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Domestic Violence

By

Erin G. Clifton

, PhD, Department of Psychiatry, University of Michigan

Last full review/revision Apr 2020| Content last modified Apr 2020
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Topic Resources

Domestic violence includes physical, sexual, and psychologic abuse between people who live together including sex partners, parents and children, children and grandparents, and siblings. Domestic violence includes intimate partner violence (IPV), which refers to physical, sexual, or psychologic abuse by a current or former sex partner or spouse.

Domestic violence occurs among people of all cultures, races, sexual orientations, occupations, income levels, and ages. In the US, as many as 30% of marriages are considered physically aggressive.

Women are more commonly victims of domestic violence than are men. About 95% of people who seek medical attention as a result of domestic violence are women. Women are more likely to be severely assaulted or killed by a male partner than by anyone else. Each year in the US, about 2 million women are severely beaten by their partner. In the US, about 44% of women and about 25% of men have experienced contact sexual violence, physical violence, and/or stalking by an intimate partner in their lifetime and were negatively affected by it (eg, became fearful, developed symptoms of posttraumatic stress disorder, were injured, infected with a sexually transmitted disease [1]). Over 21% of women and almost 15% of men experience severe physical violence by an intimate partner during their lifetime.

Physical abuse is the most obvious form of domestic violence. It may include hitting, slapping, kicking, punching, breaking bones, pulling hair, pushing, and twisting arms. The victim may be deprived of food or sleep. Weapons, such as a gun or knife, may be used to threaten or cause injury.

Sexual assault is also common; many women who are physically assaulted by their partner are also sexually assaulted by their partner. Sexual assault involves the use of threats or force to coerce sexual contact and includes unwanted touching, grabbing, or kissing, as well as rape.

Psychologic abuse may be even more common than physical abuse and may precede it. Psychologic abuse involves any nonphysical behavior that undermines or belittles the victim or that enables the perpetrator to control the victim. Psychologic abuse can include

  • Abusive language

  • Social isolation

  • Financial control

Usually, the perpetrator uses language to demean, degrade, humiliate, intimidate, or threaten the victim in private or in public. The perpetrator may make the victim think she is crazy (gaslighting) or make her feel guilty or responsible, blaming her for the abusive relationship. The perpetrator may also humiliate the victim in terms of her sexual performance, physical appearance, or both.

The perpetrator may try to partly or completely isolate the victim by controlling the victim’s access to friends, relatives, and other people. Control may include forbidding direct, written, telephone, or e-mail contact with others. The perpetrator may manipulate the victim into thinking that others cannot or will not help, or use jealousy to justify his actions. The perpetrator may also prevent the victim from accessing medical care.

Often, the perpetrator withholds money to control the victim. The victim may depend on the perpetrator for most or all of her money. The perpetrator may maintain control by preventing the victim from getting a job, by keeping information about their finances from her, and by taking money from her.

After an incident of abuse, the perpetrator may beg for forgiveness and promise to change and stop the abusive behavior. However, typically, the abuse continues and often escalates.

Perpetrators may use technology (eg, social media web sites, phones) to post videos or stalk the victim and to monitor, isolate, punish, threaten, and/or humiliate victims (2, 3). Also, perpetrators can monitor the victim's devices, often without the victim's knowing it.

General references

Effects

A victim of domestic violence may be physically injured. Physical injuries can include bruises, black eyes, cuts, scratches, broken bones, lost teeth, and burns. Injuries may prevent the victim from going to work regularly, causing her to lose her job. Injuries, as well as the abusive situation, may embarrass the victim, causing her to isolate herself from family and friends. The victim may also have to move often—a financial burden—to escape the perpetrator. Sometimes the perpetrator kills the victim.

As a result of domestic violence, many victims have psychologic problems. Such problems include posttraumatic stress disorder (PTSD), substance abuse, anxiety, and depression. About 60% of battered women are depressed. Women who are more severely battered are more likely to develop psychologic problems. Even when physical abuse decreases, psychologic abuse often continues, reminding the woman that she can be physically abused at any time. Abused women may feel that psychologic abuse is more damaging than physical abuse. Psychologic abuse increases the risk of depression and substance abuse.

Children Who Witness Domestic Violence

Each year, at least 3.3 million children are estimated to witness physical or verbal abuse in their homes. These children may develop problems such as the following:

  • Excessive anxiety or crying

  • Fearfulness

  • Difficulty sleeping

  • Depression

  • Social withdrawal

  • Difficulty in school

Also, children may blame themselves for the situation.

Older children may run away from home. Boys who see their father abuse their mother may be more likely to become abusive adults. Girls who see their father abuse their mother may be more likely to tolerate abuse as adults.

The perpetrator may also physically hurt the children. In homes where domestic violence is present, children are much more likely to be physically mistreated.

Evaluation

  • Clinical evaluation

Clinicians may suspect domestic violence based on injuries, inconsistent or puzzling symptoms, and/or behavior of the victim and/or partner (eg, a partner is reluctant to leave the victim alone with the clinician). Or a victim may report the abuse.

If clinicians suspect domestic violence, they may gently ask patients about their relationship with their partner. Many experts recommend that clinicians screen all patients for domestic violence by asking specific questions.

Clinicians also try to determine whether the victim can safely return home before leaving the office. Safety is in doubt in the following circumstances:

  • The victim has threatened to leave the relationship.

  • Violence has been increasing.

  • The partner has access to weapons.

  • The partner has threatened to kill or injure the victim.

If domestic violence is confirmed, clinicians are required to document the evidence of abuse, often by photographing the injuries. This documentation can be used to support a legal case against the perpetrator. Laws about reporting domestic violence vary by state and sometimes by type of clinician.

Management

In cases of domestic violence, the most important consideration is safety. During a violent incident, the victim should try to move away from areas in which she can be trapped or in which the perpetrator can obtain weapons, such as the kitchen, although doing so may not be possible. If she can, the victim should promptly call 911 or the police and leave the house. The victim should have any injuries treated and documented with photographs. She should teach her children not to get in the middle of a fight and when and how to call for help.

Developing a safety plan is important. It should include where to go for help, how to get away, and how to access money. The victim should also make and hide copies of official documents (such as children’s birth certificates, social security cards, insurance cards, and bank account numbers). She should keep an overnight bag packed in case she needs to leave quickly.

Sometimes the only solution is to leave the abusive relationship permanently because domestic violence tends to continue, especially among very aggressive men. Also, even when physical abuse decreases, psychologic abuse may persist. The decision to leave is not simple or easy. Victims often feel unable to leave an abusive relationship for multiple reasons, including fear of retaliation and economic dependence on the abuser.

After the perpetrator knows the victim has decided to leave, the victim’s risk of serious harm and death may be greatest. At this time, the victim should take additional steps to protect herself and her children; for example, she can obtain a restraining or protection order (although such an order does not guarantee safety).

Help is available through shelters for battered women, support groups, the courts, and a national hotline (1-800-799-SAFE or, for TTY, 1-800-787-3224). The National Domestic Violence Helpline also has chat options if the victim is unable to make a voice call.

Key Points

  • The victim is usually a woman.

  • Physical injuries, psychologic problems, social isolation, loss of a job, financial difficulties, and even death can result.

  • Keeping safe—for example, having a plan of escape—is the most important consideration.

  • Because domestic violence tends to continue, sometimes the only solution is to leave the abusive relationship permanently, which requires preparation and extra precautions to ensure safety.

More Information

  • The National Intimate Partner and Sexual Violence Survey: Ongoing data from the Centers for Disease Control and Prevention on the national prevalence of intimate partner violence, sexual violence, and stalking among women and men in the United States and tracks trends over time; special reports provide more information or in-depth analyses on a specific topic

  • National Domestic Violence Helpline: Information about the domestic violence hotline and live, online chat service available for victims, survivors, and friends and family members who are concerned about a loved one's safety

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