Intimate Partner Violence and Abuse
Abstract and Keywords
Intimate partner violence—the continual and systematic exercise of power and control within an intimate relationship that often also includes physical and sexual violence—has emerged as a significant and complex social problem warranting the attention of social workers. Risk and protective factors have been identified at the individual, family, community, and societal levels. Some of these risk factors for repeat and lethal violence have been organized into risk assessment instruments that can be used by social workers to educate and empower survivors. Intimate partner violence has multiple negative health and mental health consequences for female victims and their children. Social workers in all areas of practice should be prepared to intervene with victims of intimate partner violence in a culturally competent manner using a strengths-based framework.
Intimate partner violence is a significant problem that has existed for centuries and affects the social welfare of women and their children. Feminist advocates brought attention to the issue in the 1970s and have successfully advocated for services, legal sanctions, and policy changes (Messing, 2011). However, many women remain unable to access the resources needed to become and remain violence free (Dichter & Rhodes, 2011). Screening by social workers tends to produce some of the highest disclosure rates of intimate partner violence (Trabold, 2007). Given the negative sequelae of intimate partner violence, social workers are likely to encounter survivors in their practice and should play an integral role in intervention. However, screening is underutilized (Lindhorst, Casey, & Meyers, 2010; Shlonsky & Friend, 2007) and many social workers have reported a lack of knowledge about intimate partner violence (Bent-Goodley, 2007a; Danis & Lockhart, 2003).
Intimate partner violence is the continual and systematic exercise of power and control within an intimate relationship that often also includes or culminates in violence (Johnson, 2008; Stark, 2007). Definitions and measurement of intimate partner violence generally focus upon the constellation of abusive or violent acts experienced, such as physical violence, sexual violence or coercion, threats of physical or sexual violence, stalking, and psychological or emotional aggression (Black et al., 2011; Saltzman, Fanslow, McMahon, & Shelley, 2002). However, it is important that social workers recognize the pattern of coercive control indicative of intimate partner violence, even when physical violence is not apparent. The term intimate partner violence is intended to be broad enough to encompass all romantic relationships (heterosexual and homosexual, casual, dating, child in common, married, ex-, or separated), but narrow enough to specify that child abuse and other forms of domestic or family violence are excluded. The term intimate partner abuse may be more inclusive of emotional and psychological abuse and is used when no physical or sexual violence is present. The physical and sexual violence referred to in intimate partner violence is generally understood to be accompanied by emotional or psychological abuse (Cavanaugh et al., 2012; Smith, Thornton, DeVellis, Earp, & Coker, 2002).
The National Intimate Partner and Sexual Violence Survey (NISVS), a nationally representative telephone survey conducted by the Centers for Disease Control and Prevention in 2010, found that 35.6% of women had experienced rape, physical violence, or stalking by an intimate partner in their lifetime (Black et al., 2011). When examining severe physical violence such as being hit with a fist or something hard, beaten, or slammed against something, lifetime prevalence for women is 24.3%. In the past 12 months, an estimated 42 million women experienced at least one of these forms of violence (Black et al.).
When examining the forms of intimate partner violence measured by the NISVS separately, 32.9% of women reported physical violence, 9.4% reported rape, 16.9% reported intimate partner sexual violence other than rape (for example, sexual coercion), 10.7% reported stalking by an intimate partner, 48.8% reported psychological aggression, and 41.1% reported coercive control in their lifetime. Forms of intimate partner violence often co-occur, and 35.6% of women who experienced physical violence also experienced intimate partner rape or stalking (Black et al., 2011). In community samples of women who have experienced physical violence, rates of intimate partner sexual violence (including rape) range from 28% (Eby, Campbell, Sullivan, & Davidson, 1995) to 68% (McFarlane et al., 2005).
Risk and Protective Factors
Intimate partner violence disproportionately affects women from some social and demographic groups. However, it is important to remember that anyone can be the victim of intimate partner violence. Many of the variables that indicate high risk among women from some demographic groups (for example, race or ethnicity) may be conflated with other social and economic indicators (for example, poverty, unemployment). In fact, income has been described as “one of the most, if not the most, significant correlates of partner violence” with research demonstrating that poverty both predicts and is predicted by intimate partner violence (Goodman, Smyth, Borges, & Singer, 2009, p. 308).
Native American and African American women have been found to experience intimate partner violence at higher rates and in different ways than White women and, more recently, multiracial women have been found to be at the highest risk for intimate partner violence (Black et al., 2011; Potter, 2008; Smith, 2005). The relationship among income, education, and race or ethnicity makes it difficult to state with any certainty which factors increase risk for whom. When controlling for socioeconomic status, the effect of race on intimate partner violence often disappears (Cho, 2012). An emerging literature also suggests that the growing population of immigrant women may be more vulnerable to intimate partner violence than nonimmigrant women (Erez, Adelman, & Gregory, 2009; Raj & Silverman, 2002; Runner, Novick, & Yoshihama, 2009).
Research has found that women who are younger are more likely to experience intimate partner violence; nearly 70% of women who reported experiencing intimate partner violence reported that their first incident of abuse occurred before the age of 25 (Black et al., 2011). Women with disabilities are more likely to experience intimate partner violence and to be abused in ways that focus on their unique vulnerabilities (Lightfoot & Williams, 2009; Powers et al., 2002). Women with lower incomes and lower educational attainment have been shown to be more susceptible to experiencing intimate partner violence (for example, Cho, 2012), although it may be that women with greater economic and educational resources have means by which to leave a violent intimate relationship (Powers & Kaukinen, 2012). Women’s employment may decrease isolation and provide increased economic resources, although it may also indicate economic stress and lead to increased jealousy or feelings of inferiority on the part of a partner, particularly when that partner is unemployed (Fox, Benson, DeMaris, & Van Wyk, 2008; Powers & Kaukinen). Intimate partner violence has also been shown to decrease women’s ability to obtain and maintain employment; abusive partners may sabotage women’s employment through abuse and harassment and the psychological effects of repeated abuse may make it difficult for a woman to maintain employment (Goodman et al., 2009).
Intimate partner violence risk assessment instruments can provide social-work practitioners with information on the likelihood that abusers will reassault, severely reassault, or kill their intimate partner and can facilitate communication between social workers and professionals in other intervention systems. Risk assessment should be utilized as part of an evidence-based practice approach to intimate partner violence intervention that also takes into account a social worker’s clinical expertise and client self-determination (Gambrill, 2006). Five risk assessment instruments have been validated (that is, tested for accuracy) in multiple studies across a variety of intervention settings (Messing & Thaller, 2013).
The Danger Assessment (http://www.dangerassessment.org) is the only intimate partner violence risk assessment instrument that relies on victim self-report and is also the only instrument intended to predict lethal intimate partner violence (Campbell et al., 2003b). This risk assessment is ideal for social workers who are in direct contact with domestic violence survivors. The Danger Assessment should be administered as a collaborative effort between a survivor and a social worker or other professional and is intended to empower women toward decisions of self-care. A social worker may use the administration of the risk assessment to facilitate a conversation about risk and safety, assist in the development of a safety plan, and educate the survivor about her individual risk and potential risk factors. The Danger Assessment has been adapted for immigrant women (Messing, Amanor-Boadu, Cavanaugh, Glass, & Campbell, 2013) and women in same-sex relationships (Glass et al., 2008b).
There are several other intimate partner violence risk assessments available. Social workers who work closely with police officers may consider using the Ontario Domestic Assault Risk Assessment (ODARA). The questions on this risk assessment instrument can be answered using criminal files or during a police interview, making the risk assessment relatively easy to administer in this context (Hilton et al., 2004). The Domestic Violence Screening Inventory (DVSI) was created to assist with determinations about pretrial release and may be useful for communicating risk to judges, prosecutors, and probation officers (Williams & Houghton, 2004). For social workers with advanced training and an interest in applying professional judgment to the risk assessment process, the Spousal Assault Risk Assessment (SARA) may be the most appropriate. This risk assessment relies on interviews with the offender and victim and the examination of case files, making access to each of these information sources key to the administration of this instrument (Kropp, Hart, Webster, & Eaves, 1995).
When making decisions about their relationship and accessing resources, survivors of intimate partner violence informally assess their own risk. Survivor risk assessments have been found to be relatively accurate (Bell, Cattaneo, Goodman, & Dutton, 2008; Campbell, Webster, & Glass, 2009; Cattaneo, Bell, Goodman, & Dutton, 2007; Cattaneo & Goodman, 2003; Connor-Smith, Henning, Moore, & Holdford, 2010). However, some risk assessment instruments have been shown to be more predictive than survivor’s assessments (Campbell et al., 2009; Messing & Thaller, 2013; Wilson, Batye, & Riveras, 2008) and survivors are more likely to underestimate than overestimate their risk (Campbell, 2004; Heckert & Gondolf, 2000). Risk assessment instruments can be used as an empowerment tool to educate survivors about risk and risk factors and to compliment a survivor’s assessment of risk (Campbell, 2004; Connor-Smith et al., 2010; Heckert & Gondolf, 2004; Weisz, Tolman, & Saunders, 2000), but should not be used to mandate intervention for survivors or remove their self-determination.
Despite their experiences of abuse, survivors are resilient and continue to function as mothers, partners, employees, friends, and family members. Prior to seeking formal services, many survivors utilize informal strategies such as talking to their partner about the violence or seeking support from family and friends (Goodkind, Sullivan, & Bybee, 2004; Goodman, Dutton, Weinfurt, & Cook, 2003).
Limited prospective research exists on the specific factors that may reduce exposure to repeat assault or reduce the negative effects of intimate partner violence victimization. However, studies have found that women who report more social support or a better quality of life also report less repeat partner violence (Goodman et al., 2009). Social support, including having a supportive person in whom to confide, is thought to enhance self-esteem, affect perceptions of stressful events, provide concrete assistance, and increase knowledge of coping strategies and, in turn, reduce future violent victimization (Carlson, McNutt, Choi, & Rose, 2002; Cohen & Hoberman, 1983). For women experiencing the most severe abuse, however, social support does not appear to reduce future violence (Goodman, Dutton, Vankos, & Weinfurt, 2005). Access to financial resources, employment or employment opportunities, education, transportation, housing free of their abusive partner, and other material and financial resources that assist women in attaining financial independence are important for allowing women to become and remain violence free (Goodman et al., 2005).
Research on factors associated with resilience in the face of high levels of stress may also be informative. These factors include social support, positive self-regard, cognitive appraisal strategies, the perception of control, maintaining a positive outlook, self-efficacy, spirituality, good health, and type of coping strategies used (Carlson et al., 2002). Tactics of abusers, including isolation and limiting the economic independence of their victim, make resources such as social support and financial independence more difficult to attain for some intimate partner violence survivors. Physical and mental-health consequences of violence may also interfere with coping. Characteristics such as loyalty to partners, a desire to maintain a two-parent household for the sake of their children, and sensitivity to the needs and desires of other family members are often seen as barriers to leaving an abusive relationship, but should be reframed as indicators of strength and resilience.
Health and Mental Health
The physical health consequences of intimate partner violence include injury that is the result of violent victimization, as well as chronic health problems as a result of repeated abuse over time. According to the NISVS, 41.6% of women who reported experiencing intimate partner rape, physical violence, or stalking also reported injury as a result of their victimization. Slightly over half of the women who reported injury reported that they needed medical care because of the injury (Black et al., 2011). Physical health consequences include poor appetite, low energy, chronic fatigue, headaches, difficulty sleeping, breathing problems, gastrointestinal problems, muscle tension or soreness, traumatic brain injury, and gynecological problems (Bonomi et al., 2006; Campbell, 2002; Kwako et al., 2011). Physical health consequences appear to be cumulative; that is, women who experience more severe abuse will also experience more severe physical health consequences (Scott-Storey, 2011).
Intimate partner violence also affects women’s mental health, resulting in depression, suicide or suicidal ideation, shame, and posttraumatic stress disorder (including dissociation, increased arousal, irritability, angry outbursts, hypervigilance, and sleep disturbances) (Afifi et al., 2009; Beydoun, Beydoun, Kaufman, Bruce, & Zonderman, 2012; Cavanaugh, Messing, Del-Colle, O’Sullivan, & Campbell, 2011; Devries et al., 2013; Feinstein, Bovin, Humphreys, Marx, & Resick, 2011; Golding, 1999; Leone, 2011; Messing, Thaller, & Bagwell, in press; Wilson, West, Messing, Patchell, & Campbell, 2011). Intimate partner rape may be more emotionally harmful than rape by a stranger, causing higher levels of perceived stress and dissociation (Bergen, 2006; Temple, Weston, Rodriguez, & Marshall, 2007). Women may turn to substances to cope with the trauma resulting from victimization, and the misuse of alcohol and drugs is associated with intimate partner violence victimization (Afifi, Hendriksen, Asmundson, & Sareen, 2012; Fazzone, Holton, & Reed, 1997; Schneider, Burnette, Ilgen, & Timko, 2009).
The single largest risk factor for intimate partner homicide is intimate partner violence. Between 65% and 80% of intimate partner femicide victims were previously abused by the partner who killed them (Campbell, Glass, Sharps, Laughton, & Bloom, 2007; Campbell et al., 2003a; Moracco, Runyan, & Butts,1998; Pataki, 1998; Sharps et al., 2001). Women are much more likely than men to be killed by an intimate partner; at least 45% of murdered women are killed by an intimate (Catalano, Smith, Snyder, & Rand, 2009; Cooper & Smith, 2011; Violence Policy Center, 2011), whereas the same is true for 5–7% of murdered men (Fox, 2005). Between 1980 and 2008, there was a 5% increase in the proportion of female homicide victims killed by an intimate partner (Cooper & Smith).
African American and Native American women are at higher risk for intimate partner homicide (Mercy & Saltzman, 1989; Morton, Runyan, Moracco, & Butts, 1998). However, similar to the risk for intimate partner violence, racial or ethnic differences may be reflective of other social and economic indicators. For example, the increased risk posed by Native American and African American men may actually be a function of higher unemployment among these groups (Campbell et al., 2003b). In addition, education appears to interact with race and ethnicity—African American women with higher levels of education are at greater risk for intimate partner homicide and White women with higher levels of education are at decreased risk for intimate partner homicide (Dugan, Nagin, & Rosenfeld, 2003a, 2003b).
Other social, demographic, and relationship characteristics indicate risk for intimate partner homicide. These include an increase in the frequency and severity of abuse, having a child who is not the abuser’s child, controlling behaviors, partner unemployment, threats to kill or threats with a weapon, avoiding arrest for domestic violence, extreme sexual jealousy (Campbell et al., 2003b), recent estrangement (Dawson & Gartner, 1998; Websdale, 1999; Wilson & Daly, 1993; Wilson, Johnson, & Daly, 1995), stalking (McFarlane et al., 1999), strangulation (Glass et al., 2008a), partner access to a firearm (Campbell, 1995; Campbell et al., 2003b, 2007; Fox & Zawitz, 2004), partner use of illegal drugs or problem drinking (Sharps, Campbell, Campbell, Garry, & Webster, 2003), abuse during pregnancy (McFarlane, Campbell, Sharps, & Watson, 2002), forced sex (Campbell et al., 2003b; Messing et al., in press), and perpetrator suicide threats or attempts (Koziol-McLain et al., 2006).
The Effects on Children
Intimate partner violence negatively affects the cognitive, behavioral, and socioemotional development of children, resulting in both internalizing (for example, depression) and externalizing (for example, aggression) behaviors (Carlson, 2000; Evans, Davies, & DiLillo, 2008). Among infants as young as six months old, high nonphysical interparental conflict affects functioning in areas of the brain related to stress and emotional processes (Graham, Fisher, & Pfeifer, 2013). As intimate partner violence increases in frequency, severity, and chronicity, negative effects increase (Edleson, 2006) and children exposed to extreme intimate partner violence may present with symptoms of posttraumatic stress disorder (Evans et al.). Witnessing intimate partner violence as a child results in similar negative outcomes as experiencing physical child abuse (Kitzmann, Gaylord, Holt, & Kenny, 2003), although it has been found that other adverse childhood events may increase the difficulties that children exposed to intimate partner violence face (Edleson). The presence of a protective adult, the social environment, and coping strategies may buffer against the negative effects of witnessing intimate partner violence (Edleson). Group interventions for children have been found to be effective at helping children develop coping and safety skills (Jouriles et al., 2009; Sullivan, Bybee, & Allen, 2002).
Children in homes where intimate partner violence occur are also more likely to experience child abuse (Edleson, 1999). Witnessing intimate partner violence as a child or experiencing child abuse results in a two to six times greater likelihood of experiencing intimate partner violence as an adult (Bensley, Van Eenwyk, & Simmons, 2003; Coker, Smith, McKeown, & King, 2000; Schaaf & McCanne, 1998). Some research indicates that posttraumatic stress and depression, particularly resulting from childhood experiences of abuse, may increase risk for subsequent intimate partner violence (Devries et al., 2013; Engstrom, El-Bassel, Go, & Gilbert, 2008; Messing, LaFlair, Cavanaugh, Kanga, & Campbell, 2012; West, Williams, & Siegel, 2000).
Individual and Group Interventions
Social service interventions for survivors of intimate partner violence include crisis intervention, shelter, advocacy, legal advocacy, support groups, and individual counseling. For the most part, the focus of these interventions is to increase physical safety, enhance knowledge of intimate partner violence dynamics and the resources available, refer women to community resources and assist with accessing the justice system, normalize women’s experiences, increase coping, and decrease isolation (Macy, Giattina, Sangster, Crosby, & Montijo, 2009). Interventions with survivors should be client oriented and founded on women’s strengths, resilience, and empowerment (Dutton, 2000).
Exiting an abusive relationship is a dangerous, difficult, and lengthy process that requires social, emotional, and financial resources (Amanor-Boadu et al., 2012; Messing, Mohr, & Durfee, 2012). Women who have experienced intimate partner violence have needs in multiple areas of their lives, often including housing, employment, child care, education, financial capital, legal services, and mental health, and it is not likely that a single service provider can effectively intercede in all of these areas. As such, community referrals are often relied upon as a component of social-work intervention with intimate partner violence survivors and must provide adequate services (Sullivan, 2005). Survivors have identified shelters, victim advocates, the police, family, and friends as the most helpful of available resources (Goodman et al., 2003). Advocacy interventions appear to increase women’s use of safety strategies and may also increase self-efficacy and self-esteem, as well as reduce depression and posttraumatic stress symptoms (Ramsay et al., 2009).
Many social-work interventions focus on survivors of abuse, but without effective services for abusers, intimate partner violence will continue to be a social problem. Arrest may occur in 40% or fewer of intimate partner violence incidents (Sloan, Platt, Chepke, & Blevins, 2013), and there is mixed evidence on the efficacy of arrest as a deterrent (Campbell et al., 2003b; Maxwell, Garner, & Fagan, 2002; Stover, Meadows, & Kaufman, 2009). Prosecution is less likely than arrest and has been examined as a deterrent in fewer studies, and research has been similarly inconclusive (Sloan et al.; Ventura & Davis, 2005). Batterers intervention programs, including those utilizing cognitive behavioral therapy, have not demonstrated significant decreases in repeat violence (Smedslund, Dalsbo, Steiro, Winsvold, & Clench-Aas, 2011; Stover et al.), although evidence exists that these programs may be successful for certain types of perpetrators (Buttell & Carney, 2006).
Social and Political Interventions
In addition to individual interventions for survivors of intimate partner violence, the domestic violence advocacy movement has placed a great emphasis on policy advocacy and changing social norms about violence against women (Messing, 2011; Stark, 2007). The Violence against Women Act (1994) and its reauthorizations (2000, 2005, 2012) have provided resources at the state and federal level for domestic violence services, with a particular emphasis on legal remedies. Particularly given funding constraints of recent years, domestic violence service providers struggle to provide services to all intimate partner violence survivors in need (National Network to End Violence Against Women, 2011). In addition to policies that directly refer to intimate partner violence victims (for example, mandatory arrest, primary aggressor), many policies have intended and unintended effects on survivors (for example, child custody and divorce statutes, firearm availability). These consequences may be more salient for survivors of color and those with limited economic resources (Bent-Goodley, 2007b). In addition to the provision of direct services, social workers should advocate for laws and policies that protect survivors of domestic violence and their children.
Research on interventions for intimate partner violence have focused on White women, women in heterosexual relationships, and women of lower socioeconomic status, often generalizing findings to all survivors of intimate partner violence despite their many differences (Bent-Goodley, 2005). There are a multitude of reasons that women of color may avoid accessing formal services including discrimination, stigma, self-blame, fear of bringing shame upon their community, fear of reinforcing stereotypes, the belief that violence is a private or family matter, language barriers, definitional barriers, and distrust of the legal system (Abraham, 2000; Adam & Schewe, 2007; Bent-Goodley, 2007b; Bhuyan, Mell, Senturia, Sullivan, & Shiu-Thornton, 2005; Dasgupta & Warrier, 1996; Kasturirangan, Krishnan, & Riger, 2004; Sullivan, Senturia, Negash, Shiu-Thornton, & Giday, 2005). For immigrant women, fear of deportation, fear of the deportation of loved ones, or separation from children may lead to further isolation and reluctance to seek services (Abraham; Crandall, Senturia, Sullivan, & Shiu-Thornton, 2005; Erez & Hartley, 2003). Women with disabilities, particularly women of color with disabilities, face unique barriers to service such as negative attitudes, lack of accessibility, and differential experiences of abuse (Lightfoot & Williams, 2009).
Social workers who are part of the majority culture may be seen as outsiders, causing women of color to be reluctant to disclose their abuse. Further, the coping strategies employed by White middle-class women may not be effective for women of color or for women of lower socioeconomic status (Kasturirangan et al., 2004). Social workers must understand the cultural and historical context of violence and abuse, challenge stereotypes that may make it more difficult for survivors of color to access services, and provide culturally appropriate methods of intervention (Bent-Goodley, 2005). Sources of strength and methods of coping may be derived from women’s cultural traditions and values, and these cultural values should be accessed as strengths and built upon during intervention (Bent-Goodley, 2007b; Kasturirangan et al.). Social workers should employ community organizing strategies that focus on community education, community participation, and building capacity to respond to violence against women within communities of color (Bent-Goodley, 2007b; Kasturirangan et al.; Messing et al., 2013). Ensuring that staff reflect the culture and differential abilities of clients is also important, as is training on cultural competence (Lightfoot & Williams, 2009).
Trends and Challenges
There is a growing recognition that the traditional shelter-based model of services for intimate partner violence does not meet the needs of all survivors. Many survivors of intimate partner violence will remain in contact with their abuser, either because they choose to remain in the relationship or because shared custody of children requires coparenting. Advocacy beyond leaving, also called victim-defined advocacy, focuses on safety for women and children who remain in contact with an abusive partner through risk reduction, meeting survivor-defined goals, and a focus on basic necessities such as food and income (Davies, 2009). The housing-first model, adapted from interventions with homeless populations, focuses on permanent housing rather than emergency shelter. Driven by the belief that survivors often return to an abusive partner after a short shelter stay because they lack options for housing, employment, and child care, this model aims to provide women with long-term community-based housing rather than emergency shelter. As technological advances continue, Internet- or smart phone–based interventions may also become more accessible (Glass, Eden, Bloom, & Perrin, 2010).
Interventions focused on changing the behavior of abusive men have not demonstrated widespread success (for example, Smedslund et al., 2011). Without effective interventions that reduce men’s violence against women, the problem of intimate partner violence will not cease. Yet even as feminist organizations work to reduce violence against women, the basic understanding of intimate partner violence as a gendered phenomenon faces assault. Popular media discourse is rife with myth-based beliefs that blame women and exonerate men (Thaller & Messing, 2013). In recent years, father’s rights or men’s rights groups have proliferated. These antifeminist groups have named the domestic violence movement their political opponent and utilize their political and legal capital to reduce sanctions against intimate partner violence, particularly within the arenas of divorce, custody, and child-support decisions (Dragiewicz, 2011).
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