Intimate Partner Violence: Prevalence, impact, treatment, prevention
- 1. Intimate partner violence: Prevalence, impact, treatment, prevention ALIYA R. WEBERMANN, B.A. M.A. CANDIDATE, CLINICAL PSYCHOLOGY TOWSON UNIVERSITY
- 2. Overview This presentation will discuss the following topics: Definition of intimate partner violence (IPV) and typologies U.S. national IPV prevalence Impact and outcomes of victimization, including psychiatric comorbidities Risk factors for IPV IPV and identity Assessment and treatment of IPV Preventative and protective factors Trigger warning: this presentation will provide examples of IPV perpetration and consequences of IPV victimization, which may cause emotional distress.
- 3. Definition Physical, sexual, psychological, or emotional harm from a current or former partner or spouse A pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another partner (CDC, 2013)
- 4. Typologies Physical: Intentional use of physical force- kicking, using a weapon, grabbing Sexual: Force, coercion, assault/rape, involvement with incapacitated person Psychological: Threats, intimidation, isolation, controlling behavior Emotional: Insults, put-downs, humiliation Financial (not in CDC definition): Limiting access to money and resources, identity theft, sabotaging career opportunities, incurring debt (CDC, 2013; NNEDV, 2014a)
- 5. Typologies, continued Based on physiological differences in heart rate reactivity that may indicate differences in intent and motivation: Characterological violence (Type 1): heart rate lowers during interactions, behavior stems from desire for power and control Increased verbal and facial expressions of anger Situational violence (Type 2): heart rate increases during interactions, behavior stems from emotion dysregulation and physical loss of control Situational aggression increases more over time Equally violent within romantic partnerships as Type 1 (Babcock et al., 2004; Gottman et al., 1995; Meehan et al., 2001)
- 6. Prevalence: Victimization Lifetime prevalence: Severe physical IPV: 1 in 4 women and 1 in 7 men Rape: 1 in 5 women and 1 in 71 men Emotional IPV: 1 in 2 women and men One day of victim services: 66,581 victims served 36,348 in emergency shelter 30,233 receiving non-residential services such as counseling and court advocacy 20,267 hotline calls answered 9,641 unmet requests for services (CDC, 2011; NNEDV, 2014b)
- 7. Prevalence: Perpetration Lack of similar epidemiological U.S. national statistics on IPV perpetration Physical IPV: 19.2% of males are perpetrators Gender of perpetrators: Toward male victims: Physical and emotional IPV: Female Stalking: Mix of male and female Sexual violence: Male Toward female victims: Physical and emotional IPV: Male Stalking: Male Sexual violence: Male (CDC, 2011; Singh et al., 2014)
- 8. Impact: Adult victims Mental health PTSD: Greater than 60% Depression and anxiety disorders Physical health Chronic health conditions: asthma, diabetes, gastrointestinal issues Substance use Alcoholism Illicit and intravenous drug use 81% of women and 35% of men report 1 or more adverse health or safety outcomes (emergency medical treatment, shelter stays, fear for one’s life) 2003: $8.3 billion spent on physical and mental health services and lost productivity (CDC, 2011; Dube et al., 2002; Goodman & Epstein, 2007; Max et al., 2004)
- 9. Impact: Child victims Mental health PTSD Personality disorders: Borderline personality disorder , antisocial personality disorder Dissociative disorders Physical health Chronic health issues: Heart disease, cancer, gastrointestinal issues Sexually transmitted diseases Obesity Linked to other forms of childhood maltreatment Physical, sexual, emotional, psychological abuse (American Psychiatric Association, 2013; Dube et al., 2002; Putnam et al., 2013)
- 10. Risk factors: Perpetration Childhood maltreatment and witnessing of domestic violence Multiple types of IPV (engaging in an IPV type increases likelihood of other types) Marital dissatisfaction Illicit drug use and alcoholism Traditional gender and sex role ideology Implicit attitudes condoning violence Physical health issues: Insomnia, gastrointestinal issues Mental health issues: Personality disorders, depression Insecure/disorganized attachment style (Alexander & Warner, 2003; Eckhardt & Crane, 2014; Heise & Garcia-Moreno, 2002; Singh et al., 2014; Stith et al., 2004; Tjaden & Thoennes, 2000; Whitfield et al., 2003;)
- 11. Risk factors: Victimization Childhood maltreatment and witnessing of domestic violence Mental health issues: Personality disorders, depression, dissociative disorders Economic disempowerment Youth: 80% of female sexual assault victims are under 25 Insecure/disorganized attachment style Predictors of escalation in abusive relationships: Female victims perpetrating violence toward male perpetrators Partner threats to harm and/or kill (Alexander, 2009; CDC, 2011; Goodman & Epstein, 2007; Stith et al., 2004; ; Tjaden & Thoennes, 2000; Whitfield et al., 2003)
- 12. IPV and identity Race Institutionalized racism (criminal justice system) “Traitor” to community Gender identity Male and transgender victims Religion Taboo of divorce Sexual orientation “Outness” of victim v. perpetrator Female perpetrators
- 13. IPV and identity Income level Financially dependent on perpetrator Difficult to access resources Immigration status Fear of deportation Need to report perpetrator/assist in prosecution to receive visa Language abilities Disability Dependent on perpetrator for survival Lack of resources
- 14. Assessments Revised Conflict Tactics Scale (CTS2) Assesses perpetration and victimization typology/severity/frequency, and negotiation More often used in research, but appropriate for clinical practice Timeline Followback Spousal Violence Interview (TLFB-SV) Daily calendar method documenting typology and frequency of violence Proximal Antecedents to Violent Episodes (PAVE) Scale Context and functions of IPV incidents Guidelines Screen IPV separately with each partner Complete a lethality assessment to determine appropriate services Screen IPV again later, as it may initially be denied due to shame, fear, and guilt If IPV is identified, creating a safety plan is crucial (Fals-Stewart et al., 2003; McCloskey & Grigsby, 2005; Babcock et al., 2004; Straus et al., 1996)
- 16. Treatment: Perpetration Treatment as usual: Duluth Model/Derivative Grounded in theory of patriarchal dominance Goal = behavior change via psychoeducation and in-group processing and modeling of healthy relationships and conflict resolution Limited effectiveness, likely due to lack of addressing comorbid psychiatric and substance abuse issues and trauma history (Babcock et al., 2000; Easton, 2013)
- 17. Power and Control Wheel- Duluth Model/Derivative
- 18. Treatment: Perpetration, continued Couples therapy Only recommended with situational common-couple violence, rather then characterological violence perpetrated by one partner Behavioral couples therapy shown to be effective with substance using couples Multi-couple group therapy Demonstrated success with mild to moderate situational common-couple violence Group therapy Batterer/abuser intervention programs Most effective if comorbid psychiatric and substance use issues are addressed Demonstrated success utilizing CBT and MI modalities and in conjunction with individual therapy (Connors, Mills, & Gray, 2013; Easton, 2013; Fals-Stewart & Clinton-Sherrod, 2009; Gottman et al., 1995; Stare & Fernando, 2014; Stith et al., 2004)
- 19. Preventative and protective factors Preventing child maltreatment, including witnessing of domestic violence Promoting flexible gender roles, egalitarian relationships, non-violence, and feminist identity Treating comorbid substance use and psychiatric disorders Training physical and mental health care providers to a) identify the effects of IPV on patients presenting to treatment and b) accurately and appropriately assess IPV Targeted education about intimate partner violence, sexual assault, and healthy relationships Economic independence, vocational opportunities, affordable housing Social supports (Backus & Mahalik, 2011; Easton, 2013; Goodman & Epstein, 2007; McCloskey & Grigsby, 2005)
- 20. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Alexander, P. C. (2009). Childhood trauma, attachment, and abuse by multiple partners. Psychological Trauma: Theory, Research, Practice, And Policy, 1(1), 78-88. Alexander, P. C., & Warner, S. (2003). Attachment theory and family systems theory as frameworks for understanding the intergenerational transmission of family violence. In P. Erdman, T. Caffery (Eds.) , Attachment and family systems: Conceptual, empirical, and therapeutic relatedness (pp. 241-257). New York, NY, US: Brunner-Routledge. Babcock, J. C., Green, C. E., & Robie, C. (2004). Does batterers' treatment work? A meta-analytic review of domestic violence treatment. Clinical Psychology Review, 23(8), 1023-1053. Backus, F. R., & Mahalik, J. R. (2011). The masculinity of Mr. Right: Feminist identity and heterosexual women’s ideal romantic partners. Psychology of Women Quarterly, 35(2), 318-326. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention (2013). Intimate Partner Violence. Retrieved from http://www.cdc.gov/violenceprevention/intimatepartnerviolence/.
- 21. References, continued Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention (2011). National Intimate Partner and Sexual Violence Survey 2010. Retrieved from http://www.cdc.gov/violenceprevention/pdf/cdc_nisvs_overview_insert_final-a.pdf. Conners, A. D., Mills, J. F., & Gray, A. L. (2013). Intimate partner violence intervention for high-risk offenders. Psychological Services, 10, 12-23. Dube, S. R., Anda, R. F., Felitti, V. J., Edwards, V. J., & Williamson, D. F. (2002). Exposure to abuse, neglect and household dysfunction among adults who witnessed intimate partner violence as children: Implications for health and social services. Violence And Victims, 17(1), 3-18. Easton, C. J. (2013). Treatments for offenders of intimate partner violence. In M. McMurran (Ed.) , Alcohol-related violence: Prevention and treatment (pp. 171-185). Wiley-Blackwell. Eckhardt, C. I., & Crane, C. A. (2014). Male perpetrators of intimate partner violence and implicit attitudes toward violence: Associations with treatment outcomes. Cognitive Therapy And Research, 38(3), 291-301. Fals-Stewart, W., Birchler, G. R., & Kelley, M. L. (2003). The Timeline Followback Spousal Violence Interview to Assess Physical Aggression Between Intimate Partners: Reliability and Validity. Journal Of Family Violence, 18(3), 131-142. Fals-Stewart, W., & Clinton-Sherrod, M. (2009). Treating intimate partner violence among substance-abusing dyads: The effect of couples therapy. Professional Psychology: Research And Practice, 40(3), 257-263.
- 22. References, continued Goodman, L. A., & Epstein, D. (2007). Listening to battered women: A survivor-centered approach to advocacy, mental health, and justice. Washington, D.C.: American Psychological Association. Heise, L., & Garcia-Moreno, C. (2002). Violence by intimate partners. In E. Krug, L. L. Dahlberg, J.A. Mercy, et al. (Eds.), World report on violence and health (pp. 87-121). Geneva, Switzerland: World Health Organization. Retrieved from http://www.who.int/violence_injury_prevention/violence/ global_campaign/en/chap4.pdf. Max, W., Rice, D. P., Finkelstein, E., Bardwell, R. A., & Leadbetter, S. (2004). The Economic Toll of Intimate Partner Violence Against Women in the United States. Violence And Victims, 19(3), 259-272. McCloskey, K., & Grigsby, N. (2005). The Ubiquitous Clinical Problem of Adult Intimate Partner Violence: The Need for Routine Assessment. Professional Psychology: Research And Practice, 36(3), 264-275. Meehan, J. C., Holtzworth-Munroe, A., & Herron, K. (2001). Maritally violent men's heart rate reactivity to marital interactions: A failure to replicate the Gottman et al. (1995) typology. Journal Of Family Psychology, 15(3), 394-408. National Network to End Domestic Violence (2014a). About Financial Abuse. Retrieved from http://nnedv.org/resources/ejresources/about-financial-abuse.html. National Network to End Domestic Violence (2014b). Domestic Violence Counts National Summary 2013. Retrieved from http://nnedv.org/downloads/Census/DVCounts2013/DVCounts13_NatlSummary.pdf.
- 23. References, continued Putnam, K. T., Harris, W. W., & Putnam, F. W. (2013). Synergistic childhood adversities and complex adult psychopathology. Journal of Traumatic Stress, 26(4), 435-442. Singh, V., Tolman, R., Walton, M., Chermack, S., & Cunningham, R. (2014). Characteristics of men who perpetrate intimate partner violence. Journal of Behavioral Family Medicine, 27(5), 661-668. Stare, B. G., & Fernando, D. M. (2014). Intimate partner violence typology and treatment: A brief literature review. The Family Journal, 22(3), 298-303. Stith, S. M., Smith, D. B., Penn, C. E., Ward, D. B., & Tritt, D. (2004). Intimate partner physical abuse perpetration and victimization risk factors: A meta-analytic review. Aggression And Violent Behavior, 10(1), 65-98. Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17(3), 283-316. Tjaden, P., & Thoennes, N. (2000). Extent, nature, and consequences of intimate partner violence: Findings from the National Violence Against Women Survey. Washington (DC): Department of Justice. Retrieved from: http://www.ojp.usdoj.gov/nij/pubs-sum/181867.htm. Whitfield, C. L., Anda, R. F., Dube, S. R., & Felitti, V. J. (2003). Violent childhood experiences and the risk of intimate partner violence in adults: Assessment in a large health maintenance organization. Journal Of Interpersonal Violence, 18(2), 166-185.