Domestic abuse. Battering. Intimate partner violence. These are terms that make us wince. And they should: The phenomenon is widespread in the United States, and its effects can be long-lasting and life-threatening. Breaking the pattern of domestic violence can be extremely difficult and may take a long time. It requires courage, planning, and a support network.
The U.S. Department of Health and Human Services defines domestic violence as "a pattern of assaultive and/or coercive behaviors...that adults use against their intimate partners to gain power and control in that relationship." It includes not only physical and sexual abuse but also emotional abuse. All can have serious health consequences.
Domestic violence affects people of all ethnic backgrounds; it occurs among the poor and the rich and among the well educated and the poorly educated.
Women don't consciously choose to have an abusive partner. In fact, the abuser may be charming and well liked by most of the people who know him, but at home he shows a different side.
Changes in the relationship can be difficult to see at first. The abuser's need for control often begins to show itself in little things he says and does. He may criticize the way his partner acts or looks. He may say deeply hurtful things, such as accusing her of being a bad mother. Over time, the abuser's words can chip away at a woman's sense of herself.
Control and power
At the center of domestic violence is the issue of control. The abuser is intent on gaining and maintaining power over his partner through fear and intimidation. Abuse doesn't necessarily involve physical harm. Threats can also be highly effective and should not be minimized.
The abusive partner uses various tactics to achieve control. He may intimidate and demean his partner by constantly criticizing her, monopolizing household finances, or telling her what she can wear, where she can go, and whom she can see. He may play "mind games," such as suggesting that she's hypersensitive, hysterical, or mentally unbalanced. Often he isolates the woman from family, friends, and colleagues. Abuse may also take the form of pathological jealousy, such as false accusations of adultery. Soon, the woman may find that she's cut off from all outside connections, no longer in touch with the people and services that could help her.
Isolation may also disconnect her from a sense of what's normal. She may not even think of herself as a victim of domestic violence. After an incident, the abuser often apologizes and tries to placate his victim. There may be periods of relative calm. It may take a victim a long time to recognize that her partner's behaviors aren't random but form a pattern of abuse.
Intimate partner abuse is a health issue
Intimate partner abuse can have profound effects on a woman's health, both physical and mental. Physical harm, including fractures and lacerations, is one obvious effect. Intimate partner abuse is also linked to chronic health problems and even death — from either suicide because of depression or murder by the partner.
The intense, ongoing stress may result in chronic pain or gastrointestinal symptoms. Victims of domestic abuse are more likely to have arthritis, neck pain, pelvic pain, and migraine headaches. They also have an increased risk of menstrual problems and difficulties during pregnancy, including bleeding, low birth weight, and anemia.
Walking away from an abusive relationship is a process more than a single action. Women usually make several attempts — five, on average — before they leave the partner for good. Isolation and fear may prevent a woman from leaving, even when she knows it is probably for the best. Community support can be crucial, although a woman in an abusive relationship often has difficulty taking advantage of that support. The abuser may track her computer use, looking for visits to Web sites and evidence of keyword searches.
Care for the children
Many women stay in an abusive relationship because they think it's best not to disrupt the children's lives so long as they're not being abused themselves. But children who live with domestic violence are at serious risk for behavioral and cognitive problems. In later life, they may suffer depression and trauma symptoms, and they may tolerate or use violence in their own relationships.
What can I do to help?
You suspect that your friend is in an abusive relationship. Here are some things to consider:
October 2006 Update