Domestic Violence/Intimate Partner Violence:
Applying Best Practice Guidelines

Consequence of Violence

Introduction

Defining the Problem

Statistics

Identifying Abuse

Consequence of Violence

Risk Factors for Victimization and Preparation

Barriers to Identifcation of Intimate Partner Violence/Domestic Violence

Best Practice Guidelines for Intimate Partner Violence/Domestic Violence

Safety Planning

Conclusion

Appendicies
Appendix A
Appendix B
Appendix C
Appendix D
Appendix E

Resources

Other Websites of Interest

References

Test

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In the past it was a common belief that domestic violence/intimate partner violence was a family problem. Over the decades, public opinions and laws have changed that make domestic violence a crime. However, in addition to the criminal aspect, domestic violence is also a public health problem. Because of its alarming frequency, its significant impact on the individual, the family, the community, IPV/DV is a serious problem that is common in our society. Violence by an intimate partner is linked to both immediate and long-term health, social, and economic consequences. Factors at all levels-individual, relationship, community, and societal-contribute to the perpetration of IPV/DV. Preventing IPV/DV requires a clear understanding of those factors, coordinated resources, and empowering and initiating change in individuals, families, and society (CDC, 2005).

Case Study 4. Jenna

Jenna is 34 years old; she has 5 children, only 2 of her children have the same father. Her children have been in and out of foster homes for years, mainly because of neglect. Jenna has an addiction to crack cocaine and crystal methamphetamine. Jenna's current boyfriend is a dealer of methamphetamine. When he uses methamphetamine, he becomes verbally, physically and sexually abusive to Jenna. But in order to get meth for herself, she tolerates his behavior. Jenna's last boyfriend is currently in prison for drug offenses. He was also abusive to her. The father of 2 of her children is also in prison, for aggravated assault of Jenna and her oldest child, who is hearing impaired and in special education as a result of head trauma sustained during that beating. Jenna grew up watching her father beat her mother and enduring sexual abuse at the hands of 2 different uncles for most of her childhood.

Jenna's never held a job more than 2 weeks; she has a great deal of anxiety that often comes out as anger and irritability, making it difficult for her to get along with coworkers. Jenna is on welfare. Her children have a variety of difficulties. In addition to special education services, her children see a many of other specialists. This includes mental health and behavioral specialists; several of her children take psychotropic medications. Two of the children have had psychiatric hospitalizations. The family continues to have an open case with the Florida Department of Children and Families. A social worker comes out to visit Jenna every few weeks. Jenna wishes they would all just leave her alone.

Each year in the United States, about 2 million women are physically assaulted by their intimate partners. These assaults result in injuries that lead to over 73,000 hospitalizations and 1,500 deaths. In addition to the physical injuries domestic violence causes, it is also a major risk factor for mental health disorders. For example, one study found that 61 percent of women diagnosed with depression had also experienced domestic violence-a rate two times that of the general population (Kass-Bartlemes, 2004).

In general, victims of repeated violence over time experience more serious consequences than victims of one-time incidents (Johnson & Leone, 2005). The following list describes just some of the consequences of IPV (CDC, 2005).

Women who are victims of abuse suffer long-term consequences such as poor health status; decreased quality of life and high use of healthcare services (Campbell, 2002). Campbell (2002) reported that often those who have been abused to not present to emergency departments or primary or urgent care offices with overt trauma or injury, despite their significant injuries.

Indeed, among physicians who treat patients who are victims of abuse, success in treatment was not viewed as disclosure of the abuse, but rather success was seen as the development of a longitudinal trust relationship. That was necessary before women will admit that their injuries, often discovered during care for some other healthcare problem, are a result of IPV/DV (Campbell, et. al, 2002).

Physical Consequences of Violence

Each year in the United States, about 2 million women are physically assaulted by their intimate partners. These assaults result in injuries that lead to over 73,000 hospitalizations and 1,500 deaths. Victims of domestic violence have more physical problems, including headaches, chronic pain, sleep problems, vaginal infections, digestive problems, sexually transmitted diseases, and urinary tract infections, and they are more likely to rate their health as only fair or poor (Kass-Bartlesme, 2004).

At least 42% of women and 20% of men who were physically assaulted since age 18 sustained injuries during their most recent victimization. Most injuries were minor such as scratches, bruises, and welts (Tjaden & Thoennes, 2000a).

More severe physical consequences of IPV may occur depending on severity and frequency of abuse (Campbell et al., 2002; Heise & Garcia-Moreno, 2002; Plichta, 2004; Tjaden & Thoennes, 2000a). These include:

  • Bruises
  • Knife wounds
  • Pelvic pain
  • Headaches
  • Back pain
  • Broken bones
  • Gynecological disorders
  • Pregnancy difficulties like low birth weight babies and perinatal deaths
  • Sexually transmitted diseases including HIV/AIDS
  • Central nervous system disorders
  • Gastrointestinal disorders
  • Symptoms of post-traumatic stress disorder:
    • Emotional detachment
    • Sleep disturbances
    • Flashbacks
    • Replaying assault in mind
  • Heart or circulatory conditions

Children may become injured during IPV incidents between their parents. A large overlap exists between IPV and child maltreatment (Appel & Holden, 1998). One study found that children of abused mothers were 57 times more likely to have been harmed because of IPV between their parents, compared with children of non-abused mothers (Parkinson et al., 2001).

Unhealthy/Risky Behaviors Related to Violence

Women with a history of IPV/DV are more likely to display behaviors that present further health risks. These behaviors may be a result of force by the abuser, an inability to negotiate for protection due to limited power within the relationship, a means of numbing oneself, already feeling that there is no point in trying to be healthy within the context of abuse, and perhaps an attempt to seek help from healthcare providers through the overuse of health services.

IPV/DV is associated with a variety of negative health behaviors (Heise & Garcia-Moreno, 2002; Plichta, 2004; Roberts, Auinger, & Klein, 2005; Silverman et al., 2001). Studies show that the more severe the violence, the stronger its relationship to negative health behaviors by victims.

  • Engaging in high-risk sexual behavior - This can be the result of force on the part of the abuser. But it is important to remember that abused persons are not generally able to negotiate safer sex practices, which can keep them safe from blood borne pathogens and other sexually transmitted diseases. Since the perpetrator is motivated by power and control, women who are abused by their partners do not generally have enough power in their relationships to insure their own safety from their abusers in many ways, including safety during sex. Some of the high risk sexual behaviors can include:
    • Unprotected sex
    • Decreased condom use
    • Early sexual initiation
    • Choosing unhealthy sexual partners
    • Having multiple sex partners
    • Trading sex for food, money, or other items, either by choice or by force
    • Unwanted pregnancies

  • Using or abusing harmful substances - A way of numbing oneself the trauma of an abusive life include:
    • Smoking cigarettes
    • Drinking alcohol
    • Driving after drinking alcohol
    • Using drugs

  • Unhealthy diet-related behaviors:
    • Fasting
    • Vomiting
    • Abusing diet pills
    • Overeating

  • Overuse of health services

Psychological Consequences of Violence

Physical violence is typically accompanied by emotional or psychological abuse (Tjaden & Thoennes 2000a).IPV/DV-whether sexual, physical, or psychological-can lead to various psychological consequences for victims. Campbell's (2002) review of the literature revealed that the most common forms of mental health disorder arising from IPV/DV are:

  • Depression
  • Post-traumatic Stress Disorder - In addition to the symptoms of PTSD such as intrusive thoughts, nightmares, flashbacks, anxiety, hyper arousal, avoidance, etc., some women may turn to drugs and alcohol to numb themselves against those symptoms (Campbell, 1999).

Other mental health issues include (Bergen, 1996; Coker et al., 2002; Heise & Garcia-Moreno, 2002; Roberts, Klein, & Fisher, 2003):

  • Suicidal behavior in females
  • Anxiety
  • Low self-esteem
  • Antisocial behavior
  • Inability to trust men
  • Fear of intimacy

Social Consequences of Violence

Victims of IPV/DV sometimes face the following social consequences (Heise & Garcia-Moreno 2002; Plichta, 2004):

  • Isolation from social networks, including family, friends, work and/or school
  • Restricted access to services
  • Strained relationships with healthcare providers
  • Poor work performance or stained relationships with employers Economic Consequences of Violence
  • Costs of IPV/DV against women in 1995 exceed an estimated $5.8 billion. These costs include nearly $4.1 billion in the direct costs of medical and mental health care and nearly $1.8 billion in the indirect costs of lost productivity (CDC, 2003).
  • When updated to 2003 dollars, IPV/DV costs exceed $8.3 billion, which includes $460 million for rape, $6.2 billion for physical assault, $461 million for stalking, and $1.2 billion in the value of lost lives (Max et al., 2004).
  • Victims of severe IPV/DV lose nearly 8 million days of paid work-the equivalent of more than 32,000 full-time jobs-and almost 5.6 million days of household productivity each year (CDC, 2003).
  • Women who experience severe aggression by men (e.g., not being allowed to go to work or school, or having their lives or their children's lives threatened) are more likely to have been unemployed in the past, have health problems, and be receiving public assistance (Lloyd & Taluc, 1999).
  • The health-related costs of rape, physical assault, stalking, and homicide by intimate partners exceed $5.8 billion each year. Of this total, nearly $4.1 billion are for direct medical and mental health care services and productivity losses account for nearly $1.8 billion (CDC, 2003).

Pregnancy and IPV/DV

In a review of the literature, Jasinski (2004) found that there were a number of consequences for women who were victimized during pregnancy:

  • Late entry into prenatal care;
  • Low birth weight babies;
  • Premature labor;
  • Unhealthy maternal behaviors (such as smoking, drinking, drug use, etc.);
  • Fetal trauma;

Health issues for the mother. Gazmarian, et al. (2000) found, in a review of the literature that abuse during pregnancy resulted in:

  • Sexually transmitted diseases, including HIV-1;
  • Urinary tract-infections;
  • Substance abuse;
  • Depression; and
  • Other mental health conditions.

Continue on to Risk Factors for Victimization and Perpetration