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
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."
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.
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
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.
is Emotional Abuse?
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
- kept you from working, controlled
your money or made all the decisions
- refused to work or to share
- taken car keys or money
- 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
is Physical Abuse?
abuse is when an intimate partner has...
- pushed or shoved you
- held you to keep you from
- 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
- refused to help you when
you were sick, injured or pregnant
- forced you off the road
or driven recklessly
- threatened to hurt you with
What is Sexual Abuse?
abuse is when an intimate partner has...
- minimized the importance
of your feelings about sex
- criticized you sexually
- insisted on unwanted or
- 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
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."
violence is estimated to occur in 4 to 6 million
intimate relationships each year in the United
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."
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."
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
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
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."
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
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."
Domestic violence is most prominent among women
aged 16 to 24.
Poorer women experience significantly more domestic
violence than higher income women. 16
For both men and women, divorced or separated
persons were subjected to the highest rates
of intimate partner victimization, followed
by never- married persons.
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.
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."
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
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
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).
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
of Domestic Violence
effects of domestic violence on women who have
been abused may include:
- chronic depression
- chronic pain
- dissociative states
- drug and alcohol dependence
- eating disorders
- emotional "over-reactions"
- general emotional numbing
- health problems
- panic attacks
- poor adherence to medical
- 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
women take active steps to protect their children,
even if they do not leave their batterer.
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."
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.
have been traumatized by violence must cope
with their own trauma before they are able to
help their children.
of Domestic Violence on Children and Teenagers
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
Effects in Adulthood:
alcohol abuse; depression; low self-esteem;
violent practices in the home; criminal behavior;
sexual problems; substance abuse.
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.
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
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."
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."
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.
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
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
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
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
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.
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.
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.
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
agencies and shelters often offer men's programs
in the form of workshops and group therapy for
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
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
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
Association. Facts About the Mental Health Effects
of Violence. American Medical Association Web
Site. November 1995
Association. Facts About Family Violence. American
Psychological Association Web Site.
Association Presidential Task Force on Violence
And The Family. Issues and Dilemmas in Family
Violence: Executive Summary. American Psychological
Association Web Site.
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.
Health Care System Responses to Children Exposed
to Domestic Violence. The Future of Children:
Domestic Violence and Children (1999) 9(3):111-121.
and W. Mohr. Prevalence and Effects of Child
Exposure to Domestic Violence. The Future of
Children: Domestic Violence and Children (1999)
and S. Kelly. Child Protective Services and
Domestic Violence. The Future of Children: Domestic
Violence and Children (1999) 9(3):84-98.
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.
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,
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
The Impact of Federal and State Laws on Children
Exposed to Domestic Violence. The Future of
Children: Domestic Violence and Children (1999)
The Impact of Violence on Children. The Future
of Children: Domestic Violence and Children
and K. Williams. Intimacy and Homicide: Compensating
for Missing Data in the SHR Vol. 38 (2), May
2000, pp. 661-680.
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
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
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.
and P. Jaffe. Emerging Strategies in the Prevention
of Domestic Violence. The Future of Children:
Domestic Violence and Children (1999) 9(3):133-144.