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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, 2007).
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Case Study
4. Jenna
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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 several other specialists.
They include 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.
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Each year, women experience about 4.8 million
intimate partner related physical assaults and rapes. Men
are the victims of about 2.9 million intimate partner related
physical assaults (CDC, 2007). 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 (CDC, 2008a; Johnson & Leone, 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 (CDC, 2008a; Campbell et al.,
2002). Abused women are six to eight times more likely to
use health care services than nonabused women (USDHHS, 2008).
However, often those who have been abused do not present to
emergency departments or primary or urgent care offices with
overt trauma or injury, despite their significant injuries.
Less than one-fifth of victims reporting an injury from intimate
partner violence sought medical treatment following the injury
(NCADV, 2007a).
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
Physical and psychological abuse is connected
to chronic health problems such as gastrointestinal disorders,
chronic pain syndrome, depression, and suicidal behavior (CDC,
2008a; USDHHS, 2008).
- 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
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. The most common forms of mental
health disorder arising from IPV/DV are (CDC, 2008a; USDHHS,
2008; Campbell et al., 2002):
- 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.
Other mental health issues include (CDC, 2008a; USDHHS, 2008;
Roberts, Klein, & Fisher, 2003; Coker et al., 2002; Heise
& Garcia-Moreno, 2002):
- Suicidal behavior
- Anxiety
- Low self-esteem
- Antisocial behavior
- Inability to trust
- Fear of intimacy
Intimate partner violence results in more than 18.5 million
mental health care visits each year (NCADV, 2007a).
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 (CDC, 2008a):
- 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 or underuse of health services
Social Consequences
of Violence
Victims of IPV/DV sometimes face the following social consequences
(CDC, 2007; Plichta, 2004; Heise & Garcia-Moreno 2002):
- 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.
This is generally considered an underestimate because the
costs associated with the criminal justice system were not
included (CDC, 2008a).
- 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 (CDC, 2008a; 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, 2008a).
- 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 (CDC, 2008a).
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