The Prevalence of Intimate Partner Violence
This is a research paper that I wrote for my Master's of Science in Clinical Mental Health Counseling
In the United States, one in four women and one in ten men experience intimate partner violence (IPV) in their lifetimes (Smith, et al., 2018). Globally, 13 to 61% of people have experienced physical violence, 4 to 49% of people have experienced extreme physical violence, 6 to 59% experienced sexual violence, and 20 to 75% experienced emotional violence (World Health Organization, 2012).
IPV, as defined by the Center for Disease Control and Prevention (CDC), includes physical violence, sexual violence, coercive acts, aggression, or stalking, by a current or former intimate partner (Center for Disease Control and Prevention, 2021). The National Domestic Violence Hotline defines it as a behavioral pattern in which one intimate partner attempts to, or gains, control over another intimate partner (Kelly & Johnson, 2008). It is well documented that IPV survivors experience psychological distress from any type of violence they suffered, which manifests in anxiety, depression, loss of self-esteem, and posttraumatic stress disorder (PTSD) (Arroyo, 2017; Kelly & Johnson, 2008). Not only does IPV affect a large number of people, and affect them psychologically, but there is also a fiscal element. Over a lifetime, a female survivor pays an average of $103,767, a male survivor pays an average of $23,414, and the United States government pays 37% of survivors’ lifetime costs, equaling $1.3 trillion. These costs include medical costs, lost time at work, and property damage or loss, (Peterson, et al., 2018).
Beyer, et al. (2013) performed a literature review to determine if a person’s neighborhood caused IPV. They found that 30 out of 36 studies that they reviewed pointed to influences of a person’s neighborhood, which found that neighborhoods in a lower socioeconomic status were connected to IPV (Beyer, et al., 2013). However, they also found that, “No evidence has been found to support the idea that levels of human and economic development, largely within developing countries, are associated with IPV occurrence,” (Beyer, et al., 2013). Cunha, et al. (2021) examined the relationship between psychopathy and intimate partner violence to determine if scores on the Psychopathy Checklist-Revised (PC-R) could predict how often IPV occurred. They found that the lifestyle and antisocial facets were not correlated with IPV, but affect was (Cunha, et al., 2021). They recommend including screenings for psychopathology in risk assessments but did not state psychopathological affect as a cause. Some theories state that the patriarchal relationship is a risk factor for IPV, however literature reviews do not confirm this. As of yet, there is no established reason for the existence for IPV, (Dixon & Graham-Kevan, 2011).
Assessment of Crisis Impact on Diverse Individuals and Families
No groups of people are immune to intimate partner violence; it affects people of all ethnicities, races, religions, socioeconomic statuses, genders, and sexual orientations. However, minoritized groups experience IPV at higher rates. This is likely due to the fact that, “economic instability, unsafe housing, neighborhood violence, and lack of safe and stable childcare and social support can worsen already tenuous situations,” (Margo & Farrell, 2020). The COVID-19 pandemic has further isolated people and worsened economic disparity, especially for those without college degrees, which has exacerbated both this problem and socioeconomic differences in rates of IPV survivors (Kochar, 2020).
Native Americans, non-Hispanic black women, and multiracial people experience IPV at higher rates; as do people 18 to 24 years old, sexual and gender minorities, and people with mental and physical disabilities (Miller & Brigid, 2019). Women who are able to reproduce experience, “poor reproductive and sexual health, including unintended pregnancy, sexually transmitted infections, and human immunodeficiency virus infection,” (Miller & Brigid, 2019).
Children of survivors also experience the effects of IPV. Children of survivors have higher prevalence rates of becoming IPV survivors or perpetrators as adults (Miller & Brigid, 2019). Additionally, the COVID-19 pandemic, quarantines, and school shutdowns have increased the stresses of taking care of children, which has increased rates of child abuse, further worsening the fate of children (Pefley, 2020).
Arkins, et al. (2016) completed a comprehensive literature review of 36 research studies assessing the validity of IPV screening tools. They found four studies examined the Hurt, Insulted, Threatened, or Screamed (HITS) tool, and found an overall 99% to 88% interrater reliability. The only drawback was that the HITS does not screen for sexual violence. The Humiliation, Afraid, Rape, and Kick (HARK) assessment was found to have high validity scores, although it had a small sample size and was not tested in a mental health setting. The Partner Abuse Interview was also examined and found to have weak reliability. In ten studies, the Partner Violence Screen (PVS) was examined; one found it weak, eight found it moderate, and one found it strong. Several other assessments were examined, and all were found to be either weak or moderate. Only one study was conducted in a mental health setting. Arkins, et al. (2016) concluded that the only tool with good psychometrics was the HARK, although all assessments should be validated in mental health settings. The Mental Status Exam and Triage Assessment can both be beneficial for screening all clients that have experienced trauma, in order to determine the degree of directive assistance the client needs (Norris, et al., 2016; Myer & Conte, 2006).
During the COVID-19 quarantines, most people in the United States were confined to their homes for at least some time period. This forced people to stay inside with their abusers, which lessened their chances at being able to safely call for help. Some areas of the country saw calls to domestic violence hotlines drop by 50% (Fielding, 2020). However, even though the calls decreased, the rates of incidence of physical IPV increased by 95% in 2020, compared with rates tracked between 2017 and 2019 (Gosangi, et al., 2021). People with fewer financial resources to purchase reliable internet became at an even higher risk when they could not safely make a phone call or use the internet to seek help. Therefore, one preventative measure to assist people in the ability to seek help for IPV is for the federal government or local communities to provide broadband internet access to all of its residents, or make it more widely available in public spaces (Evans, et. al., 2020).
Another place where survivors can access help for IPV is in medical settings. “Women experiencing intimate partner violence have more medical, gynecological, and stress-related symptoms than nonabused women,” (Miller & Brigid, 2019).
The United States Preventive Services Task Force, the American Academy of Family Physicians, the American Medical Association, and the American College of Obstetricians and Gynecologists all recommend that medical providers routinely screen women of reproductive age for IPV (Miller & Brigid, 2019; O’Doherty, et al., 2014). Most studies show that screening interventions are effective to lessen the chance of subsequent IPV incidences (Miller & Brigid, 2019). Patients that have experienced IPV, and those that have not, both agree with these recommendations and report that they prefer that medical professionals ask about IPV. Most doctors also agree with the recommendation to screen, however, “only a small percentage of medical providers actually do so, largely because they are uncomfortable having such conversations,” (O’Doherty, et al., 2014).
The World Health Organization proposes several preventative measures: (a) change legislative framework, (b) increase awareness and advocacy through the media, (c) improve women’s civil rights, (d) create civil and government coalitions and institutions, (e) increase research evidence, (f) change behaviors and communications to enact social change, (g) make changes in all sectors, especially increasing attention to IPV in sexual and reproductive health centers and appointments, (h) increase female economic and social empowerment, (i) create response services in communities, (j) teach life skills in schools, (k) teach males to promote equity and nonviolence, and (l) give early-intervention services in at-risk communities, (World Health Organization, 2012).
In a literature review of interventions for IPV survivors, Arroyo, et al. (2017) found that survivors of IPV can have psychological disorders such as anxiety and depression as a result of their trauma. They reviewed twenty-one studies and found that the cognitive behavioral therapy (CBT) interventions which modified their approach specifically for IPV survivors were most effective. The approaches targeted PTSD, self-esteem, depression, general distress, and life functioning. The IPV-specific approaches were more effective than all of the other interventions, with a 69% advantage rate, compared to the general CBT approaches with an advantage rate of 29% (Arroyo, et al., 2017).
Arroyo, et al. (2017) further found that those interventions given to individuals were more effective than groups, that more sessions and overall treatment time had more effective outcomes, and that the events seemed to last over time. Based on their research, they recommended Cognitive Trauma Therapy for Battered Women (CTTBW) With PTSD, and Helping to Overcome PTSD through Empowerment (HOPE).
Kubany et al., (2003) developed CTTBW, which uses CBT principles of changing cognitions and behaviors. They do eight to eleven sessions, at one and a half hours each. Their strategy specifically addresses adjusting dysfunctional beliefs and limiting negative self-talk about guilt and shame. To specifically address beliefs about guilt, they created a step-by-step plan with four modules: “(a) self-advocacy strategies, (b) assertive communication skill building, (c) managing unwanted contacts with former partners, and (d) how to identify potential perpetrators and avoid revictimization (Kubany, et al., 2003).
HOPE, developed by Johnson (et al., 2011), was compared to standard shelter treatment (SSS). They found that the HOPE model was more effective than SSS at treating depression, empowerment, and social support. They also stressed the importance of immediate intervention for survivors because the more quickly they can help the survivor with safety and resources, the more quickly they can learn to live without their abuser. They noted that the CTTBW model is effective, however it is made for survivors who had already permanently established independence from their abuser, while the HOPE model is specifically made for people in shelters.
The HOPE model is also based off CBT, and uses “three stages: 1) establishing safety, 2) remembrance and mourning, and 3) reconnection,” (Johnson, et al., 2011). HOPE also specifically addresses thoughts about safety, trust, power and control, as well as focuses on, “safety, self-care and protection, the exchange of information on PTSD, and empowerment,” (Johnson, et al., 2011).
In a 2011 study on Traumatic Incident Reduction (TIR) for Latina and African American women, it was found to be effective (Dulen, 2011). TIR uses a type of exposure therapy, in that it allows the clients to repeat their traumatic stories over and over until the client feels significantly reduced effects of the trauma. This is unique from other trauma-focused approaches in that it gives the client complete autonomy, as opposed to being a collaborative approach, and that it is specifically planned so that the client always knows what to do and expect (Dulen, 2011).
TIR gives clients autonomy by allowing the clients to direct which aspects of the trauma they discuss, and at their own pace, until they determine they have reached their endpoint. The principle is that this allows the client to develop the autonomy they did not have while undergoing abuse, and that the mere process of repressing memories is what kept the client in a traumatic state.
Intimate partner violence is a global issue with high prevalence. It has lasting effects, including anxiety, depression, PTSD, and reduced self-esteem and autonomy. The children of the survivors are also affected, in that they have increased chances for becoming survivors and predators themselves. There are no proven causes of IPV. It affects everyone, but it disproportionally affects people 18 to 24 years old; people who are Native American, non-Hispanic Black, or multiracial; people of sexual and gender minorities; people with disabilities; and people with lower socioeconomic statuses. Possible prevention measures include improving internet access, increasing screening in medical settings, changing laws, and increasing awareness, among others. CBT treatments that are tailored to IPV survivors, that are longer lasting, and delivered individually are more effective than other CBT treatments. TIR is effective in treating trauma effects for IPV survivors, as well as increases client autonomy.
Arkins, B., Begley, C., & Higgins, A. (2016). Measures for screening for intimate partner violence: a systematic review. Journal of Psychiatric and Mental Health Nursing, 23(3-4), 217–235. https://doi.org/10.1111/jpm.12289
Arroyo, Lundahl, B., Butters, R., Vanderloo, M., & Wood, D. S. (2017). Short-term interventions for survivors of intimate partner violence: A systematic review and meta-analysis. Trauma, Violence & Abuse, 18(2), 155–171. https://doi.org/10.1177/1524838015602736
Beyer, K., Wallis, A. B., & Hamberger, L. K. (2015). Neighborhood environment and intimate partner violence: A systematic review. Trauma, Violence & Abuse, 16(1), 16–47. https://doi.org/10.1177/1524838013515758
Centers for Disease Control and Prevention. (2021, November 2). Preventing intimate partner violence. Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html
Cunha, O., Braga, T., & Gonçalves, R. A. (2021). Psychopathy and intimate partner violence. Journal of Interpersonal Violence, 36(3-4), 1720–1738. https://doi.org/10.1177/0886260518754870
Dixon, L. & Graham-Kevan, N. (2011). Understanding the nature and etiology of intimate partner violence and implications for practice and policy. Clinical Psychology Review, 31(7), 1145–1155. https://doi.org/10.1016/j.cpr.2011.07.001
Dulen, S. B. (2011). Treatment of trauma for Latina and African American survivors of intimate partner violence. ProQuest Dissertations & Theses A&I; ProQuest Dissertations & Theses Global. https://www.proquest.com/dissertations-theses/treatment-trauma-latina-african-american/docview/872082682/se-2?accountid=10901
Evans, M.L., Lindauer, M., & Farrell, M. E. (2020). A Pandemic within a pandemic — Intimate partner violence during Covid-19. The New England Journal of Medicine, 383(24), 2302–2304. https://doi.org/10.1056/NEJMp2024046
Fielding, S. (2020, April 3). In quarantine with an abuser: surge in domestic violence reports linked to coronavirus. The Guardian. https://www.theguardian.com/us-news/2020/apr/03/coronavirus-quarantine-abuse-domestic-violence
Gosangi, B., Park, H., Thomas, R., Gujrathi, R., Bay, C. P., Raja, A. S., Seltzer, S. E., Balcom, M. C., McDonald, M. L., Orgill, D. P., Harris, M. B., Boland, G. W., Rexrode, K., & Khurana, B. (2021). Exacerbation of physical intimate partner violence during COVID-19 pandemic. Radiology, 298(1), 38–45. https://doi.org/10.1148/RADIOL.2020202866
Johnson, D. M., Zlotnick, C., & Perez, S. (2011). Cognitive behavioral treatment of PTSD in residents of battered women's shelters: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 79(4), 542-551. http://dx.doi.org/10.1037/a0023822
Kelly J. B., Johnson M. P., (2008). Differentiation among types of intimate partner violence: Research update and implications for interventions. Family Court Review: An Interdisciplinary Journal, 46, 476-499. https://doi.org/10.1111/j.1744-1617.2008.00215
Kochhar R. (2020, June 30). Unemployment rate is higher than officially recorded, more so for women and certain other groups. Pew Research Center. https://www.pewresearch.org/fact-tank/2020/06/30/unemployment-rate-is-higher-than-officially -recorded-more-so-for-women-and-certain-other-groups/
Kubany, E.S., Hill, E. E., & Owens, J. A. (2003). Cognitive trauma therapy for battered women with PTSD: Preliminary findings. Journal of Traumatic Stress, 16(1), 81–91. https://doi.org/10.1023/A:1022019629803
Margo, L., & Farrell, M. E. (2020). A pandemic within a pandemic — intimate partner violence during Covid-19. The New England Journal of Medicine, 383(24), 2302-2304. http://dx.doi.org/10.1056/NEJMp2024046
Myer, R. A., & Conte, C. (2006). Assessment for Crisis Intervention. Journal of Clinical Psychology, 62(8), 959–970. https://doi.org/10.1002/jclp.20282
Miller, E., & Brigid, M. (2019). Intimate partner violence. The New England Journal of Medicine, 380(9), 850-857. http://dx.doi.org/10.1056/NEJMra1807166
Norris, D., Clark, M. S., & Shipley, S. (2016). The Mental Status Examination. American family physician, 94(8), 635–641.
O’Doherty, L. J., Taft, A., Hegarty, K., Ramsay, J., Davidson, L. L., & Feder, G. (2014). Screening women for intimate partner violence in healthcare settings: abridged Cochrane systematic review and meta-analysis. BMJ: British Medical Journal, 348. https://www.jstor.org/stable/26514759
Pefley, A. (2020, May 22). Experts see rise in child abuse cases tied to Covid-19. West Palm Beach, FL: CBS 12 News. https://cbs12.com/news/local/experts-see-rise-in-child-abuse-cases-tied-to-covid-19
Peterson, C., Kearns, M. C., McIntosh, W. L., Estefan, L. F., Nicolaidis, C., McCollister, K. E., Gordon, A., & Florence, C. (2018). Lifetime economic burden of intimate partner violence among U.S. adults. American Journal of Preventive Medicine, 55(4), 433–444. https://doi.org/10.1016/j.amepre.2018.04.049
Smith, S.G., Zhang, X., Basile, K.C., Merrick, M.T., Wang, J., Kresnow, M., Chen, J. (2018). The national intimate partner and sexual violence survey (NISVS): 2015 data brief – updated release. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/pdf/2015data-brief508.pdf
World Health Organization. (2012). Understanding and addressing violence against women: Intimate partner violence. World Health Organization. http://www.who.int/iris/bitstream/10665/77432/1/WHO_RHR_12.36_eng.pdf?ua=1.%25202012.