Domestic Violence

I. Intimate Partner Violence:A. Statement of the Problem

Identified as one of the Nation’s Most Pressing Public Health Problem.

Women are more likely to be repeatedly attacked, raped, injured or killed by male partner than by any other type of perpetrator.

Severe, serial nature enhanced by easy access, high levels of exposure, privacy.

B. Definitions

Physical Violence ranges from minor to lethal violence.– Push, hit, slap, shove– Assault with hands, objects weapons– Acts/Threats to maim kill pets, partner, family– Choke, strangle, bite, burn, throw down stairs– Sexual Assault and Rape

B. Definitions (con’t)

Emotional Abuse and Coercion– Restriction of routines, activities, relationships– Forced Isolation– Restriction of access to medical/MH care– Stalking and intense monitoring of behavior– Threatened loss of valued things– Threats to harm loved ones– Restricted access to $$, other support

B. Definitions (con’t)

Verbal Abuse:– Name Calling, Degradation/Insults– Intense Criticism.

AMA (1992) “…pattern of coercive behaviors that may include repeated battering and injury, psychological abuse, sexual assault, progressive social isolation, deprivation and intimidation perpetrated by someone who is or was involved in an intimate relationship with the victim (p. 40).”

C. Epidemiology-Population Studies

Rates vary by sample and definition.

IPV affects 3-4 million women in the U.S. annually (8-10%).

Lifetime rates of IPV for American Women range from 21-34% during adulthood.

C. Epidemiology-Risk Factors

Younger women at increased risk Single, separated, divorced higher rates

– Violence in dating/courtship increasing problem (32% in large national college sample)

– High School dating: 13-25%

Fewer years married higher rates

C. Epidemiology-Risk Factors

IPV cuts across socioeconomic lines. Higher rates associated with poverty, e.g,

60% lifetime prevalence in AFDC sample. BJS-highest rates w/lowest income, 12

per1,000 (Black) and 8 per 1,000 (White). Trapped by Abuse, Trapped by Poverty.

C. Epidemiology-Specialized Samples

Primary Care: 44-46% during lifetime. All female E.D. patients: 54% in lifetime OB samples: up to 37% during pregnancy.

Pregnant Women (Nat’l Sample): – 154/1,000 1st-4th month of pregnancy– 170/1,000 6th-9th month of pregnancy– Increased violence reported during pregnancy

D. Patterns/Dynamics

All Abusive Behavior Functions to Maintain Domination, Power and Control.

Physical abuse tends to occur w/ verbal and emotional abuse.

Emotional/verbal abuse often precedes physical violence

D. Patterns/Dynamics

Abuse tends to escalate in Frequency and Severity over time.

Perceived/Actual Separation Increased Risk of Assault and Lethal Outcomes

Stalking as a variant of IPV “Why Doesn’t She Just Leave?”(Most Do)

– Leaving is a process, not an event (Average 6x) “Why Doesn’t He Just Let Her Go?”

C. Patterns/Dynamics

Help-seeking Behaviors/Coping– BW engage in an extensive number and array of

help-seeking behaviors. They are NOT passive.– These efforts often do not “work, ” in terms of

stopping the violence or improving the situation.– Initially women cope by trying to control/prevent

the violence - eventually their coping turns to simply surviving it (can appear maladaptive)

G. Assessment and Intervention

Components of Assessment/Intervention:– Assess abuse (informal and formal)– Lethality Assessment (AAS, Campbell)– Development of a safety plan (AWARE Guide)– Provide Information about Resources (in a format

that is safe and accessible if she is in danger)– Help her access local resources

G. Assessment/Intervention: Asking Q’s

Safety is paramount– Interview the victim in a private place

Create an atmosphere of trust.– Build trust by listening without judging, avoid

“Why” questions. – Begin with less threatening questions.– Notice that she may feel shame,fear,ambivalence

and validate feelings “this is hard to talk about…”

G. Assessment/Intervention: Asking Q’s

Ask Direct questions beginning with questions about how she and her partner handle conflict. Ask if she has ever been treated badly, felt scared, or scared for her children, if her partner ever damaged her things, kept her from loved ones or access to money. (see handouts for examples)

Observe Behavior: signs of fear, trauma, etc.

G. Assessment and Intervention

It is not uncommon for battered women to deny or minimize the violence.

Other complaints, like depression, sleep problems or injuries can be clues.

Consider speaking to friends or relatives. Remind her that she is not alone and that help

is available. Don’t Interrogate her if she denies/minimizes.

G. Assessment and Intervention

Consider that her reluctance to report may be protective of herself and her children.

Expect the process to be slow and frustrating Anticipate that the victim may return many

times (6 on average) to the abuser. Support her efforts to become independent

and empowered to make healthy decisions for herself and her family.

G. Assessment:Unhelpful Responses

Responses from Professional Perceived as Unhelpful (Physical Violence) (Coates & Hamilton, 1992) :– Criticized me for staying– Suggested couple’s counseling– Went along with me when I said it wasn’t serious– Questioned the truth of my story

G. Assessment: Unhelpful Responses

Responses from Professional Perceived as Unhelpful (Emotional Abuse):

– Gave me advice which I did not wish to follow.– Did not tell me other other agency or professional

services that could help me.– Did not listen carefully.– Did not have an accepting attitude.

G. Assessment: Unhelpful Responses

Responses from Professional Perceived as Unhelpful (Sexual Abuse):

– Questioned my story.– Denied the impact it had on my life.– Suggested I wanted it.– Blamed me for what happened.

G. Assessment and Intervention

Options:– Shelter– Order of Protection– Counseling

Conjoint Therapy highly controversial- appropriate only under very restricted conditions.

G. Children: Special Issues for Intervention

Custody, mediation, court-ordered visitation “He’s a great dad, he just beats his wife”

H. Batterers

Typology of Batterers Effectiveness of Batterers Intervention

Programs

I. Special Issues: IPV in Workplace

Largely unaddressed Bureau of National Affairs (1990) estimated

that domestic violence costs employers $3-5 million/year in:– Reduced productivity costs– Staff turnover.– Increased Health Costs.

I. Special Issues: IPV in Workplace

Signs: Subtle – Tardiness– Frequent unexplained absences– Problems w/concentration and attention– Fatigue, depression, anxiety, fear.– Excessive use of telephone– Unexplained injuries

I. Special Issues: IPV in Workplace

Research Findings, 1992 Study 118 BW:– 19% of unemployed, prevented from working.– 96% of employed reported some problem in the

work place due to abuse.– 70% too distracted by violence to perform well.– 60% reprimanded for abuse related problems.– 70%+ telephoned excessively by abuser.– 50%+ missed workdays,30% lost jobs