Domestic Violence

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Domestic violence facts

  • Domestic violence (also called intimate partner violence, domestic abuse, dating violence, spousal abuse, and intimate partner abuse) is any form of maltreatment that takes place in a heterosexual or homosexual romantic relationship between adults or adolescents.
  • Intimate partner abuse is a major public-health problem, due to its affecting more than 2 million women and 800,000 men and resulting in homelessness, injury, or death of victims, billions of dollars in health-care costs, and lost work productivity.
  • Intimate partner abuse has been and in some ways continues to be endorsed in all societies through legal sanctioning of the subjugation of women and lack of legal protections for gay, lesbian, bisexual, and transgender (GLBT) victims.
  • While domestic abuse strikes couples of all races, religions, social economic status, and sexual orientations, risk factors for men or women becoming victims or abusers include poverty, lack of a high school education, witnessing family violence as a child, and attitudes of male domination and substance abuse, especially alcohol abuse.
  • Warning signs for individuals to consider if they suspect they are the victim of intimate partner violence include feeling demeaned, assaulted, or excessively controlled by their partner.
  • Warning signs friends, family members, and coworkers can look for if they wonder whether the person they care about is the victim of domestic abuse include frequent absences from school or work, numerous injuries the victim tries to explain, low self-esteem, a change in their personality, fear of conflicts, passive-aggressive behavior, blaming him- or herself for the problems in their relationship, isolation from others, or stress-related physical symptoms.
  • Health professionals unfortunately only screen for intimate partner abuse in about 20% of the patients seen. Domestic violence is most effectively assessed when the professional asks questions that call for more than a "yes" or "no" answer and do not directly inquire about domestic abuse, at least earlier during any assessment interview.
  • Domestic abuse is treated by establishing and maintaining the safety of the victim, providing appropriate legal consequences to the batterer, addressing the emotional impact on the victim and the problems of the abuser, particularly if one of the problems includes alcohol or other substance abuse.
  • The prognosis of domestic violence can be quite negative if it goes on untreated, in that the emotional and physical consequences of continued abuse can be severe and even end in homicide. Treatment and enhancing social supports to the victim can improve prognosis.
  • Prevention of domestic violence involves providing economic opportunity, mentors, role models, organized community programs for youth and families, a school environment that promotes prevention of abusiveness in any relationship, and adult family members who are nurturing and who provide consistent, structured support.
People who experience domestic abuse may develop anxiety.

Effects of Domestic Violence

Anxiety

Anxiety can be described as the response to a future or possible threat. Anxiety is closely related to fear, which is the response to a real or perceived immediate threat. Fear and anxiety are normal evolved responses in both humans and animals, and physical responses are linked to the "fight-or-flight" system. Excessive anxiety that causes distress or impairment, or that interferes with normal function, is considered an anxiety disorder.

What is domestic violence? What are the types of domestic violence?

Domestic violence -- also called dating violence, intimate partner abuse, spousal abuse, intimate partner violence, and domestic abuse -- takes many forms. Maltreatment that takes place in the context of any romantic relationship is abuse as described by the above specific terms. It therefore affects men, women, or teen girls and boys, whether in a married or unmarried heterosexual or homosexual relationship. Intimate partner violence may consist of one or more forms, including emotional, psychological, physical, sexual, or economic abuse and is defined as one person in an intimate relationship using any means to put down or otherwise control the other. Types of domestic abuse include physical, verbal (also called emotional, mental, or psychological abuse), sexual, economic/financial, and spiritual abuse. Stalking and cyber-stalking are also forms of intimate partner abuse.

Physical violence includes assault of any kind, ranging from pinching, pushing, hitting, or slapping to choking, shooting, stabbing, and murder. Verbal, emotional, mental, or psychological abuse is described as using words to criticize, demean, or otherwise decrease the confidence of the wife, husband, or other intimate partner victim. Sexual abuse refers to any behavior that uses sex to control or demean the victim, like intimidating the victim into engaging in unsafe sex or sexual practices in which he or she does not want to participate. Economic or financial abuse is described as limiting the victim's financial freedom or security. Spiritual abusers either force the victim to participate in the batterer's religious practices instead of their own or to raise mutual children in a religion that the victim is not in favor of. Stalking refers to repeatedly harassing and threatening behavior, including showing up at the victim's home or workplace, placing harassing phone calls, voicemail, email or postal mail messages, leaving unwanted items, or vandalizing the victim's property. It is usually committed by perpetrators of other forms of domestic violence.

Domestic violence is a major public-health problem in that it affects millions of people and often results in physical and emotional injuries and even deaths. Media reporting of celebrities' domestic abuse victimization demonstrates that even the most accomplished individuals can be involved in this problem. The statistics about those who are affected by intimate partner violence are staggering; domestic abuse affects 3%-5% of current adult relationships in the United States, including more than 2 million women. Despite the myth that violence against men does not occur is a myth; 800,000 men are victims of intimate partner abuse. Nearly one-third of women can expect to be the victim of intimate partner violence sometime in their lifetime. About 25% of gay, lesbian, bisexual, and transgender (GLBT) individuals are victims of intimate partner abuse, just as often as are heterosexual women. About 1,300 deaths were attributed to domestic abuse as of 2003. Research into deaths that result from intimate partner abuse in the United States and Austria indicate that more than 50% of women murdered are the result of domestic violence and 4%-9% of men are killed as victims of domestic violence.

Teen intimate partner abuse takes place at an alarming rate. Facts about domestic violence in this group include that as many as 12% of adolescents in grades 7 through 12 have been victims of physical dating violence, and 20% of youth have suffered from psychological dating violence. This abuse puts victims in danger of practicing risky sexual behavior, unhealthy eating, drug use, and suicidal behaviors. Other complications can include physical injury and death. These victims are also more likely to become sufferers of intimate partner violence as adults.

GLBT people often face unique challenges when trying to cope with domestic-abuse victimization. The assumption by family, friends, coworkers, and professionals that abuse is mutual in homosexual couples or is an expected part of what is perceived as a dysfunctional relationship since it is not heterosexual, poses major obstacles to battered GLBT individuals in getting help. Other barriers for GLBT battered men and women include the fear of losing their jobs, home, and/or custody of their children should their sexual orientation become known in the context of getting help for intimate partner abuse. That GLBT individuals do not receive the legal and financial protections their heterosexual counterparts do can inhibit their ability to support themselves and live independently after leaving the abuser. Discrimination against GLBT people and other minorities is also a deterrent to receiving care. Another formidable obstacle includes a lack of knowing other admitted GLBT victims of domestic violence, as well as the smallness of the community, which can make it difficult for battered men and women in the GLBT community to live anonymously from their abuser in the same town.

There tends to be a cycle of behavior, known as the cycle of violence, in abusive relationships. That cycle includes the tension-building, explosive, and tranquility/honeymoon stages. The tension-building stage is described as the phase of the abusive relationship in which the abuser tends to engage in lower-level abuse, like pushing, insulting, and escalating demands for control. Simultaneously, the victim of abuse tends to try to appease the abuser in an effort to avoid worsening of the abuse. Acts of abuse escalate to a severe level during the explosive stage of intimate partner violence, manifesting as the most overt and serious acts of abuse and control, like slapping, punching, rape, or inhibiting the movements of the victim. The tranquility or honeymoon stage of the cycle of domestic violence tends to immediately follow the overt acts of aggression of the explosive stage and is usually characterized by the abuser seeming to be quite remorseful and apologetic for the abuse, making promises that it will never happen again and showering the victim with affection.

What is the history of domestic violence?

Domestic violence or violence that is expressed using intimate acts is unfortunately as timeless as history. Rape and other forms of sexual exploitation have historically been used to demoralize groups of people as in German concentration camps, on North America-bound slave ships, and in World War II Japanese brothels filled with "comfort women." Society-sanctioned forms of violence against women include infibulation (fastening or buckling together, as in binding of feet, or of the female genitalia in an effort to render less able to walk or render unable to have sexual intercourse, respectively) and female genital cutting, also known as female circumcision. Virtually all the world's societies view or have viewed women as less valuable than men. From assaults of women for attending school, "honor" killings of women for being rape victims or having premarital sex in some countries, to women being omitted from serving on juries in the United States until 1701 and prevented from voting until 1920, the view that women are somehow second-class citizens encourages mistreatment of women.

What are the effects of domestic abuse?

Domestic abuse has significant health and public-health consequences. Between 25%-50% of homeless families have lost their homes as a result of intimate partner violence. Such victimization is also associated with nearly $6 billion in health-care costs and lost work productivity per year. Victims of domestic violence are more likely to experience trouble raising their children and suffer family disruption as well. Although psychological abuse can be harder to define than overt physical abuse, it has been found to cause at least as much damage. Victims of intimate partner violence are vulnerable to developing depression, anxiety, and substance abuse disorders.

Partner abuse of pregnant women has been associated with preterm deliveries of low-birth-weight babies. Domestic partner abuse puts children of the couple at risk for lower intellectual functioning, being victims of child abuse as children, and of intimate partner violence as adults. This form of family violence also puts children at higher risk of having emotional problems and engaging in drug abuse. Given such risks, the presence of intimate partner abuse in a family should be an important consideration in child custody issues. Domestic violence results in homicide, as well. Victims who live in a household where weapons are present and drugs are used have a greater risk of being killed by their abuser.

What are the causes or risk factors for intimate partner violence?

Although there is no specific cause for domestic violence, women at the highest risk for being the victim of domestic violence include those with male partners who abuse drugs (especially alcohol), are unemployed or underemployed, afflicted by poverty, have not graduated from high school, and are or have been in a romantic relationship with the victim. Unmarried individuals in heterosexual relationships tend to be more at risk for becoming victims of intimate partner abuse. A mind-set that gives men power over women puts individuals at risk for becoming involved in an abusive relationship, either as a perpetrator or as a victim. Domestic violence against women tends to be reported more often by victims who are in a relationship with a man with more conservative religious views than their own, regardless of whether or not the couple is of the same or different religions or denominations. Regular attendance at religious services is apparently associated with less reported intimate partner abuse. Research shows that those who grew up in a household in which domestic violence took place or in which a parent suffered from alcoholism are more likely to become either perpetrators or victims of intimate partner violence as adults. Teenagers who suffer from mental illness are also at risk for being an abusive relationship as young adults. African-American and Hispanic teens have been found to be at higher risk for being victims of teen domestic violence, with some studies indicating independence of socioeconomic status. Another risk factor for teen dating/domestic violence includes lower grades.

What are the warning signs and symptoms of intimate partner abuse?

PsychCentral provides a list of several screening questions for people who wonder if they are the victim of any form of domestic abuse. In addition to asking questions about whether the reader feels excessively controlled (such as having their partner keep excessive track of daily activities and associations, or being demeaned by critical remarks, insults, and name calling), the list of questions further explores whether more obvious acts of abuse have occurred, like hitting, kicking, punching, or throwing objects. The acronym AARDVARC (An Abuse, Rape, Domestic Violence Aid and Resource Collection) describes a number of warning signs for friends, family members, and coworkers for recognizing people who may be victims of intimate partner abuse. Specifically, teens, men, or women who are often absent from school or work or have numerous injuries they try to explain away, like bruises or black eyes. Individuals with low self-esteem, who show a change in their personality, have a fear of conflicts, engage in passive-aggressive behavior, blame themselves, seem isolated, or demonstrate stress-related physical symptoms (for example, headaches, stomach upset, sleep problems, or skin rashes) may be experiencing abuse in their relationship.

How is domestic violence assessed?

Unfortunately, although assessing whether a man or woman is being abused in their relationship is quite manageable, less than one in 20 doctors do so routinely. That tendency compounds the difficulty posed by the victims of intimate partner violence tending not to disclose their victimization. Despite these difficulties, it is known that questions that are most effective in assessing domestic violence are open-ended as opposed to those asking for yes or no answers (for example, "How do you and your partner tend to disagree with each other?" versus "Does your spouse hit, demean, or over-control you?"). Indirect questions about things like how many emergency-room visits, injuries, or accidents they have had this year are more likely to be answered candidly than are direct questions about the cause of each injury. As with any sensitive or potentially painful topic, questions about domestic violence are answered truthfully more often when the person asked is alone with the professional, as opposed to being asked with their partner (the potential batterer), child, or other family member present during the discussion.

How is intimate partner violence treated?

Getting and keeping the victim of domestic violence safe is an essential part of treating domestic abuse. Many legal and mental-health professionals who work with victims recommend the development of safety plans, both for home and in the workplace. Such a plan includes encouraging the victim to keep a charged cell phone in his or her possession at all times, maintaining active peace, protective, or restraining orders against the batterer, keeping a copy of the order at all times, along with distributing copies of the order to the victim's supervisor, workplace reception area, and security, as well as to schools and day-care providers for children. It is important for battered men and women to realize that abusers sometimes escalate in their abusiveness when first served with a protective order and to take appropriately heightened safety precautions. Other elements of a safety plan may include the victim changing his or her work site, parking, or work schedule, having an emergency contact person, and establishing danger signals to alert neighbors or coworkers that the victim is in immediate danger.

One well-known approach to treating domestic abuse families is the Duluth Model. It is also called the Domestic Abuse Intervention Project (DAIP) and focuses on women as the victims and men as the perpetrators of intimate partner violence. This treatment model takes the approach of empowering women by providing them information, resources, and support, which has been found to significantly decrease the violence in victims' lives over time. It also uses legal resources as a means of keeping women safe and holding males who engage in battering accountable for their actions. Regarding specific treatment for batterers, compliance with multiple counseling sessions may decrease the likelihood that domestic violence perpetrators repeat the behavior but these results continue to require research due to the small numbers of perpetrators studied so far. While there is little research on the effectiveness of support groups to treat victims of intimate partner violence, since this form of treatment has been found to improve the lives of sufferers of many conditions, it is often part of the care for people who have been in abusive relationships.

Having professionals provide victims of domestic violence with information about domestic-violence shelters and other housing, financial, and other service supports in the community has been found to greatly decrease the amount of violence that victims of intimate partner abuse experience after leaving the abuser. For couples with whom alcoholism or other excessive alcohol use is an issue, diagnosis of that illness and marital therapy that has alcoholism as a focus has also been found to be effective.

How is intimate partner abuse legally addressed?

Laws against domestic abuse are essential in the effort to protect battered men and women from their abusers. Federal law, like the Violence Against Women Act (VAWA) that was passed in 1994 and renewed in 2000 and in 2013, as well as federal anti-stalking and anti-cyber-stalking legislation, provide significant prison terms and fines of up to more than $200,000 to discourage abusive behaviors. The Federal Gun Control Act and federal firearm offenses now include provisions for domestic violence-related crimes. Limitations of this protection include the enforcement of legal protections for all victims, as well as the omission of legal protection for gay, lesbian, bisexual, and transgender (GLBT) victims of intimate partner violence. Although all 50 states and the District of Columbia have laws against stalking, less than one-third have laws that address cyber-stalking. Also, stalking can be difficult to define, since it can take the form of virtually any pattern of harassing behaviors. Furthermore, most stalking laws require that a credible threat of harm be made toward the victim or the victim's immediate family.

Some form of mandatory reporting, now the legal requirement in 47 states, requires that health professionals report suspected instances of domestic violence to the police; it is a somewhat controversial legal intervention for domestic violence. While mandatory reporting may result in some partner violence victims and perpetrators receiving the treatment they need, it is thought by some to place the victim at risk for experiencing a worsening of the abuse as a result of angering the abuser is angered by being reported. Another criticism of mandatory reporting includes the violation of doctor-patient confidentiality that is important for effective treatment to occur.

What is the prognosis for domestic violence?

Since the prognosis for victims of intimate partner violence is better for individuals who have a strong support system, support group participation is often encouraged. Enhancing the supports received by the family marred by domestic violence can even decrease the symptoms of post-traumatic stress disorder (PTSD) that is often associated with intimate partner abuse.

GLBT people who are abused in an intimate relationship face multiple obstacles to getting help. Misperceptions that GLBT victims of domestic violence participate in mutually abusing each other and that abuse is part of what some perceive to be an inherently dysfunctional relationship can result in health-care and law-enforcement professionals failing to appropriately respond to GLBT abuse sufferers. The inexperience that professionals have in managing intimate partner violence in GLBT relationships can also interfere with victims and batterers receiving appropriate and timely interventions.

How can intimate partner abuse be prevented and stopped?

Since having a strong support system has been found to be a protective factor against domestic violence, encouraging such support has been found to decrease the likelihood that a person will become the perpetrator or victim of domestic violence. An example of that is the tendency for people who are involved with a supportive religious community to have a decreased risk for being in a relationship in which intimate partner abuse occurs. This is apparently even the case for people of Hispanic or African-American ethnicity. Effective solutions for preventing intimate partner abuse include providing economic opportunity, mentors, role models who are survivors of domestic violence, organized community programs for youth and families and a school environment that promotes prevention of abusiveness in any relationship. Adult family members can help prevent domestic violence by being nurturing and by providing consistent, structured supervision. Raising the awareness about intimate partner violence in society at large, as occurs during Domestic Violence Awareness Month each October, can be invaluable to educating people about this issue.

According to the House of Ruth, a domestic violence center, everyone can help find ways to stop domestic violence, either by donating money or time to a domestic-violence organization, learning more about the problem, teaching children about healthy versus abusive relationships, listening in a nonjudgmental way to a domestic violence victim when he or she shares what they are going through, and giving victims information about where to get help. Supporters of intimate partner abuse victims can also discourage sexist jokes and remarks, boycott movies that gratuitously depict intimate partner violence and violence against women, and write legislators to support laws that protect and otherwise support intimate violence sufferers. Advocacy can further involve encouraging one's own health-care providers to post and share information about the issue. In the workplace, those who want to help stop to domestic abuse can organize a drive or fundraiser for goods or money to give to a domestic-violence organization.

Where can people get help for domestic violence?

American Domestic Violence Crisis Line
3300 N.W. 185th Street, Suite 133
Portland, OR 97229
Phone: 503-846-8748
Toll-free: 1-866-USWOMEN (International Crisis Line)
http://www.866uswomen.org
The American Domestic Violence Crisis Line provides safety planning, support services, and general information on domestic violence for American women living overseas who are victims of domestic violence.

Communities United Against Violence
160 14th Street
San Francisco, CA 94103
Phone: 415-777-5500
Support Line: 415-333-HELP
http://www.cuav.org
Communities United Against Violence offers crisis intervention, counseling, advocacy, and support for gay men and lesbians in abusive relationships.

Domestic Violence Law Project
718-834-7430 x10

GLBT National Help Center
1-888-843-4564
http://www.glbtnationalhelpcenter.org

House of Ruth
5 Thomas Circle, N.W.
Washington, D.C. 20005
202-667-7001
http://www.houseofruth.org

Maitri
234 East Gish Road #200
San Jose, CA 95112
Phone: 408-436-8393
Toll-free hotline: 1-888-8-MAITRI
http://www.maitri.org
Maitri helps South Asian (Bengali, Indian, Pakistani, and Sri Lankan) women with domestic violence, emotional abuse, and family conflict.

National Coalition of Anti-Violence Programs
212-714-1184

National Domestic Violence Hotline
1-800-799-7233 (1-800-799-SAFE)
http://www.ndvh.org
The 24-hour, toll-free hotline provides crisis intervention, referrals to battered women's shelters and programs, social-service agencies, legal programs, and other groups and organizations willing to help, and resources for battered women and their friends and families.

National Resource Center on Domestic Violence
6400 Flank Drive, Suite 1300
Harrisburg, PA 17112
1-800-537-2238 ext. 5
TTY: 1-800-553-2508
Fax: 717-545-9456

The Network La Red
P.O. Box 6011
Boston, MA 02114
Phone: 617-695-0877
Hotline: 617-423-7233
http://www.thenetworklared.org
The Network La Red offers bilingual (English and Spanish) information and resources for lesbian and bisexual women in violent relationships.

Reconstructive Surgery/Domestic Abuse Line
Toll-free: 1-800-842-4546
Reconstructive Surgery/Domestic Abuse Line provides free reconstructive surgery for male and female victims of domestic violence.

Safe Horizon
800-621-HOPE (4673)
http://www.safehorizon.org
Provides case management, individual counseling, and support groups for domestic violence victims

Violence Project
PMB 131
955 Mass Avenue
Cambridge, MA 02139
Phone: 617-354-6056
Toll-free Crisis Line: 1-800-832-1901
http://www.gmdvp.org
Violence Project offers information and resources for gay men in violent relationships.

Future

The future of finding solutions to domestic violence includes continuing to improve the effectiveness of treatment and to strengthen legal protection for victims, as well as accountability and treatment for abusers. Those goals should expand effective treatment and legal protections to address cyber-stalking and to manage the unique issues faced by individuals who are in gay, lesbian, bisexual, and transgender relationships.

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Reviewed on 10/5/2016
References
REFERENCES:

Abuse, Rape, Domestic Violence Aid and Resource Collection: AARDVARC. GLBT Domestic Violence: Similarities and Differences. March 2007. Abuse, Rape, Domestic Violence Aid and Resource Collection: AARDVARC. Warning signs of domestic violence. July 2007.

Anda, R.F., C.L. Whitfield, V.J. Felitti, et al. "Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression." Psychiatric Services 53 Aug. 2002: 1001-1009.

Attorney General of the United States. Cyberstalking: A new challenge for law enforcement and industry. 1999 Report on Cyberstalking 1999 August.

Babcock, J.C., A. Roseman, C.E. Green, and J.M. Ross. "Intimate partner abuse and PTSD symptomatology: examining mediators and moderators of the abuse-trauma link." J Fam Psychol 22.6 Dec. 2008.

Bailey, J.E., Kellermann, A.L., Somes, G.W., Banton, J.G., Rivara, F.P., and Rushforth, N.P. Risk factors for violent death of women in the home. Archives of Internal Medicine, Volume 157(7), April 1997.

Carswell, S. Historical development of the pro-arrest policy, in: Family Violence and the Pro-arrest Policy: A Literature Review. New Zealand Ministry of Justice 2006 December.

Carter, J. Domestic violence, child abuse and youth violence: strategies for prevention and early intervention. March 2005.

Coker, A.L., Smith, P.H., McKeown, R.E., and King, M.J. Frequency and correlates of intimate partner violence by type: physical, sexual and psychological battering. American Journal of Public Health. 2000 April; 90 (4): 553-559.

De Benedictis, T., Jaffe, J., and Segal, J. Domestic violence and abuse: types, signs, symptoms, causes and effects. The American Academy of Experts in Traumatic Stress, 2006.

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