Intimate partner violence
Intimate partner violence (IPV) is domestic violence by a current or former spouse or partner in an intimate relationship against the other spouse or partner. IPV can take a number of forms, including physical, verbal, emotional, economic and sexual abuse. The World Health Organization (WHO) defines intimate partner violence as "... any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviors."
The most extreme form of such violence may be termed battering, intimate terrorism, coercive controlling violence, or simply coercive control, in which one person is violent and controlling; this is generally perpetrated by men against women, and is the most likely of the types to require medical services and the use of a women's shelter. Subsequently, resistance to intimate terrorism, which is a form of self-defense and may be termed violent resistance, is usually conducted by women. Studies on domestic violence against men suggest that men are less likely to report domestic violence perpetrated by their female intimate partners.
The most common but less injurious form of intimate partner violence is situational couple violence (also known as situational violence), which is conducted by individuals of both genders nearly equally, and is more likely to occur among younger couples, including adolescents (see teen dating violence) and those of college age. A last form of violence, in which both partners in the relationship engage in controlling and violent behavior, is called mutual violent control.
Intimate partner violence occurs between two people in an intimate relationship. It may occur between heterosexual or homosexual couples and victims can be male or female. Couples may be dating, cohabiting or married and violence can occur in or outside of the home.
Studies in the 1990s showed that both men and women could be abusers or victims of domestic violence.[nb 1] Women are more likely to act violently in retaliation or self-defense and tend to engage in less severe forms of violence than men whereas men are more likely to commit long-term cycles of abuse than women.
The World Health Organization (WHO) defines intimate partner violence as "any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship". The WHO also adds controlling behaviors as a form of abuse.
According to a study conducted in 2010, 30% of women globally aged 15 and older have experienced physical and/or sexual intimate partner violence.
The WHO reported in 2013 that the incidence of women who had experienced physical or sexual abuse from an intimate partner in their lifetime was:
Although IPV screening remains controversial, some major medical organizations mandate screening. The U.S. Preventive Services Task Force (USPSTF) cautions that there is insufficient evidence to recommend for or against screening.
Some of the most studied IPV screening tools were the Hurt, Insult, Threaten, and Scream (HITS), the Woman Abuse Screening Tool/Woman Abuse Screening Tool-Short Form (WAST/WAST-SF), the Partner Violence Screen (PVS), and the Abuse Assessment Screen (AAS).
The HITS is a four-item scale rated on a 5-point Likert scale from 1 (never) to 5 (frequently). This tool was Initially developed and tested among family physicians and family practice offices, and since then has been evaluated in diverse outpatient settings. Internal reliability and concurrent validity are acceptable. Generally, sensitivity of this measure has found to be lower among men than among women.
The WAST is an eight-item measure (there is a short form of the WAST that consists of the first two items only). It was originally developed for family physicians, but subsequently has been tested in the emergency department. It has been found to have good internal reliability and acceptable concurrent validity.
The PVS is a three-item measure scored on a yes/no scale, with positive responses to any question denoting abuse. It was developed as a brief instrument for the emergency department.
The AAS is a five-item measure scored on a yes/no scale, with positive responses to any question denoting abuse. It was created to detect abuse perpetrated against pregnant women. The screening tool has been tested predominantly with young, poor women. It has acceptable test retest reliability.
For more information on the CTS, please refer to Conflict tactics scale
The probably most widely used instrument in research on family violence is the Conflict Tactics Scale (CTS). Two versions have been developed from the original CTS: the CTS2 (an expanded and modified version of the original CTS) and the CTSPC (CTS Parent-Child).
Michael P. Johnson argues for four major types of intimate partner violence (also known as "Johnson's typology"), which is supported by subsequent research and evaluation, as well as independent researchers. Distinctions are made among the types of violence, motives of perpetrators, and the social and cultural context based upon patterns across numerous incidents and motives of the perpetrator. The United States Centers for Disease Control (CDC) also divides domestic violence into types.
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Intimate terrorism, or coercive controlling violence, occurs when one partner in a relationship uses coercive control and power over the other partner, using threats, intimidation, and isolation. In such cases, "[o]ne partner, usually a man, controls virtually every aspect of the victim's, usually a woman's, life." Johnson reported in 2001 that 97% of the perpetrators of intimate terrorism were men. While research generally indicates that women are usually the victims of intimate terrorism, some studies, using Johnson's typology, have suggested that intimate terrorism is more often perpetrated by women or not gendered at all.
Intimate partner violence may involve sexual, sadistic control, economic, physical, emotional and psychological abuse. Intimate terrorism is more likely to escalate over time, not as likely to be mutual, and more likely to involve serious injury. The victims of one type of abuse are often the victims of other types of abuse. Severity tends to increase with multiple incidents, especially if the abuse comes in many forms. If the abuse is more severe, it is more likely to have chronic effects on victims because the long-term effects of abuse tend to be cumulative. Because this type of violence is most likely to be extreme, survivors of intimate terrorism are most likely to require medical services and the safety of shelters. Consequences of physical or sexual intimate terrorism include chronic pain, gastrointestinal and gynecological problems, depression, post-traumatic stress disorder, and death. Other mental health consequences are anxiety, substance abuse, and low-self esteem. A 2014 study on the mental health effects of intimate partner terrorism found that 42% of women reported thoughts of suicide and 31% had attempted it.
Abusers are more likely to have witnessed abuse as children than those who engage in situational couple violence.
Intimate terrorism batterers include two types: "Generally-violent-antisocial" and "dysphoric-borderline". The first type includes people with general psychopathic and violent tendencies. The second type includes people who are emotionally dependent on the relationship. Violence by an individual against their intimate partner is often done as a way for controlling the partner, even if this kind of violence is not the most frequent.
Violent resistance (VR), a form of self-defense, is violence perpetrated by victims against their partners who have exerted intimate terrorism against them. Within relationships of intimate terrorism and violent resistance, 96% of the violent resisters are women.
Situational couple violenceEdit
Situational couple violence, also called common couple violence, is not connected to general control behavior, but arises in a single argument where one or both partners physically lash out at the other. This is the most common form of intimate partner violence, particularly in the western world and among young couples, and involves members of both sexes nearly equally. Among college students, Johnson found it to be perpetrated about 44% of the time by women and 56% of the time by men.
Johnson states that situational couple violence involves a relationship dynamic "in which conflict occasionally gets 'out of hand,' leading usually to 'minor' forms of violence, and rarely escalating into serious or life-threatening forms of violence."
In situational couple violence, acts of violence by men and women occur at fairly equal rates, with rare occurrences of injury, and are not committed in an attempt to control a partner. It is estimated that approximately 50% of couples experience situational couple violence in their relationships.
Situational couple violence involves:
- Mode: Mildly aggressive behavior such as throwing objects, ranging to more aggressive behaviors such as pushing, slapping, biting, hitting, scratching, or hair pulling.
- Frequency: Less frequent than partner terrorism, occurring once in a while during an argument or disagreement.
- Severity: Milder than intimate terrorism, very rarely escalates to more severe abuse, generally does not include injuries that were serious or that caused one partner to be admitted to a hospital.
- Mutuality: Violence may be equally expressed by either partner in the relationship.
- Intent: Occurs out of anger or frustration rather than as a means of gaining control and power over the other partner.
Mutual violent controlEdit
Mutual violent control (MVC) is rare type of intimate partner violence occurring when both partners act in a violent manner, battling for control.
Reciprocal and non-reciprocalEdit
The CDC divides domestic violence into two types: reciprocal, in which both partners are violent, and non-reciprocal violence, in which one partner is violent. Of the four types, situational couple violence and mutual violent control are reciprocal, while intimate terrorism is non-reciprocal. Violent resistance on its own is non-reciprocal, but is reciprocal when in response to intimate terrorism.
In the 1970s and 1980s, studies using large, nationally representative samples resulted in findings indicating that women were as violent as men in intimate relationships. This information diverged significantly from shelter, hospital, and police data, initiating a long-standing debate, often coined as "the gender symmetry debate." One side of this debate argues that mainly men perpetrate IPV (the gender asymmetry perspective), whereas the other side maintains that both genders perpetrate IPV at about equal rates (gender symmetry perspective). However, research on gender symmetry acknowledges asymmetrical aspects of IPV, which show that men use more violent and often deadly means of IPV. Older conflict tactics scale (CTS) methodology was criticized for excluding two important facets in gender violence: conflict-motivated aggression and control-motivated aggression. For example, women commonly engage in IPV as a form of self-defense or retaliation.
Men and women can both be victims and perpetrators of IPV, but IPV against women has a higher prevalence rate. Although men and women commit equivalent rates of unreported minor violence via situational altercation, more severe perpetration and domestic battery tends to be committed by men. This is based on newer CTS methodology as opposed to older versions that did not take into account the contexts in which violence takes place. A 2008 systematic review published in journal of Violence and Victims found that despite less serious altercation or violence being equal among both genders, more serious and violent abuse was perpetrated by men. It was also found that women's use of physical violence was more likely motivated by self-defense or fear whereas men's use of violence was motivated by control. A 2011 systematic review published in the journal of Trauma Violence Abuse found that the common motives for female on male IPV were anger, a need for attention, or as a response to their partner's violence. Another 2011 review published in the journal of Aggression and Violent behavior found differences in the methods of abuse employed by men and women, suggesting that men were more likely to "beat up, choke or strangle" their partners, whereas women were more likely to "throw something at their partner, slap, kick, bite, punch, or hit with an object".
Researchers such as Michael S Kimmel have criticized CTS methodology in assessing relations between gender and domestic violence. Kimmel argued that the CTS excluded two important facets in gender violence: conflict-motivated aggression and control motivated aggression. The first facet is a form of family conflict (such as an argument) while the latter is using violence as a tool for control. Kimmel also argued that the CTS failed to assess for the severity of the injury, sexual assaults and abuse from ex-partners or spouses.
Researchers have found different outcomes in men and women in response to intimate partner violence. A 2012 review from the journal Psychology of Violence found that women suffered from over-proportionate numbers of injuries, fear, and posttraumatic stress as a result of partner violence. The review also found that 70% of female victims felt frightened as a result of violence perpetrated by their partners whereas 85% of male victims expressed "no fear" in response to such violence. Lastly, IPV correlated with relationship satisfaction for women but it did not do so for men.
According to government statistics from the US Department of Justice, male perpetrators constituted 96% of federal prosecution on domestic violence. Another report by the US department of Justice on non-fatal domestic violence from 2003–2012 found that 76% of domestic violence was committed against women and 24% was committed against men. According to the United Nations Office on Drugs and Crime, the percentage of victims killed by their spouses or ex-spouses was 77.4% for women and 22.6% for men in selected countries across Europe. According to the National Violence Against Women Survey, women experience more intimate partner violence than men: 22.1% of surveyed women were assaulted by a partner, compared to 7.4% of surveyed men.
Globally, men's perpetration of intimate partner violence against women often stems from conceptions of masculinity and patriarchy. A study of men in Vietnam found that 36.6% of participants perpetrated some form of violence against their partners, mostly due to gendered social learning in their childhood. Studies done in the United States, Nigeria, and Guatemala all support the idea of men reacting violently towards their partners when their masculinity is threatened by changing gender roles. Furthermore, research has found that men use violence to resolve a crisis of male identity oftentimes caused by poverty or at an inability to control women.
Violence during pregnancy is another aspect of intimate partner violence that is connected to gender asymmetry. In a study of German women who experienced IPV during pregnancy, Stockl and Gardner found that most women understood that the pregnancy was a negative turning point in the relationship. Men acted violently towards their pregnant partners for the following reasons: difficult financial or living situation, questioning relationship commitment, changing role expectations and sexual needs, adverse childhood experiences, jealously towards the unborn child, and unwanted pregnancies.
The theory that women perpetrate intimate partner violence (IPV) at roughly the same rate as men has been termed "gender symmetry." The earliest empirical evidence of gender symmetry was presented in the 1975 U.S. National Family Violence Survey carried out by Murray A. Straus and Richard J. Gelles on a nationally representative sample of 2,146 "intact families." The survey found 11.6% of men and 12% of women had experienced some kind of IPV in the last twelve months, while 4.6% of men and 3.8% of women had experienced "severe" IPV.:333 These unexpected results led Suzanne K. Steinmetz to coin the controversial term "battered husband syndrome" in 1977. Ever since the publication of Straus and Gelles' findings, other researchers into domestic violence have disputed whether gender symmetry really exists. Numerous other empirical studies since 1975 suggest there is evidence for it. Empirical studies suggest rates of perpetration remain symmetrical for both minor and severe abuse. This result may be due to a bi-directional or reciprocal pattern of abuse, with one study concluding that 70% of assaults involve mutual acts of violence. One reason that data may appear to reflect that men and women equally commit intimate partner violence is that women frequently engage in violent resistance as a means for self-defense against their violent male partners.
Sexual violence by intimate partners varies by country and can reach as high as 25% of the women having been subject to forced sex. In some countries forced sex, or marital rape, often occurs with other forms of domestic violence, particularly physical abuse.
Due to the high prevalence and devastating consequences of IPV, approaches to decrease and prevent violence from re-occurring is of upmost importance. Initial police response and arrest is not enough to protect victims from recurrence of abuse; thus, many states have mandated participation in batterer intervention programs (BIPs) for men who have been charged with assault against an intimate partner. Most of these BIPs are based on the Duluth Model and incorporate some cognitive behavioral techniques.
The Duluth model is one of the most common current interventions for IPV. It represents a psycho-educational approach that was developed by paraprofessionals from information gathered from interviewing battered women in shelters and using principles from feminist and sociological frameworks. One of the main components used in the Duluth Model is the 'power and control wheel,' which conceptualizes IPV as one form of abuse to maintain male privilege. Using the 'power and control wheel,' the goal of treatment is to achieve behaviors that fall on the 'equality wheel' by re-educate men and by replacing maladaptive attitudes held by men.
Cognitive behavioral therapy (CBT) techniques focus on modifying faulty or problematic cognitions, beliefs, and emotions to prevent future violent behavior and include skills training such as anger management, assertiveness, and relaxation techniques.
Overall, the addition of Duluth and CBT approaches results in a 5% reduction in IPV. This low reduction rate might be explained, at least in part, by the high prevalence of bidirectional violence as well as client-treatment matching versus “one-size-fits-all” approaches.
Achieving change through values-based behavior (ACTV) is a newly developed Acceptance and Commitment Therapy (ACT)-based program. Developed by domestic violence researcher Amie Zarling and colleagues at Iowa State University, the aim of ACTV is teach abusers "situational awareness"—to recognize and tolerate uncomfortable feelings – so that they can stop themselves from exploding into rage.
Initial evidence of the ACTV program has shown high promise: Using a sample 3,474 men who were arrested for domestic assault and court-mandated to a BIP (either ACTV or Duluth/CBT), Zarling and colleagues showed that compared with Duluth/CBT participants, significantly fewer ACTV participants acquired any new charges, domestic assault charges, or violent charges. ACTV participants also acquired significantly fewer charges on average in the 1 year after treatment than Duluth/CBT participants.
Some estimates show that as many as 50% of couples who experience IPV engage in some form of reciprocal violence. Nevertheless, most services address offenders and survivors separately. In addition, many couples who have experienced IPV decide to stay together. These couples may present to couples or family therapy. In fact, 37-58% of couples who seek regular outpatient treatment have experienced physical assault in the past year. In these cases, clinicians are faced with the decision as to whether they should accept or refuse to treat these couples. Although the use of conjoint treatment for IPV is controversial as it may present a danger to victims and potentially escalate abuse, it may be useful to others, such as couples experiencing situational couple violence. Scholars and practitioners in the field call for tailoring of interventions to various sub-types of violence and individuals served.
Behavioral couple's therapy (BCT) is cognitive-behavioral approach, typically delivered to outpatients in 15-20 sessions over several months. Research suggests that BCT can be effective in reducing IPV when used to treat co-occurring addictions, which is important work because IPV and substance abuse and misuse frequently co-occur.
Domestic conflict containment program (DCCP) is a highly structured skills-based program whose goal is to teach couples conflict containment skills.
Physical aggression couples treatment (PACT) is a modification of DCCP, which includes additional psychoeducational components designed to improve relationship quality, including such things as communication skills, fair fighting tactics, and dealing with gender differences, sex, and jealousy.
The primary goal of domestic violence focused couples treatment (DVFCT) is to end violence with the additional goal of helping couples improve the quality of their relationships. It is designed to be conducted over 18 weeks and can be delivered in either individual or multi-couple group format.
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Intimate male partners are most often the main perpetrators of violence against women, a form of violence known as intimate partner violence, 'domestic' violence or 'spousal (or wife) abuse.' Intimate partner violence and sexual violence, whether by partners, acquaintances or strangers, are common worldwide and disproportionately affect women, although are not exclusive to them.
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