest was found to be the most effective police response. The study found that arrest reduced the rate by half of re-offending against the same victim within the following six months.[180] The results of the study received a great deal of attention from the news media, including The New York Times and prime-time news coverage on television.[181]

Many U.S. police departments responded to the study, adopting a mandatory arrest policy for spousal violence cases with probable cause.[182] By 2005, 23 states and the District of Columbia had enacted mandatory arrest for domestic assault, without warrant, given that the officer has probable cause and regardless of whether or not the officer witnessed the crime.[183] The Minneapolis study also influenced policy in other countries, including New Zealand, which adopted a pro-arrest policy for domestic violence cases.[184]

However, the study was subject of much criticism, with concerns about its methodology, as well as its conclusions.[181] The Minneapolis study was replicated in several other cities, beginning in 1986, with some of these studies having different results; one of which being the fact that the deterrent effect observed in the Minneapolis experiment was largely localized.[185] In the replication studies which were far more broad and methodologically sound in both size and scope, arrest seemed to help in the short run in certain cases, but those arrested experienced double the rate of violence over the course of one year.[185]

Criminologists do not fully understand the reasons why deterrent effects do not last over time. But they suggest that abusers who are employed and have ties to the community may initially fear punishment, though many cases do not make it all the way through the criminal justice process. If the victim is uncooperative during investigation, the prosecutor may choose not to pursue the case.[186] If the case is pursued through the criminal justice system, sometimes the resulting sentence is minor. Subsequently, any fear that the abuser has of punishment may have diminished.[187]

Each agency and jurisdiction within the United States has its own Standard Operating Procedures (SOP) when it comes to responding and handling domestic calls. Generally, it has been accepted that if the understood victim has visible (and recent) marks of abuse, the suspect is arrested and charged with the appropriate crime. However, that is a guideline and not a rule. Like any other call, domestic abuse lies in a gray area. Law enforcement officers have several things to consider when making a warrantless arrest:

Along with protecting the victim, law enforcement officers have to ensure that the alleged abusers' rights are not violated. Many times in cases of mutual combatants, it is departmental policy that both parties be arrested and the court system can establish truth at a later date. In some areas of the nation, this mutual combatant philosophy is being replaced by the primary abuser philosophy in which case if both parties have physical injuries, the law enforcement officer determines who the primary aggressor is and only arrests that one. This philosophy started gaining momentum when different government/private agencies started researching the effects. It was found that when both parties are arrested, it had an adverse effect on the victim. The victims were less likely to call or trust law enforcement during the next incident of domestic abuse.[188][page needed]

In Spain, the 2004 "The Organic Act on Integrated Protection Measures against Gender Violence" established Courts of "Violence against Women." Spanish Courts may allow to hear the case behind closed doors and that proceedings should not be made public, order a person accused of gender violence to leave the abode he shared with his victim, suspend the alleged perpetrator of acts of gender violence from exercising parental authority, custody or guardianship with regard to the minors he or she specifies, and may order the suspension of the right to possess weapons.[189]

It was announced on April 13, 2011 that all homicides resulting from domestic abuse in England and Wales will be subject to a multi-agency review involving the police and health services, local authorities, probation, voluntary groups and any other bodies connected to a victim. Director of Public Prosecutions Keir Starmer pointed out that the survey shows young women between the ages of sixteen and nineteen at highest risk of domestic abuse, saying "What that tends to show is that there may be a next generation of domestic violence waiting in the wings. Domestic violence is serious and pernicious. It ruins lives, breaks up families and has a lasting impact."[125] In England and Wales there is no specific offence of domestic violence and incidents are prosecuted under generally applicable legislation. However, when an offence is committed in a domestic context, specific aggravating factors commonly arise.[190]

Counseling for person affected

Due to the extent and prevalence of violence in relationships, counselors and therapists should assess every client for domestic violence (both experienced and perpetrated). If the clinician is seeing a couple for couple’s counseling, this assessment should be conducted with each individual privately during the initial interview, in order to increase the victim’s sense of safety in disclosing DV in the relationship.[191] In addition to determining whether DV is present, counselors and therapists should also make the distinction between situations where battering may have been a single, isolated incident or an ongoing pattern of control. The therapist must, however, consider that domestic violence may be present even when there has been only a single physical incident as emotional/verbal, economic, and sexual abuse may be more insidious.[191]

Another important issue in assessing clients for DV lies in differing definitions of abuse – the therapist’s definition may differ from that of the client, and paying close attention to the way the client describes their experiences is crucial in developing effective treatment plans. The therapist must determine if it is in the best interest of the client to explain that some behaviors (such as emotional abuse) are considered domestic violence, even if the client did not previously consider them as such.

If it becomes apparent to the therapist that domestic violence is taking place in a client’s relationship, there are several statements the clinician can make that have been shown to be effective in rapport-building and immediate crisis intervention with clients. Firstly, it is essential that the therapist believe the victim’s story and validate their feelings. It is recommended that the therapist acknowledge them for taking a risk in disclosing this information, and assure them that any ambivalent feelings they may be having are normal. The therapist should emphasize that the abuse they have experienced is not their fault, but should keep their feelings of ambivalence in mind and refrain from blaming their partner or telling them what to do. It is unreasonable for the therapist to expect that a victim will leave their perpetrator solely because they disclosed the abuse, and the therapist should respect the victim’s autonomy and allow them to make their own decisions regarding termination of the relationship. Finally, the therapist must explore options with the client (such as emergency housing in shelters, police involvement, etc.) in order to uphold their obligation to protect the welfare of the client.[191]

Lethality assessment

A lethality assessment is a tool that can assist in determining the best course of treatment for a client, as well as helping the client to recognize dangerous behaviors and more subtle abuse in their relationship.[192] In a study of victims of attempted domestic violence-related homicide, only about one-half of the participants recognized that their perpetrator was capable of killing them, as many domestic violence victims minimize the true seriousness of their situation.[193] Thus, lethality assessment is an essential first step in assessing the severity of a victim’s situation.

Safety planning

Safety planning allows the victim to plan for dangerous situations they may encounter, and is effective regardless of their decision on whether remain with their perpetrator. Safety planning usually begins with determining a course of action if another acute incident occurs in the home. The victim should be given strategies for their own safety, such as avoiding confrontations in rooms where there is only one exit and avoiding certain rooms that contain many potential weapons (such as kitchens, bathrooms, etc.).[40]

Counseling for offenders

The main goal for treatment for offenders of domestic violence is to minimize the offender’s risk of future domestic violence, whether within the same relationship or a new one. Treatment for offenders should emphasize minimizing risk to the victim, and should be modified depending on the offender’s history, risk of reoffending, and criminogenic needs.[194] The majority of offender treatment programs are 24–36 weeks in length and are conducted in a group setting with groups not exceeding 12 participants.[195] Groups are also standardized to be gender specific (male offenders only or female offenders only). It has been demonstrated that domestic violence offenders maintain a socially acceptable façade to hide abusive behavior, and therefore accountability is the recommended focus of offender treatment programs. Successful completion of treatment is generally associated with old age, higher levels of education, lower reported drug use, non-violent criminal histories, and longer intimate relationships.[196] Anger management alone has not been shown to be effective in treating domestic violence offenders, as domestic violence is based on power and control and not on problems with regulating anger responses.[197] Anger management is recommended as a part of an offender treatment curriculum that is based on accountability, along with topics such as recognizing abusive patterns of behavior and re-framing communication skills. Treatment of offenders involves more than the cessation of abusive behaviour; it also requires a great deal of personal change and the construction of a self-image that is separate from former behaviour while still being held accountable for it.[198] Any corresponding problems should also be addressed as part of domestic violence offender treatment, such as problems with substance abuse or other mental illness.[195]

Prevention and intervention

education sample

There are many community organizations which work to prevent domestic violence by offering safe shelter, crisis intervention, advocacy, and education and prevention programs. Community screening for domestic violence can be more systematic in cases of animal abuse, healthcare settings, emergency departments, behavioral health settings and court systems. Tools are being developed to facilitate domestic violence screening such as mobile apps.[199][200]

Pregnancy

Pregnancy, when coupled with Domestic violence, may amplify health risks. Abuse during pregnancy, whether physical, verbal or emotional, produces adverse effects for both the mother and fetus. Domestic violence during pregnancy is categorized as abusive behavior towards a pregnant woman, where the pattern of abuse can often change in terms of severity and frequency of violence. Abuse may be a long-standing problem in a relationship that continues after a woman becomes pregnant or it may commence in pregnancy.[201] Although female-to-male partner violence occurs in these settings, the overwhelming form of domestic violence is perpetrated by men against women.[202]

Domestic abuse can be triggered by pregnancy for a number of reasons. Pregnancy itself can be used a form of coercion and the phenomenon of preventing an intimate partner’s reproductive choice is referred to as birth control sabotage, or reproductive coercion. Studies on the birth control sabotage performed by males against female partners have indicated a strong correlation between domestic violence and birth control sabotage.[203] Pregnancy can also lead to a hiatus of domestic violence when the abuser does not want to harm the unborn child. The risk of domestic violence for pregnant women is greatest immediately after childbirth.[204]

In 2010, the U.S. Centers for Disease Control and Prevention found that 4.8% of women reported having had an intimate partner who tried to get them pregnant when they did not want to while 8.7% of men reported having had an intimate partner who tried to get pregnant when they did not want to or tried to stop them from using birth control.[205]

Prognosis

New research illustrates that there are strong associations between exposure to domestic violence and abuse in all their forms and higher rates of many chronic conditions. The strongest evidence comes from the Adverse Childhood Experiences' series of studies which show correlations between exposure to abuse or neglect and higher rates in adulthood of chronic conditions, high risk health behaviors and shortened life span.[206] Evidence of the association between physical health and violence against women has been accumulating since the early 1990s.[207] Moreover, it is important to consider the effect of domestic violence and its psychophysiologic sequelae on women who are mothers of infants and young children. Several studies have shown that maternal interpersonal violence-related posttraumatic stress disorder (PTSD) can, despite traumatized mother's best efforts, interfere with their child's response to the domestic violence and other traumatic events.[208][209] Thus, practitioners and service agencies addressing the needs of domestic violence victims should assess the victim-as-parent and evaluate the safety and well-being of children in the home.

More recently work by such researchers as Corso[210] have begun to quantify the economic impact of exposure to violence and abuse. A recent publication, Hidden Costs in Health Care: The Economic Impact of Violence and Abuse, [211] makes the case that such exposure represents a serious and costly public health issue that should be addressed by the health care system.

Epidemiology

Domestic violence occurs across the world, in various cultures,[212] and affects people of all economic statuses.[8] According to one study, the percentage of women who have reported being physically abused by an intimate partner vary from 69% to 10% depending on the country.[213]

In the United States, according to the Bureau of Justice Statistics in 1995 women reported a six times greater rate of intimate partner violence than men.[214][215] The National Crime Victimization Survey (NCVS) indicates that in 1998 about 876,340 violent crimes were committed in the U.S. against women by their current or former spouses, or boyfriends.[216] According to the Centers for Disease Control, in the United States 4.8 million women suffer intimate partner related physical assaults and rapes and 2.9 million men are victims of physical assault from their partners.[217] However studies have found that men are much less likely to report victimization in these situations.[218] According to some studies, less than 1% of domestic violence cases are reported to the police.[219][220] In the United States 10–35% of the population will be physically aggressive towards a partner at some point in their lives.[221][222][223] As abuse becomes more severe women become increasingly overrepresented as victims.[221]

Fighting the prevalence of domestic violence in Kashmir has brought Hindu and Muslim activists together.[224] Additionally, aspects of Islamic law have been criticized for promoting domestic violence[225] One study found that half of Palestinian women have been the victims of domestic violence.[226] 80% of women surveyed in rural Egypt said that beatings were common and often justified, particularly if the woman refused to have sex with her husband.[227] The Human Rights Watch found that up to 90% of women in Pakistan were subject to some form of maltreatment, within their own homes.[228] Unofficial statistics estimate that 97% of Indian women experience violence at some point in their lives.[229] Up to two-thirds of women in certain communities in Nigeria's Lagos State say they are victims to domestic violence.[230] In Turkey 42% of women over 15 have suffered physical or sexual violence.[231]

Statistics published in 2004, show that the rate of domestic violence victimisation for Indigenous women in Australia may be 40 times the rate for non-Indigenous women.[232] In Canada, the Assembly of First Nations evaluation of the Canada Prenatal Nutrition Program conducted by CIET offers an inclusive and relatively unbiased national estimate. It documented domestic violence in a random sample of 85 First Nations across Canada: 22% (523/2359) of mothers reported suffering abuse in the year prior to being interviewed; of these, 59% reported physical abuse.[233]

In Turkey 42% of women over 15 have suffered physical or sexual violence.[234]

Results of studies which estimate the prevalence of domestic violence vary significantly, depending on specific wording of survey questions, how the survey is conducted, the definition of abuse or domestic violence used, the willingness or unwillingness of victims to admit that they have been abused and other factors. For instance, Straus (2005) conducted a study which estimated that the rate of minor assaults by women in the United States was 78 per 1,000 couples, compared with a rate for men of 72 per 1,000 and the severe assault rate was 46 per 1,000 couples for assaults by women and 50 per 1,000 for assaults by men. Neither difference is statistically significant. He claimed that since these rates were based exclusively on information provided by women respondents, the near-equality in assault rates could not be attributed to a gender bias in reporting.[235]

One analysis found that "women are as physically aggressive or more aggressive than men in their relationships with their spouses or male partners".[214] However, studies have shown that women are more likely to be injured. Archer's meta-analysis[137] found that women in the United States suffer 65% of domestic violence injuries. A Canadian study showed that 7% of women and 6% of men were abused by their current or former partners, but female victims of spousal violence were more than twice as likely to be injured as male victims, three times more likely to fear for their life, twice as likely to be stalked, and twice as likely to experience more than ten incidents of violence.[236] However, Straus notes that Canadian studies on domestic violence have simply excluded questions that ask men about being victimized by their wives.[235]

Some studies show that lesbian relationships have similar levels of violence as heterosexual relationships.[237]

History

An illustration from JJ Grandville's Cent Proverbes (1845) captioned "Qui aime bien châtie bien" (Who loves well, punishes well).

Prior to the mid 1800s, most legal systems accepted wife beating as a valid exercise of a husband's authority over his wife.[238][239] One exception, however, was the 1641 Body of Liberties of the Massachusetts Bay colonists, which declared that a married woman should be "free from bodilie correction or stripes by her husband."[240]

Political agitation during the nineteenth century led to changes in both popular opinion and legislation regarding domestic violence within the United Kingdom and the United States.[238][241] In 1850, Tennessee became the first state in the United States to explicitly outlaw wife beating.[242][243] Other states soon followed suit.[239][244] In 1878, the Matrimonial Causes Act made it possible for women in the UK to seek separations from abusive husbands.[245] By the end of the 1870s, most courts in the United States were uniformly opposed to the right of husbands to physically discipline their wives.[246] By the early twentieth century, it was common for police to intervene in cases of domestic violence in the United States, but arrests remained rare.[247]

Modern attention to domestic violence began in the women's movement of the 1970s, particularly within the contexts of feminism and women's rights, as concern about wives being beaten by their husbands gained attention. The first known use of the expression "domestic violence" in a modern context, meaning "spouse abuse, violence in the home" was in an address to the Parliament of the United Kingdom in 1973. A few months later the world's first domestic violence services federation (Women's Aid) was set up in 1974, providing practical and emotional support as part of a range of services to women and children experiencing violence in England.[248][249] With the rise of the men's movement of the 1990s, the problem of domestic violence against men also gained significant attention.

See also

References

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Bibliography

Further reading

External links