Intimate partner violence
Intimate partner violence (IPV) is domestic violence by a current or former spouse or partner in an intimate relationship against the other spouse or partner.[1][2] IPV can take a number of forms, including physical, verbal, emotional, economic and sexual abuse. The World Health Organization (WHO) defines IPV as "any behavior within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviors."[3]: page 89 IPV is sometimes referred to simply as battery, or as spouse or partner abuse.[4]
The most extreme form of IPV is termed intimate terrorism, coercive controlling violence, or simply coercive control. In such situations, one partner is systematically violent and controlling. This is generally perpetrated by men against women, and is the most likely of the types to require medical services and the use of a women's shelter.[5][6][4] Resistance to intimate terrorism, which is a form of self-defense, and is termed violent resistance, is usually conducted by women.[7][8]
Studies on domestic violence against men suggest that men are less likely to report domestic violence perpetrated by their female intimate partners.[9][10] Conversely, men are more likely to commit acts of severe domestic battery,[11][12][13] and women are more likely to suffer serious injury as a result.[14]
The most common but less injurious form of intimate partner violence is situational couple violence (also known as situational violence), which is conducted by men and women nearly equally,[6][4][7] and is more likely to occur among younger couples, including adolescents (see teen dating violence) and those of college age.[7][15]
Assessment[edit]
Screening tools[edit]
The U.S. Preventive Services Task Force (USPSTF) recommends screening women of reproductive age for intimate partner violence, and provide information or referral to social services for those who screen positive.[21]
Some of the most studied IPV screening tools were the Hurt, Insult, Threaten, and Scream (HITS),[22] the Woman Abuse Screening Tool/Woman Abuse Screening Tool-Short Form (WAST/WAST-SF), the Partner Violence Screen (PVS),[23] and the Abuse Assessment Screen (AAS).[24]
The HITS is a four-item scale rated on a 5-point Likert scale from 1 (never) to 5 (frequently). This tool was initially developed and tested among family physicians and family practice offices, and since then has been evaluated in diverse outpatient settings. Internal reliability and concurrent validity are acceptable. Generally, sensitivity of this measure has found to be lower among men than among women.[25]
The WAST is an eight-item measure (there is a short form of the WAST that consists of the first two items only). It was originally developed for family physicians, but subsequently has been tested in the emergency department. It has been found to have good internal reliability and acceptable concurrent validity.[25]
The PVS is a three-item measure scored on a yes/no scale, with positive responses to any question denoting abuse. It was developed as a brief instrument for the emergency department.[25]
The AAS is a five-item measure scored on a yes/no scale, with positive responses to any question denoting abuse. It was created to detect abuse perpetrated against pregnant women. The screening tool has been tested predominantly with young, poor women. It has acceptable test retest reliability.[25]
The Danger Assessment-5 screening tool can assess for risk of severe injury or homicide due to intimate partner violence. A "yes" response to two or more questions suggests a high risk of severe injury or death in women experiencing intimate partner violence. The five questions ask about an increasing frequency of abuse over the past year, use of weapons during the abuse, if the victim believes their partner is capable of killing them, the occurrence of choking during the abuse, and if the abuser is violently and constantly jealous of the victim.[20]
Research instruments[edit]
One instrument used in research on family violence is the Conflict Tactics Scale (CTS).[26] Two versions have been developed from the original CTS: the CTS2 (an expanded and modified version of the original CTS)[27] and the CTSPC (CTS Parent-Child).[28] The CTS is one of the most widely criticized domestic violence measurement instruments due to its exclusion of context variables and motivational factors in understanding acts of violence.[29][30] The National Institute of Justice cautions that the CTS may not be appropriate for IPV research "because it does not measure control, coercion, or the motives for conflict tactics."[31] The Index of Spousal Abuse, popular in medical settings,[32] is a 30-item self-report scale created from the CTS.
Another assessment used in research to measure IPV is the Severity of Violence Against Women Scales (SVAWS). This scale measures how often a woman experiences violent behaviors by her partner.[33]
Treatment[edit]
Individual treatment[edit]
Due to the high prevalence and devastating consequences of IPV, approaches to decrease and prevent violence from re-occurring is of utmost importance. Initial police response and arrest is not always enough to protect victims from recurrence of abuse; thus, many states have mandated participation in batterer intervention programs (BIPs) for men who have been charged with assault against an intimate partner.[90] Most of these BIPs are based on the Duluth model and incorporate some cognitive behavioral techniques.
The Duluth model is one of the most common current interventions for IPV. It represents a psycho-educational approach that was developed by paraprofessionals from information gathered from interviewing battered women in shelters and using principles from feminist and sociological frameworks.[91] One of the main components used in the Duluth model is the 'power and control wheel', which conceptualizes IPV as one form of abuse to maintain male privilege. Using the 'power and control wheel', the goal of treatment is to achieve behaviors that fall on the 'equality wheel' by re-educate men and by replacing maladaptive attitudes held by men.[91]
Cognitive behavioral therapy (CBT) techniques focus on modifying faulty or problematic cognitions, beliefs, and emotions to prevent future violent behavior and include skills training such as anger management, assertiveness, and relaxation techniques.[82]
Overall, the addition of Duluth and CBT approaches results in a 5% reduction in IPV.[92][93] This low reduction rate might be explained, at least in part, by the high prevalence of bidirectional violence[61] as well as client-treatment matching versus "one-size-fits-all" approaches.[94]
Achieving change through values-based behavior (ACTV) is a newly developed Acceptance and Commitment Therapy (ACT)-based program. Developed by domestic violence researcher Amie Zarling and colleagues at Iowa State University, the aim of ACTV is teach abusers "situational awareness"—to recognize and tolerate uncomfortable feelings – so that they can stop themselves from exploding into rage.[95]
Initial evidence of the ACTV program has shown high promise: Using a sample 3,474 men who were arrested for domestic assault and court-mandated to a BIP (either ACTV or Duluth/CBT), Zarling and colleagues showed that compared with Duluth/CBT participants, significantly fewer ACTV participants acquired any new charges, domestic assault charges, or violent charges. ACTV participants also acquired significantly fewer charges on average in the one year after treatment than Duluth/CBT participants.[95]
Psychological therapies for women probably reduce the resulting depression and anxiety, however it is unclear if these approaches properly address recovery from complex trauma and the need for safety planning.[96]
Conjoint treatment[edit]
Some estimates show that as many as 50% of couples who experience IPV engage in some form of reciprocal violence.[61] Nevertheless, most services address offenders and survivors separately. In addition, many couples who have experienced IPV decide to stay together. These couples may present to couples or family therapy. In fact, 37-58% of couples who seek regular outpatient treatment have experienced physical assault in the past year.[97] In these cases, clinicians are faced with the decision as to whether they should accept or refuse to treat these couples. Although the use of conjoint treatment for IPV is controversial as it may present a danger to victims and potentially escalate abuse, it may be useful to others, such as couples experiencing situational couple violence.[98] Scholars and practitioners in the field call for tailoring of interventions to various sub-types of violence and individuals served.[99]
Behavioral couple's therapy (BCT) is a cognitive-behavioral approach, typically delivered to outpatients in 15-20 sessions over several months. Research suggests that BCT can be effective in reducing IPV when used to treat co-occurring addictions, which is important work because IPV and substance abuse and misuse frequently co-occur.[99]
Domestic conflict containment program (DCCP) is a highly structured skills-based program whose goal is to teach couples conflict containment skills.
Physical aggression couples treatment (PACT) is a modification of DCCP, which includes additional psychoeducational components designed to improve relationship quality, including such things as communication skills, fair fighting tactics, and dealing with gender differences, sex, and jealousy.[99]
The primary goal of domestic violence focused couples treatment (DVFCT) is to end violence with the additional goal of helping couples improve the quality of their relationships. It is designed to be conducted over 18 weeks and can be delivered in either individual or multi-couple group format.[99][100]
Prevention[edit]
Home visitation programs for children from birth up to two years old, with included screening for parental IPV and referral or education if screening is positive, have been shown to prevent future risk of IPV.[20] Universal harm reduction education to patients in reproductive and adolescent healthcare settings has been shown to decrease certain types of IPV.[20]