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Domestic Violence

By Norah C. Feeny, PhD, Case Western Reserve University

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Patient Education
  • Domestic violence includes physical, sexual, and psychologic abuse between intimate partners.

  • 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.

Domestic violence includes physical, sexual, and psychologic abuse between people who live together, including intimate partners, parents and children, children and grandparents, and siblings. It occurs among people of all cultures, races, occupations, income levels, and ages. In the United States, 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, and perhaps 400,000 to 500,000 of women’s visits to the emergency department each year are for injuries related to domestic violence. Women are more likely to be severely assaulted or killed by a male partner than by anyone else. Each year in the United States, about 2 million women are severely beaten by their partner.

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: 33 to 50% of 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.

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, and 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 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 use jealousy to justify his actions.

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.

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, 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.

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. 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. 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 (such as obtaining a restraining or protection order) to protect herself and her children. 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).

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* This is the Professional Version. *