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Ending the cycle of abuse

February 1, 2006
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What behavioral health professionals need to know about domestic violence

Domestic violence is a major public health problem with physical and psychological sequelae for women, as well as a serious violation of human rights. One in every three women worldwide has been beaten, coerced into sex, or otherwise abused in her lifetime.1 The home is considered a place where people should be safe, but it may be one of society's most violent social institutions. Intimate partner violence or abuse is a pattern of coercive control that may result in physical and/or sexual assault and may include emotional abuse and economic control. One person uses abuse to exert power and control over another in a domestic relationship. Although women can be abusive, and abuse does exist in same-sex relationships, the vast majority of abuse is perpetrated by men against their female partners.2

Behavioral health therapists and counselors can make a difference in this epidemic and save lives by identifying and treating people in abusive relationships. By asking simple questions and providing information, death may be prevented and injuries and chronic stress may be lessened.

The Scope of the Problem

Between three and four million women are battered every year in the United States. Between 8 and 14% of all American women report physical abuse in the previous year by a husband, boyfriend, or ex-partner. Research indicates that the actual annual prevalence may be between 4 and 14%.3 Incidence may be higher among poor women. Lifetime prevalence is reported between 33 and 39%.

All women are at risk. Leaving the relationship or home doesn't always guarantee safety, as women may be stalked and are often in more danger when they leave an abusive relationship.

Battering often escalates in frequency and severity during pregnancy. Abuse may be the biggest cause of maternal mortality in this country. Krulewitch et al reported that 11% more homicides occur among pregnant women as compared with nonpregnant women.4 Teen pregnancies are particularly susceptible to abuse, and as many as 29% of pregnant teens experience abuse.5 Abuse can result in miscarriages, pregnancy complications, and postpartum depression. Twenty-five to 45% of battered women have been battered during pregnancy.

Sexual abuse often occurs in abusive relationships. Vaginitis, urinary tract infection, substance abuse, depression, trauma, post-traumatic stress disorder (PTSD), pelvic pain, and sexually transmitted diseases including HIV may result.6

Abused women often have more functional gastrointestinal illnesses, pelvic pain, and incidences of surgery in their lifetime than women who don't experience abuse. Teens and college students are also susceptible to intimate partner violence, with prevalence rates ranging from 12 to 22%, according to experts.7 Battering occurs in psychiatric patients, and abuse can result in suicide or homicide.6

Mental health professionals may observe signs of abuse among their patients. The patient may appear physically well, but pain, depression, and anxiety are common responses to the chronic stress experienced in an abusive relationship. Signs to look for commonly found among abused women include:

  • eating disorders or appetite changes

  • weight problems

  • dizziness

  • fatigue

  • joint pain

  • back pain

  • sleep problems

  • headaches8

Women and children affected by domestic violence may develop PTSD.9 The range of mental health effects of domestic violence includes:

  • shame

  • guilt

  • anxiety

  • low self-esteem

  • insomnia

  • suicidality

  • homicidal thoughts

While some women approach healthcare providers with these issues, others approach counselors or spiritual advisers. Some may be too embarrassed to admit to the violence, while other women may not feel safe discussing domestic violence, and some women don't seek assistance at all.10

Victims do not fit a distinct personality type but are at risk for depression, anxiety disorders, suicide, substance abuse, and eating disorders, along with physical and sexual risks.11 They may be afraid to even seek assistance because of threats that have been made. Battered women often hope that someone will offer assistance. Therapists and counselors can increase a victim's safety by offering information and support in a confidential and private way that ensures that the person abusing the woman will not learn of the discussions or shared resources.12

Why Men Batter and Why Women Stay

Abusers batter because their behavior is often effective. Abusive men see their roles in a traditional manner and believe it is their job to “keep the woman in line.” Abusers need motivation and often counseling to change their behavior. Unfortunately, counseling with batterers has been found to be less successful than hoped.13