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Dangerous RelationshipsDangerous Relationships

How to recognize the dangerous turning points in a relationship and safely diffuse tension between partners, lovers, and friends.

Possessiveness, insensitivity, and a sudden personality change are all warning signs of a potential abuser. Dangerous Relationships will help readers recognize a potentially violent personality before it's too late. Interweaving real-life stories of four couples, Dr. Noelle Nelson highlights dangerous turning points in relationships and explains how readers can safely diffuse tension between their spouses, lovers, or roommate and protect themselves from abuse. Kindle edition available.



Long Term Effects of Domestic Violence

Domestic violence has wide ranging and sometimes long-term effects on victims. The effects can be both physical and psychological and can impact the direct victim as well as any children who witness parental violence.

Physical Effects

The physical health effects of domestic violence are varied, but victims are known to suffer physical and mental problems as a result of domestic violence. Battering is the single major cause of injury to women, more significant that auto accidents, rapes, or muggings. (O'Reilly, 1983).

Many of the physical injuries sustained by women seem to cause medical difficulties as women grow older. Arthritis, hypertension and heart disease have been identified by battered women as directly caused by aggravated by domestic violence early in their adult lives. Medical disorders such as diabetes or hypertension may be aggravated in victims of domestic violence because the abuser may not allow them access to medications or adequate medical care. (Perrone, 1992).

Victims may experience physical injury (lacerations, bruises, broken bones, head injuries, internal bleeding), chronic pelvic pain, abdominal and gastrointestinal complaints, frequent vaginal and urinary tract infections, sexually transmitted diseases, and HIV. (Jones & Horan, 1997 and Bohn & Holz, 1996).

Victims may also experience pregnancy-related problems. Women who are battered during pregnancy are at higher risk for poor weight gain, pre-term labor, miscarriage, low infant birth weight, and injury to or death of the fetus.

Women at Risk: Domestic Violence and Women's HealthWomen at Risk: Domestic Violence and Women's Health


Battering by men is the most significant cause of injury to women in our society. It is also a major cause of child abuse, murder, substance abuse and female suicide attempts. This volume, the result of 15 years of research conducted by the authors - a social worker and physician respectively - explores the theoretical perspectives of this dramatic expression of male domination, together with health consequences for women and clinical interventions.



Psychological Effects

While the primary and immediate focus for many people is the physical injury suffered by victims, the emotional and psychological abuse inflicted by batterers likely has longer term impacts and may be more costly to treat in the short-run than physical injury. (Straus, 1986, 1988, 1990).

Depression remains the foremost response, with 60% of battered women reporting depression (Barnett, 2000).

In addition, battered women are at greater risk for suicide attempts, with 25% of suicide attempts by Caucasian women and 50% of suicide attempts by African American women preceded by abuse (Fischbach & Herbert, 1997).

Along with depression, domestic violence victims may also experience Posttraumatic Stress Disorder (PTSD), which is characterized by symptoms such as flashbacks, intrusive imagery, nightmares, anxiety, emotional numbing, insomnia, hyper-vigilance, and avoidance of traumatic triggers. Several empirical studies have explored the relationship between experiencing domestic violence and developing PTSD. Vitanza, Vogel, and Marshall (1995) interviewed 93 women reporting to be in long-term, stressful relationships. The researchers looked at the relationships among psychological abuse, severity of violence in the relationship, and PTSD. The results of the study showed a significant correlation between domestic violence and PTSD. In each group in the study (psychological abuse only, moderate violence, and severe violence), women scored in the significant range for PTSD. Overall, 55.9% of the sample met diagnostic criteria for PTSD. In further support of the strong relationship between domestic violence and PTSD, Mertin and Mohr (2000), interviewed 100 women in Australian shelters, each of whom had experienced domestic violence. They found that 45 of the 100 women met diagnostic criteria for PTSD.

Children may develop behavioral or emotional difficulties after experiencing physical abuse in the context of domestic violence or after witnessing parental abuse. Responses in children may vary from aggression to withdrawal to somatic complaints. In addition, children may develop symptoms of depression, anxiety, or PTSD (Harway & Hansen, 1994).

Economic Effects

Victims often lose their jobs because of absenteeism due to illness as a result of the violence. Absences occasioned by court appearances can also jeopardize their livelihood. Victims may have to move many times to avoid violence. Moving is costly and can interfere with continuity of employment. Many victims have had to forgo financial security during divorce proceedings to avoid further abuse. As a result they are impoverished as they grow older. (Kurz, 1989).

Victims are not the only ones who pay the price. Women who were victims of intimate partner violence costs health plans approximately 92% more than a random sample of general female enrollees. Findings of significantly higher mental health service use are supported by other studies. (Wisner, 1999).

Impacts on Children

One-third of the children who witness the battering of their mother demonstrate significant behavioral and/or emotional problems, including psychosomatic disorders, stuttering, anxiety and fears, sleep disruption, excessive crying and school problems. (Jaffe et al, 1990; Hilberman & Munson, 1977-78)

Those boys who witness abuse of their mother by their father are more likely to inflict severe violence as adults. Data suggest that girls who witness maternal abuse may tolerate abuse as adults more than girls who do not. (Hotaling & sugarman, 1986)

These negative effects may be diminished if the child benefits from intervention by the law and domestic violence programs. (Giles-Sims,1985)

The long-term effects of child sexual abuse include depression and self-destructive behavior, anger and hostility, poor self-esteem, feelings of isolation and stigma, difficulty in trusting others (especially men), and martial and relationship problems, and a tendency toward revictimization. (Finkelhor & Brown, 1988)

Other effects identified include runaway behavior, hysterical seizures, compulsive rituals, drug and school problems. (Conte, 1988 & 1990)



How are the effects of domestic violence treated?

Psychological treatment for victims and perpetrators can be helpful in the aftermath of domestic violence. For battered women, Hattendorf and Tollerud (1997) recommend a therapy approach in which traditional gender roles are challenged and empowerment of the victim is a primary focus. Individual therapy for victims of domestic violence should begin with a primary focus on safety, particularly if the victim is currently in an abusive relationship. The therapist should assess the current level of dangerousness and lethality in the relationship based on the following factors concerning the batterer: threats of homicide or suicide, possession of weapons, acute depression, alcohol/drug use, history of pet abuse, and level of rage (Harway & Hansen, 1994). The presence of these factors increases the level of potential lethality in the batterer.

In addition to assessing lethality, therapists and victim advocates should develop a safety plan with the victim. A safety plan may contain a strategy for how to leave a dangerous situation; the preparation of a safety kit - clothing, medications, keys, money, copies of important documents - to be kept either near an exit route or with a trusted friend; and arrangements for shelter unknown to the batterer. (Harway & Hansen, 1994).

Once lethality and safety have been addressed, the longer-term goals of treatment for victims can be addressed. These goals include helping the victim identify the impact of abuse to their life and helping them to work toward empowerment (Hattendorf & Tollerud, 1997). Victims can be empowered by regaining their independence and reconnecting with supports and resources that may have been cut off due to the isolation of domestic violence. In addition, the children may need their own treatment to address their responses to witnessing or experiencing abuse.

For some victims, additional treatment may be needed to target symptoms of depression, PTSD, substance abuse, or other disorders found to occur in the presence of domestic violence.

Batterers can also benefit from treatment, although it remains unclear exactly how effective treatment is in breaking the cycle of their violence. Batterers benefit most from batterer treatment programs, which in part focus on identifying what domestic violence is. These programs also focus on helping batterers develop a sense of personal responsibility for their actions and for stopping the violence (Harway & Hansen, 1994). Batterers can also be treated in individual therapy, but the focus of treatment must be on the violence. While some batterers and victims may seek to engage in couples therapy to address the abuse in their relationship, such therapy is NOT recommended while violence is occurring in the relationship. In addition, it is recommended that each member of the couple complete their individual treatment first, before beginning any joint therapy (Harway & Hansen, 1994).

References

Barnett, O.W. (2000). Why battered women do not leave, part 1: External inhibiting factors within society. Trauma, Violence, and Abuse, 1, 343-372.

Bohn, D.K. & Holz, K.A. (1996). Sequelae of abuse: Health effects of childhood sexual abuse, domestic battering, and rape. Journal of Nurse-Midwifery, 41, 442-456.

Conte, J. R.,& Gelles, R.J. (1990). Domestic Violence and Sexual Abuse of Children: A Review of Research in the Eighties. Journal of Marriage and the Family, 52 (4), 1045-1058.

Conte, J.R. (1988). The Effects of Sexual Abuse on Children: Results of a Research Project. Annals of the New York Academy of Sciences, 528, 310-326

Finkelhor, D. & Brown, A. 1988, Assessing the Long-term Impact of Child Sexual Abuse: A Review and Conceptualisation, in Handbook on Sexual Abuse of Children, ed. L.E.A. Walker, Springer, New York

Fischbach, R.L. & Herbert, B. (1997). Domestic Violence and Mental Health: Correlates and Conundrums Within and Across Cultures. Social Science Medicine, 45, 1161-1176.

Giles-Sims, J. (1985) A Longitudinal Study of Battered Children of Battered Wives. Family Relations, 34 (2), 205- 210.

Harway, M. & Hansen, M. (1994). Spouse Abuse: Assessing and Treating Battered Women, Batterers, and Their Children. Sarasota, Florida: Professional Resource Press.

Hattendorf, J. & Tollerud, T.R. (1997). Domestic Violence: Counseling Strategies That Minimize the Impact of Secondary Victimization. Perspectives in Psychiatric Care, 33, 14-23.

Hilberman, E. and Munson, K. (1977-78). "Sixty Battered Women." Victimology: An International Journal, 2 (3-4).

Hotaling, G., & Sugarman, D. (1986). An analysis of risk markers in husband to wife violence: The current state of knowledge. Violence and Victims, 1, 101-124.

Jaffe, P., Wolfe, D., and Wilson, S.K. 1990, Children of Battered Women, Sage Publications, California.

Jones, R.F. & Horan, D.L. (1997). The American College of Obstetricians and Gynecologists: A Decade of Responding to Violence Against Women. International Journal of Gynecology and Obstetrics, 58, 43-50.

Kurz 1989, "Social Science Perspectives on Wife Abuse: Current Debates and Future Directions." in Gender & Society. Vol. 3, Number 4.

Mertin, P. & Mohr, P.B. (2000). Incidence and Correlates of Posttraumatic Stress Disorder in Australian Victims of Domestic Violence. Journal of Family Violence, 15, 411-422.

O'Reilly, Jane (1983). Wife Beating: The Silent Crime. Time Magazine, September 5.

Perrone, J. (1992). "Red Flags Offer Clues in Spotting Domestic Abuse." Violence, A Compendium from JAMA. Chicago: The American Medical Association.

Straus, M. A. (1990). Injury and Frequency of Assault and the Representative Sample Fallacy in Measuring Wife Beating and Child Abuse. In M. A. Straus & R. J. Gelles (Eds.), Physical violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families (pp. 75-91). New Brunswick, NJ; Transaction.

Straus, M. A., & Gelles, R. J. (1986). Societal Change and Change in Family Violence from 1975 to l985 as Revealed by Two National Surveys, Journal of Marriage and the Family, 48, 465-479.

Straus, M. A., & Gelles, R. J. (1988). How Violent are American Families? Estimates from the National Family Violence Resurvey and Other Studies. In G. T. Hotaling, D. Finkelhor, J. T. Kirkpatrick, & M. A. Straus (Eds.), Family abuse and its Consequences: New Directions in Research (pp. 14-36). Beverly Hills, CA; Sage.

Vitanza, S., Vogel, L.C., & Marshall, L.L. (1995). Distress and Symptoms of Posttraumatic Stress Disorder in Abused Women. Violence and Victims, 10, 23-34.

Wisner, C., Gilmer, T., Saltzman, L., Zink, T. (1999). Intimate Partner Violence Against Women Do Victims Cost Health Plans More? Journal of Family Practice, June.

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Last Updated: March 4, 2011