domestic violence related to human behavior

Understanding Domestic Violence Linda Provus McElroy, PhD Legal Definition • Domestic violence is any assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, or any criminal offense resulting in a physical injury or death of one family or household member by another family or household member who is or was residing in the same single dwelling. • [s. 741.30F.S. 1993] Legal Definition • Family or household member is defined as spouses, former spouses, persons related by blood or marriage, persons who are presently residing together as if a family or who have resided together in the past as if a family, and persons who have a child in common regardless of whether they have been married or have resided together at any time. • [s. 741.30 F.S. 1993] Legal Definition • • • • The relationship must fit the statutory definition. Parties do not have to be married. Same sex relationships may apply if they fit the statute. Behavioral Definition • Battering is a pattern of behavior that seeks to establish power and control over another person through fear and intimidation. It often includes the threat or use of violence. Battering happens when batterers believe they are entitled to control their partners. They believe that the violence is an acceptable way to achieve desired results. Behavioral Definition • Not all battering is physical. Battering includes emotional abuse, verbal abuse, economic abuse, sexual abuse, threats to and about children, using “male privilege,” intimidation, isolation and other behaviors used to induce fear and establish power in the relationship. Behavioral Definition • Battering escalates. It may begin with name-calling or punching through a wall or kicking a pet. Next steps may be pushing, slapping, pinching; then punching, kicking, biting, tripping, throwing or restraining. It often includes sexual assault. It may lead to choking, the breaking of bones and other life threatening incidents. Forms of Battering Violence • • • • • Physical abuse Emotional abuse Economic abuse Sexual abuse Isolation Occurrence • Only 20% - 25% of incidents reported. Most violence is “minor”: hitting, slapping, etc. • U.S. assault rates approximately 47 assaults per 1,000 women, 32 assaults per 1,000 men annually Occurrence • Domestic assault results in nearly 2 million injuries and 1,300 deaths annually – 11% of all murders in U.S. • 44% of women murdered by their partner had been seen in the ER in preceding 2 years • Between 4% - 8%of all pregnant women are abused at least once by their partner during the pregnancy. Physical Consequences • • • • • • Bruises Knife wounds Pelvic pain Headaches Back pain Gynecological disorders Physical Consequences • Pregnancy difficulties, low birth-weight, prenatal death • Sexually transmitted diseases including HIV/AIDS • Central nervous system disorders • Gastrointestinal disorders • Heart and circulatory conditions Psychological Consequences • • • • • • Depression Anxiety Low self-esteem Fear of intimacy Inability to trust Antisocial behavior Psychological Consequences • Suicidal behavior • Post-traumatic stress disorder • Emotional detachment • Flashbacks • Replaying assault in mind Health – Behavior Consequences • Engaging in high-risk sexual behavior • • • • • • Unprotected sex Decreased condom use Early sexual initiation Choosing unhealthy sexual partners Having multiple sexual partners Trading sex for food, money, etc. Health – Behavior Consequences • Using or abusing harmful substances • • • • Smoking cigarettes Drinking alcohol Driving after drinking Taking drugs Health – Behavior Consequences • Unhealthy eating behaviors • • • • Fasting Vomiting Abusing diet pills Binge eating Overuse of health services Cultural Factors in Domestic Violence • Ethnic – • Asian population may have lower rate than other minorities • African American women may have higher rate than Caucasian women Cultural Factors in Domestic Violence • Sexual Orientation – • Gay women may have lower rate than heterosexual women • Gay men may have higher rate than heterosexual men Cultural Factors in Domestic Violence • Rural Populations – • Isolation from shelters and other resources for victims • Emphasis on “traditional values” • Law enforcement response may be slow, unprofessional Risk Factors for Victimization • • • • • Prior history of victimization Young age Heavy alcohol and drug use High-risk sexual behavior Witnessing or experiencing violence as a child Risk Factors for Victimization • Being less educated • Being unemployed • For women, having more education than partner • Having jealous or possessive partner Common Characteristics of Victims: • Found in every socioeconomic class, race, age-there is no “typical battered woman” • Low self-esteem • Isolated • Feels partner is dependent on her • Chronic physical pain/injuries • Depressed • Alcohol/drug abuse Common Characteristics of Victims: • Defends partner’s abusive behavior • Accepts blame for the abuse and responsibility for the abuser’s actions • Dependent on her partner for self-worth • Denies feelings of terror and anger • Hopeful the abuse will diminish • Statistics show that the only real risk factors are being born female or becoming physically handicapped Risk Factors for Perpetration • Being a victim of physical or psychological abuse • History of being abusive, aggressive or delinquent • Low education • Emotional dependence and insecurity • Personality disorders Risk Factors for Perpetration • • • • • • • Depression and low self-esteem Anger and hostility Heavy alcohol and drug use Social isolation, few friends Being unemployed, economic stress Belief in strict gender roles, stereotypes Desire for power and control in relationships Common Characteristics of the Perpetrator: • • • • In every socioeconomic class, race, age Low self-esteem Insecure and unable to trust others Often extremely or pathologically jealous • Critical of partners • Minimizes, denies or rationalizes violent behavior Common Characteristics of the Perpetrator: • Poor communication skills-inclined to resolve problems through violence • Uses battering to gain control over life • Common incidence of alcohol and drug abuse • Not restricted to one “type” of personality or psychological type • Believes in rigid sex role stereotypes Relationship Factors in Domestic Violence • Marital Conflict – Fights, tensions Relationship Factors in Domestic Violence • Marital Instability – Separations, Divorces Relationship Factors in Domestic Violence • Male dominance and control of relationship Relationship Factors in Domestic Violence • Economic Stress Relationship Factors in Domestic Violence • Unhealthy family relationships Children’s Exposure to Domestic Violence • Occurrence – 30% - 60% co-existence of woman being abused and child • being abused Children’s Exposure to Domestic Violence • Higher rate of abuse where children are 5 or younger Children’s Exposure to Domestic Violence • 80% of children in abusive homes can give detailed descriptions Children’s Exposure to Domestic Violence Influential Factors • • • • • Level of violence, frequency Level of child’s exposure Child’s coping skills Protective factors in environment Child’s age and developmental level Childhood Consequences of Exposure to Domestic Violence • • • • • • • • Sleeping and eating disorders Clinging to mother Stomach aches, headaches Erratic school attendance Inability to concentrate Isolation from peers Striving for academic perfection Running away The Physician’s Role • Routine Screening • How to ask / How to listen • Documentation • Intervention and follow-up State Requirements • Education on Domestic Violence requirement for license renewal • Mandatory Reporting • Pros and Cons