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.
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.
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. Children’s responses to the violence may vary from aggression to withdrawal to somatic complaints. In addition, children may develop symptoms of depression, anxiety, or PTSD (Harway & Hansen, 1994).
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).
And it's not only victims 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).
One-third of the children who witness the battering of their mothers 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 their fathers' abuse of their mothers 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 law enforcement, child protective agencies 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)
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 at a trusted friend’s house; and arrangements for shelter (made without the batterer’s knowledge of the location) (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 victim’s 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 batterers’ 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 one’s 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 couple’s therapy to address the abuse in their relationship, couple’s 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 couple’s therapy (Harway & Hansen, 1994).