Domestic Violence

Domestic violence, also known as domestic abuse, spousal abuse, child abuse or intimate partner violence (IPV), can be broadly defined a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, friends or cohabitation. Domestic violence has many forms including physical aggression (hitting, kicking, biting, shoving, restraining, throwing objects), or threats thereof; sexual abuse; emotional abuse; controlling or domineering; intimidation; stalking; passive/covert abuse (e.g., neglect); and economic deprivation. Domestic violence may or may not constitute a crime, depending on local statues, severity and duration of specific acts, and other variables. Alcohol consumption and mental illness have frequently been associated with abuse.

Awareness, perception and documentation of domestic violence differs from country to country, and from era to era. Estimates are that only about a third of cases of domestic violence are actually reported in the United States and the United Kingdom. According to the Centers for Disease Control, domestic violence is a serious, preventable public health problem affecting more than 32 million Americans, or over 10% of the U. S. population.

Violence between spouses has long been considered a serious problem. The United States has a lengthy history of legal precedent condemning spousal abuse. In 1879, law scholar Nicholas St. John Green wrote, "The cases in the American courts are uniform against the right of the husband to use any [physical] chastisement, moderate or otherwise, toward the wife, for any purpose." Green also cites the 1641 Body of Liberties of the Massachusetts Bay colonists -- one of the first legal documents in North American history -- as an early de jure condemnation of violence by either spouse.

Popular emphasis has tended to be on women as the victims of domestic violence. Many studies show that women suffer greater rates of injury due to domestic violence, and some studies show that women suffer higher rates of assault. Yet, other statistics show that while men tend to inflict injury at higher rates, the majority of domestic violence overall is reciprocal.

Modern attention to domestic violence began in the women's movement of the 1970s, particularly within feminism and women's rights, as concern about wives being beaten by their husbands gained attention. Only since the late 1970s, and particularly in the masculism and men's movements of the 1990s, has the problem of domestic violence against men gained any significant attention. Estimates show that 248 of every 1,000 females and 76 of every 1,000 males are victims of physical assault and/or rape committed by their spouses. A 1997 report says significantly more men than women do not disclose the identity of their attacker. A 2009 study showed that there was greater acceptance for abuse perpetrated by females than by males.

Definitions

The term "intimate partner violence" (IPV) is often used synonymously with domestic abuse/domestic violence. Family violence is a broader definition, often used to include child abuse, elder abuse, and other violent acts between family members. Wife abuse, wife beating, and battering are descriptive terms that have lost popularity recently for at least two reasons:

  • Acknowledgment that many victims are not actually married to the abuser, but rather cohabiting or other arrangement.
  • Abuse can take other forms than physical abuse and males are often victims of violence as well. Other forms of abuse may be constantly occurring, while physical abuse happens occasionally.

These other forms of abuse have the potential to lead to mental illness, self-harm, and even attempts at suicide.

Amartya Sen calculated that more than 100 million females and follow up studies showed that between 60 million and 107 million women are missing worldwide.

The U. S. Office on Violence Against Women (OVW) defines domestic violence as a "pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner". The definition adds that domestic violence "can happen to anyone regardless of race, age, sexual orientation, religion, or gender", and that it can take many forms, including physical abuse, sexual abuse, emotional, economic, and psychological abuse.

The Children and Family Court Advisory and Support Service in the United Kingdom in its "Domestic Violence Policy" uses domestic violence to refer to a range of violent and abusive behaviours, defining it as:

Patterns of behaviour characterised by the misuse of power and control by one person over another who are or have been in an intimate relationship. It can occur in mixed gender relationships and same gender relationships and has profound consequences for the lives of children, individuals, families and communities. It may be physical, sexual, emotional and/or psychological. The latter may include intimidation, harassment, damage to property, threats and financial abuse.

In Spain, the 2004 Measures of Integral Protection against Gendered Violence defined gendered violence as a violence that is directed at women for the very fact of being women. The law acknowledges that women are considered by their attackers as lacking the basic rights of freedom, respect, and decision making capability. The law established Courts of "Violence against Women" and suspended presumption of innocence for men accused of domestic violence. Spanish Courts are empowered to hold closed door hearings before trial and evict men from their homes; suspend parental rights, child custody, or visitation rights; and bar men from possessing weapons.

Forms of abuse

All forms of domestic abuse have one purpose: to gain and maintain total control over the victim. Abusers use many tactics to exert power over their spouse or partner: dominance, humiliation, isolation, threats, intimidation, denial and blame.

Physical abuse

Physical abuse is abuse involving contact intended to cause feelings of intimidation, pain, injury, or other physical suffering or bodily harm.

Sexual abuse

Sexual abuse is common in abusive relationships. is divided into three categories: The National Coalition Against Domestic Violence reports that between one-third and one-half of all battered women are raped by their partners at least once during their relationship. Any situation in which force is used to obtain participation in unwanted, unsafe, or degrading sexual activity constitutes sexual abuse. Forced sex, even by a spouse or intimate partner with whom consensual sex has occurred, is an act of aggression and violence. Furthermore, women whose partners abuse them physically and sexually are at a higher risk of being seriously injured or killed.

Some examples of sexual abuse include:

  1. Use of physical force to compel a person to engage in a sexual act against his or her will, whether or not the act is completed;
  2. Attempted or completed sex act involving a person who is unable to understand the nature or condition of the act, unable to decline participation, or unable to communicate unwillingness to engage in the sexual act, e.g., because of underage immaturity, illness, disability, or the influence of alcohol or other drugs, or because of intimidation or pressure; and
  3. Abusive sexual contact

Emotional abuse

Emotional abuse (also called psychological abuse or mental abuse) can include humiliating the victim privately or publicly, controlling what the victim can and cannot do, withholding information from the victim, deliberately doing something to make the victim feel diminished or embarrassed, isolating the victim from friends and family, implicitly blackmailing the victim by harming others when the victim expresses independence or happiness, or denying the victim access to money or other basic resources and necessities.

People who are being emotionally abused often feel as if they do not own themselves; rather, they may feel that their significant other has nearly total control over them. Women or men undergoing emotional abuse often suffer from depression, which puts them at increased risk for suicide, eating disorders, and drug and alcohol abuse.

Verbal abuse

Verbal abuse (also called reviling) is a form of abusive behavior involving the use of language. It is a form of profanity that can occur with or without the use of expletives. Whilst oral communication is the most common form of verbal abuse, it includes abusive words in written form.

Economic abuse

Economic abuse is when the abuser has complete control over the victim's money and other economic resources. Usually, this involves putting the victim on a strict "allowance", withholding money at will and forcing the victim to beg for the money until the abuser gives them some money. It is common for the victim to receive less money as the abuse continues. This also includes (but is not limited to) preventing the victim from finishing education or obtaining employment, or intentionally squandering or misusing communal resources.

Stalking

Stalking is often considered a type of psychological intimidation that causes a victim to feel a high level of fear.

Victimization

Statistics

Domestic violence occurs across the world, in various cultures, and affects people across society, irrespective of economic status. Without exception, family conflict studies find approximately equal rates of assaults by women and men. In the United States, according to the Bureau of Justice Statistics women are about six times as likely as men to experience intimate partner violence. Percent of women surveyed (national surveys) who were ever physically assaulted by an intimate partner: Barbados (30%), Canada (29%), Egypt (34%), New Zealand (35%), Switzerland (21%), United States (25%). Some surveys in specific places report figures as high as 50-70% of women surveyed who were ever physically assaulted by an intimate partner. Others, including surveys in the Philippines and Paraguay, report figures as low as 10%.

South Africa is said to have the highest statistics of gender-based violence in the world and this includes rape and domestic violence (Foster 1999; The Integrated Regional Network [IRIN], Johannesburg, South Africa, 25 May 2002). 80% of women surveyed in rural Egypt said that beatings were common and often justified, particularly if the woman refused to have sex with her husband. In India, around 70% of women are victims of domestic violence. The Human Rights Watch found that up to 90% of women in Pakistan were subject to verbal, sexual, emotional or physical abuse, within their own homes. Up to two-thirds of women in certain communities in Nigeria's Lagos State say they are victims to domestic violence.

Statistics published in 2004, show that the rate of domestic violence victimisation for Indigenous women in Australia may be 40 times the rate for non-Indigenous women. The rate of intimate partner violence in the U. S. has declined since 1993. The rate of minor assaults by women was 78 per 1,000 couples, compared with a rate for men of 72 per 1,000. The severe assault rate was 46 per 1,000 couples for assaults by women and 50 per 1,000 for assaults by men. Neither difference is statistically significant. Since these rates are based exclusively on information provided by women respondents, the near-equality in assault rates cannot be attributed to a gender bias in reporting." Strauss, Murray A. (2005) Results will vary, depending on specific wording of survey questions, how the survey is conducted, the definition of abuse or domestic violence used, the willingness or unwillingness of victims to admit that they have been abused and other factors.

Martin S. Fiebert examined 219 studies on intimate partner violence and concluded that "women are as physically aggressive or more aggressive than men in their relationships with their spouses or male partners". However, studies have shown that women are more likely to be injured. Archer's meta-analysis found that women suffer 65% of domestic violence injuries. A Canadian study showed that 7% of women and 6% of men were abused by their current or former partners, but female victims of spousal violence were more than twice as likely to be injured as male victims, three times more likely to fear for their life, twice as likely to be stalked, and twice as likely to experience more than ten incidents of violence. However, Strauss notes that Canadian studies on domestic violence have simply excluded questions that ask men about being victimized by their wives.

Some studies show that lesbian relationships have similar levels of violence as heterosexual relationships, while other studies report that lesbian relationships exhibit substantially higher rates of physical aggression.

Violence against women

In India, every two hours a "bride burning" occurs because the woman had a small dowry or so that her husband can remarry.

Between 1993 and 2001, U. S. women experienced intimate partner violence almost seven times more frequently than men (a ratio of 20:3). Statistics for the year 1994 showed that more than five times as many females were victimized by an intimate than were males.

There is currently limited research on the abuse of lesbian women by their lesbian partners. However, an investigation by the Canadian Government saw some 19% of a survey of lesbian women respond to being victims of their partners.

During pregnancy

Domestic violence during pregnancy can be missed by medical professionals because it often presents in non-specific ways. A number of countries have been statistically analyzed to calculate the prevalence of this phenomenon:

  • UK prevalence: 2.5-3.4%
  • USA prevalence: 3.2-33.7%
  • Ireland prevalence: 12.5%
  • Rates are higher in teenagers
  • Severity and frequency increase postpartum (10% antenatally vs. 19% postnatally); 21% at 3 months post partum

There are a number of presentations that can be related to domestic violence during pregnancy: delay in seeking care for injuries; late booking, non-attenders at appointments, self-discharge; frequent attendance, vague problems; aggressive or over-solicitous partner; burns, pain, tenderness, injuries; vaginal tears, bleeding, STDs; and miscarriage.

Domestic violence can also affect the fetus, the subsequent baby, and existing children:

  • Pre-birth: prematurity, Premature rupture of membranes, IUD
  • Psychosocial: interference in relationship, witnessing of violence, eating and sleeping disorders, emotional neediness, withdrawn, over-compliant, clingy, aggressive, problems at school, suicidal ideation
  • Legal: child protection issues, overlap with child abuse
  • Long-term chronic ill-health

Violence against men

Women's violence towards men is a serious social problem. While much attention has been focused on domestic violence against women, researchers argue that domestic violence against men is a substantial social problem worthy of attention. However, the issue of victimization of men by women has been contentious, due in part to studies which report drastically different statistics regarding domestic violence.

Some studies-typically crime studies-show that men are substantially more likely than women to use violence. According to a July 2000 Centers for Disease Control (CDC) report, data from the Bureau of Justice, National Crime Victimization Survey consistently show that women are at significantly greater risk of intimate partner violence than are men. Other studies-typically family and domestic violence studies-show that men are more likely to inflict injuries, but also that when all acts of physical aggression or violence are considered in aggregate, women are equally violent as men, or more violent than men

In May, 2007, researchers with the Centers for Disease Control reported on rates of self-reported violence among intimate partners using data from a 2001 study. In the study, almost one-quarter of participants reported some violence in their relationships. Half of these involved one-sided ("non-reciprocal") attacks and half involved both assaults and counter assaults ("reciprocal violence"). Women reported committing one-sided attacks more than twice as often as men (70% versus 29%). In all cases of intimate partner violence, women were more likely to be injured than men, but 25% of men in relationships with two-sided violence reported injury compared to 20% of women reporting injury in relationships with one-sided violence. Women were more likely to be injured in non-reciprocal violence.

Strauss argues that these discrepancies between the two data sets are due to several factors. For example, Strauss notes that crime statistics are compiled and analyzed differently from domestic violence statistics. Additionally, Strauss notes that most studies show that while men inflict the greater portion of injuries, women are at least as likely as men to shove, punch, slap or otherwise physically assault their partner, and that such relatively minor assaults often escalate to more serious assaults. Minor assaults perpetrated by women are also a major problem, even when they do not result in injury, because they put women in danger of much more severe retaliation by men. [...] It will be argued that in order to end 'wife beating,' it is essential for women also to end what many regard as a "harmless" pattern of slapping, kicking, or throwing something at a male partner. Strauss also notes that data confirming that women can be violent have been suppressed because the data contradicts preconceptions that men are responsible for most or all domestic violence.

The 2000 CDC report, based on phone interviews with 8000 men and 8000 women, reported that 7.5% of men claim to have been raped or assaulted by an intimate at some time in their life time (compared to 25% of women), and 0.9 percent of men claim to have been raped or assaulted in the previous 12 months (compared to 1.5% of women).

A 2007-2008 online non-random, self-report survey of the experiences and health of men who sustained partner violence in the past year. The study showed that male victims of IPV are very hesitant to report the violence or seek help. Reasons given for non-reporting were they (1) may be ashamed to come forward; (2) may not be believed; and (3) may be accused of being a batterer when they do come forward. The 229 U.S. heterosexual men, between 18 and 59, had been physically assaulted by their female partner within previous year and did seek help. The researchers say their findings emphasize the need for prevention on all levels:

  • Primary prevention: Educate public and providers that both sexes can be IPV victims
  • Secondary prevention: First responders (police, hotlines, medical professionals) should take concerns seriously from all individuals (including males) seeking help
  • Tertiary prevention: Rehabilitative services available to all individuals

Violence against children

The U. S. Department of Health and Human Services reports that for each year between 2000 and 2005, "female parents acting alone" were most common perpetrators of child abuse.

When it comes to domestic violence towards children involving physical abuse, research in the UK by the NSPCC indicated that "most violence occurred at home" (78 per cent). 40-60% of men and women who abuse other adults also abuse their children. Girls whose fathers batter their mothers are 6.5 times more likely to be sexually abused by their fathers than are girls from non-violent homes.

In China in 1989, 39,000 baby girls died during their first year of life because they didn't receive the same medical care that would be given to a boy offspring.

Counting only Asia, about one million children working in the sex trade are held in slavery-like conditions.

Violence against teens

Teen dating violence is a pattern of controlling behavior by one teenager over another teenager who are in a dating relationship. While there are many similarities to "traditional" domestic violence there are also some differences. Teens are much more likely than adults to become isolated from their peers as the result of controlling behavior by their boyfriend/girlfriend. Also, for many teens the abusive relationship may be their first dating experience and have never had a "normal" dating experience with which to compare it.

2005 World Health Organization Multi-country Study

The World Conference on Human Rights, held in Vienna in 1993, and the Declaration on the Elimination of Violence against Women in the same year, concluded that civil society and governments have acknowledged that violence against women is a public health and human rights concern. Work in this area has resulted in the establishment of international standards, but the task of documenting the magnitude of violence against women and producing reliable, comparative data to guide policy and monitor implementation has been exceedingly difficult. The World Health Organisation Multi-country Study on Women's Health and Domestic Violence against Women 2005 is a response to this difficulty. Published in 2005 it is a groundbreaking study which analysed data from 10 countries and sheds new light on the prevalence of violence against women. It seeks to look at violence against women a public health policy perspective. The findings will be used to inform a more effective response from government, including the health, justice and social service sectors, as a step towards fulfilling the state’s obligation to eliminate violence against women under international human rights laws.

Types

The form and characteristics of domestic violence and abuse may vary in other ways. Michael P. Johnson (1995, 2006b) argues for three major types of intimate partner violence. The typology is supported by subsequent research and evaluation by Johnson and his colleagues, as well as independent researchers.

Distinctions need to be made regarding types of violence, motives of perpetrators, and the social and cultural context. Violence by a man against his wife or intimate partner is often done as a way for men to control "their woman". Other types of intimate partner violence also occur, including violence between gay and lesbian couples, and by women against their male partners.

Distinctions are not based on single incidents, but rather on patterns across numerous incidents and motives of the perpetrator. Types of violence identified by Johnson:

  • Common couple violence (CCV) is not connected to general control behavior, but arises in a single argument where one or both partners physically lash out at the other. Intimate terrorism is one element in a general pattern of control by one partner over the other. Intimate terrorism is more common than common couple violence, more likely to escalate over time, not as likely to be mutual, and more likely to involve serious injury.
  • Intimate terrorism (IT) may also involve emotional and psychological abuse.
  • Violent resistance (VR), sometimes thought of as "self-defense", is violence perpetrated usually by women against their abusive partners.
  • Mutual violent control (MVC) is rare type of intimate partner violence occurs when both partners act in a violent manner, battling for control.

Another type is situational couple violence, which arises out of conflicts that escalate to arguments and then to violence. It is not connected to a general pattern of control. Although it occurs less frequently in relationships and is less serious than intimate terrorism, in some cases it can be frequent and/or quite serious, even life-threatening. This is probably the most common type of intimate partner violence and dominates general surveys, student samples, and even marriage counseling samples.

Types of male batterers identified by Holtzworth-Munroe and Stuart (1994) include "family-only", which primarily fall into the CCV type, who are generally less violent and less likely to perpetrate psychological and sexual abuse. IT batterers include two types: "Generally-violent-antisocial" and "dysphoric-borderline". The first type includes men with general psychopathic and violent tendencies. The second type are men who are emotionally dependent on the relationship. Support for this typology has been found in subsequent evaluations.

Others, such as the US Centers for Disease Control, divide domestic violence into two types: reciprocal violence, in which both partners are violent, and non-reciprocal violence, in which one partner is violent.

Theories

There are many different theories as to the causes of domestic violence. These include psychological theories that consider personality traits and mental characteristics of the offender, as well as social theories which consider external factors in the offender's environment, such as family structure, stress, social learning. As with many phenomena regarding human experience, no single approach appears to cover all cases.

Psychological

In general, about 80% of both court-referred and self-referred men in these [domestic violence] studies exhibited diagnosable psychopathology, typically personality disorders. Estimates of personality disorder in the general population would be more in the 15-20% range [...] As violence becomes more severe and chronic, the likelihood of psychopathology in these men approaches 100%." Psychological theories focus on personality traits and mental characteristics of the offender. Personality traits include sudden bursts of anger, poor impulse control, and poor self-esteem. Various theories suggest that psychopathology and other personality disorders are factors, and that abuse experienced as a child leads some people to be more violent as adults. Studies have found high incidence of psychopathy among abusers.

Dutton has suggested a psychological profile of men who abuse their wives, arguing that they have borderline personalities (between psychotics and neurotics), which are developed early in life. Gelles suggests that psychological theories are limited, and points out that other researchers have found that only 10% (or less) fit this psychological profile. He argues that social factors are important, while personality traits, mental illness, or psychopathy are lesser factors.

It should be noted that Borderline Personality Disorder as used in this context is outdated. Whilst it was originally believed that a person's psychological state was between neurotic and psychotic it is now recognised that BPD is the most severe and intransigent of the personality disorders.

Social theories

Looks at external factors in the offender's environment, such as family structure, stress, social learning, and includes rational choice theories.

Resource theory

Resource theory was suggested by William Goode (1971). Women who are most dependent on the spouse for economic well being. Having children to take care of, should they leave the marriage, increases the financial burden and makes it all the more difficult for them to leave. Dependency means that they have fewer options and few resources to help them cope with or change their spouse's behavior.

Couples that share power equally experience lower incidence of conflict, and when conflict does arise, are less likely to resort to violence. If one spouse desires control and power in the relationship, the spouse may resort to abuse. This may include coercion and threats, intimidation, emotional abuse, economic abuse, isolation, making light of the situation and blaming the spouse, using children (threatening to take them away), and behaving as "master of the castle".

Social stress

Stress may be increased when a person is living in a family situation, with increased pressures. Social stresses, due to inadequate finances or other such problems in a family may further increase tensions. Violence is not always caused by stress, but may be one way that some (but not all) people respond to stress. Families and couples in poverty may be more likely to experience domestic violence, due to increased stress and conflicts about finances and other aspects. Some speculate that poverty may hinder a man's ability to live up to his idea of "successful manhood", thus he fears losing honor and respect. Theory suggests that when he is unable to economically support his wife, and maintain control, he may turn to misogyny, substance abuse, and crime as ways to express masculinity.

Social learning theory

Social learning theory suggests that people learn from observing and modeling after others' behavior. With positive reinforcement, the behavior continues. If one observes violent behavior, one is more likely to imitate it. If there are no negative consequences (e. g. victim accepts the violence, with submission), then the behavior will likely continue. Often, violence is transmitted from generation to generation in a cyclical manner.

Power and control

In some relationships, violence is posited to arise out of a perceived need for power and control, a form of bullying and social learning of abuse.

Abusers' efforts to dominate their partners have been attributed to low self-esteem or feelings of inadequacy, unresolved childhood conflicts, the stress of poverty, hostility and resentment toward women (misogyny), hostility and resentment toward men (misandry), personality disorders, genetic tendencies and sociocultural influences, among other possible causative factors. Most authorities seem to agree that abusive personalities result from a combination of several factors, to varying degrees.

A causalist view of domestic violence is that it is a strategy to gain or maintain power and control over the victim. This view is in alignment with Bancroft's "cost-benefit" theory that abuse rewards the perpetrator in ways other than, or in addition to, simply exercising power over his or her target(s). He cites evidence in support of his argument that, in most cases, abusers are quite capable of exercising control over themselves, but choose not to do so for various reasons.

An alternative view is that abuse arises from powerlessness and externalizing/projecting this and attempting to exercise control of the victim. It is an attempt to 'gain or maintain power and control over the victim' but even in achieving this it cannot resolve the powerlessness driving it. Such behaviours have addictive aspects leading to a cycle of abuse or violence. Mutual cycles develop when each party attempts to resolve their own powerlessness in attempting to assert control.

Questions of power and control are integral to the widely utilized Duluth Domestic Abuse Intervention Project. They developed "Power and Control Wheel" to illustrate this: it has power and control at the center, surrounded by spokes (techniques used), the titles of which include:

  • Coercion and threats
  • Intimidation
  • Emotional abuse
  • Isolation
  • Minimizing, denying and blaming
  • Using children
  • Economic abuse
  • Male privilege

The model attempts to address abuse by one-sidedly challenging the misuse of power by the 'perpetrator'.

The power wheel model is not intended to assign personal responsibility, enhance respect for mutual purpose or assist victims and perpetrators in resolving their differences. It is an informational tool designed to help individuals understand the dynamics of power operating in abusive situations and identify various methods of abuse.

Critics of this model suggest that the one-sided focus, which presumes men are to blame for all domestic violence, is problematic.

Alcohol-related and non-alcohol related violence

Other factors associated with domestic violence include heavy alcohol consumption, mental illness, classism, various political and legal characteristics such as authoritarianism and dehumanisation.

Prescription drugs

It is also important to this topic to understand the paradoxical effects of some sedative drugs. Serious complications can occur in conjunction with the use of sedatives creating the opposite effect as to that intended. Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs. The paradoxical reactions may consist of depression, with or without suicidal tendencies, phobias, aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis. The contribution of these reactions is one possible component.

Sex and gender

Modes of abuse are stereotyped by some to be gendered, females tending to use more psychological and men more physical forms. The visibility of these differs markedly. However, experts who work with victims of domestic violence have noted that physical abuse is almost invariably preceded by psychological abuse. Police and hospital admission records indicate that a higher percentage of females than males seek treatment and report such crimes.

See also the section "Gender Differences" in this article, and some of the statistics in the subsection "U. S." in the "Statistics" section.

Cycle of violence

Frequently, domestic violence is used to describe specific violent and overtly abusive incidents, and legal definitions will tend to take this perspective. However, when violent and abusive behaviours happen within a relationship, the effects of those behaviours continue after these overt incidents are over. Advocates and counsellors will refer to domestic violence as a pattern of behaviours, including those listed above.

Lenore Walker presented the model of a Cycle of violence which consists of three basic phases:

Honeymoon Phase
Characterized by affection, apology, and apparent end of violence. During this stage the batterer feels overwhelming feelings of remorse and sadness. Some batterers walk away from the situation, while others shower their victims with love and affection.
Tension Building Phase
Characterized by poor communication, tension, fear of causing outbursts. During this stage the victims try to calm the batterer down, to avoid any major violent confrontations.
Acting-out Phase
Characterized by outbursts of violent, abusive incidents. During this stage the batterer attempts to dominate his/her partner(victim), with the use of domestic violence.

Although it is easy to see the outbursts of the Acting-out Phase as abuse, even the more pleasant behaviours of the Honeymoon Phase serve to perpetuate the abuse. See also the cycle of abuse article.

Many domestic violence advocates believe that the cycle of violence theory is limited and does not reflect the realities of many men and women experiencing domestic violence.

Gender differences

The role of gender is a controversial topic related to the discussion of domestic violence.

Erin Pizzey, the founder of an early women's shelter in Chiswick, London, has expressed her dismay at how domestic abuse has become a gender-political football, and expressed an unpopular view in her book Prone to Violence that roughly two-thirds of women in the refuge system had a predisposition to seek abusive relationships, and to inflict violence. Pizzey also expressed the view that domestic violence can occur against any vulnerable intimates, regardless of their gender.

A Freudian concept, repetition compulsion, has been cited as a possible cause of a woman who was abused in childhood seeking an abusive man (or vice versa), theoretically as a misguided way to "master" their traumatic experience.

Gender aspects of abuse

There continues to be discussion about whether men are more abusive than women, whether men's abuse of women is worse than women's abuse of men, and whether abused men should be provided the same resources and shelters that years of advocacy, money-raising, and funding has gained for women victims sekä Carney (2007).

Martin S. Fiebert of the Department of Psychology at California State University, Long Beach, provides an annotated bibliography of over two hundred scholarly works which demonstrate that women and men often exhibit comparable levels of IPV violence. In a Los Angeles Times article about male victims of domestic violence, Fiebert suggests that "...consensus in the field is that women are as likely as men to strike their partner but that-as expected-women are more likely to be injured than men." However, he noted, men are seriously injured in 38% of the cases in which "extreme aggression" is used. Fiebert additionally noted that his work was not meant to minimize the serious effects of men who abuse women.

In a Meta-analysis, John Archer, Ph. D., from the Department of Psychology, University of Central Lancashire, UK, writes:

The present analyses indicate that men are among those who are likely to be on the receiving end of acts of physical aggression. The extent to which this involves mutual combat or the male equivalent to “battered women� is at present unresolved. Both situations are causes for concern. Straus (1997) has warned of the dangers involved-especially for women-when physical aggression becomes a routine response to relationship conflict. “Battered men�-those subjected to systematic and prolonged violence-are likely to suffer physical and psychological consequences, together with specific problems associated with a lack of recognition of their plight (George and George, 1998). Seeking to address these problems need not detract from continuing to address the problem of “battered women."

Donald G. Dutton and Tonia L. Nicholls, from the Department of Psychology at the University of British Columbia also undertook a meta-analysis of data in 2005. They concluded:

Clearly, shelter houses full of battered women demonstrate the need for their continued existence. Moreover, outside of North American and Northern Europe, gender inequality is still the norm (Archer, in press). However, within those countries that have been most progressive about women’s equality, female violence has increased as male violence has decreased (Archer, in press). There is not one solution for every domestically violent situation; some require incarceration of a terrorist perpetrator, others can be dealt with through court-mandated treatment, still others may benefit from couples therapy. However, feminist inspired intervention standards that preclude therapists in many states from doing effective therapy with male batterers are one outcome of this paradigm. The failure to recognize female threat to husbands, female partners, or children is another (Straus et al., 1980 found 10% higher rates of child abuse reported by mothers than by fathers).
The one size fits all policy driven by a simplistic notion that intimate violence is a recapitulation of class war does not most effectively deal with this serious problem or represent the variety of spousal violence patterns revealed by research. At some point, one has to ask whether feminists are more interested in diminishing violence within a population or promoting a political ideology. If they are interested in diminishing violence, it should be diminished for all members of a population and by the most effective and utilitarian means possible. This would mean an intervention/treatment approach based on other successful approaches from criminology and psychology.

Theories that women are as violent as men have been dubbed "Gender Symmetry" theories. In the most serious violence the men do dominate for example in 1999 in the US, 1,218 women and 424 men were killed by an intimate partner, regardless of which partner started the violence and of the gender of the partner. On the other hand, Michael Kimmel of the State University of New York at Stony Brook found that men are more violent inside and outside of the home than women.

A problem in conducting studies that seek to describe violence in terms of gender is the amount of silence, fear and shame that results from abuse within families and relationships. Another is that abusive patterns can tend to seem normal to those who have lived in them for a length of time. Similarly, subtle forms of abuse can be quite transparent even as they set the stage for further abuse seeming normal. Finally, inconsistent definition of what domestic violence is makes definite conclusions difficult to reach when compiling the available studies.

Both men and women have been arrested and convicted of assaulting their partners in both heterosexual and homosexual relationships. The bulk of these arrests have been men being arrested for assaulting women. However, in the case of reciprocal violence, frequently only the male perpetrator is arrested. Determining how many instances of domestic violence actually involve male victims is difficult. Male domestic violence victims may be reluctant to get help for a number of reasons. Another study has demonstrated a high degree of acceptance by women of aggression against men.

Murders of female intimate partners by men have dropped, but not nearly as dramatically. Men kill their female intimate partners at about four times the rate that women kill their male intimate partners. Research by Jacquelyn Campbell, PhD RN FAAN has found that at least two thirds of women killed by their intimate partners were battered by those men prior to the murder. She also found that when males are killed by female intimates, the women in those relationships had been abused by their male partner about 75% of the time. (See battered person syndrome and battered woman defence.)

Some researchers have found a relationship between the availability of domestic violence services, improved laws and enforcement regarding domestic violence and increased access to divorce, and higher earnings for women with declines in intimate partner homicide. However, both men and women are far less likely to be abused when married to each other. The bulk of injuries from domestic violence involves co-habitation or the distresses of relationship break-ups.

Gender roles and expectations can and do play a role in abusive situations, and exploring these roles and expectations can be helpful in addressing abusive situations, as do factors like race, class, religion, sexuality and philosophy. None of these factors cause one to abuse or another to be abused.

Concerns about social programs dealing with violence

In 1997, the Canadian Advertising Foundation ruled that a national ad campaign that featured Nicole Brown Simpson's sister Denise with the slogan "Stop violence against women" was in fact portraying only men as aggressors, that it was not providing a balanced message and was, in fact, contributing to gender stereotyping. (The murder of Nicole Simpson also included the murder of Ronald Goldman.)

Domestic violence in same-sex relationships

Domestic violence also occurs in same-sex relationships. In an effort to be more inclusive, many organizations have made an effort to use gender-neutral terms when referring to perpetratorship and victimhood.

Historically domestic violence has been seen as a family issue and little interest has been directed at violence in same-sex relationships. It has not been until recently, as the gay rights movement has brought the issues of gay and lesbian people into public attention, when research has been conducted on same-sex relationships. Studies have indicated that partner abuse among male same-sex couples is several times that of heterosexual couples. Gays and lesbians, however, face special obstacles in dealing with the issues that some researchers have labeled "the double closet". A recent Canadian study by Mark W. Lehman suggests similarities include frequency (approximately one in every four couples); manifestations (emotional, physical, financial, etc.); co-existent situations (unemployment, substance abuse, low self-esteem); victims' reactions (fear, feelings of helplessness, hypervigilance); and reasons for staying (love, can work it out, things will change, denial). At the same time, significant differences, unique issues and deceptive myths are typically present. Lehman points to added discrimination and fear gays and lesbians can face; dismissal by police and some social services; a lack of support from peers who would rather keep quiet about the problem in order not to attract negative attention toward the gay community; the impacts of HIV status or AIDS in keeping partners together, due to health care insurance/access, or guilt; outing used as a weapon; and encountering supportive services that are targeted and/or structured for the needs of heterosexual women and which may not meet the needs of gay men or lesbians.

Diagnosis planning

The American Psychiatric Association planning and research committees for the forthcoming DSM-V (2012) have canvassed a series of new Relational disorders which include Marital Conflict Disorder Without Violence or Marital Abuse Disorder (Marital Conflict Disorder With Violence). Couples with marital disorders sometimes come to clinical attention because the couple recognize long-standing dissatisfaction with their marriage and come to the clinician on their own initiative or are referred by an astute health care professional. Secondly, there is serious violence in the marriage which is -"usually the husband battering the wife".

In these cases the emergency room or a legal authority often is the first to notify the clinician. Most importantly, marital violence "is a major risk factor for serious injury and even death and women in violent marriages are at much greater risk of being seriously injured or killed (National Advisory Council on Violence Against Women 2000)." The authors of this study add that "There is current considerable controversy over whether male-to-female marital violence is best regarded as a reflection of male psychopathology and control or whether there is an empirical base and clinical utility for conceptualizing these patterns as relational."

Recommendations for clinicians making a diagnosis of Marital Relational Disorder should include the assessment of actual or "potential" male violence as regularly as they assess the potential for suicide in depressed patients. Further, "clinicians should not relax their vigilance after a battered wife leaves her husband, because some data suggest that the period immediately following a marital separation is the period of greatest risk for the women. Many men will stalk and batter their wives in an effort to get them to return or punish them for leaving. Initial assessments of the potential for violence in a marriage can be supplemented by standardized interviews and questionnaires, which have been reliable and valid aids in exploring marital violence more systematically."

The authors conclude with what they call "very recent information" on the course of violent marriages which suggests that "over time a husband's battering may abate somewhat, but perhaps because he has successfully intimidated his wife. The risk of violence remains strong in a marriage in which it has been a feature in the past. Thus, treatment is essential here; the clinician cannot just wait and watch." The most urgent clinical priority is the protection of the wife because she is the one most frequently at risk, and clinicians must be aware that supporting assertiveness by a battered wife may lead to more beatings or even death.

Response to domestic violence

The response to domestic violence is typically a combined effort between law enforcement agencies, the courts, social service agencies and corrections/probation agencies. The role of each has evolved as domestic violence has been brought more into public view.

Domestic violence historically has been viewed as a private family matter that need not involve government or criminal justice intervention. Police officers were often reluctant to intervene by making an arrest, and often chose instead to simply counsel the couple and/or ask one of the parties to leave the residence for a period of time. The courts were reluctant to impose any significant sanctions on those convicted of domestic violence, largely because it was viewed as a misdemeanor offense.

Activism, initiated by victim advocacy groups and feminist groups, has led to a better understanding of the scope and effect of domestic violence on victims and families, and has brought about changes in the criminal justice system's response.

Several projects have aided in filling the voids in the justice system as it pertains to the protection of victims. One such initiative, The Hope Card Project, makes an attempt to remedy several problems through the issuance of an ID card to victims of abuse. The card is used to identify both parties in a domestic violence protection order and provides additional resources to the victim through a voucher program for services."There is no photograph on a protection order, so a photograph is a bonus, not a necessity. There are several methods used to obtain the photograph. Some jurisdictions have a photograph taken of the offender during the first hearing while both parties are present. Another method is for officers to take a photograph in the field or retrieve a booking photograph from their local jail. In a lot of cases the victim brings a photograph and it is scanned. Lastly, the new online site has some state motor vehicle department photograph databases connected for that purpose. This is the ideal method." The Hope Card Project

Medical response

Medical professionals, who have contact with abuse victims through medical visits, have a role to play in helping domestic violence victims. Many cases of spousal abuse are handled solely by medical professionals and do not involve the police. Sometimes cases of spousal abuse are brought into the emergency room, while many other cases are handled by family physician or other primary care provider.

Doctors and other medical professionals are in position to empower victims, give advice, and refer them to appropriate services. The health care professional in the United Kingdom, the United States, and elsewhere has not always met this role, been uneven in quality of care, and in many cases has been unhelpful due to misunderstandings they have about domestic violence. Myths that have prevailed in the past and influenced how a doctor approaches a case, where domestic violence may be involved, include the belief that domestic violence is rare, that women are responsible for the violence, and it is inevitable.

Washaw (1993) suggests that many doctors prefer not to get involved in people's "private" lives. Clifton, Jacobs, and Tulloch (1996) found that training for general practitioners in the United States about domestic violence was very limited or they had no training. Abbott and Williamson found that knowledge and understanding of domestic violence was very limited among health care professionals in a Midlands, United Kingdom county, and that they don't see themselves as being able to play a major role in helping women in regards to domestic violence. Furthermore, in the biomedical model of health care, injuries are often just treated and diagnosed, without regard for the causes. As well, there is substantial reluctance for victims to come forward and broach the issue with their physicians. On average, women experience 35 incidents of domestic violence before seeking treatment.

In the U. S., the Institute of Medicine recognized the shortcomings of the health care system in its 2002 report entitled Confronting Chronic Neglect and attributed some of the problems cited to a lack of adequate training among health professionals. Health professionals have an ethical responsibility to recognize and address exposure to abuse in their patients, in the health care setting. For example, the American Medical Association's code of medical ethics states that "Due to the prevalence and medical consequences of family violence, physicians should routinely inquire about physical, sexual, and psychological abuse as part of the medical history. Physicians must also consider abuse in the differential diagnosis for a number of medical complaints, particularly when treating women."

Longer term health effects

New research illustrates that there are strong associations between exposure to domestic violence and abuse in all their forms and higher rates of many chronic conditions. The strongest evidence comes from the Adverse Childhood Experiences' series of studies which show correlations between exposure to abuse or neglect and higher rates in adulthood of chronic conditions, high risk health behaviors and shortened life span. Evidence of the association between physical health and violence against women has been accumulating since the early 1990s.

More recently work by such researchers as Corso have begun to quantify the economic impact of exposure to violence and abuse. A recent publication, Hidden Costs in Health Care: The Economic Impact of Violence and Abuse, makes the case that such exposure represents a serious and costly public health issue that should be addressed by the health care system.

Medication

A number of medications have been used for control of aggression. Good evidence exists on the efficacy of clozapine. Evidence also exists for SSRIs (selective serotonin re-uptake ihibitors), like Prozac, hormonal antiandrogenic agents, beta-blockers, quetiapine and aripiprazole. Lithium and anticonvulsants are widely used but their efficacy is not strongly supported.

Law enforcement

In the 1970s, it was widely believed that domestic disturbance calls were the most dangerous type for responding officers, who arrive to a highly emotionally charged situation. This belief was based on FBI statistics which turned out to be flawed, in that they grouped all types of disturbances together with domestic disturbances, such as brawls at a bar. Subsequent statistics and analysis have shown this belief to be false.

Statistics on incidents of domestic violence, published in the late 1970s, helped raise public awareness of the problem and increase activism. A study published in 1976 by the Police Foundation found that the police had intervened at least once in the previous two years in 85 percent of spouse homicides. In the late 1970s and early 1980s, feminists and battered women's advocacy groups were calling on police to take domestic violence more seriously and change intervention strategies. In some instances, these groups took legal action against police departments, including in Oakland, California and New York City, to get them to make arrests in domestic violence cases. They claimed that police assigned low priority to domestic disturbance calls.

The Minneapolis Domestic Violence Experiment was a study done in 1981-1982, led by Lawrence W. Sherman, to evaluate the effectiveness of various police responses to domestic violence calls in Minneapolis, Minnesota, including sending the abuser away for eight hours, giving advice and mediation for disputes, and making an arrest. Arrest was found to be the most effective police response. The study found that arrest reduced the rate by half of re-offending against the same victim within the following six months. The results of the study received a great deal of attention from the news media, including The New York Times and prime-time news coverage on television.

Many U. S. police departments responded to the study, adopting a mandatory arrest policy for spousal violence cases with probable cause. By 2005, 23 states and the District of Columbia had enacted mandatory arrest for domestic assault, without warrant, given that the officer has probable cause and regardless of whether or not the officer witnessed the crime. The Minneapolis study also influenced policy in other countries, including New Zealand, which adopted a pro-arrest policy for domestic violence cases.

However, the study was subject of much criticism, with concerns about its methodology, as well as its conclusions. The Minneapolis study was replicated in several other cities, beginning in 1986, with some of these studies having different results; one of which being the fact that the deterrent effect observed in the Minneapolis experiment was largely localized. In the replication studies which were far more broad and methodologically sound in both size and scope, arrest seemed to help in the short run in certain cases, but those arrested experienced double the rate of violence over the course of one year.

Criminologists do not fully understand the reasons why deterrent effects do not last over time. But they suggest that abusers who are employed and have ties to the community may initially fear punishment, though many cases do not make it all the way through the criminal justice process. If the victim is uncooperative during investigation, the prosecutor may choose not to pursue the case. If the case is pursued through the criminal justice system, sometimes the resulting sentence is minor. Subsequently, any fear that the abuser has of punishment may have diminished.

Domestic response of law enforcement today

Each agency and jurisdiction within the United States has its own Standard Operating Procedures (SOP) when it comes to responding and handling domestic calls. Generally, it has been accepted that if the understood victim has visible (and recent) marks of abuse, the suspect is arrested and charged with the appropriate crime. However, that is a guideline and not a rule. Like any other call, domestic abuse lies in a gray area. Law enforcement officers have several things to consider when making a warrantless arrest:

  • Are there signs of physical abuse?
  • Were there witnesses?
  • Is it recent?
  • Was the victim assaulted by the alleged suspect?
  • Who is the primary aggressor?
  • Could the victim be lying?
  • Could the suspect be lying?

Along with protecting the victim, law enforcement officers have to ensure that the alleged abusers' rights are not violated. Many times in cases of mutual combatants, it is departmental policy that both parties be arrested and the court system can establish truth at a later date. In some areas of the nation, this mutual combatant philosophy is being replaced by the primary abuser philosophy in which case if both parties have physical injuries, the law enforcement officer determines who the primary aggressor is and only arrests that one. This philosophy started gaining momentum when different government/private agencies started researching the effects. It was found that when both parties are arrested, it had an adverse affect on the victim. The victims were less likely to call or trust law enforcement during the next incident of domestic abuse.

Intervention

In 1981, the Duluth Domestic Abuse Intervention Project became the first multi-disciplinary program designed to address the issue of domestic violence. This experiment, conducted in Duluth, Minnesota, frequently referred to as the "Duluth Project."

It coordinated agencies dealing with domestic situations, drawing together diverse elements of the system, from police officers on the street, to shelters for battered women and probation officers supervising offenders.

This program has become a model for other jurisdictions seeking to deal more effectively with domestic violence. Corrections/probation agencies in many areas are supervising domestic violence offenders more closely, and are also paying closer attention to the victim's needs and safety issues.

There has been controversy as the Duluth framework depends on a strict "patriarchal violence" model and presumes that all violence in the home and elsewhere has a male perpetrator and female victim. Also evidence of success of the model is limited, with scholarly analysis and critique.

Many victims leave their abusers, only to return. Research has shown that a major factor in helping a victim to establish lasting independence from the abusive partner is her or his ability to get legal assistance. Economists at the Brennan Center for Justice analyzed Bureau of Justice Statistics data to determine what accounted for the nationwide reduction in reported abuse. Their findings revealed that one significant factor was the availability of legal services to assist abuse victims. Another major study by economists at Colgate University and the University of Arkansas flatly stated that the only public service that reduces domestic violence in the long term is legal aid. Legal assistance can provide essential safety planning, buttress a family’s economic position through child or spousal support, allay fears planted by the batterer about loss of custody, and help victims to secure needed government benefits.

Nursing Response to Domestic Violence

Nursing Assessment

Nursing Documentation

Thorough medical records and complete documentation is crucial in preventing any further domestic violence to a victim. Complete medical documentation can be the most credible evidence in a victim’s case against their abuser. It can also be used as evidence to obtain a range of protective relief such as a restraining order. Medical records can help corroborate the police reports and data. This may help in strengthening the victim’s case. It is also extremely important that the documentation be very detailed with both written statements and all possible photo’s of the victim and their injuries. Here is some information that nurses/medical personnel should make sure is document in the victim’s chart.

  1. Complete medical and social history
  2. Multiple close-up photographs in color of each injury
  3. Documentation should be very detailed-including a body map of injuries
  4. Handwriting should be very legible
  5. Try and avoid using medical abbreviations- that way there is no misinterpretations of the records
  6. Include all the victim’s laboratory test, x-rays and any other diagnostic procedures
  7. Place the victim/patient’s statements within quotation marks as often as possible
  8. Avoid statements like “patient claims� or “patient alleges�
  9. Include names of all personnel (medical and law enforcement) that came in contact with the victim that day
  10. Note how the patient was acting/demeanor at the time of evaluation
  11. Be sure to include the specifics about the abusive incident- including any details about past abuse
  12. Finally, make sure to describe the person who harmed the victim in the victim’s own words-make sure to include the relationship between the victim and the abuser

There are multiple ways to document domestic violence as long as all the information is presented within the victim's chart. The acronym “RADAR� summarizes action steps medical personnel should take in recognizing,documenting and treating victims of violence in one way of recording vital information.

Nursing intervention

Violence against women is common in the United States with statistics as high as 25%. Men are also victims as well when it comes to domestic violence statistics show 8%. Because DMV is so prevalent many communities have outreach programs, hospitals have specialized professionals and even work places are recognizing the need to help victims.

Early identification of abuse is key in helping a victim to be safe and providing them with the appropriate resources. When domestic violence is suspected or confirmed the nurse will want to gather resources within the community to help establish interventions that will provide for a safe environment, provide support, and offer protection. In addition the nurse wants to listen to the victims concerns and believe what the victim is telling them. The National Domestic Hotline will help the nurse find resources within the community such as safe house to protect the victim and their children, and other support systems to help meet the victim’s needs. The nurse should also offer support and reassurance that confidentiality will be protected and that the nurse will help the victim with decisions that need to be made. The victim should also be reassured that intimate partner abuse is not normal and there are support groups and legal actions to help the victim not stay in an abusive situation. The best intervention for victims of intimate partner violence is to get involved and know what resources are available to help victims of domestic violence.

Nursing planning with victim on a safety plan

Every patient or victim who has a positive screening for domestic violence or intimate partner violence as the situation is known, should know that there are resources available to them within his or her community for getting help. Victims need to have a safety plan for themselves and any children. Statistics show that a typical abuser has a pattern or cycle of abuse that repeats and even escalates during the relationship. It is rare that abuse is a one time occurrence.

Victims are often frightened, isolated, without financial resources, caring for small children, and unable to take charge of their own decisions. They may be unable to make simple choices without careful intervention by the nursing community. A number one priority for nurses and all health care professionals is to help find the victim a safe environment for themself and any children. Many safe houses exist throughout the U.S and elsewhere for this reason. Besides being an emergency shelter, a safe house is set up to provide other confidential services to IPV vicitms. Counseling, referrals for schooling and job placement, court accompaniment or day care are some of the benefits available to the person. Most communities will have a list of safe houses plus help resources and support systems in place.

The State of Maryland has an informative site specifically addressing a safety plan; most other states have a site also. Their information starts with a list of points such as 1. Call 911 if you are in immediate danger or need help. Many hospitals, by way of a domestic violence co-ordinator offer their victims donated cell phones that are programmed to call 911. These individuals are also great resource people. The person can keep the phone and throw it out if necessary should the abuser find out. Otherwise, it offers them a means of direct help and communication. 2. Get medical attention if you are injured. 3. Take photos of injuries for use later in court. 4. Have a signal with a neighbor if you are in trouble. 5. Keep some money, change of clothes and important documents ready. 6. Contact your local DV program. Strongly encourage the victim to file for a protective order ; the local DV hospital program co-ordinator will know how to help them get to the local courthouse. The entire list from the State of Maryland can be viewed at:

Myths

According to Bancroft the following statements are myths:

  • Abuse is caused by a loss of control: Abusers may blame the victim's actions for causing them to lose control of their temper. But in fact their anger can be carefully controlled, such as destroying only their partner's possessions and not their own, and quickly altering their demeanor upon the arrival of witnesses or police. At this point the abuser, who is calm, will often pass the blame to the victim, who is likely to be visibly disturbed.
  • Too much anger causes abuse: Abuse therapists find that anger is usually only one of many abusive tactics employed against a victim. Anger results from abusive attitudes and the abuser's sense of entitlement rather than being a cause of these. Anger management courses are unlikely to stop abuse because they do not address the abuser's attitudes.
  • Abusers are always mentally ill: Some abusers do have personality disorders such as borderline personality disorder or psychopathy, but most abusers are mentally normal. It is their attitudes, absorbed from society or their family background, that make them abusively seek power over their partner or child.
  • Abusers have low self-esteem: Abusers are found in all walks of life, and many of them are successful and confident. They include heads of corporations, high-ranking police officers and judges. Boosting abusers' egos may increase their sense of entitlement and lead to worse abuse.
  • Alcohol or drug abuse causes abuse: Many substance abusers do not abuse their partners. However, those who do usually continue or even intensify psychological abuse if they give up the substance abuse. Having used the substance abuse as an excuse for their behavior before, they are likely to change to using the stress of staying away from the substance as the excuse.