Intimate partner violence

This article is about assessment, types, and treatment of intimate partner violence. For more information, see Domestic violence.

Intimate partner violence (IPV) is defined as physical, sexual, or psychological harm by a current or former partner or spouse.  IPV can occur among heterosexual or same-sex couples and does not require sexual intimacy.

IPV is a prevalent public health concern, affecting about 10 million Americans every year. IPV is concerning not only because of its high prevalence but also because it has been tied to a variety of negative consequence for affected individuals, including increased stress and poor mental health, relationship distress, negative child outcomes, and economic burden.

 Scholars have identified different types of IPV that raise attention to important distinctions that can be made based on the basis of gender symmetry versus asymmetry and reciprocal versus non-reciprocal perpetration of IPV. One of the most widely used typologies based on empirical research supports differentiation among four types of IPV: (1) Coercive Controlling Violence, (2) Violent Resistance, (3) Situational Couple Violence, and (4) Mutual Violent Control.

Background

Intimate partner violence occurs between two people in an intimate relationship. It may occur between heterosexual or homosexual couples and victims can be male or female. Couples may be dating, cohabiting or married and violence can occur in or outside of the home.

The World Health Organization (WHO) defines intimate partner violence as:

"... any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship".

To these forms of abuse, the WHO adds controlling behaviours as a form of abuse.

According to a study conducted in 2010, 30% of women globally aged 15 and over have experienced physical and/or sexual intimate partner violence.

The WHO reported in 2013 that the incidence of women who had experienced physical or sexual abuse from an intimate partner in their lifetime was:

Region	Percent
Global	30%
Africa	36.6%
Eastern Mediterranean	37%
European	25.4%
South-East Asia	37.7%
The Americas	29.8%
Western Pacific	24.6%

Assessment

Screening Tools

Although IPV screening remains controversial, some major medical organizations mandate screening. The U.S. Preventive Services Task Force (USPSTF) cautions that there is insufficient evidence to recommend for or against screening.

Some of the most studied IPV screening tools were the Hurt, Insult, Threaten, and Scream (HITS), the Woman Abuse Screening Tool/Woman Abuse Screening Tool-Short Form (WAST/WAST-SF), the Partner Violence Screen (PVS), and the Abuse Assessment Screen (AAS).

Research Instrument

Conflict tactics scale

The probably most widely used instrument in research on family violence is the Conflict Tactics Scale (CTS). Two versions have been developed from the original CTS: the CTS2 (an expanded and modified version of the original CTS) and the CTSPC (CTS Parent-Child).

Types

Importance of Distinguishing Between Different Types of IPV

The recognition that different types of IPV exist in our society and are represented in different samples is important because it helps reconcile one of the major debates in the field, questioning whether it is primarily men who are violent in intimate relationships, or whether there is gender symmetry in perpetrating violence.

Furthermore, differentiating among types of IPV is imperative for the development of appropriate screening instruments and processes that more accurately describe the central dynamics of the partner violence, the context, and the consequences. This can lead to better decision-making, appropriate sanctions, and more effective treatment programs tailored to the different characteristics of partner violence.

The Gender Symmetry Debate

See also: Domestic violence against men § Gender symmetry

In the 1970’s and 80’s, scholar studying incidence, perpetrators, severity, and context of IPV, mainly family sociologists, typically focused their efforts on large, nationally representative samples. These large-scale studies resulted in findings indicating that women were as violent as men in intimate relationships, information that diverged significantly from shelter, hospital, and police data. As a result, advocates and service providers strongly rejected family sociologists’ research, fearing that what they viewed as misinformation would dilute society’s focus on and funding of services and education for battered women. Thus, as pointed out by Kelly and Johnson, until recently the two groups most concerned with intimate partner violence, feminist activists/practitioners and family sociologists, have rarely intersected, and “misunderstanding and acrimonious debate have interfered with a more constructive and unified approach to what remains a serious societal problem for intimate partners and their children.”

Research indicates that the prevalence of IPV perpetration by men and women may depend on the type and context of this violence. Although men and women commit equivalent rates of unreported minor violence via situational altercation, more severe perpetration and domestic battery is committed by men. A 2008 review published in journal of Violence and Victims found that despite less serious altercation or violence was equal among both genders, more serious and violent abuse was perpetrated by men. It was also found that women's physical violence was more likely motivated by self-defense or fear whereas men's violence was motivated by control. A 2011 systematic review published in the Journal of Trauma, Violence, and Abuse also found that the common motives for female on male domestic violence were anger, a need for attention, or as a response to their partner's own violence. Another 2011 review published in the Journal of Aggression and Violent Behavior found differences in the methods of abuse employed by men and women, suggesting that men were more likely to "beat up, choke or strangle" their partners, while women were more likely to "throw something at their partner, slap, kick, bite, punch, or hit with an object". Researchers have also found different outcomes in men and women in response to Intimate Partner Violence. A 2012 review published in the journal Psychology of Violence found that women suffered over-proportionate number of injuries, fear, and posttraumatic stress as a result of partner violence. The review also found that 70% of female victims felt frightened as a result of violence perpetrated by their partners but 85% of male victims expressed "no fear" in response to them.

The gender symmetry debate underscores the importance of distinguishing between different types of IPV, as the aforementioned results show that prevalence rates of IPV among men and women may differ based in the samples and measures used to collect data.

Reciprocity of IPV

In addition to providing insight into the gender symmetry debate, distinguishing between different types of IPV is important because it raises attention to another aspect related to IPV prevalence, incidence and course: The United States Centers for Disease Control distinguishes between reciprocal, in which both partners are violent, and non-reciprocal violence, in which one partner is violent.

"Femme battant son mari"; Albrecht Dürer

Types

Michael P. Johnson argues for four major types of intimate partner violence (Johnson's Typology), which is supported by subsequent research and evaluation, as well as independent researchers. Distinctions are made among the types of violence, motives of perpetrators, and the social and cultural context based upon patterns across numerous incidents and motives of the perpetrator.

Coercive Controlling Violence

Prevalence of physical and sexual violence against women by an intimate partner, in their lifetime
by the World Health Organization

Location	Physical violence	Sexual violence	Both
Bangladesh city	40	37	53
Bangladesh province	42	50	62
Brazil city	27	10	29
Brazil province	34	14	37
Ethiopia	49	59	71
Japan city	13	6	15
Namibia city	31	16	36
Peru	61	47	69
Peru city	49	23	51
Samoa	41	20	46
Serbia and Montenegro city	23	6	24
Thailand city	23	30	41
Thailand province	34	29	47
Tanzania city	33	23	41
Tanzania province	47	31	56

Formerly termed “patriarchal terrorism” and “intimate terrorism,” coercive controlling violence refers to violence that occurs when one partner in a relationship uses coercive control and power over the other partner, using threats, intimidation, and isolation. In such cases, "[o]ne partner, usually a man, controls virtually every aspect of the victim's, usually a woman's, life." Johnson reported in 2001 that 97% of the perpetrators of intimate terrorism were men. While research generally indicates that women are usually the victims of coercive controlling violence, some studies, using Johnson's typology, have suggested that coercive controlling violence is more often perpetrated by women or not gendered at all.

Coercive controlling violence is more likely to escalate over time, not as likely to be mutual, and more likely to involve serious injury. The victims of one type of abuse are often the victims of other types of abuse. Severity tends to increase with multiple incidents, especially if the abuse comes in many forms. If the abuse is more severe, it is more likely to have chronic effects on the victim because the long-term effects of abuse are cumulative with each episode over time. Because this type of violence is most likely to be extreme, survivors of coercive controlling violence are most likely to require medical services and the safety of shelters. Consequences of physical or sexual coercive controlling violence include chronic pain, gastrointestinal and gynecological problems, depression, post-traumatic stress disorder, and death. Other mental health consequences are anxiety, substance abuse, and low-self esteem. A 2014 study on the mental health effects of coercive controlling violence found that 42% of women reported thoughts of suicide and 31% had attempted it.

Abusers are more likely to have witnessed abuse as children than those who engage in situational couple violence.

Coercive controlling violence batterers include two types: "Generally-violent-antisocial" and "dysphoric-borderline". The first type includes people with general psychopathic and violent tendencies. The second type are people who are emotionally dependent on the relationship. Violence by a person against their intimate partner is often done as a way for controlling their partner, even if this kind of violence is not the most frequent. Support for this typology has been found in subsequent evaluations.

Violent Resistance

Violent resistance (VR), a form of self-defense, is violence perpetrated by victims against their partners who have exerted intimate terrorism against them. Within relationships of intimate terrorism and violent resistance, 96% of the violent resisters are women.

Situational Couple Violence

Situational couple violence, also called common couple violence, is not connected to general control behavior, but arises in a single argument where one or both partners physically lash out at the other. This is the most common form of intimate partner violence, particularly in the western world and among young couples, and involves members of both sexes nearly equally. Among college students, Johnson found it to be perpetrated about 44% of the time by women and 56% of the time by men.

Johnson states that it is a relationship dynamic "in which conflict occasionally gets 'out of hand,' leading usually to 'minor' forms of violence, and rarely escalates into serious or life-threatening forms of violence."

In situational couple violence, acts of violence by men and women occur at fairly equal rates, with rare occurrences of injury, and are not committed in an attempt to control a partner. It is estimated that approximately 50% of couples experience situational couple violence in their relationships.

Situational couple violence involves:

• Mode: Mildly aggressive behavior such as throwing objects, ranging to more aggressive behaviors such as pushing, slapping, biting, hitting, scratching, or hair pulling.
• Frequency: Less frequent than partner terrorism, occurring once in a while during an argument or disagreement.
• Severity: Milder than partner terrorism, very rarely escalates to more severe abuse, generally does not include injuries that were serious or that caused one partner to be admitted to a hospital.
• Mutuality: Violence may be equally expressed by either partner in the relationship.
• Intent:Occurs out of anger or frustration rather than as a means of gaining control and power over the other partner.

Mutual Violent Control

Mutual violent control (MVC) is rare type of intimate partner violence occurring when both partners act in a violent manner, battling for control.

Of these types of IPV, situational couple violence appears to be the type of violence most often studied by family violence researchers using large-scale representative samples. Coercive controlling violence, on the hand, appears to be the type of violence most prevalent in clinical samples found in shelters and batterers’ treatment programs.

With regards of reciprocity of violence, situational couple violence and mutual violent control are reciprocal, while intimate terrorism is non-reciprocal. Violent resistance on its own is non-reciprocal, but is in face reciprocal when in response to intimate terrorism.

Treatment

Individual Treatments

Due to the high prevalence and devastating consequences of IPV, approaches to decrease and prevent violence from re-occurring is of upmost importance. Initial police response and arrest is not enough to protect victims from recurrence of abuse; thus, many states have mandated participation in batterer intervention programs (BIPs) for men who have been charged with assault against an intimate partner. Most of these BIPs are based on the Duluth Model and incorporate some cognitive behavioral techniques.

Duluth Model

The Duluth Model is one of the most common current interventions for IPV. It represents a psycho-educational approach that was developed by paraprofessionals from information gathered from interviewing battered women in shelters and using principles from feminist and sociological frameworks. One of the main components used in the Duluth Model is the “power and control wheel,” which conceptualizes IPV as one form of abuse to maintain male privilege. Using the “power and control wheel,” the goal of treatment is to achieve behaviors that fall on the “equality wheel” by re-educate men and by replacing maladaptive attitudes held by men.

Cognitive-Behavioral Therapy (CBT) Approaches

Cognitive Behavioral Therapy (CBT) techniques focus on modifying faulty or problematic cognitions, beliefs, and emotions to prevent future violent behavior and include skills training such as anger management, assertiveness, and relaxation techniques. (Adams, 1988).

Overall, the addition of Duluth and CBT approaches results in a 5% reduction in IPV. This low reduction rate might be explained, at least in part, by the high prevalence of bidirectional violence as well as client-treatment matching versus “one-size-fits-all” approaches.

Achieving Change Through Values-Based Behavior (ACTV)

Achieving Change Through Values-Based Behavior (ACTV) is a newly developed Acceptance and Commitment Therapy (ACT)-based program. Developed by domestic violence researcher Amie Zarling and colleagues at Iowa State University, the aim of ACTV is teach abusers "situational awareness" -- to recognize and tolerate uncomfortable feelings – so that they can stop themselves from exploding into rage.

Initial evidence of the ACTV program has shown high promise: Using a sample 3,474 men who were arrested for domestic assault and court-mandated to a BIP (either ACTV or Duluth/CBT), Zarling and colleagues showed that compared with Duluth/CBT participants, significantly fewer ACTV participants acquired any new charges, domestic assault charges, or violent charges. ACTV participants also acquired significantly fewer charges on average in the 1 year after treatment than Duluth/CBT participants.

Conjoint Treatment

Some estimates show that as many as 50% of couples who experience IPV engage in some form of reciprocal violence. Nevertheless, most services address offenders and survivors separately. In addition, many couples who have experienced IPV decide to stay together. These couples may present to couples or family therapy. In fact, 37-58% of couples who seek regular outpatient treatment have experienced physical assault in the past year. In these cases, clinicians are faced with the decision as to whether they should accept or refuse to treat these couples. Although the use of conjoint treatment for IPV is controversial as it may present a danger to victims and potentially escalate abuse, it may be useful to others, such as couples experiencing situational couple violence. Scholars and practitioners in the field call for tailoring of interventions to various sub-types of violence and individuals served.

Behavioral Couple’s Therapy (BCT)

BCT is cognitive-behavioral approach, typically delivered to outpatients in 15-20 sessions over several months. Research suggests that BCT can be effective in reducing IPV when used to treat co-occurring addictions, which is important work because IPV and substance abuse and misuse frequently co-occur.

Domestic Conflict Containment Program (DCCP)

DCCP is a highly structured skills-based program whose goal is to teach couples conflict containment skills.

Physical Aggression Couples Treatment (PACT)

PACT is a modification of DCCP, which includes additional psychoeducational components designed to improve relationship quality, including such things as communication skills, fair fighting tactics, and dealing with gender differences, sex, and jealousy.

Domestic Violence Focused Couples Treatment (DVFCT)

The primary goal of DVFCT is to end violence with the additional goal of helping couples improve the quality of their relationships. It is designed to be conducted over 18 weeks and can be delivered in either individual or multi-couple group format.

See also

• Info-graphic on intimate partner violence, sexual violence, and stalking from the US Centers for Disease Control and Prevention available on Wikimedia Commons

Further reading

• Bachman, Ronet; Carmody, Dianne Cyr (December 1994). "Fighting fire with fire: the effects of victim resistance in intimate versus stranger perpetrated assaults against females". Journal of Family Violence. 9 (4). Springer: 317–331. doi:10.1007/BF01531942. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link)
• Browne, Angela; Salomon, Amy; Bassuk, Shari S. (April 1999). "The impact of recent partner violence on poor women's capacity to maintain work". Violence Against Women. 5 (4). Sage: 393–426. doi:10.1177/10778019922181284. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link)
• Chang, Valerie (1996). I just lost myself: psychological abuse of women in marriage. Westport, Connecticut: Praeger. ISBN 9780275952099. Details.
• Eriksson, Maria (March 2013). "Tackling violence in intimacy: interacting power relations and policy change". Current Sociology, special issue: Violence and Society. 61 (2). Sage: 171–189. doi:10.1177/0011392112456504. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link)
• Follingstad, Diane R.; Rutledge, Larry L.; Berg, Barbara J.; Hause, Elizabeth S.; Polek, Darlene S. (June 1990). "The role of emotional abuse in physically abusive relationships". Journal of Family Violence. 5 (2). Springer: 107–120. doi:10.1007/BF00978514. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link)
• Graham-Kevan, Nicola; Archer, John (April 2003). "Physical aggression and control in heterosexual relationships: the effect of sampling". Violence & Victims. 18 (2). Springer: 181–196. doi:10.1891/vivi.2003.18.2.181. PMID 12816403. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link)
• Hassan, Tengku Nur Fadzilah Tengku; Ali, Siti Hawa; Salleh, Halim (January 2015). "Patterns of help-seeking among women experiencing intimate partner violence in Malaysia". Asian Journal of Women's Studies. 21 (1). Taylor and Francis: 77–92. doi:10.1080/12259276.2015.1029226. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link)
• Holtzworth-Munroe, Amy (December 2005). "Male versus female intimate partner violence: putting controversial findings into context". Journal of Marriage and Family. 67 (5). Wiley for the National Council on Family Relations: 1120–1125. doi:10.1111/j.1741-3737.2005.00203.x. JSTOR 3600299. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link) Pdf.

Response article: Johnson, Michael P. (December 2005). "Domestic violence: it's not about gender: or is it?". Journal of Marriage and Family. 67 (5). Wiley for the National Council on Family Relations: 1126–1130. doi:10.1111/j.1741-3737.2005.00204.x. JSTOR 3600300. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link) Pdf.

• Johnson, Michael P. (November 2006). "Conflict and control: gender symmetry and asymmetry in domestic violence". Violence Against Women. 12 (11). Sage: 1003–1018. doi:10.1177/1077801206293328. PMID 17043363. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link) Pdf.
• Johnson, Michael P. (2001), "Conflict and control: images of symmetry and asymmetry in domestic violence", in Booth, Alan; Crouter, Ann C.; Clements, Mari (eds.), Couples in conflict, Mahwah, New Jersey: Lawrence Erlbaum, pp. 95–104, ISBN 9781410600134. {{citation}}: Invalid |ref=harv (help)
• Johnson, Michael P. (May 1995). "Patriarchal terrorism and common couple violence: two forms of violence against women". Journal of Marriage and Family. 57 (2). Wiley for the National Council on Family Relations: 283–294. doi:10.2307/353683. JSTOR 353683. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link)
• Johnson, Michael P. (2006), "Violence and abuse in personal relationships: conflict, terror, and resistance in intimate partnerships", in Vangelisti, Anita; Perlman, Daniel (eds.), The Cambridge handbook of personal relationships, Cambridge New York: Cambridge University Press, pp. 557–576, ISBN 9780521533591. {{citation}}: Invalid |ref=harv (help) Preview.
• Kirkwood, Catherine (1993). Leaving abusive partners: from the scars of survival to the wisdom for change. London: Sage. ISBN 9780803986855.
• Leone, Janel M.; Johnson, Michael P.; Cohan, Catherine L.; Lloyd, Susan E. (May 2004). "Consequences of male partner violence for low-income minority women". Journal of Marriage and Family. 66 (2). Wiley for the National Council on Family Relations: 472–490. doi:10.1111/j.1741-3737.2004.00032.x. JSTOR 3599849. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link)
• Roberts, Albert R. (September 1996). "Battered women who kill: a comparative study of incarcerated participants with a community sample of battered women". Journal of Family Violence. 11 (3). Springer: 291–304. doi:10.1007/BF02336946. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link)
• Tilbrook, Emil; Allan, Alfred; Dear, Greg (2010). Intimate partner abuse of men (PDF). East Perth, Western Australia: Edith Cowan University School of Psychology. ISBN 9780646535180. Archived from the original (PDF) on 2013-07-12. {{cite book}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help) A report commissioned by the Men's Advisory Network (MAN).
• Voth Schrag, Rachel J.; Edmond, Tonya (May 2017). "School sabotage as a form of intimate partner violence: provider perspectives". Affilia. 32 (2). Sage: 171–187. doi:10.1177/0886109916689785. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: postscript (link)