Domestic abuse in the United States is a large-scale and complex social and health problem. Domestic violence has become a major health threat to this nation, costing America thousands of lives and millions of dollars (Moore, Zaccaro, & Parsons, 1998). Domestic violence is known by many names including spouse abuse, domestic abuse, domestic assault, battering, partner abuse, and so on.
McCue (1995) maintains that domestic abuse is commonly accepted by legal professionals as “the emotional, physical, psychological, or sexual abuse perpetrated against a person by that person’s spouse, former spouse, partner, former partner or by the other parent of a minor child”, although several other forms of domestic violence have become increasingly apparent in today’s society. This threat has no prejudice, it spans all socioeconomic classes, professions, cultures, religions, ages, and gender; however, research shows that 95 to 98% of victims are women (Ellis, 1999). As many as one in ten women are abused each year in the United States (Attala, McSweeney, Mueller, Bragg, & Hubertz, 1999).
It is inadequate to view domestic violence as an aspect of the normal interpersonal conflict, which takes place in most families. According to McCue (1995), many families experience conflict, but not all male members in families inevitably resort to violence. It is not the fact of family disputes or marital conflict that generate or characterize violence in the home. Violence occurs when one person assumes the right to dominate over the other and decides to use violence or abuse as a means of ensuring that (Currie, 1988). According to McCue (1995), many of the men who present most violently in the household portray themselves quite differently to the rest of society.
They are generally not lawbreakers, but rather appear to be charming, often handsome law-abiding citizens outside of their own homes who maintain an image as friendly and devoted family men. In fact, it is likely that many such aggressors are not even aware of the major impact their actions have upon their partners. The abuser assumes control over a woman’s activities and prevents or limits interaction with friends, family, and service from health care providers to decrease her access to information and support (Attala et al., 1999).
The frequency and severity of abuse increases in frequency and severity and unless stopped will continue to severe acts of violence (Landenburger, 1998). The longer the abuse progresses the more powerful the batter becomes. The batterer perceives a feeling of no accountability if the abuse occurs while under the influence of alcohol. This provides a “socially acceptable” excuse for the violence. Therefore, a higher risk of domestic violence occurs if the abuser uses drugs or alcohol (Hightower & Gorton, 1998).
Domestic violence remains a hidden problem because it occurs within the privacy of the home and those involved are usually reluctant to speak out (Healey, 1993). However, if one is aware of and screens for the warning signs, successful intervention can be achieved. Commonly, abuse results in multiple health problems. Besides the direct injuries from the physical violence; increased substance abuse, chronic pelvic and abdominal pain, headaches, and gastrointestinal disorders are common (Moore, Zaccaro, & Parsons, 1998). Posttraumatic stress disorder symptoms can develop and finally homicide may result (Landenburger, 1998). In fact, one in five of all murder victims is a woman killed by her partner or ex-partner (Frost, 1999).
Of all female homicide victims, 31% were murdered by a boyfriend, spouse, or ex-spouse (Glass & Campbell, 1998). As the frequency and severity of abuse increases, the victim becomes isolated, fearful for their lives or those of her children, and experience increased feelings of desperation and depression (Landenburger, 1998).
Abuse is more likely to start or worsen when the woman becomes pregnant. In fact, 20% of all pregnant women are abused. Moreover, the leading cause of death among pregnant women was due to partner abuse (McFarlane, Parker, Soeken, Silva, and Reel, 1997). Complications such as low weight gain, anemia, infections, 1st and 2nd trimester bleeding, and greater risk for late entry into prenatal care are significantly higher in abused women. The effects on the fetus from abuse include higher incidence of fetal distress and low birth weight. In addition, abuse during pregnancy is associated with significantly higher maternal depression rates, suicide attempts, and substance abuse (McFarlane et al., 1997).
Research indicates approximately 3-10 million children witness their mothers being treated violently each year. These children are at a risk for cognitive, behavioral, and emotional delays (Glass and Campbell, 1998). Not only are they at risk for abuse, but posttraumatic stress disorder, sleep disturbance, separation anxiety, hyperactivity, emotional disorders, and eventually they may imitate such aggressive behavior (Moore, Zaccaro, Parsons, 1998).
These children are also at risk for being abused themselves are becoming an abuser. In addition, the cost to society is great, due to the fact that children of battered women use health services 6 to 8 times more than other children (Glass & Campbell, 1998). These children are often neglected and live in a world surrounded by fear. However, the likelihood that a woman gets help is increased if she has children. Children play a major role in notifying others that the abuse occurs. In addition, the scars that form and grow in these children and the fear for their safety influence the woman’s decision to leave (Landenburger, 1998).
What has to occur for the woman to break the cycle of abuse and seek help? Research indicates a window phase in the cycle of abuse as the ideal time for adequate and sincere interventions to be successful. The cycle of abuse has three phases: tension-building phase, acute battering incident, and the honeymoon phase. The tension-building phase starts with a moody and hostile batterer who is overly critical of his partner. This phase is followed by the actual assault on the woman.
Lastly, the honeymoon phase involves desperate pleas of forgiveness and promises of “never again” by the batterer. The open window of opportunity for healthcare members to be successful in their interventions is in between the second and third phases (Matar-Curnow, 1997). Research shows multiple barriers in this process, both in the woman’s lack of disclosure and healthcare workers failing to ask (Shea, Mahoney, & Lacey, 1997).
Patterns of Morbidity and Mortality
Domestic violence is the mistreatment of one family member by another. Most often perpetrators of an abuse and battering are a spouse, ex-spouse, boyfriend/girlfriend, ex-girlfriend/boyfriend, or lover. Domestic violence occurs in one of five forms: physical, sexual, psychological, emotional, and economic (Chez, 1994). It is more prevalent than most people are aware. Annually, females experience over 10 times as many incidents of violence by an intimate than men. On average each year, 1.8 million women are battered by their husbands. Experts suggest a violent act occurs against a woman every 12 seconds (Straus and Gelles, 1990).
Domestic violence accounts for at least 20% of all medical visits by women and 22-30% of all women seeking emergency treatment. Reported injuries include contusions; abrasions; fractures; injuries to the head, neck, chest, breasts, and abdomen; as well as injuries during pregnancy. Reported medical findings include symptoms related to stress, chronic posttraumatic stress disorder, depression, and other anxiety disorders. However, most women choose not to discuss the abuse with their health-care professional and over half do not discuss the abuse with anyone due to the fear that the revelation will cause the violence to (National Clearinghouse for the Defense of Battered Women [NCDBW], 1991).
According to the latest available FBI statistics, in 1990, 30% of female murder victims were killed by their husbands or boyfriends. This statistic represents approximately three thousand women (Knall, 1992). In a study of females killed by intimate partners between 1980 and 1982, it was found that the majority of women killed were married (57.7%). Girlfriends were the next highest percentage (24.5%), followed by common-law wives (8%), ex-wives (4.8%), and friends (4.6%). Seventeen percent of workplace homicides were committed by a male intimate (Stout, 1993, p. 3). The number one risk factor for actual and attempted suicide in adult women is spouse abuse. She may kill herself or her abuser to escape because she sees no other way out (Radford and Russell, 1992).
In the United States, the average annual medical expense resulting form domestic violence is four billion dollars. In the workplace, domestic violence accounts for 175,000 days of absenteeism and 25% of excessive medical (NCDBW, 1991).
Domestic violence knows no boundaries. It persists in every level of society. From 1983 to 1991, the number of domestic violence reports received increased by almost 117% (Domestic Violence Myths, n. d.). Some experts theorize the “battered woman syndrome” can characterize the effects of battering. “Battered woman syndrome” is defined by a common set of symptoms which include emotional reactions (fear, anger, sadness); changes in beliefs and attitudes about self, others and the world (self-blame, distrust, belief that the world is unsafe); and psychological distress (depression, flashbacks, anxiety, sleep problems, substance abuse) to name a few (Dutton, 1996).
Characteristics of the batterer vary widely. Battering men come from all ages, ethnic, and educational backgrounds. Batterers are traditionalists and have unrealistic expectations of marriage, believing in male supremacy and stereotypical gender roles. Many have high incidence of substance abuse and violence in their backgrounds. Other common characteristics include low self-worth, difficulty trusting people, difficulty forming relationships, and extreme reactions to emotions.
Of all the factors that characterize the background of abusers, the most predictably present is previous exposure to some form of violence (Straus and Gelles, 1990). As children, abusers were often beaten themselves or witnessed the beating of siblings or a parent. Children raised in this way may detest violence, but they have had no experience with other models of family relationships (Stanhope and Lancaster, 1996).
Women remain with the abuser because of psychological, economic, and social reasons. Guilt, fear, self-blame, low self-esteem, and feelings of helplessness are all psychological reasons that make it difficult for them to conceive of leaving. Fear of losing their children due to lack of resources and finances is a major determinant for staying. There are half as many shelters for battered women in this country as there are for stray animals, and most do not accept children.
For every two women sheltered, five are turned away. For every two children sheltered, eight are turned away. Approximately half of all homeless women and children are on the streets because of violence in the home. Socially, women stay to avoid the stigma of domestic violence (Landenburger, 1989). Violence is the reason stated for divorce in 22% of middle-class marriages. Lastly, another major determinant for staying is fear. The National Coalition Against Domestic Violence reports that women who leave their batterers are at a 75% greater risk of being killed by the batterer than those who stay (Lowery, 2000).
Women of all cultures, races, occupations, income levels, and ages are battered by husbands, boyfriends, lovers, and partners. Just like the victims, there are no typical abusers. Anyone can be an abuser. On the surface, abusers may appear to be good providers, loving partners, and law-abiding citizens. Approximately one-third of the men counseled for battering are professionals who are well respected in their jobs and communities. These men are doctors, psychologists, lawyers, ministers, and business executives (“Domestic Violence Myths,” n. d.).
Domestic violence is self-perpetuating because it is a learned behavior. It is used to establish control and fear. The batterer uses violence, intimidation, threats, isolation, and psychological abuse to coerce and control the other person. Even if the violence does not happen often, it remains as a hidden, constant and terrorizing threat. Unfortunately, abuse tends to escalate in frequency and severity over time, and the man’s remorse tends to lessen (Walker, 1984).
Domestic violence has a positive correlation with drug and alcohol abuse. The substance abuse problems must be addressed along with the abusive behavior to reach a successful resolution.
Battering during pregnancy has serious implications for the health of both women and their children. These women are at risk for spontaneous abortion, premature delivery, low birth weight infants, substance abuse during pregnancy, and depression (Bullock and McFarlane, 1989).
Public services play an important role in providing services for the battered population. Examples of public services include crisis intervention, counseling services, and abuse intervention (YWCA Crisis Services, 2000).
The private sector is very limited in the services provided to the battered population. An example would be private counseling or counseling within the church. The church would also lend spiritual support, provide positive role models, and reinforcement for peaceful behavior (Stanhope and Lancaster, 1996).
Domestic violence is not prevalent in any one culture or religion. It is found in all cultures and all religions. However, some faiths uphold the victimization of people with their disapproval of divorce. Family members stay together, although they are at emotional or physical war with one another, because of religious commitments (Lancaster, 1980). Other women give up religion in disillusionment, feeling that a just and merciful God would not let them suffer so (Brown, Finney, Jestis, Johnson, McCorkel, Roach, Schlinke, Smith, Snook, ; Warning, 1998).
In our culture, the media has brought attention to the problem of domestic violence. This has lessened the stigma associated with domestic violence and publicized services available to this population. However, the media also brings violence into our homes on a daily basis through television and newspaper reports of violence. This has caused our society to become somewhat desensitized to and the acceptance of violence (Stanhope and Lancaster, 1996).
Domestic violence affects all ages from before birth to the elderly. From the abuse of the pregnant female to the battering of the elderly in the nursing home, violence does not discriminate based on age.
In the community, there are facilities available to assist and empower battered women. They provide women with safety and security against the abuser. Referrals to these facilities are most often made by the police department or by a social worker in the hospital.
In Oklahoma City, the Domestic Violence Victim Assistance Program (DVVAP) is a cooperative effort through the city and the YWCA, providing support and assistance to victims of domestic violence. The YWCA provides safety by providing emergency shelter and care for battered women who are in immediate danger, and their children (YWCA Crisis Services, 2000).
The YWCA’s program, Passageways, is a nonprofit organization. Passageways is funded by the Department of Justice, Office for Victim’s of Crime, and the United Way. This facility accepts single women and women with children. The maximum stay is sixty days. Women are assisted in obtaining housing, medical care, legal counsel, and transportation. Women staying in the shelter are required to attend classes addressing domestic violence, anger management, and parenting.
Education and support help their children avoid further victimization, verbalize feelings, and learn appropriate ways to express emotions. The school they attend is confidential and aids in helping them understand what is occurring in their family. Additionally, the YWCA provides a structured re-education and counseling domestic violence program for men who are violent and/or abusive in interpersonal relationships. (YWCA Crisis Services, 2000)
The DVVAP provides onsite assistance at the Oklahoma City Municipal Court building to aid the victim in filing a Victim Protection Order (V-PO) and/or exploring other options. The DVVAP advocate will accompany the victim to court when appropriate. In addition, referrals are made for Legal Aid of Central Oklahoma, Oklahoma Housing Authority, mental health counseling, and job training. The cost for these services is based on a sliding scale (YWCA Crisis Center, 2000).
The YWCA is committed to ending domestic violence through social change and empowering those who have been violated. To this end, the YWCA assist victims through referrals to community outreach programs that provide education and support for individuals who have experienced domestic violence and/or sexual abuse. Referrals to domestic violence groups, sexual assault groups, and individual counseling are also available. Finally, a structured, re-education program called “Third Phase” is available for men who are violent and/or abusive in interpersonal relationships. The YWCA is building brighter futures through support and education (YWCA Crisis Center, 2000).