2 Definition of Domestic Violence
Domestic violence has many names: wife abuse, marital assault, woman battery, spouse abuse, wife beating, conjugal violence, intimate violence, battering, partner abuse, for example. Sometimes these terms are used interchangeably to refer to the problem, while at other times a particular term is used to reflect a specific meaning (e.g., “woman abuse” to highlight the fact that most victims are women). In addition to these multiple terms, there are different behavioral and legal definitions for domestic violence. With so many varying terms and definitions, there can be a lack of clarity about what is meant by domestic violence, leading to inconsistencies in identification, assessment, and interventions as well as inconsistencies in research.
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.
Perpetrators’ use of disinformation tactics such as distorting what is real through lying, providing contradictory information, or withholding information is compounded by the forced isolation of the victims. For example, perpetrators may lie to victims about their legal rights or the outcomes of medical interventions. While many victims are able to maintain their independent thoughts and actions, others believe what the perpetrators say because the victims are isolated from contrary information. Through his victim’s isola- tion, the perpetrator prevents discovery of the abuse and avoids being held responsible for it.
The perpetrator isolates the victim by acting jealous and interrupting social/ support networks. Some perpetrators act very possessive about their victims’ time and attention. They often accuse them of sexual infidelity and of other supposed infidelities, such as spending too much time with children, the extended family, at work, or with friends. They claim that family or friends are trying to ruin their relationship. This jealousy about alleged lovers, friends, or family is a tactic of control.
Use of children
Some abusive acts are directed against or involve the children in order to control or punish the adult victim (e.g., physical attacks against a child, sexual use of the children, forcing children to watch the abuse of the victim, engaging children in the abuse of the victim). A perpetrator may use children to maintain control over his partner by not paying child support, requiring the children to spy, requiring that at least one child always be in the company of the victim, threatening to take children away from her, involving her in long legal fights over custody, or kidnapping or taking the children hostage as a way to force the victim’s compliance.
Children are also drawn into the assaults and are sometimes injured simply because they are present (e.g., the victim is holding an infant when pushed against the wall) or because the child attempts to intervene in the fight. The perpetrator’s visitations with the children are used as opportunities to monitor or control the victim. These visitations become night- mares for the children as they are interrogated about the victim’s daily life.
Use of Economics
Perpetrators control victims by controlling their access to all of the family resources: time, transportation, food, clothing, shelter, insurance, and money. It does not matter who the primary provider is or if both partners contribute. The perpetrator is the one who controls how the finances are spent. He may actively resist the victim becoming financially self-sufficient as a way to maintain power and control. Conversely, he may refuse to work and insist that she support the family. He may expect her to be the family “book- keeper,” requiring that she keep all records and write all checks, or he may keep financial information away from her. In all instances he alone makes the decisions. Victims are put in the position of having to get “permission” to spend money on basic family needs.
When the victim leaves the battering relationship, the perpetrator may use economics as a way to maintain control or force her to return: refusing to pay bills, instituting legal procedures costly to the victim, destroying assets in which she has a share, or refusing to work “on the books” where there would be legal access to his income. All of these tactics may be used regardless of the economic class of the family.
The Connection Between Violence and Other Tactics of Control
It is the perpetrators’ use of physical and sexual force or threats to harm person or property that gives power to their psychologically abusive acts. Psychological battering becomes an effective weapon in controlling victims because they know from experience that perpetrators will at times back up their threats or taunts with physical assaults. Sometimes the perpetrator uses physical force infrequently, with no discernible pattern. However, even when the assault only happens once or ends without injury, that incident establishes the threat of violence. If the perpetrator has been violent against someone else (e.g., a previous intimate partner, in war, on the street), reference to that history can also establish the threat of violence against the victim. The fact that the perpetrator has used violence in the past to get what he wants gives him power over her by instilling fear and conveying a promise of violence absent her compliance.
Perpetrators will use that fear to coercively control their victims through other, non-physical tactics. Sometimes perpetrators are able to gain compliance from the victim by simply saying, “Remember what happened the last time you tried to get a job?”, referring to a time when the perpetrator assaulted the victim for getting “the wrong kind of job.” Because of the past use of physical force, there is an implied threat in the statement and the victim becomes reluctant to pursue a job against the perpetrator’s wishes. Sometimes the perpetrator will refer to his violence against others (e.g., “You know, I was a trained killer in the military,” “You’re acting like Susie and you know what happened to her”) or sometimes use more overt threats to kill or maim the victim or others.
Psychological control through intermittent use of physical assault along with psychological abuse is typical of domestic violence and is the same control tactic used against hostages or prisoners of war (Graham & Rawlings, 1991; Ganley, 1981). Sometimes physical abuse, threats of harm, and isolation tactics are interwoven with seemingly loving gestures (e.g., expensive gifts, intense displays of devotion, sending flowers after an assault, making romantic promises, tearfully promising it will never happen again). Amnesty International (1973) describes such “occasional indulgences” as a method of coercion used in torture. With such tactics, the perpetrator provides positive motivation for victim compliance. The perpetrator is able to control the victim through this combination of physical and psychological tactics since the perpetrator connects the threat of physical harm so closely with the psycho- logical tactics. The message is always there that if the victim does not respond to this “loving” gesture or verbal abuse, then the perpetrator will escalate and use whichever tactic, including force, is necessary to get what he wants.