Relationship Abuse, Intimate Partner Violence, & Domestic Violence Threatens Individuals and Society

Relationship abuse, intimate partner violence, and domestic violence are major social problems in the U.S.

Forming relationships is an essential part of life for human beings. Most people need to be in healthy, mutually beneficial relationships in order to thrive. Unfortunately, many people suffer abuse within the context of their intimate relationships. Relationship abuse may come in many forms — emotional, verbal, physical, or sexual — and it often has serious long-term consequences for the individuals involved, their families, communities, and society as a whole (ACOG, 1999; APA, 1996; Johnson & Ferraro, 2000). Violent relationship abuse is known by many names — domestic violence, partner abuse, intimate partner violence, dating violence, and marital and date rape. All refer to abuse by one person or another within a current or previous intimate relationship.

This fact sheet explores the problem of relationship abuse, describing the nature and scope of the many forms of abuse, the effects of abuse, and what can be done to help those in abusive relationships. It also details the many ways in which relationship abuse jeopardizes women's reproductive health by increasing the risk of unplanned pregnancy, sexual intercourse before the age of 15, delayed entry into prenatal care, sexually transmitted infections, miscarriage, and having multiple induced abortions (Dietz, et al., 1997; Martin, et al., 1999; Silverman, et al., 2001; Webster, et al., 1996).

Defining Relationship Abuse

Relationship abuse may occur in any type of intimate relationship — marriage, cohabitating, or dating — and its perpetrators and victims may be women or men, young or old, homosexual, bisexual, or heterosexual (APA, 1996; Rennison & Welchans, 2000). At the core of abusive relationships is an imbalance and abuse of power, in which one partner exhibits behaviors designed to control the other (APA, 1996; Johnson & Ferraro, 2000; Poirier, 1997). These coercive behaviors range greatly, and may include physical, sexual, emotional, and psychological abuse.

• pushing, shoving, slapping, biting, kicking, choking, punching, burning, stabbing, shooting, and murder
• physical restraint
• subjecting partners to reckless driving
• locking partners out of the house or abandoning them in dangerous places

• unwanted touching and forced sex
• treating partners as sex objects
• forcing partners to strip
• repeatedly subjecting partners to anti-woman/anti-man jokes and sexual insults

• ridiculing, humiliating, insulting, and degrading
• isolating partners from family and friends by direct means, such as denying access to a telephone, or indirect means, such as invoking feelings of guilt or forcing partners to choose between the relationship or their family and friends
• threatening to disclose a secret about partners, such as "outing" a same-sex partner
• exhibiting extreme jealousy
• threatening suicide if partners do not submit or if partners attempt to leave the relationship
• constantly checking up on partners and demanding they account for their time
• seeking control by not allowing their partners access to money and by sabotaging their efforts to hold a job (FTG, 2001; Wilson, 1997)

Often, an abuser will use many different tactics to exert control, and the nature of the abuse typically escalates over time (APA, 1996; Burge, 1997).

History

 People have been subjected to abuse within their relationships for thousands of years. In ancient Rome, husbands had the legal right to chastise, divorce, or kill their wives for infractions such as drinking from the family wine cellar, or attending public games without a husband's permission (Wilson, 1997). The American colonies borrowed from English common law, which stated that a man could not chastise his wife with a rod thicker than his thumb. By the 1870s, most states had prohibitions on wife abuse, but these laws were rarely enforced (Schornstein, 1997). The Violence Against Women Act (VAWA) (P.L. 103-322) was passed in 1994, marking the first time that a federal law deemed domestic violence a crime (Schornstein, 1997). VAWA has many provisions that address domestic violence, including education and training programs, establishment of a national hotline, funding for research on domestic violence, and grants to law enforcement agencies to better enforce domestic abuse laws.

Prevalence

Estimates of the prevalence of relationship abuse vary greatly due to a lack of a clear definition of relationship abuse, problems with research methodology that exclude certain high-risk populations from being surveyed, and significant underreporting of abuse (AMA, 1992; Abbott, et al., 1995). Although recent studies have shown that women are as likely as men to be physically aggressive toward their partner, in reported instances of IPV crimes, approximately 60 percent of IPV victims are women (Brown, 2004; Fiebert, 2004).

There are nearly eight million instances of intimate partner violence (IPV) a year in the U.S. (Tjaden & Thoennes, 2000). It is estimated that more than two million people — 1.5 million women and 834,732 men — are victims of IPV each year (Gazmararian, et al., 2000; Tjaden and Thoennes, 2000; Tonelli, 2004).

Intimate partner violence is the leading cause of injury to women in the U.S. (Diloreto, 2001; Rennison, 2001). In 2000, of the 1,687 people killed by intimate partners, 74 percent were women and 26 percent were men (Rennison, 2003). Sexual abuse is also very common in abusive relationships. In about half of violent relationships, rape is a regular form of abuse (Berry, 1998).

Who Is at Risk?

Women and men of all sexual orientations, races, ages, and marital and socioeconomic status are at risk for relationship violence — however, some groups report higher rates of victimization.

• Young women aged 20–24 have the highest rates of victimization.
• African-American women reported higher rates of victimization than women of other races.
• While household income does not affect the rate of victimization for men from domestic violence, women living in households with lower income have much higher rates than women in households with higher annual incomes.
• Divorced and separated people experienced relationship violence at three times the rate of never married people. Married and widowed people reported the lowest rates of victimization (Rennison & Welchans, 2000). Women who are divorced or separated report being battered 14 times more often than those still living with their abusers (Berry, 1998).
• A study of men seeking care at an emergency room found that 13 percent had been physically abused by a female partner in the preceding year. Half of the men who had been victimized reported being choked, kicked, bitten, or punched, and 37 percent of the cases involved the use of a weapon. Seven percent of the victimized men reported being forced to have sex (Mechem, et al., 1999).
• Intimate partner violence occurs less often between women in same-sex relationships. While 30.4 percent of women in opposite sex relationships have reported abuse, only 11 percent of women in same-sex relationships have reported similar abuse. However, men in same-sex relationships report intimate partner violence almost twice as often as men in opposite-sex relationships — 15 percent as opposed to 7.7 percent (National Center for Injury Prevention and Control, 2000).
• Adolescents are also at risk of relationship abuse. One study found that one third of heterosexual high school students had experienced either psychological abuse or minor physical violence, such as pushing, shoving, or having an object that could inflict pain thrown at them within at least one of their three previous dating relationships (Halpern, et al., 2001). Another study of adolescent females found that 20 percent had experienced physical and/or sexual violence by a dating partner (Silverman, et al., 2001).
• Disabled women are at great risk of being victims of violence. It has been estimated that an astonishing 85 percent of women with disabilities are victims of domestic violence (Feuerstein, 1997).
• Women with unwanted or mistimed pregnancies are at increased risk for intimate partner violence. A study found that women with unplanned pregnancies had four times the odds of experiencing violence by their partners than did women with intended pregnancies (Gazmararian, et al., 1995).

Profiles of Abusers

Most studies that have sought to identify characteristics of abusers have looked at men in heterosexual relationships. Men who witnessed or experienced parental abuse as children are significantly more likely to be abusive in their intimate relationships than men who did not witness parental abuse (AMA, 1992; APA, 1996). Men who abuse alcohol or drugs are also more likely to batter their partners (AMA, 1992; Kyriacou, et al., 1999).

Male batterers have been characterized as being either "pit bulls" or "cobras" (Jacobson & Gottman, 1998). Pit bulls typically confine their violent behavior to their intimate relationships. They are jealous, and because of a severe fear of abandonment, they seek to deprive their partners of independence. Pit bulls are prone to rage and stalking. Cobras, on the other hand, are not emotionally dependent on the relationship, but feel that their every wish should be met. Cobras are prone to aggression toward everyone, and they tend to calm down internally as they become aggressive. Cobras are more likely to threaten with or use deadly weapons. Pit bulls have much more potential for rehabilitation than cobras, who are difficult to treat with therapy (Jacobson & Gottman, 1998).

Gender Roles and Risk for Abuse

For both women and men, traditional, stereotypical gender roles are associated with an increased risk for involvement in sexual aggression (McKelvie & Gold, 1994). Hypermasculine, or "macho," men who subscribe without question to the masculinity ideology are more likely to report engaging in sexually coercive behavior, to indicate a greater hypothetical likelihood to rape in the future, and to confuse violence with masculinity (APA, 1996; Murnen & Byrne, 1991). Researchers have defined "hyperfemininity" as an exaggerated adherence to the stereotypic feminine gender role, and they have found that women who have high levels of hyperfemininity, as opposed to low- or non-hyperfeminine women, are more likely to be abused by an intimate partner, are more accepting of adversarial sexual behavior, and blame themselves more when they experience sexual coercion (McKelvie & Gold, 1994; Murnen & Byrne, 1991; Schornstein, 1997).

Nature of abusive relationships

While every relationship is different, relationships characterized by abuse typically cycle through three repeating phases — the tension-building, explosion, and tranquil phases.

• During the tension-building phase, abusers may verbally abuse and threaten their partners, or may slap or push. Partners often become hypervigilant in pleasing the abusers and keeping the peace, trying to avert the next phase, the explosion.

• The explosion is an acute episode of abuse that often includes violence and/or sexual abuse.

• Following the explosion, abusers are typically remorseful during the tranquil phase and often romance their partners with gifts, profound apologies, and promises that they will never be abusive again (Berlinger, 1998; Schornstein, 1997).

There is no set time for each phase, and the abuser's behavior may vary over the course of the relationship. But generally, over time, the intensity of the abuse tends to escalate (APA, 1996).

Because of the complex of a myriad of psychological, emotional, physical, and financial conditions and reasons, it is often very difficult or impossible for victims to leave abusive relationships. When victims do leave, they often return. For example, the average female victim in a heterosexual relationship leaves her abuser seven times before she leaves for good (Berlinger, 1998). The period immediately following separation is a particularly dangerous time for abuse victims. The point of separation is the time at which the risk is highest for serious or lethal violence to occur. Additionally, separation may add new abusive behaviors to the relationship, including threatened or attempted child kidnapping and stalking (APA, 1996).

Impact of Relationship Abuse

Relationship abuse can cause serious short- and long-term consequences. Physical injuries resulting from violence can range from minor bruises to death. Injuries from intimate partner assault are typically to the head, face, neck, breast, or abdomen, and victims usually have multiple injuries, often at different stages of healing (AMA, 1992). Other common physical ailments of people who are abused include chronic headaches, abdominal pains, muscle aches, recurrent vaginal infections, and sleep and eating disorders. Some studies have also associated arthritis, hypertension, and heart disease with abuse (AMA, 1992). Psychological sequelae of relationship abuse are also serious and may be debilitating. Depression, anxiety, eating disorders, sleep disturbances, substance abuse, and attempted suicide have all been associated with victimization (ACOG, 2001).

Adolescent girls who experience sexual and physical violence by a dating partner are at increased risk of many serious health problems. As compared with adolescents who do not experience violence, they are nearly five times more likely to use cocaine, three times more likely to have unhealthy weight control behaviors, such as use of laxatives and vomiting, eight times more likely to have intercourse before the age of 15, six times more likely to get pregnant, and nearly eight times more likely to attempt suicide (Silverman, et al., 2001).

Women's sexual and reproductive health are also compromised by abuse. Pregnant women are particularly vulnerable to relationship violence, and the effects can be grave. Abused pregnant women are more likely to delay entry into prenatal care, putting them at risk of poor pregnancy outcomes (Dietz, et al., 1997). Abused women seeking care at a prenatal clinic were found to be over two times more likely to have had a sexually transmitted infection than pregnant women who had not experienced abuse (Martin, et al., 1999). Women who are abused are also more likely to smoke cigarettes during pregnancy and have more unplanned pregnancies, miscarriages, and neonatal death (Webster, et al., 1996). Taken together, these risk factors contribute to significantly higher costs of health care for abused women, and contribute to poor maternal and fetal outcomes.

Relationship abuse costs victims, survivors, and society countless billions of dollars. In general, the costs associated with relationship abuse exceed $5.8 billion annually. Nearly $4.1 billion of which is directly related to health care services, and nearly $1.8 billion of which is the result of lost productivity due to both nonfatal and fatal abuse (National Center for Injury Prevention and Control, 2003). When the calculated costs of relationship abuse include components for which data is largely unavailable, e.g. criminal justice services and social services, the estimated annual losses can exceed $67 billion (Laurence & Spalter-Roth, 1996).

Relationship abuse is also a leading cause of homelessness. Between one-quarter and one-half of homeless women and children became homeless because of abuse (NCH, 1999). Abusers often seek to undermine their partner's independence by sabotaging employment and educational endeavors. Seventy-five percent of abused women are harassed by their abuser at work, and 64 percent of battered women arrived an hour late five times per month. Even abused women seeking welfare benefits are often stripped of their benefits because they cannot fulfill the welfare-to-work obligations due to partner harassment (Laurence & Spalter-Roth, 1996).

Effects on Children

Each year, between 3.3 million and 10 million children are exposed to violence by family members against their mothers or female caretakers (APA, 1996; Edelson, 1995). Children who live in homes in which a parent or caretaker is being abused are at significant risk for being abused themselves. Between 40 and 70 percent of men who abuse women also physically abuse children — in homes with four or more children, this figure exceeds 90 percent (APA, 1996; Berry, 1998). Further, battered women are at least twice as likely to physically abuse their children than women who are not abused (Straus & Gelles, 1990). Adolescent males living in homes in which their mother is abused are at greatly increased risk of being battered. One study found that all sons over the age of 14 living in violent homes attempted to intervene to protect a mother from abuse; 62 percent were injured as a result (Berry, 1998). Sexual victimization is also very high among children of partner abusers. One-quarter to one-third of men who batter their partners also sexually abuse their children (Berry, 1998).

The consequences of growing up in an abusive home can be grave. Witnessing abuse may have long-term effects on children, such as lower self-esteem and greater depression lasting into adulthood (Johnson & Ferraro, 2000). They may suffer from posttraumatic stress disorder, anxiety, and have lower verbal, cognitive, and motor abilities (Edelson, 1995; Zuckerman, et al., 1995). Children who witness the abuse of their mother are six times more likely to attempt suicide than children who grow up in non-abusive homes, and are 50 percent more likely to abuse drugs (Berry, 1998). Exposure to abuse in childhood may affect many aspects of the child's adulthood. A survey of adult women revealed that those women who were exposed to abuse or were abused as children were more likely to have an unintended first pregnancy than women who did not experience any abuse (Dietz, et al., 1999). Witnessing parental violence as a child is strongly and consistently associated with being battered in adulthood in an intimate relationship (AMA, 1992). Additionally, as previously stated, although children affected by violence do not necessarily grow up to be violent, those who grow up in abusive homes are significantly more likely to abuse their own partners and children, passing violence down from generation to generation (APA, 1996).

What Should Be Done

Clearly, relationship abuse is an extremely serious, widespread problem that must be addressed. Law enforcement and governmental agencies need to send a clear message, through their words and their actions, that relationship abuse has no place in society.

Both the general public and professionals who may come in contact with people affected by relationship abuse must receive education and training about the issue. Health care providers have an important opportunity to identify victims, document abuse, and provide counseling and referrals. Despite their high usage of health care, women who are abused are not often asked about abuse by health care providers (Swenson-Britt, et al., 2001).

Mental health professionals usually do not recommend couples counseling as an effective way to relieve violent relationship abuse. What is needed for people trying to escape IPV is a wide range of services and programs — shelters, safe houses, hotlines, support services, counseling, education and training programs, relocation programs, and services for the children of the abused (NYSOPDV, 2000). Access must be ensured for all victims and survivors of IPV. For example, in 1994, fewer than 20 percent of domestic violence and rape shelters in California were accessible under the basic standards set in the Americans with Disabilities Act (CWLC, 1994). Nationally, gay, lesbian, bisexual and transgender victims and survivors often have difficulty finding sensitive services (NCAVP, 2001). Men, pregnant women, prisoners, homeless women, mentally ill women, adolescents, and immigrant women who experience violence also face barriers in finding appropriate crisis and support services (Moore, 1999; Orloff, et al., 1995; Weiss, 2000). Services also need to be targeted towards the children of abused people, as they are likely to suffer long-term consequences.

The U.S. federal government has set national goals to reduce the rate of physical assault by current or former intimate partners and to reduce rape and sexual assault, as well as unplanned pregnancies, poor pregnancy outcomes, sexually transmitted infections, and reproductive cancers (OPA, 2001). The nation's sexual and reproductive health goals cannot be reached, however, until the prevalence of relationship abuse is greatly reduced by an increased awareness that abuse is not acceptable and that people can be successful in ending abusive relationships.

National Resources

Family Violence Prevention Fund
383 Rhode Island St. Suite #304
San Francisco, CA 94103-5133
Phone: (415) 252-8900
http://endabuse.org/

National Coalition Against Domestic Violence
P.O. Box 18749
Denver, CO 80218
Phone: 303-839-1852
http://www.ncadv.org/

National Domestic Violence Hotline
1-800-799-SAFE

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Lead Author — Jennifer Johnsen, MPH

Published: 06.01.05 | Updated: 06.01.05

Published by the Katharine Dexter McCormick Library

©2005 Planned Parenthood^® Federation of America, Inc.
All rights reserved.


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