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Domestic Abuse
THE FACTS
27,758 temporary protective orders and 18,252 emergency protective orders are issued annually in Kentucky. (Source: Kentucky State Police)
Studies show 22-35% of women who seek aid in emergency room settings are in need of treatment for injuries stemming from domestic abuse.(1)
Up to half of all battered women are abused during pregnancy, with physical abuse often beginning or escalating in pregnancy. (2)
21,089 cases of spouse abuse were reported in Kentucky by the end of fiscal year '95. A 7% increase from fiscal year '94. Trend data documents that the most vulnerable adult is an abused spouse, Caucasian, female, age 29 or under, married, living with spouse and referred to Department for Community Based Services by law enforcement. (3)
An estimated four million U.S. women are abused by intimate partners each year and one-quarter of all women will be abused at some point in their lives.(4)
Between 30-50 % of all marriages will at some point involve the use of physical violence. (5)
The rate of depression for domestic abuse victims is twice that of the general population of women; 26% of all women and 30% of women of color who attempt suicide are battered women.(6)
31,260 women were murdered by intimate partners in the past two decades (1976 - 1996) Of those: 64% were by spouse; 5% by former spouse; and 32% by unmarried partner. (7)
60% of stalking by intimate partners occurs before the relationship ends. (8)
44% of cities surveyed by the US Conference of Mayors identified domestic violence as the primary cause of homelessness. (9)
38% of convicted violence offenders in local jails committed crimes against their intimate partner were on probation/parole or under an active protective order. (7)
59% of high school students reported at least one dating violence incident within the past year. (10)
63% of young men between the ages of 11 and 20 who are serving time for homicide have killed their mother's abusers. (11)
Over 5,400 women and children seek refuge annually in Kentucky's 14 state-funded Spouse Abuse Centers (source: Kentucky Domestic Violence Association).
SOURCES
The Commonwealth Fund, Commission on Women's Health, Violence Against Women in the United States: A Comprehensive Background Paper. November 1995; 43.
Helton, McFarlane, and Anderson, 1987; Bohn, 1990
Commonwealth of Kentucky, Department of Social Services Profile on Child Abuse and Neglect. Fiscal Year 1995
American Medical Association. (1992) Diagnosis and Treatment Guidelines on Domestic Violence.
Substance Abuse and Mental Health Services Administration, 1994
Plichta, S. (forthcoming) "Violence, Health and Use of Health Services." In Women's Health and Care Seeking Behavior. Baltimore: John Hopkins University Press.
U.S. Department of Justice, Bureau of Justice Statistics. March 1998.
National Institute of Justice, Center for Policy Research. November 1997.
Waxman, Laura & Reny Trupin. A Status Report on Hunger and Homelessness in America's Cities: 1997.
Jezl D., Molidor, C., and Wright, T. (1995) Child and Adolescent Social Work Journal, 12, 199-135.
March of Dimes, 1992.
The Incidence of Violence in Families
The past two decades have seen a slow but startling awakening to the existence of widespread abuse within American families. The literature on physical abuse has "discovered" and focused upon populations of victims in a singular fashion. In the 1960's, studies began to reveal the routine victimization of children (Gil, 1970); in the 1970's, researchers began a focus on spouse as well as child abuse (Gelles, 1980); and abuse perpetrated against the elderly received attention in the 1980's (Steinmetz, 1981). Similarly, studies have revealed the sexual victimization of family members. In the late 1970's, reports of child sexual abuse began to skyrocket (Russell, 1983; Fritz, Stall & Wagner, 1981; Finkelhor, 1979), and research of the 1980's addressed the incidence of rape in marital relationships (Shields, Resick & Hanneke, 1990; Russell, 1982).

The Federal Bureau of Investigation reports that domestic violence is the country's most prevalent crime . . . and the least reported.

Researchers in the area of domestic violence estimate that the number of women beaten within one year by a spouse reaches approximately two to four million (Straus & Gelles, 1986). The Surgeon General of the United States has stated that domestic violence is the leading cause of injuries of women aged 15 to 44 in this country (Novello et al, 1992). Though not well studied, rates of violence among gay and lesbian couples appear to be comparable to heterosexual couples (Coleman, 1994; Island & Letellier, 1991). In a 1979 study on the incidence of spousal violence in Kentucky, a Lou Harris study found that 23% of women polled answered affirmatively when asked if they had ever been the victim of this type of crime (Schulman, 1979). The Bureau of Justice Statistics National Crime Victimization Survey reports the following about domestic violence victims (1995):
nearly 30% of all female homicide victims were killed by their husbands, former husbands or boyfriends;
in contrast, just over three percent of male homicide victims were known to have been killed by their wives, former wives, or girlfriends;
the rate of intimate-offender attacks on women separated from their husbands was about three times higher than that of divorced women and about 25 times higher than that of married women.
The Types of Domestic Violence and Abuse
Domestic violence means the chronic physical, sexual and psychological maltreatment of one family member against another with the intent to control. This misuse of power harms the psychological, social, economic, sexual and physical well-being of the victim.
Domestic violence has traditionally been defined in its narrowest sense as physical violence or assault of a spouse. In reality, however, domestic violence is the summary or aggregate of physically, sexually and psychologically abusive behaviors directed by one partner against another. This more inclusive view is important, for generally when one form of abuse exists, it is coupled with differing levels of other forms as well. As if by definition, the infliction of physical assault also involves the infliction of fear, sexual assault or exploitation and attempts to control and dominate the victim's environment. The broader view is also important because the impact of domestic violence on victims differs dependent upon the specific form the abuse takes.
Domestic abuse may also be defined by identifying its function, that being the domination, punishment or control of one's partner (Ganley, 1989). Violence is not random, it is goal driven and very functional in nature for the offender. Hamberger & Barnett (19XX) also note clinical observations which suggest three primary functions of partner violence:
the cessation of something noxious to the offender (e.g., stopping an argument);
obtaining something positive or desirable to the offender (e.g., sexual gratification or money); or
suppression of the victim's behavior (e.g., keeping her from leaving the residence).
The following provides a categorization of four types of domestic abuse:
physical violence or abuse - the nonaccidental injury of an adult which is the result of facts of commission by a spouse. Physical abuse involves a wide range of behavior, including pushing or shoving, slapping, hitting, kicking, biting, the use of weapons, or other acts which result in injury or death. It is the most common pattern in cases of domestic violence for the specific form of physical violence and the resultant injury to grow more severe as abuse continues in the relationship. The type of injury sustained by the victim may also differ by the motivating factor for the violence, that is, violence which results from an inappropriate expression of emotion occurring during an argument frequently results in facial or other types of visible injury. In those instances where violence is the tool of the perpetrator by which the victim is controlled, however, the victim's injury may be inflicted on a part of the body which may be easily hidden from view, and hence hidden from the awareness of persons outside the family.
sexual violence or abuse - a non-consenting sexual encounter in which an adult is either pressured, coerced (expressed or implied), or forced into sexual activity with the spouse. Sexual violence or abuse involves fondling, fellatio or cunnilingus, anal or vaginal penetration, and exploitation through photography or prostitution.
Until recent years, discussions related to sexual assault have excluded the significant number of battered spouses who are also victimized by this crime. In one of the first studies of its kind, Diana Russell (1982) found that over 12% of women reported that their husbands had committed acts against them which would qualify under the legal definition of rape. It is undoubtedly the case that this figure is lower than the actual incidence of marital rape in that many spouses share the common stereotype that rape is an act committed by a stranger, and as a result, are less likely to label the experience of forced sexual relations with a spouse as "rape" (Yllo, 1983). In review of Russell's work and from subsequent research, Finkelhor and Yllo (1985) estimate that rape by a spouse is one of the forms of sexual coercion which a woman is most likely to experience. The incidence of marital rape is higher among battered women than among the general population of women, reaching 32-59% in shelter samples (Shields, Resick & Hanneke, 1990).
In 1990, the Kentucky General Assembly passed legislation to recognize the crime of rape in marriage by removing the spousal exclusion in the sexual offense chapter of the penal code.

The growing awareness and understanding of marital rape have revealed three primary types of relationships within which this crime occurs (Finkelhor & Yllo, 1985).
Relevant to the discussion of domestic violence is the category of "battering rapes" where sexual assault occurs in combination with physical beatings and psychological abuse. The primary emotional motivations for the marital rapist in this case is that of anger. In "sex-specific" cases, the sexual assault is not accompanied by physical assault, but rather is the primary means by which the spouse is victimized. In these instances, the amount of physical violence used is only as much force as is necessary to coerce the victim into sexual relations, and appears to be motivated primarily by a desire to be powerful over the woman. The third type of marital rape is perpetrated by individuals with deviant sexual arousal patterns. Typically involving obsessive types of forced sex, these victims may be required to have an inordinately high number of sexual encounters, or to have sex which is associated with sadistic, brutal or perverse behavior.

emotional or psychological abuse - emotional abuse can best be defined by describing its result, that being the destruction of an victim's self-esteem. This abuse, whether dealt in a manner of name calling, ridicule, threats, or other forms, is systematic and purposeful, and has the effect of giving power to the abusive partner. This effect is most often the desired result of a perpetrator whose low self-esteem stimulates insecurity and fears of abandonment which are mitigated for him by the victim's growing dependence and feelings of self-worthlessness. When threats occur within a relationship in which violence has previously occurred, their ability to induce fear is significantly enhanced. This so-called "psychological battering" is particularly terrorizing, for a victim need not imagine what violence might be like, nor is she able to deny the possibility that violence might actually occur. In the case of psychological battery, the victim's anticipatory anxiety which results from threats can be as debilitating as the violence itself.
As noted in later sections, the incidence of Post-Traumatic Stress Disorder among battered women is now documented. One of the factors which plays a significant role in the risk of PTSD among victims of domestic abuse is the emotional or psychological abuse they endure, particularly as that abuse relates to establishing control over the victim. As expressed by Herman (1992):
The methods of establishing control over another person are based upon the systematic, repetitive infliction of psychological trauma. These methods are designed to instill terror and helplessness, to destroy the victim's sense of self in relation to others, and to foster a pathologic attachment to the perpetrators.
Although violence is a universal method of instilling terror, the threat of death or serious harm, either to the victim or to others close to her, is much more frequent than the actual resort to violence. Fear is also increased by unpredictable outbursts of violence, and by inconsistent enforcement of numerous trivial demands and petty rules.
In addition to inducing terror, the perpetrator seeks to destroy the victim's sense of autonomy. This is achieved by control of the victim's body and bodily functions. Deprivation of food, sleep, shelter, exercise, personal hygiene, or privacy are common practices. Once the perpetrator has established this degree of control, he becomes a potential source of solace as well as humiliation. The capricious granting of small indulgences may undermine the psychological resistance of the victim far more effectively than unremitting deprivation and fear.
environmental abuse - it is characteristic of domestic violence cases that perpetrators exert efforts to control the victim's environment. Such behaviors may include isolating victims from family members; restricting access to bank accounts; following or monitoring telephone calls; and other measures. As in the case of emotional abuse, such controls allow the perpetrator to increase the victim's dependence and create a perspective in her that she has no alternatives to the violent relationship. Additionally, when perpetrators destroy the valued property or pets of victims, as unmistakable message regarding the victim's vulnerability is clear.
The Common Characteristics of Abuse
While abuse in families takes many forms and impacts family members at all generational levels, there are some characteristics which appear to be common to spouse and child abuse, whether physical or sexual (Finkelhor et al, 1983). Finkelhor's delineation of commonalties includes the following:
Abuse as abuse of power - the abuse of one family member by another is predicated on the abuse of power. The dynamic within sexually or physically abusive families is most often that a more powerful family member takes advantage of a less powerful member. More specifically, abuse is most likely to occur in those familial relationships where the power differential is most significant. This may be between a parent and a minor child, between adult children and elderly parents, or in a marital or other intimate relationship where power is unequally distributed between partners.
Abuse as a response to perceived powerlessness - Ironically, while abusive acts are most often acts of the strong against the weak, they often involve perpetrators of abuse who perceive themselves as losing or lacking power. This may be true for a husband who perceives growing independence in his spouse, or for a mother who becomes more physically violent toward her children when she feels she has lost her control over them and their behavior. In these examples, abusive behavior may be used instrumentally to regain or restore power to the abusive individual, or as an act of frustration which is vented by one family member against another.
Shared effects on victims - victims of spouse and child abuse share strikingly similar reactions to the forms of abuse which they experience. Such similarities may well be the result of experiencing a pattern of abuse which occurs repeatedly within a family rather than a single incident of extra-familial victimization. These patterns of abuse are closely tied to the nature of the family relationship, and their damage is increased ten-fold by an accompanying psychological abuse and exploitation. The result is that victims do not only experience physical or sexual abuse, they are exploited and controlled until their perception of reality is distorted. As described by Finkelhor:
. . . abused children are told they are bad, uncontrollable and unlovable (Herbruck, 1979) . . . abused wives are persuaded by their husbands that they are incompetent, hysterical, and frigid (Walker, 1979), . . . (and) sexually abused children are misled to believe that their father's sexual attentions are normal and testimony of his great and genuine affection (Armstrong, 1978) ...
The result of this psychological manipulation is that victims tend to blame themselves, take responsibility for the abuse directed toward them, feel a significant sense of guilt, shame and humiliation, and suffer from an extreme sense of isolation. Concurrently, feelings of helplessness and a subsequent entrapment is common to many child and adult victims of physical and sexual abuse. Finally, victims of all forms of family abuse have in common the long-term effects they frequently experience, including depression, suicide, low self-esteem, an inability to trust, and difficulties developing intimate relationships (Walker, 1979; Herman & Hirschman, 1977).

shared characteristics of abusive families - evidence suggests that all forms of abuse are more common in families where unemployment and economic deprivation are serious problems (Meiselman, 1978; Strauset al, 1980), in families which are more patriarchically organized (Finkelhor, 1980; Gelles, 1974), and where there is isolation from community ties, friends, and organizational affiliations (Finkelhor, 1980; Garbarino & Gillian, 1980; Gelles, 1974).

A Social Learning Perspective on Spousal and Partner Violence
A final dynamic which is not discussed by Finkelhor in this framework is the tendency of family abuse to be a legacy given from one generation to the next. Studies show a high, positive correlation between a childhood during which abuse is witnessed or experienced and a similar experience during adulthood (Jaffe et al, 1986; Carlson, 1984; Fagan et al., 1983; Straus et al, 1980). In other words, children who witness or experience physical or sexual abuse are more likely than children who do not to be involved in a similarly abusive relationship as adults. One study, for example documented that male children who observed physical violence between their parents as children were three times more likely to engage in violent behavior toward a spouse or partner as an adult (Straus et al, 1980).
The lessons learned in childhood about responses to emotion, controlling others, and inappropriate boundaries between family members are often re-enacted, and hence abuse occurs, as the child interacts in later adolescent and adult relationships. This notion that individuals react behaviorally and emotionally to external circumstances based on a learning process was articulated by Bandura within the concept of the social learning theory (1973). As applied to domestic violence cases, Bandura's model shows a step-by-step process of learning abusive behavior. Step one involves an observation of violence used by another person close to the child, particularly including a parent. Children who grow up in violent homes are frequent witnesses to instances in which one parent inflicts abuse upon another. It may be a by-product of repeated exposure or observation of violent acts that children become desensitized to aggression and to signs of suffering on the part of others (Cline, Croft, and Courrier, 1973).

Social Learning Model for Learning Aggression
Observe Violence
Observe Consequences Practice Violence
Experience Consequences
Step two of the social learning paradigm involves an observation of consequences. It is a sad irony that children most often observe immediate, positive consequences to the use of spousal violence. That is, violent spouses frequently benefit, at least in the short-term, from the use of aggression by controlling others, by getting their way, and by increasing their power within the family. Within Bandura's model, individuals who acquire behaviors through observational learning are likely to put them into actual use only when rewards are anticipated, or at least when no punishment is expected. As children witness the reward of spousal violence, then, they are likely to engage in or practice the behavior themselves, thus moving to step three in the process. Whether children will continue to engage in the behavior they have witnessed and learned is largely contingent upon the fourth and final step in the learning process, that being the consequences directly experienced by the child in response to their behavior. In exploring the quality of these consequences which are likely to reward aggressive behavior, Bandura identifies an "instrumental value" whereby the behavior is viewed as a quick means to gain a desirable end. Potent in domestic violence cases is a second identified reinforcer in which the individual derives pleasure from the experience of inflicting pain on others.

The Cycle of Violence
Understanding the connection between childhood abuse and the occurrence of domestic abuse in subsequent relationships only partially explains why violence occurs. It cannot serve as the entire explanation, for there are individuals experiencing abuse in relationships who are seeing violence for the first time. Insight into why violence occurs when there has been no abusive learning experience can be gained by analyzing the pattern in which violence in intimate relationships occur. Walker (1979) offered a tri-phase conceptualization of the occurrence of violence in relationships termed the "cycle of violence."

First Phase
According to Walker, the first phase of the cycle involves the escalation of tension between family members. This may be precipitated by interpersonal, economic, health, or other stressors, and may occur concomitantly with increased substance use or abuse by one or both partners. Emotionally or psychologically abusive behaviors directed at the victim also increase during this period. Without some form of intervention or relief, tension rises until an abusive episode occurs.

Second Phase
The second phase of the cycle involves the discharge or acting out of tension through physical abuse. As violence continues in the relationship, the degree of abuse tends to worsen in severity. Walker also suggests that a continuation of the cycle leads to an increase in the frequency with which the a use occurs.

The Third Phase
The third and final phase of the cycle of violence is a contrite phase characterized by apology, the reestablishment of intimacy between partners, and a return to a homeostasis to which the family is accustomed. In long-standing and severely abusive relationships, the cycle appears to evolve such that tension and contrite phases of the cycle shrink in dimension. As a result, in these families violence is triggered with minimal precipitation, and genuine expressions of remorse following the abuse are negligible.

The three phased sequence of events where violence is immediately preceded by escalating tension and followed by a loving or contrite phase is a powerful dynamic as it means that abusive behavior is doubly reinforced. As depicted in the cycle, abuse is reinforced because it causes an end to escalating conflict and because it leads to the mot positive phase of the familial relationship.
The Profile of Domestic Violence Offenders
Introduction
Studies related to perpetrators of domestic violence have, for the most part, documented small percentages of a major mental illness among this population, but nonetheless indicate predominate dysfunctioning in the affective, cognitive, and interpersonal spheres of their lives. The clinical literature has revealed significant childhood histories of physical and sexual abuse (Sonkin, 1987) and witnessing violence between parents (Hotaling & Sugarman, 1986; Walker, 1984); suicidality (Sonkin, Martin & Walker, 1985); depression (Gondolf, 1985); and evidence of personality disorders (Hamberger & Hastings, 1986). In some cases more serious psychiatric problems among perpetrators are seen, as evidenced in one study of a psychiatric hospital which found that 27% of the hospitalized men had inflicted violence upon a partner (Post et al, 1980). Studies also reveal a a close correlative relationship between substance abuse and violence perpetration. (Sonkin, Martin & Walker, 1985; Coleman & Straus, 1983).

Early research on perpetrators focused largely on finding what they had in common, although no singular diagnostic category for domestic violence offenders has been identified. Findings from this research indicated that domestic violence offenders tend to be:
less assertive and have lower self esteem than non-offenders
often hostile and frequently abuse alcohol
have a history of abuse in childhood during while attitudes of acceptance of violence and specific targets and bahaviors were learned;
more likely to hold stereotypic views of men and women;
emotionally impoverished;
manipulative, jealous, and possessive
A variety of categories have been delineated in an effort to understand and describe domestic violence offenders. In a simplistic characterization, three types of offenders can be identified. The following typologies should be viewed as generalizations arising from studies of lethality in domestic violence offenders and other offenders whose patterns interface with domestic violence. For the general practice of mental health, it may prove useful to work with three broad categories of offender: 1) the reactive, 2) the instrumental and 3) the antisocial offender. (It is important to note that these typologies are not entirely discrete and there can be considerable overlap of features in any one offender).

Reactive Offenders
The reactive offender is the one that most general mental health practitioners think of when they approach domestic violence. It is this type of offender who is the subject of "anger management" program referrals because they are typically seen as not intending harm so much as being incapable of restraining themselves from causing harm. Clinicians are cautioned about their understanding of this offender. This label for the problem presents a ready excuse for violent conduct which can lead to a depreciation of the seriousness of the offense. Reactive offenders are generally characterized by poor socialization skills, poor inhibition of impulses, rapid escalation of anger, immaturity, and low verbalization skills. He is likely to be emotionally abusive by yelling and cursing, but is less likely to make serious threats. Sexual offenses are likely to be for the immediate gratification of urge, not for the purpose of hurting the partner. These offenders are frequently abusers of alcohol or other drugs and, by virtue of their immaturity, can exhibit a puzzling mixture of competency in some areas of their lives, but glaring incompetence in others - primarily in their partner relationships. The reactive offender is more likely to experience remorse for his conduct and is, in general, a more responsive client.

Instrumental Offenders
The instrumental offender may appear more competent than the reactive, but this strength can be very misleading. The instrumental offender generally finds a high degree of congruence between his controlling behavior and his world and self view. He frequently has a very possessive understanding of women and their roles with men. Violence, is not an impulse but a tool for control of others. This offender often has a personality structure that is consistent with Masterson's concept of the "closet narcissist". He is generally very dependent upon his partner, but will describe the relationship in opposite terms that portray the woman as "needing" him to make things work. He is persistently observant of her actions, may be prone to stalking, and is vulnerable to intense jealousy with the slightest "evidence" of her interaction with other males and even other women. He views her interest in other people as taking something away from him to which he is entitled. This may even include their children, who can be seen as an interference and impediment to his full enjoyment of his partner. While any offender is likely to also commit sexual abuse, the instrumental offender is more likely to use sex acts for the humiliation of the partner than for actual sexual pleasure. He is not likely to experience remorse, and in extreme manifestations, is a very dangerous and difficult client who should be only treated by domestic violence specialists. Like other perpetrators, he might use alcohol or other drugs, but these are rarely the dominant issue. His jealousy or paranoia might appear to be a product of psychosis, but this generally not the case. He is very unlikely to leave the relationship and will exert threats, stalking and other means of terror to prevent her leaving. He is vulnerable to suicidal thoughts and his risk of lethality to others increases as suicidality becomes more intense.

Antisocial Offenders
The antisocial offender uses his relationship with his partner to further his other interests. Unlike the instrumental offender, he does not have a dependent attachment to his partner, and, as a result, is generally less lethal. He is more likely to be an alcohol and/or drug user and is likely to have a criminal history that includes offenses other than domestic violence. His violent behavior may appear similar to either the reactive or instrumental types in that he very likely has poor impulse inhibitions, but also can use violence and threats to get his way. Unlike the narcissist, he generally is not using his violence to dominate so much as to get his way - which might actually mean relieving his sense of being controlled by his partner. These relationships generally do not last a long time and the woman's risk of harm decreases when the offender leaves the relationship. These cases present a problem for mental health professionals who will see the woman partner's dependency as the clinically significant issue rather than identifying the antisocial nature of the offender and working with her on managing this danger.

Stalking in the Context of Domestic Violence
Research has begun to focus on the stalking behavior of domestic violence offenders. Attention to stalking as it occurs in domestic violence cases is important in part because of its frequency, but also because of its indication of increased danger risk for victims. Dziegielewski & Roberts (1995) have identified a typology of three types of stalkers:
domestic violence stalkers who comprise 75-80% of the total;
erotomania or delusional stalkers; and
nuisance stalkers.
Domestic violence stalkers tend to be motivated by the need to continue or reestablish the relationship and the control of the victim. Those offenders who are characteristically dependent upon the victim often feel desperate in the fear of losing the relationship. These types of stalkers and their obsessive thinking and behavior tend to pose significant danger to the victim and any children in the home.

Carol E. Jordan, M.S.
Executive Director
Governor's Office of Child Abuse and Domestic Violence Services
The Psychological Impact of Domestic Violence on Domestic Violence Victims and Child Witnesses
As the literature has begun to document the extent of violence in families, attention has focused on the serious psychological impact which domestic violence may have on adults who are its victims and children who witness the crime. Rates of depression among battered women have been found to double that of the general population of women (Walker, 1979), and battered women have been found in substantial numbers among cases of attempted suicide and alcoholism (Stark, 1984). Finally, research within the past five years has begun to take a broader view of who is victimized by domestic violence by beginning to address the negative psychological impact on children of witnessing violence between parents (Davison & Carlson, 1987).


Impact of Domestic Abuse on Adult Victims
As mental health professionals have begun to intervene with battered women, three distinct levels of mental health need become apparent. A first category of women has as its primary source of distress, the violence of the partner. When the stressor is removed, either by separation from the partner, or by his meaningful involvement in treatment, symptoms of psychological distress are also ameliorated. These are women whose psychological injuries do not meet the criteria for clinical diagnosis, but who may be suffering great distress.

The mental health need of a second category of victims is more profound, generally resulting from a long-standing exposure to the traumatic stress of the violence. Victims within this second category frequently exhibit post-trauma related symptoms and may appear to mimic the behavior of a hostage held captive for an extended period. Other applicable diagnostic categories include depressions and affective disorders and dissociative and anxiety disorders. Not surprisingly, a growing body of research indicates that battered women frequently present symptoms characteristic of Post-Traumatic Stress Disorder (PTSD) (e.g., Astin, Lawrence & Foy, 1993; Houskamp & Foy, 1991). PTSD is a diagnostic category which is specifically linked to the experience of a traumatic event and is characterized by a re-experiencing of the trauma; avoidance of stimuli associated with the event; and increased autonomic arousal (American Psychiatric Association, 1994). The likelihood of developing PTSD has been found to increase when stressors are experienced under conditions of perceived life threat, injury, and a great deal of force (Finkelhor, 1988; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993), all of which are characteristic of domestic abuse cases.

More pronounced mental health needs are also generally found among adult spouse abuse victims who have a childhood history of physical or sexual abuse, an experience not uncommon to battered women (Weaver & Clum, 1996). Studies comparing populations of battered women with and without child abuse histories reveal significant positive correlations between the severity of childhood abuse and borderline personality characteristics, dissociative symptoms and other symptomotology ( Halle, Burghardt, Dutton & Perrin 1991).

Battered Women Syndrome
The characteristics and effects of domestic abuse manifested in victims of domestic abuse define the battered woman syndrome. The syndrome, which is accurately applied to some but not all victims, can be seen in victims who tend to be less able to respond effectively to the violence around them. Battered woman syndrome has three major components:
post-trauma symptoms associated with victimization, specifically including reexperiencing the violence through intrusive thoughts or dreams and numbing or reduced expression of affect;
"learned helplessness" resulting from repeated abuse. Depression and a sense of lacking control of the environment are often artifacts of the learned helplessness, but it does not necessarily result in passivity on the part of the victim; and
coping responses viewed as self-destructive by others, including behaviors which appear to placate the offender or numb the victim to the abusive environment.
Why Don't Battered Women Leave?

The question, "why don't battered women leave" is based on the assumption that leaving will end the violence.

While this may be true for some women who leave after the first or second incident of violence, more often the risk of serious or lethal violence actually increases when the victim attempts to leave or escape the relationship. Similarly, the greatest risk of serious physical injury or death occurs at the point of separation. Studies estimate that over 50% of battered women who leave are followed, harassed or attacked by their partners. The majority of homicide-suicides in domestic violence cases occur at the point of the victim's separation from the offender.

Other factors which impact a victim's decision to remain in or return to the relationship include:
financial considerations
lack of job skills or other resources
offender threatens death of the victim or children
offender threatens to kidnap the children
victims loves the offender and believes the offender's promise that the violence will end
victim believes in traditional values of keeping families together and remaining married
victim has low self-esteem resulting from repeated abuse which leaves her believing she has no alternatives to the abusive relationship
Impact of Domestic Abuse on Child Witnesses

Within the last decade, child advocates and domestic violence experts have begun to recognize the significant impact which domestic abuse has on children who live in the home of violent adults. Historically, children have been the "forgotten victims" of domestic violence as there has been a mistaken belief that children in the home can somehow escape direct exposure to the violence and its effects. Research shows, however, that children are present in 80% of homes where there is violence against a women (Bureau of Justice Statistics, 1993), and that 90% of these children witness the violence directed by one parent against another (Pagelow, 1990). The correlation between spouse abuse and the physical or sexual abuse of children in the home is now documented to reach 30-70% (Suh & Abel, 1990; Bowker, Arbitell & McFerron, 1988). Abuse of the mother usually precedes violence against the child and a positive relationship exists between the severity of abuse directed at spouses and children (Bowker et al, 1988; Stark & Flitcraft, 1988).

The impact of domestic violence on children is complex, as it must take into account cases where children witness adult violence, cases in which children also targeted for abuse by the batterer, and cases where a child is injured by stepping in to protect a victimized parent. The impact is manifested in emotional, behavioral, cognitive and physical spheres of the child's life. Some children withdraw and manifest internalized behavioral difficulties, such as somatic disorders, insomnia and heightened anxiety, depression, guilt and damaged self-esteem, many of which result from the self-perception of helplessness in the face of violence (Jaffe et al., 1990; Hughes, 1988; Pynoos & Eth, 1986). Post-trauma symptoms are also seen in child witnesses of violence, in large part due to the overstimulation and terror to which they are routinely exposed (Landis, 1990; Silvern & Kaersvange, 1989). Children's reactions to witnessing domestic abuse may also be more aggressive in nature. A child may model the offender and act out aggressively with parents, siblings, peers or others (Straus et al, 1980).

Straus et al (1980) also note that children in violent families are at risk for developing psychological adjustment problems in response to parental neglect when violence is the primary focus of both parents.


The Lessons of Domestic Violence in the Home

Jaffe (1986) points out what children tend to learn in violent homes. The extent to which children learn these lessons directly relates to their propensity to identify with the aggressor and model the violent behavior:
interaction of family members contains violence;
conflict is resolved through violence;
violence is sanctioned as a mode of stress management; and
victims of violence are, at best, to tolerate this behavior and, at worst, to examine their responsibility in bringing on the violence.
Carol E. Jordan, M.S.