2 Definition of Domestic Violence

For the purpose of this manual, a behavioral definition of domestic violence is used rather than a legal definition, since a behavioral definition is more comprehensive and more relevant to the health care setting.1 (See Figure 1-1) Domestic violence is herein defined by (1) the relationship context of the violence, (2) the perpetrator’s behaviors, and (3) the function those behaviors serve. Throughout this manual, the terms “domestic violence,” “abuse,” and “battering” will be used interchangeably.

Relationship Context

Domestic violence occurs in a relationship where the perpetrator and victim are known to each other. It occurs in both adult and adolescent intimate relationships. The victim and perpetrator may be dating, cohabiting, married, divorced, or separated. They are heterosexual, gay or lesbian.2 They may have children in common. The relationships may be of short or long duration.

The intimate context of the violence is important in understanding the nature of the problem and in developing effective interventions. To an outside observer, domestic violence may look like stranger- to-stranger violence (e.g., punching, slapping, kicking, choking). Domestic violence victims experience traumas similar to those of victims of stranger violence (e.g., burns, internal injuries, head injuries, bruises, stab wounds, broken bones, muscle damage, psychological trauma). However, the intimate context of domestic violence shapes the way in which both the perpetrator and the victim relate to and are affected by the violence. And, unfortunately, the intimate context all too often leads those outside the relationship to take domestic violence less seriously than other types of violence.

In domestic violence, perpetrators have on-going access to their victims, know their daily routines and vulnerabilities, and can continue after violent episodes to exercise considerable physical and emotional control over their daily lives. In addition, these perpetrators have knowledge of their victims (e.g., prior medical conditions, allegiance to their children) which they use to target their assaults (e.g., withholding medications, grabbing victims from behind, threatening to harm the children), increas- ing the victims’ trauma and fear.

Victims of domestic violence not only deal with the particularities of a specific trauma (e.g., head injury) and the fear of future assaults by a known assailant, but must also deal with the complexities of an intimate relationship with that assailant. Many perpetrators believe that they are entitled to use tactics of control with their partners and too often find social supports for those beliefs. It is the “family” nature of these relationships that sometimes gives the perpetrator social, if not legal, permission to use abuse. Unlike victims of stranger violence, victims of domestic violence face social barriers to a separation from their perpetrators as well as barriers to other strategies for self protection (Hart, 1993).

Domestic violence as defined here does not include other types of intimate or family violence: child abuse/neglect, child- to-parent violence, sibling violence, and the abuse of the elderly (unless the abuse is being perpetrated by the elder’s intimate partner). While other types of family violence may result in the same kinds of physical injuries and psychological damage found in domestic violence cases, the dynamics are different, require different interventions, and are beyond the scope of this manual.

Domestic Violence: A Pattern of Behaviors

Domestic violence is not an isolated, individual event, but rather a pattern of perpetrator behaviors used against a victim. The pattern consists of a variety of abusive acts, occurring in multiple episodes over the course of the relationship. Some episodes consist of a sustained attack with one tactic repeated many times (e.g., punching), combined with a variety of other tactics (such as name calling, threats, or attacks against property). Other episodes consist of a single act (e.g., a slap, a “certain look”). One tactic (e.g., physical assault) may be used infrequently, while other types of abuse (such as name calling or intimidating gestures) may be used daily. Battering episodes last a few minutes to several hours or days. While some perpe- trators repeat a particular set of abusive acts, other perpetrators use a wide variety of tactics with no particular routine.

Each episode of domestic violence is connected to the others. One battering episode builds on past episodes and sets the stage for future episodes. Perpetrators refer to past episodes (e.g., “Remember the last time?”) and make threats about future abuse as a way to maintain control. Batterers use a wide range of coercive behaviors that result in a wide range of consequences, some physically injurious and some not, but all psychologically damaging. Some parts of the pattern are crimes in most states (e.g., physical assault, sexual assault, menacing, arson, kidnap- ping, harassment) while other battering acts are not illegal (e.g., name calling, interrogating children, denying the victim access to the family automobile). All parts of the pattern interact with each other and can have profound physical and emotional effects on victims. Victims respond to the entire pattern of perpetrators’ abuse rather than simply to one episode or one tactic. While a health care provider may be attempting to make sense of one incident that resulted in an injury, the victim is dealing with that single episode in the context of all the other obvious and subtle episodes of abuse.

The abusive and coercive behaviors take different forms: physical, sexual, psychological, and economic. To under- stand the pattern, different types of domes- tic violence behaviors are described below. The first two categories are types of physically assaultive battering where the perpetrator has direct contact with the victim’s body. The other categories involve tactics where the perpetrator has no direct physical contact with the victim’s body during the attack although the victim is clearly the target of the abuse.

Physical Assaults

Physical abuse may include spitting, scratching, biting, grabbing, shaking, shoving, pushing, restraining, throwing, twisting, slapping (with open or closed hand), punching, choking, burning, and/or use of weapons (e.g., household objects, knives, guns) against the victim. The physical assaults may or may not cause injuries. Sometimes a seemingly less serious type of physical abuse, such as a shove or push, can result in the most serious injury. The perpetrator may push the victim against a couch, a wall, down a flight of stairs, or out of a moving car, all of which could result in varying degrees of trauma (e.g., bruising, broken bones, spinal cord injuries). Sometimes the physical abuse does not cause a specific injury but does cause other health problems. For example, one perpetrator frequently abused his partner during meals and late at night. He would push, restrain, and spit at his partner as well as abuse her verbally. While there were no visible injuries, the victim suffered from severe sleep deprivation and poor nutrition, since both her sleep and eating patterns were repeatedly interrupted by her abuser’s conduct.

Sexual Assaults

Some perpetrators sexually batter their victims. Sexual battering consists of a wide range of conduct that may include pressured sex when the victim does not want sex, coerced sex by manipulation or threat, physically forced sex, or sexual assault accompanied by violence. Victims may be coerced or forced to perform a kind of sex they do not want (e.g., sex with third parties, physically painful sex, sexual activity they find offensive, verbal degradation during sex, viewing sexually violent material) or at a time they do not want it (e.g., when exhausted, when ill, in front of children, after a physical assault, when asleep). Some perpetrators attack their victims’ genitals with blows or weapons. Some perpetrators deny victims contraception or protection against sexually trans- mitted diseases. The perpetrators’ message to the victims is that they have no say over their own bodies. Sometimes victims will resist and are then punished, and sometimes they comply in hopes that the sexual abuse will end quickly. For some battered victims this sexual violation is profound and may be difficult to discuss. Some victims are unsure whether this sexual behavior is really abuse, while others see it as the ultimate betrayal.

Psychological Assaults

There are different types of psychological assaults.

Threats of violence and harm

The perpetrator’s threats of violence or harm may be directed against the victim or others important to the victim or they may be suicide threats. Sometimes the threat includes killing the victim and others and then committing suicide. The threats may be made directly with words (e.g., “I’m going to kill you,” “No one is going to have you,” “Your mother is going to pay,” “I cannot live without you”) or with actions (e.g., stalking, displaying weapons, hostage taking, suicide attempts). Perpetrators may be violent towards others (e.g., neighbors, family members) as a means of terrorizing victims. Perpetrators may coerce victims into doing something illegal (e.g., prostitution, larceny) and then threaten to expose them, or may make false accusations against them (e.g., reports to Child Protective Services, to the welfare department, or to immigration).

Attacks against property or pets and other acts of intimidation.

Attacks against property and pets are not random acts. It is the wall the victim is standing near that gets hit, or the door she is hiding behind that gets torn off of its hinges, the victim’s favorite china that is smashed or her pet cat that is strangled in front of her, the table that she is sitting near that gets pounded or one of the perpetra- tor’s favorite objects that gets smashed while he says, “Look what you made me do.” The message to the victim is always, “You can be next.”

The intimidation can also be carried out without damage to property, by the perpetrator yelling and screaming in the victim’s face, standing over the victim during a fight, driving recklessly when the victim or children are present, stalking, or putting the victim under surveillance. The intimidation may not always include a threat of physical harm, but may instead be carried out by damaging the victim’s relationships with others or her reputation in her community by discrediting her with employers, ministers, friends, neighbors.

Emotional abuse

Emotional abuse is a tactic of control that consists of a wide variety of verbal attacks and humiliations, including repeated verbal attacks against the victim’s worth as an individual or role as a parent, family member, friend, co-worker, or community member. The verbal attacks often emphasize the victim’s vulnerabilities (such as her past history as an incest victim, language abilities, skills as a parent, religious beliefs, sexual orientation, or HIV status).

Sometimes the batterer will play “mind games” to undercut the victim’s sense of reality (e.g., specifically directing her to do something, then claiming that he never asked her to do it when she complies). Sometimes emotional abuse consists of forcing the victim to do degrading things (e.g., going to the perpetrator’s mistress’ home to retrieve her children, getting on her knees and using a toothbrush to clean up food the perpetrator smeared on the kitchen floor, or going against her own moral standards). Emotional abuse may also include humiliating the victim in front of family, friends or strangers. Perpetrators may repeatedly claim that victims are crazy, incompetent, and unable “to do anything right.” These tactics of abuse are similar to those used against prisoners of war or hostages and they are used for the same purpose: to maintain the perpetrator’s power and control.

Emotional abuse in domestic violence cases is not merely a matter of someone getting angry and calling his partner a few names or cursing. Not all verbal insults between partners are acts of violence. In order for verbal abuse to be considered domestic violence, it must be part of a pattern of coercive behaviors in which the perpetrator uses or threatens to use physical force. In domestic violence, verbal attacks and other tactics of control are intertwined with the threat of harm in order to maintain the perpetrator’s dominance through fear. While repeated verbal abuse is damaging to partners and relationships over time, it alone does not establish the same climate of fear as verbal abuse combined with the use or threat of physical harm.

The presence of emotionally abusive acts may indicate undisclosed use of physi- cal force or it may indicate possible future domestic violence. There is no way at this time in domestic violence research to predict which emotionally abusive relation- ships will become violent and which will never progress beyond verbal abuse. If the victim feels abused or controlled or afraid of her partner without showing or offering clear descriptions of physical harm, then the cautious approach would be to accept the patient’s views as stated and to respond with concerns about the victim’s safety and psychological well-being.

Isolation

Perpetrators often try to control victims’ time, activities and contact with others. They gain control over them through a combination of isolating and disinformation tactics. Isolating tactics may become more overtly abusive over time. At first perpetrators cut victims off from supportive relationships by claims of loving them “so much” and wanting to be with them all the time. In response to these statements, victims may initially spend increasing amounts of time with their perpetrators. These subtle means of isolating the victim are then replaced with more overt verbal abuse (e.g., complaints about “interfering” family or “dykey” looking friends, complaints about her spending too much time with others); sometimes the perpetrator uses physical assaults or threats of assault to separate the victim from her family or friends. He may lock her out of her house or control her movements by taking her car keys or forcing her to quit her job. Through incremental isolation, some perpetrators increase their psychological control to the point where they deter- mine reality for the victims.