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.
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