Intimate partner violence: Prevalence, impact, treatment, prevention

ALIYA R. WEBERMANN, B.A.

M.A. CANDIDATE, CLINICAL PSYCHOLOGY

TOWSON UNIVERSITY

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.

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)

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)

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)

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)

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)

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)

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)

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;)

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)

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

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

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)

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)

Power and Control Wheel- Duluth Model/Derivative

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)

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)

References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington,

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