ⓘ Intimate partner violence


ⓘ Intimate partner violence

Intimate partner violence 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 defines IPV 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 womens 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.


1. Background

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. 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:


2.1. Assessment Screening tools

The U.S. Preventive Services Task Force USPSTF as of 2018 recommends screening women of reproductive age.

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.


2.2. Assessment Research instrument

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.

Another assessment used in research to measure IPV is the Severity of Violence Against Women Scales SVAWS. This scale measures how often a woman experiences violent behaviors by her partner.


3. Types

Michael P. Johnson argues for four major types of intimate partner violence also known as "Johnsons 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. Elaine Storkey in her comprehensive analysis, Scars Across Humanity IVP Academic 2018, argues that intimate partner violence is one aspect of a global manifestation of violence against women. Other examples she cites are selective abortion, female genital mutilation, early, enforced marriage, honour killings, rape, trafficking, prostitution and sexual violence in war.


3.1. Types Intimate terrorism

Intimate terrorism, or coercive controlling violence CCV, occurs when one partner in a relationship, typically a man, uses coercive control and power over the other partner, using threats, intimidation, and isolation. CCV relies on severe psychological abuse for controlling purposes; when physical abuse occurs it too is severe. In such cases, "ne partner, usually a man, controls virtually every aspect of the victims, usually a womans, life." Johnson reported in 2001 that 97% of the perpetrators of intimate terrorism were men.

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.

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.


3.2. Types Violent resistance

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. VR can occur as an instinctive reaction in response to an initial attack or a defense mechanism after prolonged instances of violence. This form of resistance can sometimes become fatal if the victim feels as though their only way out is to kill their partner.


3.3. Types Mutual violent control

Mutual violent control MVC is rare type of intimate partner violence occurring when both partners act in a violent manner, battling for control.


3.4. Types Reciprocal and non-reciprocal

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.


4. By gender

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, termed "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. Research has shown that the nature of the abuse inflicted by women upon male partners is different from the abuse inflicted by men, in that it is generally not used as a form of control and does not cause the same levels of injury or fear of the abusive partner. Scholars state these cases should not be generalized and each couples specificities must be assessed. A 2016 meta-analysis indicated that the only risk factors for the perpetration of intimate partner violence that differ by gender are witnessing intimate partner violence as a child, alcohol use, male demand, and female withdrawal communication patterns.


4.1. By gender Gender asymmetry

While both women and men can be victims and perpetrators of IPV, the majority of such violence is inflicted upon women, who are also much more likely to suffer injuries as a result, in both heterosexual and same-sex relationships. 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 womens use of physical violence was more likely motivated by self-defense or fear whereas mens use of violence was motivated by control. A 2010 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 partners violence. A 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.

Women generally suffer more severe and long-lasting forms of partner abuse than men, and men generally have more opportunities to leave an abusive partner than women do. Researchers have found different outcomes in men and women in response to such abuse. 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.

Globally, mens perpetration of intimate partner violence against women often stems from conceptions of masculinity and patriarchy. 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.


4.2. By gender Gender symmetry

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.

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. Sociologist Michael Flood writes, "there is no gender symmetry in domestic violence; there are important differences between mens and womens typical patterns of victimization; and domestic violence represents only a small proportion of the violence to which men are subject".

Other empirical studies since 1975 suggest gender symmetry in IPV. 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. A 2011 review by Straus found that men and women commit IPV against each other at the same rate. 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 of self-defense against their violent male partners. A 2010 systematic review of the literature on womens perpetration of IPV, however, found that distinguishing between self-defense and retaliation was difficult.

A 2013 review of evidence from five continents found that when partner abuse is defined broadly, it is relatively even. However, when the review examined who is physically harmed and how seriously, expresses more fear, and experiences subsequent psychological problems, domestic violence primarily affects women. A sample from Botswana demonstrated higher levels of mental health consequences among females experiencing IPV, contrasting the results with males and females who experience IPV in Pakistan for which similar levels of mental health consequences were found.


5. Sexual violence

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.


6.1. Treatment Individual treatment

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 always 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.


6.2. Treatment Conjoint treatment

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 couples 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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