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Causes, Effects, and Prevention of Domestic Violence

Chapter 6
Causes, Effects, and Prevention of Domestic Violence

SOCIOLOGICAL THEORIES ON THE CAUSES OF DOMESTIC VIOLENCE

Researchers have studied domestic violence for about thirty years. While scholars from different intellectual traditions have varying theories on the causes of domestic violence, sociological explanations have gained wide acceptance. Some sociological models are examined in this chapter.

General Systems Theory

The general systems theory views violence as a system rather than as a result of individual mental disturbance. It describes a system of violence that operates at the individual level, the family level, and the societal level.

In "A General Systems Theory Approach to a Theory of Violence between Family Members" (Social Science Information, June 1973), Murray A. Straus provides eight concepts to illustrate the general systems theory:

  • Violence between family members has many causes and roots, and personality, stress, and conflicts are only some of the causes of domestic violence.
  • More family violence occurs than is reported.
  • Most family violence is either denied or ignored.
  • Stereotyped family-violence imagery is learned in early childhood from other family members.
  • The family-violence stereotypes are continually reaffirmed through ordinary social interactions and the mass media.
  • Violent acts by violent people may generate positive feedback; that is, these acts may produce desired results.
  • Use of violence, when contrary to family norms, creates additional conflict.
  • People who are labeled violent may be encouraged to play out a violent role, either to live up to the expectations of others or to fulfill their own self-concepts of being violent or dangerous.

Resource Theory

The second theory in sociological models used to explain domestic violence is known as the resource theory. According to this theory, the more resources—social, personal, and economic—a person can command, the more power he or she can potentially call on. The individual who is rich in terms of these resources has less need to use force in an open manner. In contrast, a person with little education, low job prestige and income, or poor interpersonal skills may use violence to compensate for a real or perceived lack of resources and to maintain dominance.

EFFECTS OF POVERTY

Straus finds that serious physical acts of wife abuse are more likely to occur in poorer homes. His research shows that for lower levels of violence, such as shoving or slapping, the differences in socioeconomic status are small. For more serious types of violence, the rates increase dramatically as the socioeconomic status drops.

The 1985 National Family Violence Survey, based on 6,002 households, provided researchers with the primary data to test their observations against a database large enough to produce statistically significant, valid findings. In the survey, families living at or below the poverty level had a rate of marital violence 500% greater than more affluent families.

In "Neighborhood Environment, Racial Position, and Domestic Violence Risk: Contextual Analysis" (Public Health Reports, January-February 2003), Deborah N. Pearl-man et al. present the findings of an analysis of police-reported domestic violence in relation to variables including socioeconomic conditions, age, race, and ethnicity. They find a complex but strong relationship between poverty and domestic violence. Pearlman et al. speculate that one explanation for the increased risk of domestic violence in poorer neighborhoods might be differences in law enforcement availability and practices—economically deprived communities might have less police notification, attention, and documentation.

The desire to dominate one's partner may be manifested using methods other than violence, such as attempts at financial, social, and decision-making control. Some researchers theorize that men of lower socioeconomic status are more likely to batter because they do it to assert the power that they lack economically. Violence becomes the tactic that compensates for the control, power, independence, and self-sufficiency these men lack in other areas.

Exchange/Social Control Theory

The exchange/social control theory argues that violence can be explained by the principle of costs and rewards. The private nature of the family, the reluctance of social institutions to intervene, and the low risk of other interventions reduce the risk of negative consequences from abuse. This theory maintains that cultural sanction and approval of violence increase the potential rewards for violence.

LEARNED GENDER ROLES

Pointing to history, some researchers see wife abuse as a natural consequence of women's second-class status in society. Among the first to express this viewpoint were R. Emerson Dobash and Russell E. H. Dobash in Violence against Wives: A Case against the Patriarchy (1979). Dobash and Dobash argue that men who assaulted their wives were actually living up to roles and qualities expected and cherished in Western society—aggressiveness, male dominance, and female subordination—and that they used physical force as a means to enforce these roles. Many sociologists and anthropologists believe that men are socialized to exert power and control over women. Some men may use both physical and emotional abuse to attain the position of dominance in the spousal relationship. In "Gendering Violence: Masculinity and Power in Men's Accounts of Domestic Violence" (Gender and Society, June 2001), a study of thirty-three male batterers, Kristin L. Anderson and Debra Umberson state that "violence is … an effective means by which batterers reconstruct men as masculine and women as feminine."

Subculture of Violence Theory

Another sociological theory explaining domestic violence posits that there is a subculture of violence in which some groups within society hold values that permit, and even encourage, the use of violence. This theory is offered as an explanation of why some segments of society and some cultures are more violent than others. This theory is perhaps the most widely accepted theory of violence.

ATTITUDES TOWARD VIOLENCE

Some researchers believe attitudes about violence are shaped early in life, long before the first punch is thrown in a relationship. In "The Attitudes towards Violence Scale: A Measure for Adolescents" (Journal of Interpersonal Violence, November 1999), Jeanne B. Funk et al. asked junior high and high school students attending an inner-city public school in a midwestern city about their attitudes toward violence. Some students identified themselves as victims of violence and others completed the survey before and after participating in a violence awareness program.

Using the responses of 638 students who took the survey before the violence awareness program, Funk et al. examined the correlation of violence with gender, grade level, and ethnicity. They find that males endorsed more pro-violence attitudes independent of age, grade level, and ethnicity, as did those students who identified themselves as victims of violence. African-American teenagers endorsed "reactive violence," or violence used in response to actual or perceived threats, at higher levels than other groups. Endorsement of reactive violence was linked to having violent behaviors in one's repertoire, willingness to act in a violent manner, and supporting the actual choice of a violent response. Hispanics endorsed "culture of violence" measures, reflecting a pervasive identification with violence as a valued activity, at slightly higher levels than the teenagers as a group. "Culture of violence" measures included the belief that the world is a dangerous place where the best way to ensure survival is to be vigilant and prepared to take the offensive. European-Americans scored lower on measures of "reactive violence" as well as on "total pro-violence attitudes."

Funk et al. find that gender, ethnicity, and self-identification as a victim of violence were all related to pro-violence attitudes. Males, regardless of cultural background, were more likely than females to endorse pro-violence attitudes. Funk et al. conclude that a combination of biological, environmental, and social influences were responsible for these findings.

Feminist Theory

Feminist theories of violence against women emphasize that societal patriarchal structures of gender-based inequalities of power are at the root of the problem. That is, the violence, rather than being an individual psychological problem, is instead an expression of male domination of females. Violence against women, in the feminist view, includes a variety of "control tactics" meant to control women.

DOES A PATRIARCHAL SOCIETY BREED VIOLENCE?

Donald G. Dutton questions the role of male domination in wife battering and offers alternative explanations for violence in "Patriarchy and Wife Assault: The Ecological Fallacy" (Violence and Victims, 1994). According to the patriarchal model, societies that place a high value on male dominance should have high rates of abuse. However, Dutton and other investigators cite studies that contradict this premise. For example, Diane Coleman and Murray A. Straus, in "Marital Power, Conflict, and Violence in a Nationally Representative Sample of American Couples" (Violence and Victims, 1986), find that in marriages where spouses agreed that the husband should be dominant, violence levels were low.

Other research discounts the weight of the patriarchal theory of abuse. David B. Sugarman and Susan Frankel, in "Patriarchal Ideology and Wife-Assault: A Meta-analytical Review" (Journal of Family Violence, 1996), examine studies for evidence of a relationship between patriarchy and violence. They measure whether violent husbands had a higher acceptance of violence than nonviolent men and whether they believed that women should exhibit traditional gender roles of obedience, loyalty, and deference. Sugarman and Frankel also measure whether assaultive men were more likely to possess a traditional "gender schema," an internal perception of an individual's own levels of masculinity, femininity, or androgyny. They also consider whether assaulted wives held more traditional gender attitudes than wives who were not battered and whether battered wives held more traditional feminine gender schemas.

Overall, Sugarman and Frankel's analysis finds support for only two of the five hypotheses. Predictably, assaultive husbands found marital violence more acceptable than nonviolent husbands, and battered wives were more likely to be classified as having "traditional" feminine gender schemas than wives who were not assaulted. Sugarman and Frankel conclude that their findings offer only partial support for the patriarchy theory.

In contrast, Donna Chung, in "Violence, Control, Romance, and Gender Equality: Young Women and Heterosexual Relationships" (Women's Studies International Forum, November-December 2005), concludes that patriarchal belief systems combine with heterosexual norms and sometimes result in violence. She examines dating violence with a view to discerning the "structural factors" that influence the violent actions of young people within relationships. She argues that the "micropractices" of heterosexual relationships embody power relations between the genders. This inequality in power relationships at times results in intimate partner violence.

In "Girlfriend Abuse as a Form of Masculinity Construction among Violent, Marginal Male Youth" (Men and Masculinities, July 2003), a study of thirty male adolescents, primarily gang members, Mark Totten finds another link between patriarchy and violence. He concludes that underprivileged males in society use violence toward women in response to their lack of access to the traditional benefits of patriarchy. Totten posits that the ideals of patriarchy—and the inability of these disenfranchised boys to wield any patriarchal power outside of their gangs or family groups—leads them to be violent toward their girlfriends as one way to define their masculinity. He states that "violence was one of the few resources over which they had control." However, he also suggests that "men with more resources can commit different, less visible forms of abuse."

Structure of Interpersonal Relationships Theory

Joseph H. Michalski, in "Making Sociological Sense out of Trends in Intimate Partner Violence" (Violence against Women, June 2004), argues that many of the insights of other theories need to be integrated into a more comprehensive theory of the impact of the structure of relationships on domestic violence. He suggests that key risk factors of domestic violence include:

  • Social isolation of the couple
  • Separate peer support networks
  • Inequality between partners
  • Lack of relational distance, or a high degree of intimacy within a couple
  • The centralization of authority—in other words, patriarchal dominance within a family
  • Exposure to violence and violent networks

DOES SUBSTANCE ABUSE CAUSE DOMESTIC VIOLENCE?

The role of alcohol and drug abuse in family violence features in many studies, and it is a factor in physical violence and stalking, according to researchers such as Pam Wilson et al., who examine this issue in "Severity of Violence against Women by Intimate Partners and Associated Use of Alcohol and/or Illicit Drugs by the Perpetrator" (Journal of Interpersonal Violence, September 2000). Although researchers generally do not consider alcohol and drug use to be the cause of violence, they find that it can contribute to, accelerate, or increase aggression. A variety of data sources establish a correlation (a complementary or parallel relationship) between substance abuse and violence, but a correlation does not establish a causation. In theory, and possibly even in practice, substance abuse may promote or provoke domestic violence, but both may also be influenced by other factors, such as environmental, biological, and situational stressors. Based on available research, it remains unclear whether substance abuse is a key factor in most domestic violence incidents.

TABLE 7.1
Victimizations by offenders who appeared to be under the influence of drugs and/or alcohol, 2004
Perceived drug or alcohol use by offender Percent of victimizations
Crimes of violence Rape/sexual assaulta Robbery Assault
Total Aggravated Simple
Note: Detail may not add to total shown because of rounding.
*Estimate is based on about 10 or fewer sample cases.
aIncludes verbal threats of rape and threats of sexual assault.
Source: "Table 32. Personal Crimes of Violence, 2004: Percent Distribution of Victimizations by Perceived Drug or Alcohol Use by Offender," in Criminal Victimization in the United States, 2004, U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, June 2006, http://www.ojp.usdoj.gov/bjs/pub/pdf/cvus04.pdf (accessed July 8, 2006)
    Total victimizations 100.0% 100.0% 100.0% 100.0%* 100.0% 100.0%
Total (perceived to be under the influence of drugs or alcohol) 30.0 44.4 22.4 30.2* 34.5 28.9
    Under the influence of alcohol 18.4 34.1  6.9 18.9* 21.7 18.1
    Under the influence of drugs  5.0  4.1*  9.2  4.5*  3.4  4.9
    Under the influence of both drugs and alcohol  5.0  6.1*  4.0*  5.0*  7.1  4.4
    Under the influence of one, not sure which  1.1  0.0*  1.7*  1.1*  0.9*  1.2
    Not available whether drugs or alcohol  0.6*  0.0*  0.6*  0.6*  1.5*  0.3*
Not on alcohol or drugs 26.9 11.9* 20.5 28.3* 23.2 29.8
Don't know or not ascertained 43.1 43.7 57.1 41.5* 42.4 41.3

In 2004, 18.4% of victims of violent assaults believed their offenders had been using alcohol, 5% believed offenders had been using both alcohol and drugs, 5% believed offenders had been using drugs only, and 1.1% believed offenders had used either alcohol or drugs. Only 26.9% of victims believed the offender had not used any drugs or alcohol, whereas another 43.1% reported they did not know. (See Table 7.1.)

While anecdotal evidence suggests that alcohol and drugs appear to be linked to violence and abuse, in controlled studies the connection is not as clear. For example, some research finds that heavy binge drinking is more predictive of abuse than daily consumption of alcohol. Other research reveals little evidence that drug use directly causes people to become aggressive or violent, and some investigators believe that the substance abuse-violence link varies across individuals, over time within an individual's life, and even in response to environmental influences, such as epidemics of drug use and changing law enforcement policies. In Alcohol and Intimate Partner Violence (March 2005, http://pubs.niaaa.nih.gov/publications/Social/Module8IntimatePartnerViolence/Module8.html), the National Institute on Alcohol Abuse and Alcoholism states that "alcohol is not a clearly identified direct cause of IPV [intimate partner violence], though it clearly is a correlate and may be a contributing factor."

Richard J. Gelles, in "Alcohol and Other Drugs Are Not the Cause of Violence" (Gelles and Donileen R. Loseke, eds., Current Controversies on Family Violence, 1993), argues that substance abuse is not a cause of family violence—rather, it is often used as an excuse for family violence. Gelles argues that although substantial evidence has linked alcohol and drug use to violence, there is little scientific evidence that alcohol or other drugs, such as cocaine, have pharmacological properties that produce violent and abusive behavior. Although amphetamines have been proven to generate increased aggression, there is no evidence that such aggression is routinely expressed as family or intimate partner violence. Gelles maintains that although alcoholism may be associated with intimate violence, it is not a primary cause of the violence. He cites experiments using college students as subjects that have found that when the students thought they were consuming alcohol, they acted more aggressively than if they were told they had been given nonalcoholic drinks. According to Gelles, it is the expectation of the effects of alcohol that influences behavior, not the actual liquor consumed.

In "Risky Mix: Drinking, Drug Use, and Homicide" (National Institute of Justice Journal, November 2003), a study of patterns of alcohol and drug use in murders and attempted murders of women by their partners, Phyllis Sharps et al. show a relationship between substance use and violence. They find that in the year before the violent incident, female victims used alcohol and drugs less frequently and consumed smaller amounts than did their male partners. (See Table 7.2.) Sharps et al. also find that during the homicide or attempted homicide, 31.3% of perpetrators consumed alcohol, 12.6% of perpetrators used drugs, and 26.2% used both. Less than one out of three perpetrators (29.9%) used neither alcohol nor drugs. (See Table 7.3.) By contrast, perpetrators who abused their partners without attempting to kill them consumed alcohol 21% of the time, drugs 6.7% of the time, and both drugs and alcohol 5.8% of the time. Nearly two-thirds (65.8%) of perpetrators used neither alcohol nor drugs. Sharps et al. conclude that increased substance use results in more serious violence.

TABLE 7.2
Rate of alcohol and drug use by victims and their partners in the year prior to selected violent acts against women, 1996
Substance Homicide/attempted homicide % Abused % Nonabused %
Women Partners Women Partners Women Partners
Source: Phyllis Sharps, Jacquelyn C. Campbell, Doris Campbell, Faye Gary, and Daniel Webster, "Table 1. Alcohol and Drug Use by Victims and Their Partners in the Year Prior to the Killing or Attempted Killing of Women or the Worst Violent Incident," in "Risky Mix: Drinking, Drug Use, and Homicide," National Institute of Justice Journal, no. 250, November 2003, http://www.ncjrs.gov/pdffiles1/jr000250d.pdf (accessed July 2006)
Alcohol
Drunk every day35.111.61.2
Problem drinker13.049.27.031.11.76.2
Drinks per episode
1-264.624.461.435.177.765.8
3-422.917.127.927.218.225.5
5-68.924.87.918.23.84.8
7+3.733.72.919.53.03.9
Ever been in alcohol treatment27.713.513.318.157.119.2
Drugs
Use drugs18.454.213.425.06.74.3
Ever been in drug treatment20.611.33.512.414.321.4

Does Treatment Help?

Timothy J. O'Farrell and Christopher M. Murphy, in "Marital Violence before and after Alcoholism Treatment" (Journal of Consulting and Clinical Psychology, April 1995), examine whether behavioral marital therapy was helpful in reducing violence in abusive relationships. They find the percentage of couples who experienced violent acts decreased from about 65% before treatment to about 25% after treatment. Severe violence dropped from between 30% and 35% before to about 10% after treatment.

According to O'Farrell and Murphy, following treatment, recovering alcoholics no longer had elevated violence levels, but alcoholics who relapsed did. Based on women's reports of their partners' violence, 2.5% of non-drinking alcoholics, compared with 12.8% of the nonalcoholic sample, were violent. In contrast, 34.7% of the relapsed alcoholics were violent. O'Farrell and Murphy warn that the data do not permit drawing the conclusion that drinking caused the continued violence because other factors may have influenced behavior. They do conclude, however, that their findings support the premise that recovery from alcoholism can reduce the risk of marital violence.

According to Gregory L. Stuart et al. in "Reductions in Marital Violence following Treatment for Alcohol Dependence" (Journal of Interpersonal Violence, October 2003), after intensive inpatient treatment of male batterers for alcoholism, both alcohol consumption and levels of violence within families decreased. Not only did the frequency of husband-to-wife physical and psychological abuse decrease, but the frequency of wife-to-husband marital violence also decreased significantly.

TABLE 7.3
Rate of substance use during the commission of selected violent acts against women, 1996
Homicide/attempted homicide Abuse
Victims (N=456) % Perpetrators (N=456) % Victims (N=427) % Perpetrators (N=427) %
Note: N=population.
Source: Phyllis Sharps, Jacquelyn C. Campbell, Doris Campbell, Faye Gary, and Daniel Wester, "Table 2. Substance Use During the Killing or Attempted Killing of Women or the Worst Violent Incident," in "Risky Mix: Drinking, Drug Use, and Homicide," National Institute of Justice Journal, no. 250, November 2003, http://www.ncjrs.gov/pdffiles1/jr000250d.pdf (accessed July 2006)
Substance use
Alcohol14.631.38.921
Drugs3.312.61.6 6.7
Both4.726.20.9 5.8
None77.429.988.565.8

DOES PREGNANCY EXACERBATE DOMESTIC VIOLENCE?

Research about intimate partner violence reveals that violence does not stop when women become pregnant. The Division of Reproductive Health at the Centers for Disease Control and Prevention (CDC) gathers data about the health of expectant mothers using its Pregnancy Risk Assessment Monitoring System (PRAMS). An analysis of PRAMS data reveals that between 2.9% to 5.7% of women report being abused by their husbands or partners in the year before they gave birth. Jana L. Jasinski states in "Pregnancy and Domestic Violence: A Review of the Literature" (Trauma, Violence, and Abuse, January 2004) that this estimate is too low because PRAMS asks limited questions about domestic violence and asks about abuse rather than about particular behaviors. Still, she argues, pregnancy does not appear to increase the risk of domestic violence, although more research into this question is needed.

Studies estimating higher rates of abuse of pregnant women—as many as 324,000 women per year and rates as high as 20% of pregnant women—have been reported (Julie Gazmararian et al., "Prevalence of Violence against Pregnant Women," International Journal of Gynecology and Obstetrics, December 1996; and Julie Gazmararian et al., "Violence and Reproductive Health: Current Knowledge and Future Research Directions," Maternal and Child Health Journal, June 2000). According to Gazmararian et al. in "Prevalence of Violence against Pregnant Women," higher abuse rates were reported later in pregnancy, with 7.4% to 20% of that violence occurring in the third trimester. The lowest rates were reported in a study of women with a higher socioeconomic status who were treated in a private clinic. The assailants were mainly intimate or former intimate partners, parents, or other family members. Two studies that also examined violence in the period after birth found that violence was more prevalent after birth than during pregnancy.

Jasinski suggests that violence directed toward pregnant women is usually part of an ongoing pattern of domestic violence. Some factors, however, do seem to increase the risk of violence for pregnant women. In "Prevalence of Violence against Pregnant Women," Gazmararian et al. find that women with unwanted pregnancies had 4.1 times the risk of experiencing physical violence by a husband or boyfriend during the months before delivery than did women with desired pregnancies. Loraine Bacchus, Gill Mezey, and Susan Bewley, in "A Qualitative Exploration of the Nature of Domestic Violence in Pregnancy" (Violence against Women, June 2006), find that abuse of pregnant women centered around financial worries, the woman's inability to be as physically and emotionally available during pregnancy, the lack of support of a male partner, and doubts about paternity. In "Police-Reported Intimate Partner Violence during Pregnancy: Who Is at Risk?" (Violence and Victims, February 2005), Sherry Lipsky et al. find that certain factors put pregnant women at risk for police-reported intimate partner violence, including unmarried status, public health program use, smoking or alcohol use while pregnant, and having previously been pregnant or given birth.

EXPERIENCING VIOLENCE AS A CHILD

Research demonstrates a relationship between having been a victim of violence and becoming violent in future relationships. In fact, a 1996 report prepared by the American Psychological Association Task Force on Violence and the Family concluded that children's exposure to their father abusing their mother is the single strongest risk factor for passing violence down from one generation to the next. Shelby A. Kaura and Craig M. Allen find in "Power and Dating Violence Perpetration by Men and Women" (Journal of Interpersonal Violence, May 2004), a study of 352 male and 296 female undergraduate college students, that witnessing parental violence was the strongest predictor of perpetrating dating violence.

According to Erika L. Lichte and Laura A. McCloskey, in "The Effects of Childhood Exposure to Marital Violence on Adolescent Gender-Role Beliefs and Dating Violence" (Psychology of Women Quarterly, December 2004), adolescents who were exposed to domestic violence during their childhoods were in fact more likely to justify being violent in dating relationships. However, Lichte and McCloskey find that even more important in predicting dating violence was an adolescent's belief in traditional models of male-female relationships and the belief that violence was sometimes justified.

Along this line, Straus cautions against jumping to the conclusion that once violence occurs in a family it will inevitably or automatically be transmitted to the next generation. Not all men who grow up in violent families end up abusing their spouses, and not all abused children or abused wives will abuse others. Conversely, some violent individuals grow up in nonviolent families.

Dating Violence in Adolescence

Dating violence encompasses physical, sexual, or psychological violence in a dating relationship. Experiencing dating violence puts victims at a greater risk for engaging in risky sexual behavior, anorexia or bulimia, substance abuse, and suicide. It can also be an indicator that a person is at risk for victimization in intimate relationships in adulthood. The CDC's Youth Risk Behavior Surveillance system surveyed students in grades nine to twelve on their experience of dating violence. Students were asked: "During the past twelve months, did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose?" Almost one out of ten students answered yes. Experience of dating violence was similar for male teens (8.9%) and female teens (8.8%). It was higher for African-Americans (13.9%) than for whites (7%) or Hispanics (9.3%). (See Table 7.4.)

AGE AND DOMESTIC VIOLENCE

Intimate Partner Violence Declines with Increasing Age

Jill Suitor, Karl Pillemer, and Murray A. Straus, in "Marital Violence in a Life Course Perspective" (Murray A. Straus and Richard J. Gelles, eds., Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families, 1990), find that both marital conflict and verbal aggression consistently decline with age over every ten-year period. Analysis of the 1975 National Family Violence Survey and 1985 National Family Violence Resurvey data reveals that the rate of violence in the age eighteen- to twenty-nine-year-old group dropped when its members entered the age thirty- to thirty-nine-year-old group. The rate dropped even further when the older group became the age forty- to forty-nine-year-old group. The consistent decline applied to both men and women in all age groups between ages eighteen and sixty-five.

Suitor, Pillemer, and Straus conclude that marital conflict and verbal aggression decrease with age. They considered several different possible explanations for this observation, including greater pressure to conform (perhaps because of a greater stake in society), the greater cost of deviating from accepted patterns—having "more to lose"—and greater expectations.

TABLE 7.4
Prevalence of physical dating violence among high school students by sex and by selected characteristics, 2003
Characteristic Total Male Female
%%%
Note: Victimization is defined as a response of "yes" to a single question: "During the past 12 months, did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose?"
*Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
Source: "Table 1. Prevalence of Physical Dating Violence Victimization among High School Students, by Sex and Selected Characteristics—United States, 2003," in "Physical Dating Violence among High School Students—United States, 2003," MMWR Weekly, vol. 55, no. 19, May 19, 2006, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5519a3.htm (accessed August 4, 2006)
Overall 8.9 8.9 8.8
Grade level
 98.17.88.6
108.89.38.2
118.17.98.2
1210.110.110.2
Race/ethnicity
White, non-Hispanic7.06.67.5
Black, non-Hispanic13.913.714.0
Hispanic9.39.29.2
Geographic region*
Northeast10.610.810.4
Midwest7.58.36.5
South9.69.39.9
West6.96.17.8
Self-reported grades
Mostly A's6.16.65.7
Mostly B's7.77.48.0
Mostly C's11.210.412.3
Mostly D's or F's13.713.014.9

Subsequent studies confirm that intimate partner violence declines with advancing age. Analyzing National Crime Victimization Survey data, Callie Marie Rennison, in Intimate Partner Violence and Age of Victim, 1993–99 (October 2001, http://www.ojp.usdoj.gov/bjs/pub/pdf/ipva99.pdf), finds married women ages twenty to twenty-four had eight victimizations per one thousand women, compared with just one per one thousand among married women age fifty or older. In "Nonlethal Intimate Partner Violence against Women: A Comparison of Three Age Cohorts" (Violence against Women, December 2003), Callie Marie Rennison and Michael Rand also find lower rates of intimate partner violence in women over age fifty-four in their study. They believe lower rates might be because of several factors, such as homicides of younger women, earlier divorces from abusive partners, or the turning of older perpetrators to other forms of victimization, such as psychological abuse or economic domination.

Effects of Abuse among Older Adults

In "The Nature and Impact of Domestic Violence across Age Cohorts" (Affilia, Fall 2005), a study of the nature and extent of domestic violence among women of different age groups, Dina J. Wilke and Linda Vinton find that there were no differences among abused women of different ages in the severity of the abuse, the kind of injuries received, substance abuse at the time of the incidents, the likelihood that women would report the violence, or the rates of childhood abuse or depression. However, older women, on average, had endured abuse for a longer time. They were also more likely to currently be in violent relationships and to have health and mental health problems than were younger women.

SIGNS OF POTENTIAL VIOLENCE

Can a woman expect to see certain signs of potential violence in a man she is dating or living with before she becomes a victim of abuse? Some researchers focus on risk markers, which may indicate an increased propensity for violence. These include:

  • An unemployed male
  • A male who uses illegal drugs
  • Males and females with different religious backgrounds
  • A male who saw his father hit his mother
  • Male and female unmarried cohabitants
  • Males with blue-collar occupations
  • Males who did not graduate from high school
  • Males between eighteen and thirty years of age
  • Males or females who use severe violence toward children in the home
  • Total family income below the poverty level

In "Men Who Batter: The Risk-Markers" (Violence Update, 1994), Richard Gelles, Regina Lackner, and Glen Wolfner find that in families where two risk markers are present, there is twice as much violence as those with none. In homes with seven or more of those factors, the violence rate is a staggering forty times higher.

A separate analysis by Gerald T. Hotaling and David B. Sugarman surveys risk markers present in more than four hundred studies. In "A Risk Marker Analysis of Assaulted Wives" (Journal of Family Violence, March 1990) and in "Prevention of Wife Assault" (Robert T. Ammerman and Michel Hersen, eds., Treatment of Family Violence, 1990), Hotaling and Sugarman use the analysis of risk markers to test the theory that there is a continuum (progression) of aggression in husband-to-wife violence that is linked to some of the risk markers. The risk markers considered were marital conflict, depressive symptoms, alcohol use, attitude toward interpersonal violence, violence in the family in which the individuals grew up, nonfamily violence level, and socioeconomic status. Hotaling and Sugarman find that an increase in the severity of husband-to-wife violence is associated with an increase in depressive symptoms in the husband, along with his greater acceptance of marital violence and a higher likelihood that he experienced and witnessed violence in his family as a child. In addition, greater alcohol use and higher levels of nonfamily violence by the couple are linked to more severe violence.

Hotaling and Sugarman's conclusions are consistent with other research: people who engage in minor violence do not necessarily progress to severe violence, but those who use severe violence almost always began with minor violence. The most important implication of this finding is that early intervention (at the stage of minor abuse) may prevent more severe abuse. Most treatment programs are only initiated after a woman has suffered severe battering. Prevention programs that emphasize the importance of seeking treatment for low-level abuse before it escalates to serious violence might encourage women to escape abuse before it claims their health or their lives.

In "The Utility of Male Domestic Violence Offender Typologies: New Directions for Research, Policy, and Practice" (Journal of Interpersonal Violence, February 2005), Mary M. Cavanaugh and Richard J. Gelles review the literature on battering and identify three types of batterers: a low, moderate, and high-risk offender. Cavanaugh and Gelles find that most male batterers do not escalate over time from low to high levels of risk.

Jacquelyn C. Campbell et al., in "Assessing Risk Factors for Intimate Partner Homicide" (National Institute of Justice Journal, November 2003), evaluate the risk factors among abused women for being killed by their intimate partners. Campbell et al. find that abused women whose abusers owned guns and who had threatened to kill them were at a high risk of being killed by their intimate partners. (See Figure 7.1.) Other high-risk factors for homicide include extreme jealousy, attempts to choke, and marital rape. Campbell et al. hope that the "danger assessment" tool they use may assist women and advocates for battered women to better assess the level of risk in abusive relationships.

WHY DOES SHE STAY?

Why don't battered women leave? This question does not have a single answer but, rather, many answers. Even the question has many connotations. For battered women, the question is not uniformly "How can I leave him?" but "How can I get the violence to stop?" or "How can I get my relationship to be happy and fulfilling?" For women who want to leave, the question may become "Can I support myself and the children bymyself?" "How can I escape?" "Will he kill me if I try?" or "How will my children fare without a father?" For clinicians working with battered women, the question might be "How can she make any decisions when she is so emotionally traumatized?"

—Ola W. Barnett, "Why Battered Women Do Not Leave, Part 1" (Trauma, Violence, and Abuse, October 2000)

One of the most frequently asked questions about abused women is: Why do they stay? Some authors and advocates argue that the relevant questions for battered women themselves are different. They believe that the very question implies there is something wrong with the woman for staying, rather than placing the blame where it belongs: on the batterer. Better questions, Ola W. Barnett argues, might be: "Why does he beat her?" or "Why does society let him get away with it?" or "What can be done to stop him?"

However, not all women stay in abusive relationships. Many leave abusive relationships and situations without turning to the police or support organizations. While their number is unknown, most women who leave without asking for help usually have strong personal support systems of friends and family or employment and earnings that enable them to live economically independent of their abusive partners. Yet, there can be little question that a large percentage of women remain with their abusers. There are as many reasons women stay as there are consequences and outcomes of abusive relationships.

Women's Reasons to Stay

Women stay in abusive relationships for a variety of reasons. A major reason women stay is their economic dependency on their batterers. Many women feel they are better off with a violent husband than facing the challenge of raising children on their own. Some harbor deep feelings for their abusive partners and believe that over time they can change their partner's behavior. Others mistakenly interpret their abuser's efforts to control their life as expressions of love. Some frequently reported practical considerations include:

  • Most women have at least one dependent child who must be cared for.
  • Many are unemployed.
  • Their parents are either distant, unable, or unwilling to help.
  • The women may fear losing mutual friends and the support of family, especially in-laws.
  • Many have no property that is solely their own.
  • Some lack access to cash, credit, or any financial resources.
  • If the woman leaves, then she risks being charged with desertion and losing her children and joint assets.
  • She may face a decline in living standards for herself and her children, and the children, especially older ones, may resent this reduced living standard.
  • The woman and/or children may be in poor health.
  • The abuser may have threatened or harmed her pets, as noted by Catherine A. Faver and Elizabeth B. Strand in "To Leave or to Stay? Battered Women's Concern for Vulnerable Pets" (Journal of Interpersonal Violence, December 2003).

Some battered women hold values and beliefs that experts term traditional ideology. These patriarchal beliefs, often reinforced by clergy, mental health professionals, and physicians, tend to normalize violence against women. This ideology may include:

  • A belief that divorce is not a viable alternative and that marriage is a permanent commitment
  • A belief that having both a mother and father is crucial for children
  • An emotional dependence on her husband, and a feeling she needs someone to take care of her
  • Feelings of helplessness and a belief that she is dependent on a man and unable to take the initiative to escape her situation
  • A belief that a "successful marriage" depends on her, leading her to assume responsibility or to blame herself for the abuse
  • Feelings of low self-esteem and self-worth
  • The rationalization that her situation is caused by heavy stress, alcohol, problems at work, or unemployment
  • A cycle of abuse that includes periods when her husband is exceedingly romantic, leading her to believe that she still loves him or that he is basically good
  • A feeling of isolation from friends and family that may have been forced on her by a jealous and possessive husband who does not allow her any freedom

Some social isolation may be self-imposed by a woman who is ashamed and neither wishes to admit that the person she loves is an abuser, nor wants visible signs of beating to be seen by friends or family.

In her article "'We Don't Have Time for Social Change': Cultural Compromise and the Battered Woman Syndrome" (Gender and Society, October 2003), Bess Rothenberg argues that women are victimized and coerced into staying in violent relationships by a combination of different forces. According to Rothenberg, women are victimized first and foremost by violent abusers; second, by a society that sanctions the right of men to hit women and socializes women into staying in abusive relationships; third, by representatives of institutions who are in a position to help but who instead ignore the plight of battered women (for example, doctors, police, the criminal justice system, clergy, and therapists); and fourth, by the everyday realities of being a woman in a patriarchal system that expects women to raise children and denies them access to education, job skills, and good employment.

Similarly, April L. Few and Karen H. Rosen, in "Victims of Chronic Dating Violence: How Women's Vulnerabilities Link to Their Decisions to Stay" (Family Relations, April 2005), examine why women stay in abusive dating relationships and describe a combination of "relational" and "situational" vulnerabilities that work together to influence a woman's decision to stay. They define relational vulnerabilities as one's beliefs about what behaviors and interactions are normal in an intimate relationship. Situational vulnerabilities refer to the degree to which a woman was experiencing stress at the beginning of the abusive relationship (either as a consequence of life changes or as a consequence of feeling like one is getting too old for marriage or parenthood). Few and Rosen find that an accumulation of vulnerabilities, combined with lacking protective factors such as high self-esteem, a social support system, and healthy coping skills, made it more likely a woman would stay in a chronically abusive dating relationship.

The Role of Self-Blame

Some researchers find that battered women often hold distorted beliefs and perceptions that tend to keep them in abusive relationships. Some women blame themselves for the violence; they believe that they cause the abuse and that they should be able to prevent it by changing their behavior. Others see the abuse as normal and rationalize the violence as "not that bad."

Ola W. Barnett, Tomas E. Martinez, and Mae Keyson, in "The Relationship between Violence, Social Support, and Self-Blame in Battered Women" (Journal of Interpersonal Violence, June 1996), find that battered women have higher levels of self-blame and perceive less availability of social support than women who are not battered. They also found that women who return to abusive relationships have higher levels of self-blame than women who permanently leave their abusers.

Escalating levels of violence in a relationship often lead to greater use of violence by the woman as a means of self-defense or retaliation. This can result in still more self-blame, because the woman feels she is at fault for the violence. It also may deter her from seeking help and prompt her to believe no help is available. External sources of support may be less inclined to help a woman who presents the problem as her fault; as a result, the self-blaming woman may receive less assistance from health and social service agencies and organizations. To break this vicious cycle requires counselors or advisers who can help the woman shift the blame to her abusive mate. In fact, some researchers, such as Kate Cavanagh in "Understanding Women's Responses to Domestic Violence" (Qualitative Social Work, September 2003), suggest that while women may blame themselves when the abuse begins, as the frequency and severity of violence increases, they do eventually begin to assign the blame to the perpetrators.

The Role of Fear

Many women fear that attempting to end an abusive relationship will lead to even worse violence. Research has shown that this fear of reprisal is well founded. As Lenore E. Walker explains in Terrifying Love: Why Battered Women Kill and How Society Responds (1989), batterers often panic when they think women are going to end the relationship. In the personal stories women told Walker, they repeatedly related that after calling the police or asking for a divorce, their partners' violence escalated.

Walker observes that in an abusive relationship it is often the man who is desperately dependent on the relationship. Battered women are likely to feel that the batterers' sanity and emotional stability is their responsibility—that they are their men's only link to the normal world. Walker alleges that almost 10% of abandoned batterers committed suicide when their women left them.

It appears, however, that more batterers become homicidal than suicidal. Angela Browne, in "When Battered Women Kill," and Kirk Williams, in "Resource Availability for Women at Risk and Partner Homicide" (both published in Law and Society Review, 1989), find that more than 50% of all female homicide victims were murdered by former abusive male partners. Barnett emphasizes that evidence consistently demonstrates that after women leave abusive partners they often continue to be assaulted, stalked, and threatened and that leaving provokes some batterers to kill their partners. In "How Can Practitioners Help an Abused Woman Lower Her Risk of Death?" (National Institute of Justice Journal, November 2003), Carolyn Rebecca Block concurs that an attempt to leave can escalate domestic violence. She finds that 45% of homicides of a woman by a man were in response to women trying to leave abusive partners.

The Battered Woman Syndrome

In The Battered Woman (New York; Harper & Row, 1979), Lenore E. Walker claims that abused women suffer from a constellation of symptoms—"the battered woman syndrome"—that keeps them from leaving abusive partners. As part of her book, Walker argues that a psychological condition known as learned helplessness plays a significant role in keeping women in abusive relationships. While Walker recognizes, as do other multiple-victimization theorists, that women are victims of a patriarchal society and institutions that fail to advocate for abused women, she emphasizes the psychological problems women develop in response to abuse.

The concept of learned helplessness was discovered by researcher Martin E. P. Seligman. In Helplessness: On Depression, Development and Death (1975), Seligman describes how he conducted an experiment in which he taught dogs to fear the sound of a bell. He did so by restraining a dog, ringing the bell, and then subjecting the dog to a painful (but not dangerous) shock. This process was repeated many times.

Next, to test the effectiveness of the training, Seligman placed the dog in a cage with a floor that could be electrified. One wall of the cage was low enough that the dog could jump over it if it wished. Seligman then rang the bell and administered shocks through the floor. He expected that the dog would jump out of the cage. However, most of the dogs did not. Seligman theorized this was because their earlier experience, where they had been shocked with no possibility of escape, had taught them that they were helpless.

Seligman called this learned helplessness. He and other psychologists theorize that it also occurs in humans, with similar effects. In The Battered Woman Walker contends that battered women have learned through their life experiences that they are helpless to escape or avoid violence. These battered women are conditioned to believe that they cannot predict their safety and that nothing can be done to fundamentally change their situations. They become passive, submissive, depressed, overwhelmingly fearful, and psychologically paralyzed. Walker emphasizes that although they do not respond with total helplessness, they narrow their choices, choosing the ones that seem to have the greatest likelihood of success.

Based on her research, much of which focused on severely abused women who killed their husbands, Walker identifies five factors in childhood and seven factors in adulthood that contribute to learned helplessness. The childhood factors include physical or sexual abuse, the learning of traditional sex roles, health problems, and episodes during childhood when a child loses control of events, such as in frequent moves or the death of a family member. Adult factors include patterns of physical and sexual abuse, jealousy and threats of death from a batterer, psychological torture, seeing other abuse committed by the batterer, and drug or alcohol abuse by either partner.

In "The Battered Woman Syndrome Is a Psychological Consequence of Abuse" in Current Controversies on Family Violence, Walker claims that battered woman syndrome is common among severely abused women and that it is part of the recognized pattern of psychological symptoms called posttraumatic stress disorder (PTSD). Normally, fear and the responses to fear abate once the feared object or circumstance is removed. People who have suffered a traumatic event, however, often continue to respond to the fear with flashbacks and violent thoughts long after the event has passed. Symptoms of PTSD may include difficulty in thinking clearly and a pessimistic outlook, memory distortions, intrusive memories, sleep and eating disorders, and medical problems associated with persistent high levels of stress. Over time, the more aggressive symptoms diminish and are replaced by more passive, constrictive symptoms, making the affected women appear helpless. The abused woman's outlook often improves, however, when she regains some degree of power and control in her life.

Women Are Not Helpless

Beginning in the 1980s a number of critics emerged who argued that the emphasis on psychological problems of abuse victims was an inadequate explanation of domestic violence. Lee H. Bowker argues in "A Battered Woman's Problems Are Social, Not Psychological" in Current Controversies on Family Violence that women remain trapped in violent marriages because of conditions in the social system rather than because they suffer from psychological problems. According to Bowker, battered women are not as passive as they are portrayed in abuse literature and routinely take steps to make their lives safer or to escape abuse. Bowker views husbands' unwillingness to stop being dominant and a lack of support from traditional social institutions as the factors that delay battered women in escaping from abuse.

To support these findings, Bowker analyzes survey questionnaires completed by one thousand women and finds that women used several major strategies to end abuse. They tried to extract promises from their partners that the battering would stop, threatened to call police or file for divorce, avoided their partners or certain topics of conversation, hid or ran away, tried to talk the men out of violent behavior, covered their bodies to deflect the blows, and, in some cases, tried to hit back. Of these strategies, extracting a promise to change helped most often (54% of the time), whereas self-defense proved the least effective strategy.

Because the effectiveness of these strategies was limited, most women turned to outside sources for help. First, they contacted family or friends. However, for most women, family and friends did not help stop the violence. Generally, these women then turned to organized or institutional sources of aid, such as police, physicians, clergy, lawyers, counselors, women's groups, and shelters. Calling a lawyer or prosecutor proved the most effective way to end the battering, followed by seeking assistance from women's groups and social service agencies offering referral to shelters or counselors.

Bowker does not find that loss of self-esteem inevitably paralyzes women, leading them to remain in abusive relationships. While battered women do lose self-esteem for a time, many still escape from their abusers. This suggests that when all seems hopeless, an innate need to save themselves propels abused women to escape from their situations. Bowker theorizes that the reason women's groups and shelters are effective is that they counter the effects of abuse by supporting personal growth and nurturing the women's strength.

Bowker concludes that because women recover from their feelings of helplessness as they gain strength, battered woman syndrome symptoms are fundamentally different from the long-lasting symptoms that characterize most psychiatric disorders. In Bowker's interpretation, battered woman syndrome refers to the social, economic, psychological, and physical circumstances that keep women in abusive relationships for long periods. The abusive relationship engenders feelings of learned helplessness that are difficult to escape. Conditioned by their batterers to feel helpless, some women have not yet learned how to resist this type of brainwashing and how to compel their abusers to retreat without having to leave or kill the batterer.

External Barriers to Leaving

Barnett argues that battered women face many obstacles to leaving abusive relationships. She states that many of these barriers are external—in other words, not because of an individual or psychological problem with the abused woman. Barnett outlines many external obstacles to an abused woman's quest to leave her partner, including:

  • The patriarchal structure of society—When men control all of a family's resources, women may be economically powerless.
  • Problems with the criminal justice system—The U.S. criminal justice system is underfunded and tends not to enforce legislation prohibiting the abuse of women. The lack of adequate funding keeps battered women from getting legal assistance. Police decisions to arrest or not arrest batterers tend to be inconsistent; when police do not arrest, it impedes women's attempts to leave and leaves them vulnerable to further abuse. Barnett notes that only one-quarter of batterers are arrested, about one-third of those arrested are prosecuted, and only 1% of those prosecuted serve jail time beyond the time served at arrest. Orders of protection are ineffective because most judges will not enforce them.
  • Child custody and visitation—Women fear losing their children if they report intimate partner violence. A report of domestic violence can trigger an investigation by child protective services. When women do retain custody of their children, judges usually do not take intimate partner violence into account when writing visitation orders. Court-ordered visitation is often used by abusers as an opportunity for further battering.

Internal and Psychological Barriers to Leaving

In "Why Battered Women Do Not Leave, Part 2" (Trauma, Violence, and Abuse, January 2001), Ola W. Barnett outlines several internalized socialization beliefs—normal, learned beliefs about how society and relationships work—as well as psychological factors induced by trauma that serve as obstacles to battered women leaving their abusers. Barnett emphasizes that many of these beliefs are detrimental to all women—but battered women are particularly vulnerable. Among them are:

  • Gender-role socialization—Society values male traits more than female traits and often devalues female gender roles. As girls age into adolescents, they begin to lose self-confidence as they turn to romantic relationships for a sense of self-worth. When an adult woman values her ability to form a relationship with a male partner over other characteristics, losing the relationship may seem worse than staying and enduring the abuse.
  • Distorted beliefs and perceptions—As previously mentioned, battered women tend to hold some distorted beliefs that keep them in abusive relationships. Common distorted thought patterns among battered women include a belief that violence is commonplace and not abusive, a belief that they caused the abuse, a lack of recognition that children are harmed more by witnessing intimate partner violence than by living with a single parent, and a belief that they can and should help the abuser to change.
  • PTSD—This is a prolonged psychological reaction to a traumatic event. The level of psychological distress abused women experience can keep them from being able to escape the violence.
  • Impaired problem-solving abilities—Many factors can impede the problem-solving abilities of battered women, including postconcussion syndrome resulting from head injuries and the cognitive distortions of PTSD.
  • Prior victimization effects—Women who have been abused during their childhoods have an increased risk of becoming involved with an abusive intimate partner in adulthood. This may be because these women have difficulty judging how trustworthy people are, or they hold a distorted belief that they cannot escape violence.

WHAT CAN A WOMAN DO?

Cavanagh gathered qualitative data from interviews with the female partners of violent men to illustrate that battered women try to end the violence in their relationships in many ways, even if they stay—complicating the notion of the battered woman as passive and helpless. She finds that women worked to stop the violence by talking with their partners about the violence, developing strategies for avoiding the violence (for example, being affectionate or feigning agreement with the abuser), challenging the violence (for example, fighting back, verbally or physically), telling other people about the violence, and leaving (usually temporarily) the relationship. Cavanagh argues that abused women almost always actively fight the abuse: "At some points in time the struggle to change took second place to the struggle to survive but not even women subjected to the extremes of abuse totally 'gave up.'"

Avoidance

For their landmark book Intimate Violence (1988), Richard J. Gelles and Murray A. Straus interviewed 192 women who suffered minor violence and 140 who suffered severe violence, and asked which long-range strategies they used to avoid violence. Fifty-three percent of the minor-violence victims and 69% of the severe-violence victims learned to avoid issues they thought would anger their partners. Others learned to read a change in their partners' facial expressions as one of the first signs of impending abuse. "I have learned what gets him mad. I also know just by looking at him, when he gets that kind of weird, screwed-up expression on his face, that he is getting ready to be mad. Most of the time I figure I just have to walk on eggshells," one woman said. Avoidance worked for about 68% of those women who suffered minor abuse, but this tactic was successful for less than one-third of the more severely abused victims.

Leaving

Some battered women do leave their husbands. Straus and Gelles find that 70% had left their spouses in the year preceding the interview. Only about half of those who left, however, reported that this was a "very effective" method of ending the abuse. In fact, for one out of eight women it only made things worse. Batterers put incredible pressure on their partners to return. Often, when the women returned they were abused more severely than before—as revenge or because the men learned that, once again, they could get away with this behavior. Women who returned also risked losing the aid of personal and public support systems, because these people perceived that their help or advice was useless or ignored.

Just Say "No"

Many researchers believe that there is real truth to the statement that men abuse because they can. A wife who will not permit herself to be beaten from the first act of minor abuse, such as a slap or push, is the most successful in stopping it. Straus and Gelles find that simply eliciting a promise to stop was by far the most effective strategy women could undertake—especially in cases of minor violence. Threatening to divorce or leave the home worked in about 40% of the minor-abuse cases, but this strategy worked in less than 5% of the severe-abuse situations. Physically fighting back was the most unsuccessful method. It worked in fewer than 2% of the minor-abuse cases and in less than 1% of the severe-abuse cases.

HEALTH EFFECTS OF DOMESTIC VIOLENCE

There are often urgent and long-term physical and health consequences of domestic violence. Short-term physical consequences include mild to moderate injuries, such as broken bones, bruises, and cuts. More serious medical problems include sexually transmitted diseases, miscarriages, premature labor, and injury to unborn children, as well as damage to the central nervous system sustained as a result of blows to the head, including traumatic brain injuries, chronic headaches, and loss of vision and hearing. The medical consequences of abuse are often unreported or underreported because women are reluctant to disclose abuse as the cause of their injuries, and health professionals are uncomfortable inquiring about it. In fact, in "Violence against Women" (Dawn Misra, ed., The Women's Health Data Book, December 2001, http://www.kff.org/womenshealth/6004-index.cfm), Nancy Berglas and Dawn Misra find that while more than half of abused women are physically injured by their abusers, only four out of ten seek professional medical care.

Abused women are also at risk for health problems not directly caused by the abuse. In "Intimate Partner Violence and Physical Health Consequences" (Archives of Internal Medicine, May 2002), Jacquelyn Campbell et al. compare the physical health problems of abused women to a control group of women who had never suffered abuse. Campbell et al. find that abused women suffered from 50% to 70% more gynecological, central nervous system, and stress-related problems. Examples of stress-related problems included chronic fear, headaches, back pain, gastrointestinal disorders, appetite loss, and increased incidence of such viral infections as colds. Although women who most recently suffered physical abuse reported the most health problems, Campbell et al. find evidence that abused women remain less healthy over time.

Hospitalization of Battered Women

The hospital emergency department is often the first contact the health care system has with battered women and offers the first opportunity to identify victims, refer them to support services and safe shelters, and otherwise intervene to improve their situations.

In "Rates and Relative Risk of Hospital Admission among Women in Violent Intimate Partner Relationships" (American Journal of Public Health, September 2000), Mary A. Kernic, Marsha E. Wolf, and Victoria L. Holt report on hospitals and battered women. They find that women who had filed for protection orders against male intimate partners had an overall increased risk for earlier hospitalization than women who had not been abused. Abused women had a 50% increase in hospitalization rates for any diagnosis, compared with nonabused women, and the risk of hospitalization was highest in the younger age groups of abused women. Abused women were hospitalized much more frequently for injuries resulting from assaults, suicide attempts, poisonings, and digestive system disorders than the nonabused women and were almost four times as likely to be hospitalized with a psychiatric diagnosis. Kernic, Wolf, and Holt reaffirm the observation that intimate partner violence has a significant impact on women's health and their utilization of health care services.

WHEN WOMEN KILL THEIR PARTNERS

According to the Federal Bureau of Investigation's Crime in the United States, 2004: Uniform Crime Reports (2005, http://www.fbi.gov/ucr/cius_04/documents/CIUS2004.pdf), in 2004, 7.1% of all known murder offenders were female. Their victims were often their spouses or intimate partners. A 1994 U.S. Department of Justice study on "murder in families" analyzed ten thousand cases and determined that women made up more than 41% of those charged in familial murders, but only 10.5% of those charged with murder overall. In 2004, 1,159 women and 385 men were killed by an intimate partner. (See Table 6.11 in Chapter 6.) CDC researchers also report in Morbidity and Mortality Weekly Report Surveillance Summaries (October 12, 2001, http://iier.isciii.es/mmwr/PDF/ss/ss5003.pdf) that the risk of intimate partner homicide increases with population size—rates in metropolitan areas with more than 250,000 people are two to three times higher than rates in cities with fewer than ten thousand residents.

Figure 6.3 in Chapter 6 shows that the number of males killed by intimate partners dropped substantially (by 71%) between 1976 and 2004. Researchers and advocates for battered women attribute this dramatic decline to the widespread availability of support services for women, including shelters, crisis counseling, hotlines, and legal measures such as protection and restraining orders. These services offer abused women options for escaping violence and abuse other than taking their partners' lives. Other factors that may have contributed to the decline are the increased ease of obtaining divorce and the generally improved economic conditions for women.

Spousal Murder Defendants

In the report Spouse Murder Defendants in Large Urban Counties (September 1995, http://www.ojp.usdoj.gov/bjs/pub/pdf/spousmur.pdf), Patrick A. Langan and John M. Dawson report on their examination and analysis of 540 spouse homicide cases in the nation's seventy-five largest counties—59% of the killers were husbands and 41% were wives. Even though Langan and Dawson analyzed data from crimes and court decisions that took place more than a decade ago, they explain that "the Bureau of Justice Statistics knows from long experience with surveying courts that changes in case processing are quite gradual. The report's results are therefore likely to be applicable today."

In 44% of wife defendant cases there was evidence that the wife had acted in response to a violent attack from her husband at the time of the killing. In contrast, just 10% of the husbands claimed that their victims had assaulted them at the time of the murder. Female spouses in this study were more likely to be acquitted than were male spouses (31% versus 6%). According to the Bureau of Justice Statistics (October 1995, http://www.ojp.usdoj.gov/bjs/pub/pdf/spousfac.pdf), Langan observes that "in many instances in which wives were charged with killing their husbands, the husbands had assaulted the wife, and the wife then killed in self-defense."

In fact, with strong legal defense and detailed documentation of abuse, many women are able to successfully argue that after suffering years of mental and/or physical abuse at the hands of their abusers, they suffer from battered woman syndrome and killed in self-defense. Battered woman syndrome has become a recognized defense in courtrooms throughout the country. At least some scholars, however, advocate relying on evidence of "battering and its effects" rather than on testimony of a "syndrome" that reduces the issues facing battered women to a psychological problem and does not fit every victim's circumstances. Kathleen J. Ferraro explores this issue in "The Words Change, but the Melody Lingers: The Persistence of the Battered Woman Syndrome in Criminal Cases Involving Battered Women" (Violence against Women, January 2003).

Factors That Influence the Murder of Husbands by Wives

In When Battered Women Kill (1987), one of the first studies of wives who murdered their abusive partners, Angela Browne compares forty-two women charged with murdering or seriously injuring their spouses with 205 abused women who had not killed their husbands. Wondering why some women were unable to see that their partners were dangerously violent, she finds that some of the personal characteristics of men inclined to violent, abusive behavior were the same qualities that initially attracted the women to them. For example, a woman might initially perceive a man who always wanted to know where she had been as intensely romantic. Only later, when she was unable to act or move without her partner's supervision, might she realize that she had become a virtual prisoner of her controlling mate.

Browne's findings suggest a link between homicide potential and three things: marital rape, murder and suicide threats, and drug use. In her study, more than 75% of women who had committed homicide claimed they were forced to have sexual intercourse with their husbands, compared with 59% in the group of women who had not killed their husbands. Some 39% of the former group had been raped more than twenty times, compared with 13% of the latter group. One woman Browne interviewed said, "It was as though he wanted to annihilate me …; as though he wanted to tear me apart from the inside out and simply leave nothing there."

In addition, men murdered by their spouses had often threatened to kill their partners. In Browne's study 83% of the men killed by their wives had threatened to kill someone, compared with 59% of the men whose wives did not kill them. Men killed by their wives had used guns to frighten their spouses and were sometimes killed with their own weapons. Nearly two-thirds (61%) of this group also threatened to kill themselves. Many of the threats were made when women tried to leave the relationship or when the men were depressed. Browne questioned whether the suicide threats were genuine expressions of wishes to die or whether they were used to manipulate the women in efforts to make them feel guilty and prevent them from leaving.

When Browne compared abused women who had murdered their spouses and women who had not, she found that in the homicide group, 29% of the men had used drugs daily or almost daily versus only 7.5% of the men in the other group. There were even sharper differences in reported alcohol use. Twice as many (80%) of the men killed by their wives were reportedly drunk every day, compared with 40% of the abusive men not killed by their spouses.

Legal Defense

In legal cases involving battered women who kill their abusers, the defendants often admit to the murder and reveal a history of physical abuse. The charge is usually first- or second-degree murder, which is murder with malicious intent either with or without premeditation. The outcome of these trials depends on three main issues: self-defense, equal force, and imminent versus immediate danger (all three of which are explained in detail below). Expert witnesses are crucial in an abused woman's trial to explain how these issues are different for cases involving battered women than for other homicide cases.

SELF-DEFENSE

Women often plead that they killed in self-defense, a plea that requires proof that the woman used such force as was necessary to avoid imminent bodily harm. Self-defense was originally intended to cover unexpected attacks by strangers and did not take into account a past history of abuse or a woman's fear of renewed violence. Traditionally applied, a self-defense plea does not exonerate a woman who kills during a lull in the violence, for example, when the drunken abuser passes out.

Many observers feel that self-defense law is problematic, inadequate, and/or not appropriate for use in self-defense cases of battered women, according to Diane Follingstad et al. in "The Impact of Elements of Self-Defense and Objective versus Subjective Instructions on Jurors' Verdicts for Battered Women Defendants" (Journal of Interpersonal Violence, October 1997). Traditionally, self-defense permits an individual to use physical force when he or she reasonably believes it is necessary to counteract imminent or immediate danger of serious bodily harm. Furthermore, a person must use only a reasonable amount of force to stop the attack and cannot be the one who provoked the encounter or initiated the violence. To justify the use of reciprocal deadly force, most jurisdictions require that the defendant reasonably believes the attacker is using or is about to use deadly force. Some jurisdictions further require that before resorting to deadly force, the defendant must make an effort to retreat, although this is not required in most courts if the attack took place in the defendant's own home.

Advocates of battered women have succeeded in convincing many courts to accept a subjective standard of determining whether a battered woman who killed her husband was protecting her own life. This concession allows the court to judge the circumstances of the crime in relation to the special needs of battered women and not according to the strict definition of self-defense. This looser definition is especially important for women who killed during a lull in the violence, because a strict interpretation of imminent danger does not provide legal justification for their actions.

According to Gena Rachel Hatcher in "The Gendered Nature of Battered Woman Syndrome: Why Gender Neutrality Does Not Mean Equality" (New York University Annual Survey of American Law, March 2003), for this modified definition of self-defense to work, the court must first be subjective in understanding the woman's circumstances. Next, it must be objective in deciding that, given the situation, she truly did act in a reasonable manner. Courts have already accepted the notion that self-defense does not require perfect judgment in a violent situation, only reasonableness. In Brown v. United States (1921), Justice Oliver Wendell Holmes said: "Detached reflection cannot be demanded in the presence of an uplifted knife." Battered women and their advocates have asked the courts to revise their definitions of imminent danger and appropriate force in cases involving domestic violence.

EQUAL FORCE

Self-defense permits the use of equal force, which is defined as the least amount of force necessary to prevent imminent bodily harm or death. Women, however, who are generally physically weaker than men and who know the kind of physical damage their batterers can inflict, may justifiably feel that they are protecting their lives when shooting unarmed men. In State v. Wanrow (1977), the Washington Supreme Court ruled that it was permissible to instruct the jury that the objective standard of self-defense does not always apply.

Yvonne Wanrow was sitting up at night fearful that a male neighbor, who she thought had molested the child in her care, was going to make good on his threats to break into the house where she was staying. When the large, intoxicated man did enter, Wanrow, who was incapacitated with a broken leg, shot him. The court ruled, "The respondent was entitled to have the jury consider her actions in the light of her own perceptions of the situation, including those perceptions which were the product of our nation's 'long and unfortunate history of sex discrimination.' Until such time as the effects of that history are eradicated, care must be taken to assure that our self-defense instructions afford women the right to have their conduct judged in light of the individual physical handicaps which are the product of sex discrimination. To fail to do so is to deny the right of individual women involved to trial by the same rules which are applicable to male defendants."

IMMINENT VERSUS IMMEDIATE DANGER

Traditionally, self-defense required that the danger be immediate, meaning that the danger was present at the moment the decision to respond was made, to justify the use of force, as noted by Kimberly Kessler Ferzan in "Defending Imminence: From Battered Women to Iraq" (Arizona Law Review, Summer 2004). Accepting imminent danger, or danger that is about to occur, as justification for action permits the jury to understand the motivations and dynamics of a battered woman's behavior. A history of abuse may explain why a defendant might react to the threat of violence more quickly than a stranger would in the same circumstances. In Wanrow, the Washington Supreme Court found that "it is clear that the jury is entitled to consider all of the circumstances surrounding the incident in determining whether the defendant had reasonable grounds to believe grievous bodily harm was about to be inflicted."

LEGAL OUTCOMES

Whether a woman will be convicted depends largely on the jury's attitude, or the judge's disposition when it is not a jury trial, and the amount of background and personal history of abuse that the judge or jury is permitted to hear. Juries that have not heard expert witnesses present the battered woman defense are often unsympathetic to women who kill their abusive partners.

In "Jurors' Decisions in Trials of Battered Women Who Kill: The Role of Prior Beliefs and Expert Testimony" (Journal of Applied Psychology, February 1994), Regina Schuller, Vicki L. Smith, and James M. Olson find that jurors who learned about battered woman syndrome from expert testimony were more likely to believe the defendant feared for her life, that she was in danger, and that she was trapped in the abusive relationship. Equipped with knowledge and understanding of battering and its effects, jurors handed down fewer murder convictions than were issued by a control group of jurors who were not given this specialized information.

PREVENTION OF DOMESTIC VIOLENCE

Empowerment of Battered Women

Researchers and advocates find that one of the most effective ways to deal with partner violence is by giving the victim the power, encouragement, and support to stop it. In "Estrangement, Interventions, and Male Violence toward Female Partners" (Violence and Victims, Spring 1997), Desmond Ellis and Lori Wight assert that abused women want the violence to stop and most, if not all, attempt to do something to stop it. They find evidence showing that empowerment of abused women is related to a decrease in the likelihood of further violence. The interventions Ellis and Wight recommend to promote gender equality include:

  • Social service agencies such as counselors or shelters to provide information and support
  • Mediation to facilitate a woman's control over the process
  • Prosecution with an option to drop the charges, which also facilitates control by female victims
  • Separation, which indicates the woman's strength in decision making

Ellis and Wight find that separation or divorce is one of the most effective strategies for ending abuse. Levels of violence after separation, according to Ellis and Wight, vary with the type of legal separation or divorce proceedings. Women who participate in mediation before separation are less likely to be harmed, either physically or emotionally, than women whose separation is negotiated by lawyers. Ellis and Wight find that other legal proceedings, such as restraining orders and protection orders, were relatively ineffective in protecting female abuse victims.

Interventions to Help Battered Women

Throughout the United States, voluntary health and social service agencies and institutions, such as hospitals, mental health centers, clinics, and shelters, have developed programs that aim to help abused women break free physically, economically, and emotionally from their violent partners. Still, many abused women do not seek help from these specialized programs and services as a result of fear, shame, or lack of knowledge about how to gain access to available services. Instead, many injured women seek medical care from physicians, nurses, and other health professionals. For this reason, medical professional organizations, such as the American Medical Association and the American College of Obstetricians and Gynecologists, exhort physicians to advocate on behalf of abused women. They offer guidelines to help professionals detect and intervene in cases of domestic violence.

Despite the ambitious objectives of professional societies and the widespread distribution of guidelines, many health professionals most likely to encounter victims of abuse remain untrained, fearful, and unable even to question patients about domestic violence. Barbara Gerbert et al. interviewed physicians to determine how they have overcome these and other barriers to help patients who are victims of domestic violence. Their findings were published in "Interventions That Help Victims of Domestic Violence: A Quantitative Analysis of Physicians' Experiences" (Journal of Family Practice, October 2000).

Although physician respondents reported feeling overwhelmed, frustrated, and often inadequately prepared to tackle these problems, they nonetheless felt it was their responsibility to help battered women improve their situations. The technique they believed most effective was validation—expressing concern by compassionately communicating to the woman that the abuse was undeserved. Other strategies they considered effective were:

  • Overcome denial and plant seeds of change—Physicians helped the women to appreciate the seriousness of their situations and to understand that the abusers' actions were wrong and criminal. Some physicians used photographs of injuries to remind patients who denied the extent of their abuse about the severity of the injuries they had sustained.
  • Nonjudgmental listening—To build trust, physicians listened without rushing to judgment or criticizing women for not fleeing their abusers.
  • Document, refer, and help prepare a plan—Physicians documented abuse with photographs and detailed descriptions in the patients' medical records for use in medical and mental health treatment as well as in court proceedings. They offered ongoing, confidential referrals to hotlines, shelters, and other community resources; advised patients about when to call police; and assisted them to develop escape plans.
  • Use a team approach—Physicians felt it was valuable to be able to immediately refer abused women to on-site professionals, such as counselors, nurses, social workers, or psychologists, who were able to take advantage of the medical visit as a "window of opportunity," that is, an occasion to detect and intervene to stop abuse.
  • Make domestic violence a priority—Given time constraints of busy medical practices, many physicians advocated forgoing all but the most urgent medical treatment and instead used the appointment time to address the issue of abuse. They also encouraged colleagues and personnel in their practices to obtain continuing education about domestic violence, child, and elder abuse.

The author of "How Can Practitioners Help an Abused Woman Lower Her Risk of Death?," mentioned previously, Carolyn Rebecca Block makes recommendations to nurses, doctors, and other service professionals likely to come in contact with battered women on what to look for as indications that the violence may soon escalate to deadly violence. She finds that practitioners should evaluate three aspects of the violence:

  • The type of past violence—Women who had experienced at least one serious or life-threatening incident (for example, being choked, burned, or threatened with weapons) in the past year were at the greatest risk of being killed by their partners. Being choked, burned, or threatened with weapons also indicated a higher risk.
  • The number of days since the last incident—No matter how severe the incident of past abuse, women who have been abused within the past thirty days are at greatest risk for being killed.
  • The frequency, or increasing frequency, of violence—If violent episodes are increasing, women are at high risk of deadly violence.

AN INNOVATIVE PROGRAM TO HELP BATTERED WOMEN

Collaboration between law enforcement and hospital emergency department personnel produced a novel program to prevent and intervene in domestic violence. This program was developed in Richmond, Virginia, in response to a challenge issued by Mark Rosenberg, the director of the National Center for Injury Prevention and Control at the CDC. The program, called Cops and Docs, involves participation of law enforcement personnel working "handcuff in glove" with emergency and trauma nurses. The program is described by Colleen McCue in "Cops and Docs Program Brings Police and ED Staff Together to Address the Cycle of Violence" (Journal of Emergency Nursing, December 2001).

Program personnel are trained together in a variety of techniques, including interviewing victims, collecting and preserving forensic evidence, and gathering and documenting information. Besides helping to safeguard victims and apprehend and prosecute offenders, the program offers other health benefits to the community it serves. For example, shared emergency department data about substance abuse gives law enforcement personnel additional information to use in efforts to combat drug-related violence and crime.

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