Domestic Violence: An Overview C. J. Newton, MA FindCounseling.com, Mental Health Journal. February, 2001. Nationwide Crisis Line and Hotline Directory Introduction Domestic Violence isn't just hitting, or fighting, or an occasional mean argument. It's a chronic abuse of power. The abuser tortures and controls the victim by calculated threats, intimidation, and physical violence. Actual physical violence is often the end result of months or years of intimidation and control. In their diagnostic and treatment guidelines for physicians, The American Medical Association defines intimate partner abuse as "the physical, sexual, and/or psychological abuse to an individual perpetrated by a current or former intimate partner. While this term is gender-neutral, women are more likely to experience physical injuries and incur psychological consequences of intimate partner abuse." In a study, published in the Archives of Family Medicine, designed to measure physician's attitudes and practices toward victims of domestic violence, Snugg, et al, defined domestic violence as "past or present physical and/or sexual violence between former or current intimate partners, adult household members, or adult children and a parent. Abused persons and perpetrators could be of either sex, and couples could be heterosexual or homosexual." Defining the problem: Domestic violence is violence between adult intimate partners. Though the definition above seems simple enough (it is widely accepted in the law enforcement community as the definition), the application of the definition varies quite significantly from organization to organization, state to state, and country to country. The term "intimate partners" in some cases refers only to people who are cohabitating or have cohabited (lived together) whereas at other times "intimate partners" refers to people who are dating or who have dated at some time in the past. Perhaps a better definition of domestic violence is emotional abuse, physical abuse, or sexual abuse between people who have at some time had an intimate or family relationship. To understand how the meaning of "domestic violence" has and is changing, think about how the term "family" has changed in the past 50 years. They are both ever-changing, and a bit controversial. Many view the above definition of domestic violence as overly restrictive. They argue that domestic violence can occur between adult family members who are not "intimate" in the traditional sense, such as adult brothers and sisters, cousins, brothers-in-law, sisters-in-law, mothers- and fathers-in-law. For example, many consider elder abuse to be a form of domestic violence. Though the definition above clearly states "adult...", there is a recent trend for states to adopt legal definitions of domestic violence that include violence toward children (more than half of states now mention children in their domestic violence laws). This could broaden the definition to be violence between any of the following: husbands, wives, ex-husbands, ex-wives, partners, ex-partners, brothers, sisters, mothers, fathers, children, people who have lived together (which could include cousins, brothers-in-law, sisters-in-law, and caregivers), and people who are or have dated in the past. What is Emotional Abuse? Emotional abuse is when an intimate partner has... continually criticized you, called you names or shouted at you insulted or driven away your friends or family humiliated you in private or public kept you from working, controlled your money or made all the decisions refused to work or to share money taken car keys or money from you regularly threatened to leave or told you to leave threatened to kidnap the children when the abuser was angry with you abused pets to hurt you manipulated you with lies and contradictions What is Physical Abuse? Physical abuse is when an intimate partner has... pushed or shoved you held you to keep you from leaving slapped or bitten you kicked or choked you hit or punched you thrown objects at you locked you out of the house abandoned you in dangerous places refused to help you when you were sick, injured or pregnant forced you off the road or driven recklessly threatened to hurt you with a weapon What is Sexual Abuse? Sexual abuse is when an intimate partner has... minimized the importance of your feelings about sex criticized you sexually insisted on unwanted or uncomfortable touching withheld sex and affection forced sex after physical abuse or when you were sick raped you been jealously angry, assuming you would have sex with anyone insisted that you dress in a more sexual way than you wanted Domestic Violence Statistics: Prevalence and Trends "Around the world at least one woman in every three has been beaten, coerced into sex, or otherwise abused in her lifetime. Most often the abuser is a member of her own family." "Physical violence is estimated to occur in 4 to 6 million intimate relationships each year in the United States." "Nearly one in every three adult women experiences at least one physical assault by a partner during adulthood. Approximately four million American women experience a serious assault by an intimate partner during a 12-month period." "It is estimated that 2 million to 4 million US women are assaulted by a domestic partner every year. Twelve million women (25% of the female population) will be abused in their lifetime. Up to 35% of women and 22% of men presenting to the emergency department have experienced domestic violence." The precise incidence of domestic violence in America is difficult to determine for several reasons: it often goes unreported, even on surveys; there is no nationwide organization that gathers information from local police departments about the number of substantiated reports and calls; and there is disagreement about what should be included in the definition of domestic violence. "One study estimated that more than 3% (approximately 1.8 million) of women were severely assaulted by male partners or cohabitants over the course of a year, while other studies indicate the percentage of women experiencing dating violence, including sexual assault, physical violence, or verbal and emotional abuse, ranges as high as 65%." However, the U.S. Department of Justice Bureau of Justice Statistics published a report in May, 2000 which sheds some light on part of domestic violence. Their report is based on their own surveys (National Crime Victimization Survey), and on data from the FBI (homicide data). In their report they define domestic violence as violent crimes by current or former spouses, boyfriends, and girlfriends. Violent crimes include lethal (homicide) and nonlethal (rape, sexual assault, robbery, aggravated assault, and simple assault) offenses. From their data, we can say that in 1998, women experienced at least 900,000 violent offences at the hands of an intimate, and men were victims of at least 160,000 violent crimes by an intimate partner. Their report did not mention emotional abuse, harassment or stalking. So, more than 1 million violent crimes were committed against persons by their current or former spouses, boyfriends, or girlfriends. To view the report, go to Intimate Partner Violence. Fred C. Pampel and Kirk R. Williams warn, however, that "researchers using this database must address the problem of missing data, which typically is the result of the failure to file, inconsistent filing of reports to the FBI by local police agencies, or incomplete records about the characteristics of specific incidents of homicide (particularly, missing information about perpetrators), even when reports are filed." Even though we don't know how frequently domestic violence occurs (and some estimates suggest that it is as much as 10 times more prevalent than reported by the Bureau of Justice Statistics), the report does help with identifying very interesting trends. The rates of domestic violence vary along several lines, including race, gender, economic and educational status, and geographical location. Gender trends: Women make up 3/4 of the victims of homicide by an intimate partner. Actually, 33% of all women murdered (of course, only cases which are solved are included) are murdered by an intimate partner. Women make up about 85% of the victims of non-lethal domestic violence. In all, women are victims of intimate partner violence at a rate about 5 times that of males. Racial and Ethnic trends: Black women and men suffer from the highest rates of domestic violence. "Black females experienced domestic violence at a rate 35% higher than that of white females, and about 22 times the rate of women of other races. Black males experienced domestic violence at a rate about 62% higher than that of white males and about 22 times the rate of men of other races." Age trends: Domestic violence is most prominent among women aged 16 to 24. Economic Trends: Poorer women experience significantly more domestic violence than higher income women. 16 Marital status: For both men and women, divorced or separated persons were subjected to the highest rates of intimate partner victimization, followed by never- married persons. Reporting to police: The rates at which individuals report domestic violence to police vary along racial and gender lines. Hispanic and black women report domestic violence at the highest rate (approximately 65% to 67% of abuse is reported). For white females, only about 50% of the abuse is reported. It's Hard to Stop Because It's Hard to Report. Victims of domestic violence are reluctant to report abuse. Women very reasonably fear retaliation against themselves and their children by the abuser and fear the economic upheaval that may follow the report. Studies show that the highest risk for serious injury or death from violence in an intimate relationship is at the point of separation or at the time when the decision to separate is made. 2 "Threats and violence are control strategies used by the batterer, the woman's leaving may threaten his sense of power and increase his need to control the woman and children." Many times, women's self-esteem is so low as a result of spouse abuse that they are unable to see themselves as worthy of seeking help, or they rationalize the abuse, believing they caused or deserve it. Police complain that often when they arrest an abuser, the victims want them to drop the charges. For children, the fear is more than fear of injury or death. Children fear the destruction of their family - their world. Middle-school aged children have an awareness of things such as poverty, foster homes, and homelessness, and may be unable to cope with the uncertainty that reporting abuse may cause. Even when adults in the community such as school personnel or neighbors report the abuse, children may outright deny it. Children may experience feelings of shame, guilt, and divided loyalties to parents making it unlikely that they will disclose the violence to others. In an abusive situation, many battered women will try to solve the problem by talking it out with the abuser, by fighting back, or by trying to change their behavior to meet the demands of the abuser (of course, then the demands change). When they fail to stop the abuse, women may become passive, which may reduce the immediate danger, or may go into a state of emotional withdrawal. In the end, abuse may push a woman to see only two options: suicide or homicide. When women do discuss domestic violence with an authority, they are most likely to do so with their physician. Still, in a recent AMA study of physicians, Rodriguez, et al, found that only 1% of physicians practicing in health maintenance organizations screened for domestic violence. Obstetrician/gynecologists (17%) and physicians practicing in public clinic settings (37%) were more likely to screen patients. A recent survey of physician attitudes found that "45% of clinicians never or seldom asked about domestic violence when examining injured patients". The result is less than 15% of female patients report being asked about abuse by doctors or telling their doctors about their abuse. Recognition rates by physicians in a variety of settings have been as low as 5 percent (ie, the physician identifies abuse as a problem in only one abuse victim in twenty who presents for care). Despite physicians being the primary link to families, many doctor's attitudes toward domestic violence and their knowledge about it's prevalence, warning signs and effects are lacking. In a survey of physician attitudes, it was found that "fifty percent of clinicians and 70% of nurses/assistants believed that the prevalence of domestic violence in their practice was 1% or less" and "twenty-five percent believed the abused person's personality led to the violence." 19 Effects of Domestic Violence Long-term effects of domestic violence on women who have been abused may include: anxiety chronic depression chronic pain death dehydration dissociative states drug and alcohol dependence eating disorders emotional "over-reactions" to stimuli general emotional numbing health problems malnutrition panic attacks poor adherence to medical recommendations poverty repeated self-injury self neglect sexual dysfunction sleep disorders somatization disorders strained family relationships suicide attempts an inability to adequately respond to the needs of their children.   In a 1999 study from Johns Hopkins, it was reported that abused women are at higher risk of miscarriages, stillbirths, and infant deaths, and are more likely to give birth to low birth weight children, a risk factor for neonatal and infant deaths. In addition, children of abused women were more likely to be malnourished and were more likely to have had a recent untreated case of diarrhea and less likely to have been immunized against childhood diseases. Most battered women take active steps to protect their children, even if they do not leave their batterer. Domestic violence can severely impair a parent's ability to nurture the development of their children. Mothers who are abused may be depressed or preoccupied with the violence. They may be emotionally withdrawn or numb, irritable or have feelings of hopelessness. The result can be a parent who is less emotionally available to their children or unable to care for their children's basic needs. Battering fathers are less affectionate, less available, and less rational in dealing with their children. Studies even suggest that "battered women may use more punitive child-rearing strategies or exhibit aggression toward their children." When children cannot depend on their parents or caregivers - for emotional support and for practical support - their development can be seriously delayed or, in severe cases, permanently distorted. Children without an emotionally available parent may withdraw from relationships and social activities. Since childhood is the time when social skills and attitudes are learned, domestic violence can affect their ability to form relationships for the rest of their lives. Parents who have been traumatized by violence must cope with their own trauma before they are able to help their children. Effects of Domestic Violence on Children and Teenagers CHILDREN: Effects of Domestic Violence: academic problems; agitation - feeling "jumpy"; aggression; avoidance of reminders; behavior problems; clinginess to caregivers; depression; distractibility; emotional numbing; emotional changes; fear - feeling scared; fear of natural exploring; feelings of guilt; feelings of not belonging; flashbacks; general emotional distress; increased arousal; intrusive thoughts; insomnia; irritability; low levels of empathy; low self-esteem; nightmares; numbing of feelings; obsessive behaviors; phobias; poor problem-solving skills; posttraumatic stress disorder; revenge seeking; social problems; suicidal behaviors; truancy; withdrawal from activities. Effects in Adulthood: alcohol abuse; depression; low self-esteem; violent practices in the home; criminal behavior; sexual problems; substance abuse. Estimates are that more than 3.3 million children are exposed to physical and verbal spousal abuse each year. 14 Exposure means seeing or hearing the actual abuse or dealing with the aftermath of the abuse. When describing the effects of domestic violence on children, it is important to note that domestic violence and child abuse are often present in the same families. "In homes where domestic violence occurs, children are physically abused and neglected at a rate 15 times higher than the national average. Several studies have shown that in 60% to 75% of families in which a woman is battered, children are also battered." In addition, children living in households where domestic violence is occurring are at a higher risk for sexual abuse. The effects of witnessing or experiencing violence at home vary tremendously from one child to another. The attributes that give a child the greatest chance of surviving unscathed are "average or above-average intellectual development with good attention and interpersonal skills. Also feelings of self-esteem and self-efficacy, attractiveness to others in both personality and appearance, individual talents, religious affiliations, socioeconomic advantage, opportunities for good schooling and employment, and contact with people and environments that are positive for development." Many children in families where domestic violence has occurred appeared to be "parentified." They are forced to grow up faster than their peers, often taking on the responsibility of cooking, cleaning and caring for younger children. Laura Gillberg, MSW, is the child and adolescent program director at Sarah's Inn, an agency in Oak Park, Illinois. She stated, "Many of these children were not allowed to have a real childhood. They don't trust their fathers because of his role as an abuser and they may have been worried about what to expect when coming home. They learned at a young age to be prepared for anything." Children may also be isolated. Typical activities such as having friends over to their house may be impossible due to the chaotic atmosphere. "Kids aren't going to have their friends over when mom has a black eye." However, school performance is not always obviously affected. Children may respond by being overachievers. Gillberg noticed that children in domestic violence tend to be either extremely introverted or extremely extroverted. Psychosomatic problems (aches and pains for no apparent reason) are common; these children's eating and sleeping patterns tend to be disrupted. Children who witness domestic violence can develop behavior problems, including aggression and violent outbursts. Underlying all these "symptoms" of domestic violence are children's emotional responses: i.e. anger - misery - intense terror - fear of dying - fear of the loss of a parent. Children may feel rage, guilt, or a sense of responsibility for the violence, which can stifle emotional and social development. To learn and grow into a healthy adult, children must feel confident in the world and in themselves. Domestic violence can wipe out a child's confidence and leave them shocked. INFANTS AND TODDLERS: Infants and toddlers who witness violence show excessive irritability, immature behavior, sleep disturbances, emotional distress, fears of being alone, and regression in toileting and language. Preschool children may develop enuresis and speech disfluencies, such as stuttering. "Exposure to trauma, especially family violence, interferes with a child's normal development of trust and later exploratory behaviors, which lead to the development of autonomy." 14 TEENS: Being a teenager is difficult, as most of us remember. But being a teenager and living in a house infected with domestic violence can have devastating, life-long effects. Teens living with domestic violence face the unique problem of trying to fit in with their peers while keeping their home life a secret. Teens in shelters often face the problem of having to move and begin school in a new place, having to make new friends while feeling the shame of living in a shelter. Needless to say, their family relationships can be strained to the breaking point. The result can be teens who never learn to form trusting, lasting relationships, or teens who end up in violent relationships themselves. In addition, teens face the same issues as younger children in an abusive family, namely feeling lonely and isolated, growing up too fast, behavior problems, stress related medical and mental health problems, and school problems. Teenagers are also faced with entering into the dating world for the first time. They are formulating their own theories about relationships, and some may not have the best models on which to base a healthy relationship. They have witnessed the cycle of violence with the abuse, apologies from the perpetrator, tensions building and more abuse. Unfortunately, some teenagers may be faced with a higher risk of being victims of dating violence and as mentioned earlier, ending up in violent relationships as adults either as victims or abusers. Domestic Violence Shelters: What They Do In 1999, the National Coalition Against Domestic Violence reported that the number of agencies providing services to battered women surpassed 2,000. Shelters often offer temporary as well as transitional living programs, where women and their children can live in an agency-owned apartment for an extended period of time, during which they receive counseling and assistance. To be accepted into a program, women are interviewed and must demonstrate need. The cost is usually on a sliding scale, dependent on a woman's ability to pay. There is usually a waiting list for transitional living apartments because it is a much-needed service. For children, group and individual counseling, education and play-therapy services, along with case management services are often available. About half of residents in domestic violence shelters are children. Domestic Violence agencies and shelters often offer men's programs in the form of workshops and group therapy for abusers. Outpatient services include support groups, vocational counseling and job training, outreach to high schools and the community, court advocacy, and mental health services or referrals. Many agencies have funding for practical matters such as locating temporary shelters and, if none are available, putting women and their children up at a hotel for a few days. Conclusions The effects of domestic violence on our society are obviously enormous, but are impossible to measure. Our entire nation suffers. You can see the effects at bus stations, fast-food restaurants, and schools. You can see it on television and in jails. You can see it in people's faces on the street - hopelessness, pessimism, hard-headedness, meanness. A person's spirit is priceless, and a broken spirit costs more than can be measured in dollars. Still, think about the cost of domestic violence in terms of just dollars and cents, and it's devastating. Abuse victims need medical care. Up to 54% of women seeking emergency services, up to 66% of women seeking general medical care, and up to 20% of women seeking prenatal care report experiencing domestic violence. 17 Victims of abuse also require mental health care. There is enormous cost to the state in the form of time spent by law enforcement officers, courts, lawyers, public health workers and more. There is cost to social welfare organizations in the form of money and donated time to staff and run shelters, counseling services, hotlines, and more. There is cost to the productivity of our workhouse in the form of absenteeism, worker re-training (when a victim is killed), and decreased productivity. The educational system is required to provide specialized services to children suffering from attentional and behavioral problems resulting from domestic violence. Now think about the fact that children growing up in a house with domestic violence will grow up and require medical care for stress-related illnesses, mental health care for anxiety, depression, panic, and shock. They will likely end up costing the state money in the legal system, will earn less than their peers because of their academic difficulties as children and because they may have lost the optimistic and risk-taking qualities necessary to become successful, and finally, they will likely raise children who will in turn continue the cycle. References American Medical Association. Facts About the Mental Health Effects of Violence. American Medical Association Web Site. November 1995 American Psychological Association. Facts About Family Violence. American Psychological Association Web Site. American Psychological Association Presidential Task Force on Violence And The Family. Issues and Dilemmas in Family Violence: Executive Summary. American Psychological Association Web Site. Carter, L., Weithorn, L., and R. Behrman. Domestic Violence and Children: Analysis and Recommendations. The Future of Children: Domestic Violence and Children (1999) 9(3):1-20. Culross, P. Health Care System Responses to Children Exposed to Domestic Violence. The Future of Children: Domestic Violence and Children (1999) 9(3):111-121. Fantuzzo, J. and W. Mohr. Prevalence and Effects of Child Exposure to Domestic Violence. The Future of Children: Domestic Violence and Children (1999) 9(3):21-32. Findlater, J. and S. Kelly. Child Protective Services and Domestic Violence. The Future of Children: Domestic Violence and Children (1999) 9(3):84-98. Goldman, L., Horan, D., Warshaw, C. Kaplan, S., and M. Hendricks-Matthews. Diagnostic and Treatment Guidelines on Mental Health Effects of Family Violence. American Medical Association Web Site. November, 1995. Groves, B. Mental Health Services for Children Who Witness Domestic Violence. The Future of Children: Domestic Violence and Children (1999) 9(3):122-132. Heise, L., Ellsberg, M. and M. Gottemoeller. Ending Violence Against Women. Population Reports, Series L, No. 11. Baltimore, Johns Hopkins University School of Public Health, Population Information Program, December 1999. Lemon, N. The Legal System's Response to Children Exposed to Domestic Violence. The Future of Children: Domestic Violence and Children (1999) 9(3):67-83. Massey, J. Domestic Violence in Neurologic Practice. Archives in Neurology. 1999;56:659-660. Matthews, M. The Impact of Federal and State Laws on Children Exposed to Domestic Violence. The Future of Children: Domestic Violence and Children (1999) 9(3):50-66. Osofsky, J. The Impact of Violence on Children. The Future of Children: Domestic Violence and Children (1999) 9(3):33-49. Pampel, F., and K. Williams. Intimacy and Homicide: Compensating for Missing Data in the SHR Vol. 38 (2), May 2000, pp. 661-680. Rennison, M. and W. Welchans. Intimate Partner Violence. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. May 2000, NCJ 178247, Revised 7/14/00 Rodriguez, M., Bauer, H., McLoughlin, E., and K. Grumbach. Screening and Intervention for Intimate Partner Abuse: Practices and Attitudes of Primary Care Physicians. JAMA, The Journal of the American Medical Association. 1999;282:468-474 Saathoff, A., and E. Stoffel. Community-Based Domestic Violence Services. The Future of Children: Domestic Violence and Children (1999) 9(3):97-110. Sugg, N., Thompson, R., Thompson, D., Maiuro, R., and F. Rivara. Domestic Violence and Primary Care: Attitudes, Practices, and Beliefs. Archives of Family Medicine. 1999;8:301-306. Wolfe, D., and P. Jaffe. Emerging Strategies in the Prevention of Domestic Violence. The Future of Children: Domestic Violence and Children (1999) 9(3):133-144.