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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
Click here for the Professional Version
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
Topic Resources

Domestic violence is physical, sexual, or psychologic abuse between people who live together. It includes intimate partner violence, which refers to physical, sexual, or psychologic abuse by a current or former sex partner or spouse.

  • The victim is usually a woman but may be a man.

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

  • Doctors may suspect domestic violence based on injuries, inconsistent or puzzling symptoms, or the behavior of the victim and/or the victim's partner.

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

Domestic violence can occur between parents and children, children and grandparents, and siblings, as well as intimate partners. It occurs among people of all cultures, races, sexual orientations, occupations, income levels, educational levels, religious backgrounds, and ages.

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.

In the United States, domestic violence was reported at some point in their life by the following groups:

  • About 35% of heterosexual women

  • Almost 44% of homosexual women

  • Almost 61% of bisexual women

  • About 29% of heterosexual men

  • About 26% of homosexual men

  • About 37% of bisexual men

More than 21% of women and almost 15% of men in the United States have experienced severe physical violence at the hands of an intimate partner during their lifetime. Women are more likely to be severely assaulted or killed by a male partner than by anyone else. Each year in the United States, experts estimate that about 2 million women are severely beaten by their partner.

Did You Know...

  • Domestic violence can happen to anyone.

  • In the United States, more than 21% of women and almost 15% of men have experienced severe physical violence at the hands of an intimate partner during their lifetime.

  • The abusing partner may try to control the victim by limiting the victim's access to money and to other people, even by telephone or e-mail.

Physical abuse

Physical abuse is the most obvious form of domestic violence. It may include hitting, slapping, kicking, punching, breaking bones, pulling hair, pushing, twisting arms, slamming against something, choking, suffocating, beating, and burning. 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

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, kissing, and rape.

Psychologic abuse

Psychologic abuse is very common and often accompanies physical or sexual abuse. 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 that her perceptions of reality are wrong and that she is crazy (called 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 contact with others—directly or through writing, telephone, e-mail, texting, or social media. The perpetrator may use jealousy to justify his actions. The perpetrator may further isolate the victim by convincing her that family members and friends cannot or will not help her.

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

The perpetrator may also prevent the victim from getting medical care.

Abuse using technology

Perpetrators may use technology (such as social media) to post videos of, stalk, monitor, isolate, punish, threaten, and/or humiliate the victim. Also, perpetrators often monitor the victim's devices, often without the victim's knowing it.

The perpetrator's behavior after abuse

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.

The perpetrator's outbursts of violence tend to be episodic and unpredictable. Thus, victims may live in near-constant fear of the next outburst.

Reasons victims remain in an abusive relationship

Often, victims do not leave the abusive relationship. Reasons may include

  • Feeling dependent on the perpetrator for money

  • Feeling alone, with no one to help

  • Being afraid that planning or trying to leave will trigger more intense violence

  • Being afraid of what the perpetrator will do after they leave (for example, stalk them or hurt their children, another family member, or a pet)

  • Believing that the abuser will change (for example, because of promises to do so)

  • Still loving the abuser

  • Believing that abuse may be normal (for example, because of upbringing or culture)

Effects of Domestic Violence

Victims 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 victims from going to work regularly, causing them to lose their job. Injuries, as well as the abusive situation, may cause embarrassment, causing victims to isolate themselves from family and friends.

Victims may develop symptoms that have no obvious physical cause. These symptoms can include headaches, abdominal or pelvic pain, and fatigue.

Many victims also get sexually transmitted diseases and have problems during pregnancy.

Victims may have to move often—a financial burden—to escape the perpetrator.

Sometimes the perpetrator kills the victim.

Did You Know...

  • Victims of domestic violence may develop depression, anxiety, or drug or alcohol abuse.

  • They are in greatest danger of serious harm after their partner knows they have decided to leave.

As a result of domestic violence, many victims have psychologic problems. For example, more than 50% have posttraumatic stress disorder (PTSD) and/or depression. They may also develop anxiety disorders, eating disorders and/or substance abuse. Domestic violence may also worsen symptoms of preexisting mental disorders.

Even when physical abuse decreases, psychologic abuse often continues, reminding victims that they can be physically abused at any time. Psychologic abuse can be more damaging than physical abuse. Psychologic abuse increases the risk of depression and substance abuse.

Children Who Witness Domestic Violence

Each year, millions of children are estimated to witness physical or verbal abuse in their homes.

These children may develop problems such as

  • 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

  • A doctor's evaluation

Doctors may suspect domestic violence based on injuries, inconsistent or puzzling symptoms, and/or the behavior of the victim and/or partner. Or a victim may report the abuse.

If doctors suspect domestic violence, they may gently ask the person questions about the relationship with the partner. Many experts recommend that health care practitioners ask all people questions about domestic violence.

If domestic violence is suspected, doctors 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, doctors 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.

Management

  • Developing a safety plan

  • Seeking help when needed

Abuse is never justified. Support is available whether victims decide to stay in or leave the abusive relationship.

In cases of domestic violence, the most important consideration is safety. If possible, during a violent incident, victims should try to move away from areas in which they can be trapped or in which the perpetrator can obtain weapons, such as knives in the kitchen. If possible, victims should promptly call 911 or the police and leave the residence.

Victims should have any injuries treated and documented with photographs. Victims should teach their children not to get in the middle of a fight and when and how to call for help.

Developing a safety plan is extremely important. It should include

  • Where to go for help (victims should have several possible places to go and people who can be called)

  • How to get away (often including appearing to do a routine task that involves leaving the house, such as going on an errand or walking the dog)

  • How to access money (including hiding money away and obtaining a separate bank account and, if possible, credit card)

Victims should also make and hide copies of official documents (such as children’s birth certificates, social security cards, insurance cards, and bank account numbers). They should keep an overnight bag packed and hidden in case they need to leave quickly.

Sometimes the only solution is to leave the abusive relationship permanently because domestic violence tends to continue, especially among very aggressive perpetrators. Also, even when physical abuse decreases, psychologic abuse may persist.

The decision to leave is not simple or easy. Often, victims feel unable to leave an abusive relationship for many reasons, including being afraid of what the perpetrator will do after they leave and being dependent on the perpetrator for money.

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, victims should take additional steps to protect themselves and their children. For example, they 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 speak safely. Victims should seek such help even if abuse is not severe. Seeking such help does not necessarily cause trouble for the partner. Information about using technology safely is available online.

More Information

  • Centers for Disease Control and Prevention (CDC): Intimate Partner Violence. This web site provides links to fast facts, prevention strategies, dating, risk and protective factors, and the National Intimate Partner and Sexual Violence Survey, which is an ongoing survey that collects the most current and comprehensive national and state data on intimate partner violence, sexual violence and stalking victimization in the United States.

  • Centers for Disease Control and Prevention (CDC): Sexual Violence Resources. Resources include links to the CDC's publications about sexual violence, related issues such as mental health after a disaster, rape prevention, and sex trafficking.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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