Intimate Partner Violence
Summary and Keywords
Intimate partner violence (IPV) is a serious problem that affects many individuals and crosses national borders, religions, gender, sexual orientation, racial, and ethnic groups (Harvey, Garcia-Moreno, & Butchart, 2007; Krug, Mercy, Dahlberg, & Zwi, 2002). The World Health Organization has defined intimate partner violence as any behavior that inflicts harm on an intimate partner, such as a spouse, prior spouse, or partner. This harm can be physical, psychological, or sexual in nature and is inflicted through physical aggression, psychological abuse, sexual coercion, or other controlling behaviors (Krug et al., 2002). At times, the terms domestic violence and partner/spouse abuse are used interchangeably with the term intimate partner violence (Harvey et al., 2007).
Historically, intimate partner violence was seen as a matter to be dealt with in the home (Andrews & Khavinson, 2013); that is, it was largely considered a private issue between intimate partners. As such, little attention or support was extended toward victims of violence. The women’s rights movement during the 1970s brought many of the deleterious effects of IPV to the attention of the public. As a result, assistance became increasingly available for victims (Dugan, Nagin, & Rosenfeld, 2003). Some of the efforts to provide assistance to victims of IPV include mandatory arrest laws, victim advocacy, counseling services, shelters, and crisis hotlines.
Substantial efforts have been made to provide needed services to the victims of IPV, yet the exact rates of victimization are unknown. This is due to different research methodologies and operationalizations of IPV that are used across studies. For instance, there is some controversy as to whether IPV should be measured by acts of violence (e.g., hitting, choking) or the severity of injuries (e.g., bruises, broken bones). Complicating the issue is the fact that different sampling methods may yield different estimates of IPV. Research drawn from the general population, for instance, may uncover higher rates of less severe IPV, while purposive samples drawn from domestic violence shelters may yield higher rates of severe IPV (Johnson, 2008). Measurement challenges also occur because many individuals underreport or misrepresent their victimization. Thus, research that incorporates multiple study designs and sampling techniques, indicates that approximately 16% of adults in the United States experience IPV victimization each year (Langhinrichsen-Rohling, Misra, Selwyn, & Rohling, 2012).
Social scientists have used a number of theories to better understand IPV. These theories include feminist theories, power theories, social learning theories, and personality theories. Research grounded in these theories has found many risk factors that are related to the likelihood of victimization and perpetration. Additionally, various risk factors for IPV perpetration and victimization have been identified, including individual (e.g., alcohol abuse, anger), historical (e.g., abuse as a child), and demographic (e.g., cohabitation, age) factors (Stith et al., 2000; Stith, Smith, Penn, Ward, & Tritt, 2004). Recently, behavioral scientists have begun to investigate the biological and genetic factors related to IPV perpetration (Barnes, TenEyck, Boutwell, & Beaver, 2013; Hines & Saudino, 2004). Because there are many short- and long-term negative effects of IPV victimization, scholars and advocates continue to explore new avenues to increase understanding of IPV perpetration and victimization to better assist victims and perpetrators. Currently, the main sources of help for victims of IPV include mandatory arrest laws, domestic violence shelters, crisis hotlines, civil protection orders, victim advocacy, treatment programs, and informal means of assistance. However, each of these resources has demonstrated varying degrees of effectiveness for increasing victim support and reducing repeated victimization.
Theoretical Perspectives on Intimate Partner Violence
Several theoretical perspectives account for intimate partner violence between couples. These include feminist perspectives, power-related theories, social learning theories, and personality theories. Traditionally, most have been used to explain IPV perpetrated against women, though some theoretical tenants (e.g., learning) could also explain women’s violence against males in intimate settings. This discussion is focused on partner violence against women since the majority of theorizing and research has been conducted on male-perpetrated IPV as opposed to female-perpetrated IPV.
Feminist accounts of IPV typically stipulate that women are oppressed through violence from their male partners. These theories focus on power and control imbalances between the partners that give rise to violence in the relationships; such imbalances are due to inequality in society that make women dependent upon their male “providers,” and this inequality is fostered by patriarchy (Simpson, 1989). Patriarchal societies and patriarchal viewpoints within the household foster violence against women because they support male domination. Feminist perspectives on IPV have changed somewhat over time: initially, they called attention to the prevalence of IPV against women, naming the phenomenon “battering,” shedding light on the dominant and controlling atmospheres within which this violence existed, and explaining the “battered women’s syndrome,” whereby battered women retaliated against their abusive husbands with lethal violence. Over time, however, feminist research began to shed light on the context in which violence against women occurs—focusing less on prevalence and more on context, motivations, and effects and consequences (Stark, 2007). Feminist perspectives state that males utilize violence against women for instrumental purposes, such as gaining or maintaining control in relationships, and that their violence (in comparison to women’s) is more severe and injurious, carrying more deleterious effects—i.e., they are more defensive (Caldwell, Swan, & Woodbrown, 2012; Swan, Gambone, Caldwell, Sullivan, & Snow, 2008).
Power theories are rooted within the feminist perspective. These perspectives attempt to explain the perpetration of IPV as a tactic men use to gain power and control over their partners within a patriarchal society. Pence and Paymar’s (1993) “Duluth model” utilizes the “Power and Control Wheel” to explain controlling and violent behaviors of abusive male partners. The major elements in this wheel include male privilege, economic abuse, using children, blaming, isolation, emotional abuse, and intimidation and coercion (Pence & Paymar, 1993). According to Pence and Paymar, it is through these techniques that men gain control and dominance over their female partners. While exclusively developed for the use of explaining male IPV toward females, Hines, Brown, and Dunning (2007) have noted that abusive females use similar controlling behaviors as outlined in the Power and Control Wheel. They suggest that although women do not have male privilege, it is possible that they might manipulate the domestic violence system to gain power and control over their husbands (Hines et al., 2007).
Also considered under the feminist perspective is Daly’s “pathways” to crime. This was designed to explain how and why women engage in criminal behavior and draws heavily on the role of victimization as a precursor to women’s criminal behavior (Alarid & Wright, 2015). Daly (1992) discusses five pathways that lead women to criminal behavior: (1) street women, which includes those who run away from abusive homes, become addicted, and engage in various illegal behaviors in order to support their addition; (2) harmed-and-harming women, which includes those who were abused and neglected as children and now have difficulties coping with difficult situations and may suffer from addition and psychological problems; (3) battered women, which includes those who are in a relationship with an abusive partner; (4) drug-connected women, which includes those who have become addicted to drugs or sold drugs because of their relationships with others; and (5) “other women,” which includes those who do not fall in any of the other categories but engage in criminal behavior because of economic circumstances or greed. Perhaps the most pertinent of these pathways to the discussion of IPV are battered women. They typically responded with violence to their partners. As a result, they became involved with the criminal justice system.
Social learning theory (Bandura, 1979) can also be used to help explain IPV. This theory holds that behavior is learned by watching others engage in it, practicing the behavior, and being reinforced for engaging in it. The cycle of violence (Widom, 1989) stipulates that violence against intimates is a learned behavior and is supported via modeling and reinforcement. The basic tenant is that being abused or seeing someone in one’s family of origin (e.g., a mother) abused can lead to later perpetration of such violence against others as well as victimization by others. In other words, children may witness their parents engage in IPV, and in doing so they may learn the techniques of such violence and that it is an acceptable means of behavior. Subsequently, they may use violence against others (thereby practicing it) or believe that it is acceptable to be victimized by IPV (Ehrensaft et al., 2003). If such violence is reinforced, it becomes more likely to occur again (Bandura, 1979). Thus, the cycle of violence is grounded in social learning theory, with its premise that IPV is experienced or modeled, learned, reinforced, and subsequently used against others.
Personality theories also explain why perpetrators engage in IPV. These perspectives examine the characteristics that may orient an individual to have a greater propensity to engage in violence against his or her partner. Research has identified anger and hostility (Norlander & Eckhardt, 2005), depression, antisocial personality disorder, and borderline personality disorder (Mauricio, Tein, & Lopez, 2007) to be characteristics linked to higher likelihoods of IPV. Additionally, there is potential for various genetic factors to influence the likelihood of engaging in IPV (Barnes et al., 2013; Hines & Saudino, 2004). While there is no “crime” gene or “IPV” gene, slight variations within many genes can predispose individuals toward more aggressive behavior (Barnes et al., 2013). Understanding the genetic and biological basis for IPV is a research area that is in its infancy, however, and there is no gene or combination of genes that guarantees certain behaviors such as IPV. In addition to investigating how genetic factors influence IPV, research in this area has also examined the neurochemical, neurophysiological, and endocrinological influences (Pinto et al., 2010).
Prevalence, Types, and Trends of Intimate Partner Violence
Violence against women is most often inflicted by an intimate partner (Krug et al., 2002). Globally, it is estimated that nearly one-third (30%) of women have experienced IPV (García-Moreno, 2013), and similarly, the National Intimate Partner and Sexual Violence Survey (NIPSVS) finds that approximately one-third of women and a quarter of men in the United States have experienced intimate partner violence at some time in their life in the form of rape, physical violence, and/or stalking (Black, 2011). It is estimated that approximately 16% of U.S. citizens are victimized by an intimate partner each year (Langhinrichsen-Rohling et al., 2012). The NIPSVS also indicates that rates of severe physical violence are slightly lower for men (one-seventh) than for women (one-fourth). In addition to being victimized at higher rates, women also tend to be victims of more severe forms of violence compared to men (Black et al., 2011; Johnson, 2010; Stark, 2007). Thus, overall evidence from these studies appears to indicate that while both men and women engage in IPV, it is more common that men will use more severe forms of violence against their partners.
Yet obtaining precise measures of IPV is a challenging task for a variety of reasons. First, as Johnson (1995) argues, different types of IPV offending, namely common couple violence and intimate partner terrorism, may bias prevalence estimates. Second, and closely related to the first, is that different sampling methodologies complicate the process of obtaining accurate estimates. Third, IPV may be underreported to officials for a variety of reasons, which may systematically lower estimates. Finally, the National Crime Victimization Survey (NCVS)—one of the main sources from which national estimates of IPV are gathered—was revised in 1993; this redesign has likely influenced the national estimates of IPV within the United States. These issues are discussed in further detail below.
Different Types of IPV
Scholars suggest that there are different “types” of IPV, and this impacts the national estimates obtained regarding partner victimization every year. The most notable types of intimate partner violence are common couple and patriarchal or intimate terrorism; however, these are certainly not the only forms of intimate partner violence theorized to exist. Johnson and Ferraro (2000) suggest that violent resistance and mutual violent control are two additional subtypes of IPV, and Stark (2007) has suggested coercive control as another subtype of intimate terrorism that is specific in its extreme dominance and severe violence. However, common couple violence and intimate terrorism are both conceptually meaningful and distinct and have enjoyed the most scholarly attention in the IPV literature; additionally, the other subtypes mentioned above may be thought of as subtypes of violence within common couple and intimate terrorism. Thus, the discussion here centers on the common couple and intimate terrorism forms of IPV.
It is important to distinguish between common couple violence and intimate terrorism because they are unique in terms of the purpose of violence, the frequency at which the violence transpires, the gendered nature of violence, and the prevalence of it among couples. Common couple violence is conflict that may “get out of hand” when sparked by a specific argument, frustration, or stressor (Johnson, 1995; Johnson & Ferraro, 2000); it also occurs relatively infrequently between both males and females in a relationship. Common couple violence is often defined by the acts of IPV (e.g., hitting, shoving) and exhibits a high prevalence of male- as well as female-perpetrated violence (often referred to as gender symmetry) (Johnson, 1995; Straus et al., 2006). Common couple violence rarely escalates to severe violence, so victims sustain fewer injuries compared to victims of more serious violence.
Intimate terrorism, on the other hand, refers to more frequent and serious forms of partner violence and is theorized to be perpetrated primarily against females within relationships (often referred to as unidirectional violence, where one partner perpetrates the violence) (Johnson, 1995; Johnson & Ferraro, 2000). This type of violence inflicts serious physical harm to women, escalates in severity and frequency over time, and is initiated almost completely by males (Johnson, 1995; Johnson & Ferraro, 2000). Intimate terrorism, unlike common couple violence, is said to arise from a man’s desire to control his wife and may be just one tactic in his overall pattern of controlling behavior (Johnson & Ferraro, 2000; Stark, 2007). For instance, males using this type of violence may also use economic subordination, threats, and other tactics to control and dominate their partners (Johnson, 1995, 2006; Stark, 2007). Victims of intimate terrorism, unlike victims of common couple violence, rarely respond with violence, yet the violence typically escalates into more dangerous and lethal situations (Johnson, 1995, 2008).
Given the severity of intimate terrorism—victims often sustain serious physical injury, whereas victims of common couple violence do not—data gathered from police calls for service, victims in hospital and emergency facilities, and victims in shelters may be more likely to reflect intimate terrorism (Johnson, 2006). These data are also more likely to identify females as victims and males as perpetrators. Common couple violence, on the other hand, may be more easily uncovered in general population samples (e.g., non-shelter, non-hospital, etc.), where self-report data may reflect more gender symmetry in the prevalence of perpetration (Johnson, 2006).
The “gender symmetry” debate in the IPV literature is predicated upon the notion that there are at least two types of IPV—common couple and intimate terrorism—and that one would find evidence of these types using different research methodologies and sampling techniques (e.g., general population samples as opposed to shelter samples). Indeed, research that has sampled general population participants and focused on the “acts” (such as hitting) of violence has generally found similar rates of IPV among males and females (Johnson, 2011; Straus, 2011). This is also known as “bidirectional” or “mutual” violence. On the other hand, samples drawn from domestic violence shelters, emergency rooms, and other situations that focus on the severity and consequences of violence (e.g., in the form of injury or fear) typically show uneven rates of perpetration, with males primarily identified as the perpetrator of violence (Dobash, Dobash, Wilson, & Daly, 2005). This is also known as “unidirectional” violence, where one partner is the perpetrator. The debate regarding whether there is truly gender symmetry in IPV has ushered in a renewed focus on the “context” in which IPV occurs—including a better understanding of the motivations for violence as well as who the primary aggressor is in the relationship; some scholars have suggested that findings of gender symmetry simply reflect the self-defensive actions on the part of the primary, or “true,” victim (Caldwell et al., 2012; Swan et al., 2008).
A systematic review of the literature from Langhinrichsen-Rohling et al. (2012) examined bidirectional and unidirectional IPV. This examination revealed that out of these violent relationships, approximately half were bidirectional in that both partners engaged in some type of violence toward each other. Unidirectional violence was most typically perpetrated by females to males. The exception to this unidirectional female finding was for military personnel and criminal males, where in these groups males were more likely to engage in unidirectional IPV (Langhinrichsen-Rohling et al., 2012).
Caution should be taken when interpreting results claiming symmetrical or bidirectional violence. A common way of measuring bidirectional violence is through the use of the conflict tactics scale (CTS), which measures the extent to which each partner engages in abusive acts; however, the scale fails to account for who initiated the violence and does not take into account the impact that the violence has on each partner (Langhinrichsen-Rohling et al., 2012). This means that while both men and women engage in violence toward their partners at near-equal rates, it could be that men initiate the violence more often and inflict more severe injuries while the female violence that is being reported is that of self-defense (or vice versa). Some scholars argue that it is nearly impossible to identify the “true” perpetrator and victim in violent partnerships without taking the context of violence into account—that is, without understanding the motivations for violence, instigators of violence, as well as level of injury inflicted (Swan et al., 2008). Others, however, stress that the gender symmetry debate simply comes down to a debate over “effects” versus “perpetration” (Straus, 2011). Further, much of the gender symmetry debate is founded in the existence of common couple and intimate terrorism within IPV, yet some scholars have questioned this assumption, primarily because common couple and intimate terrorism typologies do not adequately address the problem of sexual assault within IPV (O’Neal, Tellis, & Spohn, 2014). Given the high occurrence of sexual assault and IPV and the high male-to-female-perpetration of sexual assault (Sack, 2009; Tjaden & Thoennes, 2000), critics say this is an unfortunate oversight that holds important implications for the response to IPV (Tellis, 2010). Certainly, these issues complicate the estimates of IPV derived from research each year.
Another reason that measuring rates of IPV is particularly difficult is because victims tend to underreport their victimization (Szinovacz & Egley, 1995). Official measures of IPV can be misleading, as it is estimated that less than one-fourth of victims actually report the crime to the police (Sinha, 2012). It appears that men (7% report rate) tend to underreport at a greater rate than females (23% report rate). There are many reasons why victims may tend to underreport their victimization. Some victims may be afraid to contact police because of potential retaliation from their partner, or they may rely on their partner for financial support or child care and thus do not want them to be arrested or incapacitated. Men in particular may fear ridicule for being a victim of IPV. Finally, not all victims interpret the violence as a crime. All of these issues may deflate estimates of IPV (Black & Breiding, 2008; Dutton & Nicholls, 2005; Felson & Paré, 2005; George, 1994; Hamel, 2009; Outlaw, 2009).
Redesign of NCVS
The National Crime Victimization Survey (NCVS; National Crime Survey prior to 1993) is administered by the U.S. Census Bureau and has been collecting data on victimization since 1973 (Cantor & Lynch, 2005). The NCVS provides a conservative measure of the number of victimizations that occur from a nationally representative sample of U.S. households. The NCVS underwent revisions, and the first results from the redesigned methodology and survey were published in 1993 (Cantor & Lynch, 2005). This update more accurately obtained data for certain crimes such as domestic violence/IPV. Specifically, the redesign incorporated methods that encouraged victims to be more open about experiences they had, and questions were improved to help victims recall particular victimizations. As a result, the NCVS is better able to measure crimes such as IPV, although caution must be taken when comparing pre- and post-1993 estimates.
Data regarding the trends of IPV derived from the NCVS tend to be estimated after the revision in 1993 because of the prior underreporting issues discussed above (Farmer & Tiefenthaler, 2003). According to the Bureau of Justice Statistics (BJS), there was an overall decline in victimization rates for serious IPV (including rape, robbery, and aggravated assault) among men and women from 1993 to 2013. Specifically, the number of these victimizations among females dropped from 5.9 to 1.6 per 1,000 during that time (Catalano, 2013). Victimizations among males dropped from 1.1 to 0.4 per 1,000 (Catalano, 2013). The largest decline for both men and women was between 1994 and 2001.
Simple assaults resulting from an intimate partner follow a similar pattern to that of serious IPV. However, simple assaults typically occur at a higher rate, and this is especially true for women. Female simple assault victimization occurred at a rate of 10.3 per 1,000 females in 1994 and fell to 3.1 per 1,000 by 2011 (Catalano, 2013). The rates for male simple assault victimization from an intimate partner also followed a similar pattern, falling from 1.9 per 1,000 males in 1994 to 1.0 per 1,000 in 2001, after which rates plateaued (Catalano, 2013).
In general, these data suggest that the trends in IPV victimization have been declining since the mid-1990s (Dugan, Nagin, & Rosenfeld, 1999; Lauritsen & Heimer, 2009; Powers & Kaukinen, 2012). The trend follows for both lethal and non-lethal perpetration, although they do not necessarily follow hand-in-hand (Powers & Kaukinen, 2012). Also, patterns have differed for white and non-white women in that prior to the 1990s, non-white women were at a greater risk of experiencing IPV victimization, with the gap narrowing until the mid-2000s (Powers & Kaukinen, 2012). However, risk of IPV victimization among non-white women has once again increased compared to white women (Powers & Kaukinen, 2012).
Some researchers have attributed the decline in IPV rates over the last 30 years to the increased availability of resources for victims (Browne & Williams, 1989; Dugan et al., 1999). Dugan et al. (2003) explain that resources in the form of policies, programs, and other services reduce IPV because these programs typically reduce the extent to which the victim has contact with the perpetrator. It is also possible that the risk factors for IPV have declined over time, which may in part account for the decline in IPV rates. We discuss these risk factors and consequences of IPV before turning to a discussion of the resources and interventions for IPV victims.
Risk Factors for Intimate Partner Violence
There are several risk factors associated with IPV victimization and perpetration, such as relationship conflict, stress, low socioeconomic status, unemployment, number of children, marital satisfaction, living in disadvantaged neighborhoods, alcohol use, anger, low self-control, pro-violence attitudes, childhood exposure to violence, and other general demographic characteristics (Brownridge, 2009, 2010; DeMaris, Benson, Fox, Hill, & Van Wyk, 2003; Sinha, 2012; Stith et al., 2004; Tillyer & Wright, 2013). For example, relationships that experience constant conflict tend to be at higher risk of violence (Jewkes, 2002). Conflict may stem from a variety of sources, including stress, financial difficulties, jealousy, and gender roles within the household. Stress or strain is a major influence of negative behavior, such as IPV, because it creates pressure to react or cope through aggressive behavior (Agnew, 1992, 2001). Stress may be the underlying reason that low socioeconomic status, unemployment, number of children, marital or relationship satisfaction, and living in disadvantaged neighborhoods have been identified as risk factors for IPV, as they may all be associated with higher levels of stress (Wright, 2011).
Individual characteristics such as alcohol use, anger, pro-violence attitudes, and violence propensity more generally have also been linked to IPV. Alcohol use is a particularly potent risk factor of all forms of violence and holds true for IPV as well (Brownridge, 2009, 2010; Foran & O’Leary, 2008; Jewkes, 2002). Alcohol use may reduce inhibitions against violence, increase the likelihood that disagreements escalate into physical confrontations, or be used as an excuse to justify behaviors, such as violence within relationships, that are normally unacceptable (Caetano, Schafer, & Cunradi, 2001; Kantor & Straus, 1987)—all of which make IPV more likely. A meta-analysis of alcohol use and IPV found that alcohol use is associated with a small to moderate effect size for men and a small effect size for women (Foran & O’Leary, 2008). Further, alcohol tends to have a stronger association with male-perpetrated IPV in cases with more severe alcohol problems (Foran & O’Leary, 2008). Similarly, attitudes condoning violence in general, and against partners specifically, are positively associated with IPV, as are feelings of anger, hostility, and negative emotionality (Moffitt, Krueger, Caspi, & Fagan, 2000; Norlander & Eckhardt, 2005; Stith et al., 2004; Sugarman & Frankel, 1996). It may be that persons willing to use violence in general are more apt to use violence within their relationships as well, or that persons unable to regulate their emotions are more likely to lash out at others, even intimate others (Norlander & Eckhardt, 2005; Pratt, Turanovic, Fox, & Wright, 2014; Tillyer & Wright, 2013).
Childhood experiences—especially growing up in a violent household—are risk factors for IPV as well (Hamel, 2009; Harvey et al., 2007; Riggs, Caulfield, & Street, 2000). Social learning theory may play a role in explaining why witnessing IPV or being abused as a child is such a potent risk factor. As previously discussed, these behaviors may reinforce the idea that violence in relationships is acceptable and an appropriate means of coping. It is also possible that early childhood abuse and maltreatment can lead to hostile attribution bias (Dodge, Bates, & Pettit, 1990), where the child views the behaviors of others in more hostile ways and thus engages in more aggressive behavior, which then leads to rejection from normal peer groups (Ehrensaft et al., 2003). In turn, the child might select into more deviant peer groups (Wright, Caspi, Moffitt, & Silva, 1999), which puts them at higher risk to select a peer from this group as a romantic partner. All of this might lead to the child’s heightened risk to experience violence—as a victim, a perpetrator, or both—in his or her own romantic relationship. The research in this area has demonstrated that childhood abuse is indeed related to subsequent violence and victimization in one’s adult romantic relationships (Stith et al., 2000, 2004).
Other demographic characteristics such as age, race, and cohabitation have been identified as IPV risk factors. Younger couples may not have had much time to develop conflict management skills, which increases the possibility of dealing with marital and relationship issues via abuse (DeMaris et al., 2003). Further, younger individuals are more likely to engage in violent behavior in general, which also raises their likelihood of IPV. As mentioned, minorities have a slightly higher risk of IPV than non-minorities (Rennison & Welchans, 2000); differences in cultural appraisals of violence and the meaning of partner violence (Wright, 2011), as well as exposure to violence in different contexts could account for minorities’ higher risk of IPV (Wright & Fagan, 2013). In addition, those who cohabitate as opposed to those who are married are also at higher risk of IPV. This could be due to less commitment to the relationship or because cohabitating couples have a greater fear of losing the relationship (strain), which could lead to maladaptive coping such as IPV (Stets, 1991). It is important to remember, however, that the risk factors discussed above are exactly that: they are risk factors. The presence of these factors may enhance the likelihood of IPV, but they do not guarantee it.
Consequences of Intimate Partner Violence Victimization
There are short- and long-term physical and mental health consequences associated with IPV, and there is evidence that IPV victimization may promote violence against others (particularly family members) as well. The associated costs of this violence—financial, social, and emotional—are also incredibly high. Because the majority of research on intimate partner violence has centered on female victims, the majority of the research summarized here concerns consequences among females. Some have suggested that regardless of the type of IPV examined (e.g., common couple or intimate terrorism), females are more likely to be injured (Archer, 2000; Caldwell et al., 2012; Straus, Gelles, & Steinmetz, 2006; Tjaden & Thoennes, 2000). Nonetheless, more research is needed regarding the physical and mental health consequences of IPV perpetrated against males.
IPV victimization can take a physical toll on one’s body, especially when the abuse is chronic and/or severe. Victims of IPV have elevated risk for experiencing poor physical health such as frequent headaches and chronic pain, as well as risky behaviors associated with poor health, such as alcohol and substance abuse, binge drinking, and smoking (Black et al., 2011; Bonomi et al., 2006; Coker et al., 2002). For instance, victims may develop chronic pain or suffer consequences of the abuse (e.g., episodes of fainting caused by extensive head trauma, sexually transmitted diseases, etc.; see Campbell, 2002) for months and years after the violence occurs. As a source of chronic stress, IPV victims suffer more gastrointestinal problems (e.g., loss of appetite), hypertension, fainting, and sickness, among other things (Campbell, 2002). In sexually abusive situations, victims report pelvic pain, sexual dysfunction, menstrual problems, and sexually transmitted diseases (Campbell, 2002). Bonomi and colleagues (2006) found that women who had experienced IPV had overall health scores comparable to those suffering from chronic allergies, back pain, cancer, diabetes, heart disease, and hypertension. In most cases, research finds that the more severe, frequent, or chronic the abuse, the worse short- and long-term health outcomes are for victims (Bonomi et al., 2006; Fletcher, 2010).
Emotional Well-Being and Mental Health
IPV can impact victim’s emotional well-being and mental health. Victims of IPV experience anxiety, fear, shame, anger, confusion, and a sense of betrayal, while some may begin to believe that they deserve the violence from their partner. Such feelings can lead to lowered self-concepts, depression, feelings of powerlessness, and symptoms of post-traumatic stress disorder (PTSD; DeMaris & Kaukinen, 2005; McCann, Sakheim, & Abrahamson, 1988). As a source of stress, abuse can contribute to depression by disrupting daily routines, increasing other stressful events in one’s life, lowering the victim’s feelings of security and sense of self-esteem, or increasing their feelings of powerlessness to control the situation (Campbell, 2002; Campbell, Kub, & Rose, 1996; Goodman, Smyth, Borges, & Singer, 2009).
Scholars have suggested that victims of partner violence may be particularly susceptible to experiencing mental health problems in the aftermath of abuse in part because their victimization (and the associated trauma) is inflicted by people whom the victim trusts, loves, or considers to be “safe” (DeMaris & Kaukinen, 2005). Depression and PTSD are among the most prevalent mental health consequences of IPV (Caldwell et al., 2012; Campbell, 2002). Elevated levels and severity of depression are evident in women who have been victimized by their partners, and the significant effect of IPV on depression remains even after controlling for other prior victimization experiences (such as childhood abuse) (Fletcher, 2010). Like the effects of IPV on physical health, many studies report that PTSD symptoms and depression levels decrease if and when the abuse stops, but effects remain over time (Coker, Weston, Creston, Justice, & Blackeney, 2005). In fact, Bonomi and colleagues (2006) found that women who experienced IPV recently were over two times more likely to report depressive symptoms and severe depressive symptoms than non-victims and approximately 1.5 times more likely than women who had previously, but not recently (in more than five years), experienced IPV. A longer duration of IPV victimization is also associated with significantly higher depression risk and overall health problems (Bonomi et al., 2006).
Violence Against Others
IPV can affect those outside of the relationship, such as children and other family members. Victims may turn to violence themselves, either by attacking their attacker or lashing out on other, often smaller and weaker members of the family (Gelles & Straus, 1988). In this way, IPV may promote a cycle of violence that occurs between family members and may be used by future generations (Widom, 1989). It is estimated that over 60% of IPV cases are witnessed either directly or indirectly (e.g., hearing violence, seeing the aftermath of violence) by children in the home (Catalano, 2007; Catalano, Smith, Snyder, & Rand, 2009; Clements, Oxtoby, & Ogle, 2008; Holt, Buckley, & Whelan, 2008). Witnessing IPV as a child is linked to problematic internalizing and externalizing behaviors such as PTSD, depression, anxiety, delinquency, alcohol problems, drug use, and IPV perpetration as an adult (thus rounding out the cycle) (Holt et al., 2008; White & Widom, 2003).
Death, Injury, and Related Costs
Clearly, IPV is a problem that affects a significant proportion of individuals and families and has a multitude of serious consequences for the parties involved. Of course, the most extreme forms of violence in partnerships may lead to death. In fact, the largest majority of female homicide victims—ranging from 24 to 30%—are killed by their intimate partners (Catalano, 2007; Catalano et al., 2009). Such consequences increase human suffering, reduce the quality of family life, and result in billions of dollars of costs to the health care, mental health care, and criminal justice systems every year. For instance, Fletcher (2010) estimates that IPV-related injuries and consequences increase health care utilization in the United States by 5%. Other estimates suggest that intimate partner violence against adults costs approximately $67 billion per year in the United States, which accounts for nearly 15% of total crime costs. Of that total, $8.8 billion is associated with tangible costs such as medical expenses, while $58 billion is accounted for by costs associated with reductions in quality of life (Wright & Vicniere, 2010).
Prevention, Intervention, and Resources
Prior to the 1970s, relatively little was known about IPV as it was generally seen by the public and law enforcement as a family matter that should be dealt with “behind closed doors” (Straus et al., 2006). The harmful effects of IPV were brought to light through the efforts of women’s rights activists who championed the expansion of the domestic violence resource system (Dugan et al., 2003). The domestic violence resource system includes all those efforts aimed at providing assistance to victims and perpetrators of IPV. Shelters, support groups, legal aid, restraining orders, and treatment programs are included in this system (Bennett, Riger, Schewe, Howard, & Wasco, 2004; Browne & Williams, 1989). This resource system has continued to grow so that information and help can now be found through a variety of sources, including hotlines, Internet sites, and smartphone applications.
According to Browne and Williams (1989), the resources that would be most effective in assisting victims of IPV would have five essential characteristics. The first of these characteristics is that the resource must be known to the victims. Second, victims must be able to access the resource. Third, victims must utilize the resource (mobilization). Fourth, staff must be open to and receive the victim. Finally, the resource must have the capacity to meet the needs required by the victim. Following are several types of prevention and intervention programs and services.
Mandatory Arrest Laws
As responders to domestic violence, police play an important role in assisting victims and preventing the future perpetration of violence. Police have traditionally responded in three primary ways to domestic violence situations by (1) providing advice, (2) removing one or both partners from the premises, and (3) making an arrest (Berk & Sherman, 1988). There has been much controversy over the type of response police should utilize (Berk & Sherman, 1988). Arguments regarding police actions in response to IPV have primarily been grounded in labeling theory (Goffman, 1959; Matza, 1982; Tannenbaum, 1938) and deterrence theory (Grasmick & Bursik, 1990; Sherman, 1993; Stafford & Warr, 1993). According to labeling theory, arrest effectively “labels” the individual as an IPV perpetrator. The perpetrator may internalize this label and engage in more frequent future perpetration. A more appropriate response, according to this theory, would include such actions as providing advice to the couple, or suggesting referrals for service, thus refraining from labeling as much as possible. Deterrence theory, on the other hand, identifies two benefits of making an arrest in response to an IPV situation. First, arresting a perpetrator of IPV would provide specific deterrence (Nagin, 1998)—the notion that the specific individual is prevented from committing future violent acts against an intimate partner because they are incapacitated (e.g., arrested, incarcerated) or they fear receiving punishment (e.g., arrest, incapacitation) in the future. Second, there is also a potential benefit of a general deterrence effect that could occur. That is, people who have not received the punishment may be unlikely to commit IPV for fear of severe sanction (arrest) (Grasmick & Bursik, 1990; Sherman, 1993; Stafford & Warr, 1993).
In an effort to clarify whether labeling or deterrence applied to IPV cases, Berk and Sherman (1988) examined police responses to domestic violence calls in a randomized experiment in Minneapolis. The results of this study supported a deterrent effect in that recidivism was lower among domestic violence perpetrators who had been arrested as opposed to those who had not been arrested. Many states and police agencies adopted mandatory arrest policies based on these results (Berk & Sherman, 1988). Following this major finding, a number of replication studies were performed from cities across the United States, including Milwaukee, Colorado Springs, Miami, Charlotte, Atlanta, and Omaha (Paternoster, Brame, Bachman, & Sherman, 1997). These studies failed to converge on a single finding but rather indicated that there may be times when arrest is appropriate and other times in which arrest does more harm than good. This research has demonstrated the complexity of policy intervention strategies for intimate partner violence. Further, evidence indicated that the issue of most concern is not what police do but how fair the treatment is perceived to be by the offender (Paternoster et al., 1997).
Despite the conflicting findings on the effectiveness of arrests in IPV incidents, many jurisdictions in the United States and Canada have adopted pro-arrest policies and mandatory arrest laws (Straus, 2009). Under mandatory arrest laws, police officers are unable to use their discretion regarding what course of action would be best in an IPV situation. These laws require law enforcement to arrest perpetrators of IPV regardless of the events surrounding the situation. While this may benefit victims in some cases, there are those who have raised concern about these arrest laws. For instance, Chesney-Lind (Chesney-Lind, 2002) suggests that such laws have inadvertently brought more females into the criminal justice system as domestic violence “perpetrators,” when they were more likely the victims of IPV who were engaging in self-defense. She argues that the context of the violence—motives, intentions, and consequences—is important to consider when responding to violence within relationships.
Shelters for IPV victims and their children began to appear around the 1970s (Goodman & Epstein, 2008). In the beginning, these shelters were small and typically run by survivors and held in homes or apartments. However, as the number of victims who sought refuge grew, the need for outside funding arose (Chang, 1992). Today, it is estimated that shelters within the United States serve approximately 16,000 women and their children each day (National Network to End Domestic Violence, 2007).
Using a purposive sample of 215 domestic violence shelters throughout eight states, Lyon, Lane, and Menard (2008) performed a comprehensive study on residents of domestic violence shelters. This study found that those who were served by shelters tended to be less educated heterosexual women with children. These residents had stayed in the shelter for a median of 22 days with the shortest time being one day and the longest being 624 days. These shelter residents typically heard about the shelter through domestic violence advocates, the police, or friends. Nine percent of these women had attempted to stay at the shelter before and were turned down primarily due to insufficient space. Those who seek assistance and refuge through shelters have typically exhausted other options (Glenn & Goodman, 2015; Lyon et al., 2008). When shelter residents were asked what they would have done without the shelter, the most commonly reported responses were that they would have been homeless, lost everything (children, jobs, valuables, etc.), acted in desperation (called police, acted out violently, etc.), were uncertain what would have happened, or would have continued in the abusive relationship (Lyon et al., 2008).
In addition to the fundamental benefit of providing a safe location, free from physical and emotional abuse, there are several additional benefits that shelters provide to those involved in IPV (Bennett et al., 2004; Lyon et al., 2008). Shelters provide residents with a safe place for children, assistance in safety planning, education (Lyon et al., 2008), and feelings of safety (Bennett et al., 2004). Further, many shelters provide women with social, legal, and medical assistance if residents are in need (Bennett et al., 2004). There have also been reports that women who stay at shelters have experienced a reduction in the frequency and intensity of future violence (Berk, Newton, & Berk, 1986), fewer depressive symptoms, and higher levels of hopefulness (Sedlak, 1988).
Although shelters provide many benefits to victims of IPV, there are nonetheless some concerns. A consequence of shelters being supported by outside funding is the bureaucratization of these facilities (Bennett et al., 2004). As a result, the climate of shelters has changed for victims (Glenn & Goodman, 2015). While shelter residents overall feel welcomed and respected by staff (Lyon et al., 2008), studies suggest they may lack emotional support from staff typically stemming from staff member’s unavailability and lack of concern (Glenn & Goodman, 2015; Lyon et al., 2008; Tutty, Weaver, & Rothery, 1999).
Crisis hotlines are staffed by a combination of volunteers and professionals who are trained to assist in crisis situations (Bennett et al., 2004). These hotlines are typically operated all day, every day by domestic violence agencies in order to provide support and legal information to those in abusive situations (Bennett et al., 2004). Bennett et al. (2004) found that victims of IPV gain important information regarding violence as well as receive support through the use of crisis hotlines.
Civil Protection Orders
Civil protection orders, sometimes referred to as restraining orders, are legal contracts by the court that restrain an individual—often the IPV perpetrator—from further contact with a particular person (often the IPV victim) (Finn & Colson, 1990). The guiding principle of civil protection orders and many other IPV services is that of exposure reduction—that is, by limiting the amount of contact between perpetrators and victims, there will be less opportunity for perpetration to occur, thereby decreasing the risk of being revictimized (Dugan et al., 2003). Approximately 20% of women who become victims of IPV obtain a restraining order (Holt, Kernic, Lumley, Wolf, & Rivara, 2002). While civil protection orders may attempt to reduce the amount of contact that perpetrator and victim have, there is much ambiguity regarding the effectiveness of these legal contracts (Dugan et al., 2003; Kane, 2000).
Victim advocates assist victims of IPV to find and navigate legal, medical, and social resources in order to help prevent future violence (Bennett et al., 2004). The available research indicates that advocates increase the likelihood of victims seeking out and finding legal services and other resources (Sullivan, Campbell, Angelique, Eby, & Davidson, 1994; Weisz, 1999). In addition, research has also indicated that victims who are assisted by advocates are less likely to be re-abused compared to those who were not helped by advocates (Sullivan & Bybee, 1999).
In addition to the services discussed above, there are community- and school-based batterer intervention programs (BIPs), which are usually led by various domestic violence agencies (Bennett et al., 2004). During the 1980s, there was an influx of perpetrators being referred to BIPs because of the increase in arrests that came from the widespread adoption of pro-arrest laws in many jurisdictions (Gondolf, 1997). Many of these perpetrators of IPV were court-mandated to treatment programs as a way to deal with the influx of IPV perpetrators in the criminal justice system (Feder & Dugan, 2002). Referring perpetrators to BIPs is seen as an attractive option because it is thought of as a way to decrease recidivism rates, an alternative to costly incarceration, and a more efficient way to handle court cases (Gondolf & Foster, 1991).
BIPs can be categorized into three groups based on the treatment approach of the program. The psychoeducational model is the model that is most prevalently used. It focuses on the feminist perspective and is based on the Duluth model (Hines & Douglas, 2009; Pence & Paymar, 1993). The Duluth model makes use of the Power and Control Wheel (Babcock, Green, & Robie, 2004), which describes different ways in which men use their power to control their female partners (Hines et al., 2007). By helping perpetrators understand ways in which they inappropriately use male power to control their partners, it is hoped that these men will be able to create relationships that are based on equality in the future (Pence & Paymar, 1993). The second type of BIP is founded on cognitive behavioral therapy (CBT; Babcock et al., 2004). This program is based on the theoretical idea that non-violent alternatives can be learned and later used instead of engaging in violent behavior (Babcock et al., 2004). While CBT is theoretically different from programs that use the Duluth model, in practice it tends to be very similar, making these two programs hard to distinguish from one another (Babcock et al., 2004). All other types of programs are included in the third category, which uses such techniques as couples’ group therapy (Babcock et al., 2004). The advantage to couples’ therapy is that it helps prevent male batterers from discussing women in a negative manner during the meeting (Dunford, 2000).
Meta-analyses on the effectiveness of BIPs have indicated that these programs tend to be minimally effective, producing small effect sizes overall (Akoensi, Koehler, Lösel, & Humphreys, 2012; Babcock et al., 2004). Further, it does not appear that there are differences in effectiveness between the types of intervention programs used (Babcock et al., 2004). Babcock et al. (2004) found that programs that make use of motivational interviewing and relationship enhancement tend to have the greatest influence on subsequent behavior. Motivational interviewing is a technique designed to help increase retention and motivation in programs (McMurran, 2009), while relationship enhancement focuses on developing communication and problem-solving skills to help perpetrators cope with potential situations that may lead them to act violently toward their partners (Dion, 2005). Radatz and Wright (2015) suggest that to be more effective at changing behavior, BIPs need to amend their treatment modalities to address the risk factors, need factors, and responsivity factors that foster violence in relationships and which create barriers to treatment success.
In addition to the formal sources of support discussed above, there are many informal sources that victims of IPV can utilize in order to cope with an abusive relationship. Victims most commonly seek assistance from informal sources such as family, friends, and neighbors (Ansara & Hindin, 2010; Goodman, Dutton, Weinfurt, & Cook, 2003). As with other IPV research, the majority of help-seeking behavior has focused on female victims (Ansara & Hindin, 2010), with only a limited amount of that research including male victims in their examination (Coker, Smith, McKeown, & King, 2000; Walby, Allen, & Simmons, 2004).This research has typically found that men are less likely to seek either formal or informal help when victimized by an intimate partner, but the discrepancy between men’s and women’s help-seeking behaviors tends to diminish as the severity and frequency of violence increases within the relationship (Walby et al., 2004). Possible reasons for male victims’ greater reluctance to seek help could be a result of the comparatively fewer resources available to male victims of IPV or because of internalized gender norms (Ansara & Hindin, 2010).
Over the last 40 years the resources available to victims of IPV have greatly increased. This increased availability coupled with advancements in women’s rights and economic status (through greater educational opportunities, work force participation, and decreased income disparities) has greatly benefited women who are in abusive relationships (Dugan et al., 1999; Farmer & Tiefenthaler, 2003). As a result of these economic gains, women have become less dependent on their partner, enabling them to escape the situation (Dugan et al., 2003). Thus, in a sense, these economic improvements for women have become somewhat of an informal and indirect way of helping women in abusive situations. On the other hand, these employment gains may also increase female victimization because the male may use violence to “regain” dominance in the relationship (Macmillan & Gartner, 1999; Powers & Kaukinen, 2012). This trend may be race dependent, though—for employed white women the trends in the United States show a heightened risk for IPV victimization, but this risk does not appear to the same extent for employed non-white women (Powers & Kaukinen, 2012).
Intimate Partner Violence Today, and Future Directions
The empirical and practical issues revolving around IPV are complex with no easy solutions. Researchers find difficulty in measuring IPV accurately, while practitioners and law enforcement organizations face problems with underreporting this form of violence. Furthermore, partner violence is a multifaceted problem that is impacted by a multitude of risk factors. Because IPV can impact short- and long-term physical, mental, and behavioral health, it has been identified as an important public health issue as well. The last several decades have seen a shift toward more victim services as well as an increase in interventions for perpetrators of IPV. The current knowledge base regarding the causes, consequences, and interventions for IPV are founded by theory and based on empirical evidence, but continued research is needed. Future research in the area should continue to unpack the “context” of IPV to better understand the “gender-symmetry” debate. Also, many services are available to help victims (e.g., shelters, restraining orders, court-mandated treatment programs, legal aid, and hotlines), more research and evaluation are needed to refine these efforts in order to make them as effective as possible.
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