Domestic Violence (Florida)

Course Objectives:                 

  1. Describe and clarify the different typologies of the abusing spouse.
  2. Identify potential countertransference issues when working with abuser.
  3. Describe psychodynamic intervention techniques used with perpetrators.
  4. Identify available community resources for victims and their families.
  5. Learn to identify cultural factors that may contribute to an abusive relationship.
  6. escribe the dynamics within an abusive same sex relationship.

 

Florida Domestic Violence Continuing Education Course Material

 Domestic Violence is defined as violence or mistreatment an individual may experience at the hands of a marital, common-law, former or same-sex partner.  The abuse may happen during a relationship or after it has ended. There are many different forms of abuse, below is a list of the types of abuse.  A victim can experience more than one kind of abuse at a time.

Physical abuse may include the use of physical force that can include injuries, including beating, hitting, pushing, choking, and kicking.  Physical abuse can include threats and/or assault with a weapon. Other forms of physical abuse may include confinement or restraint.

 Sexual abuse and exploitation includes all forms of sexual assault including rape, coercion and sexual exploitation. Forcing someone to participate in unwanted or unsafe or degrading sexual activity, without that persons consent is abusive and against the law. 

 Emotional abuse includes verbal attacks, such, social isolation, intimidation or exploitation to dominate another person. Stalking including threats to a person or their family is abusive behavior.

 Economic or financial abuse includes withholding money that is necessary to buy food or medical treatment or preventing a partner from working while withholding money.  These are also forms of economic abuse. 

 Spiritual abuse includes using a person's religious or spiritual beliefs to manipulate, dominate or control them. It may include preventing someone from engaging in spiritual or religious practices, or ridiculing their beliefs.

 Family Violence

Domestic violence is a global issue and is not limited to any one gender, religious, cultural or income group. A wide range of studies agree that the causes of violence are multi-factorial, and that the co-occurrence of factors may increase the likelihood that a person will abuse a family member, such as a parent, partner or ex-partner, child or sibling. Ultimately we need to intervene at multiple levels in order to be effective in reducing family violence. By combining individual-level risk factors with findings of cross-cultural studies, a model has been developed that contributes to understanding why some societies and some individuals are more violent than others.

 At the individual level these include:

• being abused as a child or witnessing violence in the home

• being a very young, under-resourced or ill parent (in the case of child abuse)

• sexist attitudes about the role of men and women (in the case of partner abuse).

 At the level of the family and relationship, there are risk factors present where:

• family members are vulnerable, disempowered or in a dependent position, for example, women with very young children, or children themselves

• families have a lack of practical, social, psychological and financial support

• there is parental incapacity, parental illness, or a basic lack of parenting skills and support (in the case of child abuse)

• there is male control of wealth and decision-making within the family (in the case of partner abuse)

• one or both caregivers abuse substances.

At the community level, risk factors include:

• the lack of safe, inclusive and nurturing communities, which may minimize opportunities for intervention and the transmission of non-violent norms of behavior and contribute to the isolation and lack of social support for both victims and caregivers

• peer groups that condone and legitimize violence towards women and children

• barriers to community participation, such as poverty, cultural alienation, and racism that create and sustain social isolation.

At the societal level, risk factors exist where there is:

• acceptance of violence as a means to settle interpersonal disputes

• reinforcement of violence as glamorous and exciting through film and television

• social tolerance of physical punishment of women and children

• a lack of effective sanctions against intra-familial violence

• rigidly defined and enforced gender roles

• the linkage of the concept of masculinity to toughness and dominance

• the perception that men have ‘ownership’ of women, or parents have ‘ownership’ of children

• barriers to independence, participation, self-fulfillment, dignity and the resulting isolation and low self esteem

• a cultural norm about women’s role as caregivers

• lack of funding for family violence prevention programs.

The Causes of Domestic Violence:

 Most interventions employ a mixture of theories in their curriculums, the most common of which is a psychoeducational model that encourages profeminist attitude change while building interpersonal skills using cognitive-behavioral techniques.  Three categories of theories of domestic violence dominate the field. Each locates the cause of domestic violence differently, and each theory leads practitioners to employ different approaches to batterer intervention:

Society and Culture - Social and cultural theories attribute the problem to social structure and cultural norms and values that endorse or tolerate the use of violence by men against women partners. The feminist model of intervention educates men concerning the impact of these social and cultural norms and attempts to re-socialize them by emphasizing nonviolence and equality in relationships. 

Batterer intervention programs were started in the 1970s when feminists and others brought public attention to the problem of domestic violence and grassroots services began to be established in response. The feminist perspective has influenced most batterer intervention programs.

Central to the perspective is a gender analysis of power, which holds that domestic violence mirrors the patriarchal organization of society. In this view, violence is one means of maintaining male power in the family. Feminist programs, which attempt to raise consciousness about society’s sex-role conditioning and how it constrains men’s behavior, present a model of egalitarian relationships based on trust instead of fear.

Support for the feminist analysis comes from the observation that most batterers, when “provoked” by someone more powerful than they, are able to control their anger and avoid resorting to violence. Further support comes from research showing that batterers are less secure in their masculinity than non-batterers.

Family Systems Theory- Family-based theories of domestic violence focus on the structure of the family, interpersonal interactions within the family, and the social isolation of families. The family systems model of intervention focuses on developing healthy communication skills with a goal of family preservation and may use couples therapy, a treatment approach prohibited by 20 State standards and guidelines regulating batterer intervention (to protect the safety of the victim).

Couples counseling, an intervention based on family systems theory, is controversial because of its failure to assign blame for the abuse to one person and to identify a victim. Couples counseling is also considered dangerous to the victim because it encourages the victim to discuss openly issues that may spark later retaliation by the batterer.

This model regards the problem behaviors of individuals as a manifestation of a dysfunctional family, with each family member contributing to the problem.  Both partners may contribute to the escalation of conflict, with each striving to dominate the other. In this view, either partner may resort to violence. Intervention involves improving communication and conflict resolution skills, which both partners can develop. It focuses on solving the problem rather than identifying the causes.

The Individual - Psychological theories attribute domestic violence to personality disorders, the batterer’s social environment during childhood, biological disposition, or attachment disorders. Psychotherapeutic interventions target individual problems and/or build cognitive skills to help the batterer control violent behaviors.

Attachment theory - a form of social learning theory, focuses on the interaction of caregivers with their children and the impact of that first attachment on an individual’s ability to establish safe and healthy relationships later in life. Batterer interventions based on this theory attempt to facilitate secure attachments between batterers and loved ones (intimate partners, children, and parents).

Psychodynamic approaches target the underlying psychological cause of the violence, while cognitive behavioral approaches teach batterers new patterns of nonviolent thinking and behavior. These perspectives, which focus on the individual, hold that personality disorders or early traumatic life experiences predispose some people to violence. Being physically abusive is seen as symptomatic of an underlying emotional problem, which may be traced to parental abuse, rejection, and failure to meet a child’s dependence needs.

From this perspective, two forms of batterer intervention—individual and group psychodynamic therapy and cognitive-behavioral group therapy— have evolved. The former involves uncovering the batterer’s unconscious problem and resolving it consciously. Although a recent study revealed that the approach retained a higher percentage of men in treatment than did a feminist/cognitive-behavioral intervention, critics fault psychodynamic therapy for not explaining what can be done to stop the behavior, allowing the behavior to continue until the underlying problem is solved, and ignoring the cultural acceptability of male dominance.

The cognitive-behavioral approach focuses on the conscious rather than the unconscious and the present rather than the past to help batterers function better by modifying how they think and behave. The approach is compatible with a criminal justice response, simply addressing the violent acts and attempting to change them, without trying to solve larger issues of social inequality or delve into deep-seated psychological problems. Feminists fault the approach for failing to explain why many batterers are not violent in other relationships.

Critics claim the feminist perspective overemphasizes sociocultural factors to the exclusion of traits in the individual, such as growing up abused.  In their view, feminist theory predicts that all men will be abusive. Other criticisms hold that feminist educational interventions are too confrontational and as a result self-defeating because they alienate batterers, increase their hostility, and make them less likely to enter treatment. Another concern, revealed in some evaluations, is that the education central to the feminist program may transmit information but not deter violent behavior.

It is important for criminal justice professionals to understand the assumptions and goals of service providers whose interventions have divergent theoretical bases, because not all intervention approaches employ techniques that are equally compatible with the goals of the criminal justice system—protecting the victim as well as rehabilitating the offender.

Both feminist educational and cognitive-behavioral interventions can be compatible with the goals of the criminal justice system—protecting the victim as well as rehabilitating the offender. However, feminist educational programs offer some advantages. By contrast, family systems interventions conflict with criminal justice goals by failing to identify a victim and a perpetrator.

Origins of Domestic Violence and Eclectic Approaches

The origins of domestic violence are the subject of active debate among victim advocates, social workers, researchers, and psychologists concerned with batterer intervention. More than in most fields, the theoretical debate affects practice. Over the last two decades, a number of practitioners representing divergent theoretical camps have begun to move toward a more integrated “multidimensional” model of batterer intervention in order to better address the complexity of a problem that has psychological, interpersonal, social, cultural, and legal aspects.

In practice, few batterer programs represent a “pure” expression of one theory of domestic violence; the majority of programs combine elements of different theoretical models. As a result, when discussing program theory with batterer intervention providers, criminal justice professionals need to understand not only the primary theory the program espouses but also the program's content, because programs may identify with one theory but draw on or two more theories in their work.

Experts caution criminal justice agencies against accepting an eclectic curriculum uncritically: program components borrowed from different theoretical perspectives should be thoughtfully chosen to create a coherent approach, not a scattershot attempt hoping to hit some technique that works.

The primary intervention strategy for spousal and partner abuse is to insure the safety of the victim and children.  The confidentiality of the victim is to be maintained unless it conflicts with the safety of the children.

The Cycle of Violence

Many people who work with violent families have noted a pattern or cycle of violence. While there is no uniformity on how long a phase lasts, there seems to be a pattern, however: the tension building phase, the explosion or acute battering incident, and the calm, loving respite. There are also other models of domestic violence dynamics.

In phase one, the tension builds. In this phase the abuser becomes increasingly edgy. The victim, noticing this behavior, may try to calm or appease the abuser in ways that have worked in the past. There may be minor outbursts of violence for which the abuser may quickly apologize using such words as "I'm really sorry that I hit you, but if you only had (or hadn't) done . . ." Usually the victim forgives and assumes the guilt for these incidents. The victim will rarely become angry because she fears that her anger would serve to escalate the violence. The abuser is aware of his inappropriate behavior even if he doesn't acknowledge it. This serves to make him even more fearful that she will leave him. He attempts to keep her captive by being more abusive, possessive and controlling. His ability to defend these assaults or to placate his victim becomes less effective. The tension builds to a point where an assaultive explosion is inevitable.

Phase two is the shortest and most violent part of the cycle. It may begin with the abuser attempting to teach the victim a lesson, not with the intent of doing her physical injury, although this is the result of his unrestrained rage. At the end of the episode the abuser cannot fully understand or remember what has occurred.* Although the victim will often let her anger out during this phase, she does not usually fight back because she believes that to do so will only bring her more abuse and injury. Although most victims are seriously beaten at the end of this phase, they consider themselves "lucky" for surviving and will often placate the abuser by denying the extent of their injuries.

Phase three is a period of calm.** Some victims, sensing that phase two is in-evitable, will "encourage" its appearance and completion because they know that once the violence of phase two is over, phase three brings the "reward" of a kind, caring, if not contrite, partner. The abuser is usually sorry for his behavior even if he does not acknowledge this. He promises never to do it again and the victim wants to believe him. He may even become especially helpful and compromising in his behavior. Just prior to this phase a victim may have sought outside help, perhaps in connection with treatment for injuries. The appearance of her idealized, loving husband during this phase provides her with a glimpse of what she hopes for -- that people who truly love one another can overcome all odds. The apparent calm and bliss of phase three often undercuts a victim's interest in seeking and utilizing help. The cycle of violence inevitably continues as phase one behavior unfortunately reappears.

Not all violent situations follow this pattern. Some abusers have been known to wake their victims up with physical assaults. In some cases, violence occurs only sporadically while other abusers engage in violent behavior of some form on a consistent or daily basis.

Some suggest there is never "calm", merely periods of respite.

 An Overview of a Batterer

 Not all batterers are alike, but they often share some common characteristics. Batterers appear to:

  • have intense, dependent relationships with their victims;

  • have low self-esteem;

  • believe all the myths about domestic violence;

  • be traditionalists, believe in male supremacy and stereotyped masculine sex roles;

  • have poor impulse control or explosive tempers;

  • have limited tolerance for frustration and severe reactions to stress;

  • often present a dual-personality -- loving or violent;

  • have difficulty acknowledging or describing feelings;

  • deny and minimize their violent behavior;

  • not believe their violent behavior should have negative consequences;

  • be extremely jealous, possessive, controlling and fear they will be abandoned;

  • be depressed and vulnerable to drug and alcohol abuse.

Why Do Abusers Continue to Abuse?

Why do men batter and continue to batter? Most of the men in batterers' programs have been violent throughout their relationship with their victims. Most often, these men have learned to use violence as a way of managing everyday stress and frustration. They may not use violence at work, because they know that they would be fired. They have unrealistic expectations of themselves and their partners. At the same time, they have low self-esteem. Thus, they are extremely dependent on their partners for their sense of self-worth and for a sense of control over their lives. Because of this dependency they are often extremely jealous and possessive of their partners. In some cases, the fearful rage that can result has impelled an abuser to murder his partner rather than let her leave him.  Abusers may not like their violence, but they know of no other options. Because most of them cannot accept what they are doing, they will minimize, deny and even lie about their abuse.

Profile of a Battered Woman

While battered women are different from one another in circumstances and characteristics and vary as much as non-battered women from one another, there are some characteristics that appear to be common to victims of domestic violence. And these characteristics often correspond to the needs of their violent abusers. Victims appear to:

  • believe all the myths about domestic violence;

  • be traditionalists about home, family unity and female sex roles;

  • accept responsibility for the batterer's behavior;

  • have low self-esteem;

  • feel guilt, self-blame and self-hatred and deny legitimacy of their own feelings and needs;

  • show martyr-like endurance and passive acceptance;

  • hold unrealistic hopes that change is imminent;

  • become increasingly socially isolated;

  • act compliant, helpless and powerless in order to appease the offender;

  • define themselves in terms of other people's needs;

  • have a high risk for drug and alcohol addictions;

  • exhibit stress disorders, depression and psychosomatic complaints.

Why Do Abused Women Stay?

For some women, physical punishment in their childhood was rare or mild, but their homes were controlled, traditional and authoritarian. Other women experienced violence in their childhood homes and appear to expect it in their homes and relationships. Both groups of women cling to the hope that it will never happen again and that the batterer's promise to stop is true.

Battered women often hold fiercely to conventional views of marriage and sex-stereotypical roles. They believe they are responsible for their husband's well being. They make excuses for his behavior. They believe it is a woman's responsibility to insure the peace and success of the family. These women think they can change their partner's behavior by acting more loving or being better wives themselves. They believe they can save their partners. Violence for many has been interpreted as "their cross to bear."

Women also stay because they are socially and economically dependent on their abusing partner. Some women with children often stay because they cannot imagine how the children will be fed and clothed without the income from their spouse. Others believe that a violent father is better than no father at all. Some women have been told that the family must stay together at all costs.  These reasons combine into what been has called "learned helplessness." The victim becomes passive and submissive because she believes that she has no control over the relationship's violence or her own children's safety.

The Psychological Impact of Domestic Violence

Domestic violence can also have psychological effects including depression, anxiety, Post Traumatic Stress Disorder (PTSD) and suicide. Victims may also feel anxious, helpless, afraid, demoralized, ashamed and angry and may experience panic attacks. Battered Women Syndrome (BWS) is a psychological condition that is characterized by psychological, emotional and behavioral deficits arising from chronic and persistent violence. The central features of BWS include ‘learned helplessness’, passivity and paralysis. In relation to domestic violence, common features associated with PTSD include anxiety, fear, and experiencing flashbacks or persistently re-experiencing the event, nightmares, sleeplessness, exaggerated startle responses, difficulty in concentrating, and feelings of shame, despair and hopelessness. There is little doubt that psychiatric illness, particularly PTSD, depression and anxiety is greater among people who have experienced domestic violence compared to those who have not.”

Prerequisites for identifying and responding to family violence:

Due to the high prevalence of family violence in the population and the negative health effects of this abuse, health professionals need to become competent in abuse intervention. This includes knowing how to ask questions to identify the presence of abuse, and having the procedures in place to support brief intervention and appropriate referral of identified victims.

 Health care providers should have received appropriate training on issues of:

• cultural competency

• principles of increasing safety and respecting autonomy of abused women.

• care and protection issues related to abused children.

These are considered to be core competencies that should have been achieved as part of any clinical training. In the event that an individual provider does not have these skills, assistance should be sought from a more experienced colleague and the provider should take active steps to acquire the necessary knowledge and skills. Good practice will be best achieved and maintained in settings where there is sufficient organizational and institutional support for addressing abuse as a critical health care issue, and where health care providers work in partnership with community-based service providers who can provide other support to abuse victims. Health care providers should have established working relationships and referral pathways with local family violence agencies in their community prior to undertaking intervention for family violence. 

The Goal of Domestic Violence Treatment:

The goal of treatment is to make the victim and perpetrator recognize that Domestic violence is unacceptable behavior.  Every human has the right is to live free from intimidation, abuse and violence. The abuser is 100% responsible for his abusive behavior. Domestic violence is not the fault of the victim.  No one ever deserves to be abused no matter what is said or done. Violence towards a partner is intentional behavior.  Abusers can change their behavior.  It is within their control and they can choose to stop. Making changes is not easy.  Sufficient motivation is required for change to occur. When a victim first comes to see you she almost always needs information. It is important to discuss with the victims what their options are and help them to find a way to be safe.

In beginning domestic violence sessions the counselor should put safety of the victim first. Developing a safety plan with a client can mean the difference between her getting out of a dangerous situation and her being abused again. Additionally, beginning domestic violence sessions should focus on educating the client on the dynamics of abuse. Teaching clients the dynamics of abuse helps minimize the client's feelings of isolation and helps them to start to look at the abuse in the relationship as something that is not their fault.

Currently, because of the predominance of individual and socio-cultural factors in understanding the etiology of domestic violence, most treatment programs for domestic violence offenders are based on a cognitive behavioral approach.  The focus of understanding has been on individual and/or socio-cultural pathologies.  Group approaches are also based on the assumption that domestic violence offenders have deficits in knowledge or skills that are necessary for avoiding battering. Building on such assumptions is a treatment orientation which holds that the behaviors of domestic violence offenders can and need to be changed through a re-educational process.

Consequently, the core components of these treatment programs generally include communication training, direct education about violence, anger management, conflict containment, and stress management and raising awareness of patriarchal power and control. The resulting psycho-educational programs usually focus on confronting participants so they will recognize and admit their violent behaviors, take full responsibility for their problems, learn new ways to manage their anger, and communicate effectively with their spouse.

Motivation and the Domestic Violence Offender

A major therapeutic hurdle when working with offenders is the issue of motivation. Most domestic violence offenders are involuntary, court-mandated clients who are not self motivated to receive treatment. Many practitioners who work with court mandated domestic violence offenders are only too familiar with defensiveness, commonly manifested in constant evasiveness, silence, phony agreement, and vociferous counterarguments when participants are confronted with their problems of violence. Many participants stop attending the program altogether.

According to one survey, nearly half of the treatment programs faced dropout rates of over 50% of the men accepted at intake.

In addition, some professionals have begun to raise doubts about how a focus on deficits, blame, and confrontation can be conducive to stopping violence or initiating positive changes in offenders. Because blaming is one of the main strategies used by offenders to intimidate victims and to justify their own abusive acts, using confrontation and assigning blame in treatment may re-create a similar and non-helpful dynamic in abusive relationships. The effectiveness of a deficit perspective or a blaming stance in treatment is dubious if one looks at the characteristics of domestic violence offenders.

The most consistent risk markers for violent males have been identified as having experienced and/ or witnessed parental violence, frequent alcohol use, low assertiveness, and low self-esteem. As a result, a high percentage of domestic violence offenders are likely to be insecure individuals at the margins of society who victimize others to boost their own low self-esteem. Studies on personality further indicate that many domestic violence offenders fit the profile of narcissistic or borderline personality disorder.

Cultural Factors

Women and children constitute approximately two-thirds of all legal immigrants in the United States. Increasing evidence indicates that there are large numbers of immigrant women trapped and isolated in violent relationships, afraid to turn to anyone for help. A survey conducted by the Coalition for Immigrant Rights revealed that 34% of Latinas and 25% of Filipinas surveyed had experienced domestic violence either in their country of origin, in the U.S., or both.  Battered immigrant women encounter obstacles that can be attributed to language, culture, citizenship status, or lack of access to services.

Immigrant Women    

In addition to the physical violence, a battered immigrant woman may experience:

ISOLATION:  The abusing partner often keeps his victim isolated from family and friends - and from anyone who speaks her language. He also may not allow her to learn English.

THREATS:  The mate may threaten to report her to the Immigration and Naturalization Service (INS) to have them deported. Or he may threaten to withdraw the petition to legalize her immigration status.

INTIMIDATION:  He may hide or destroy important papers (such as her passport, identification card, Green card, health insurance card). He also may destroy the only property she has from her country of origin, including important mementos.

ECONOMIC ABUSE:  He may report her to the INS if she works "under the table" -- or threaten to do so. He may not let her obtain job training or schooling so she can become financially independent.

EMOTIONAL ABUSE:  The abusive spouse may lie about her immigration status. He may write lies about her to her family and friends. He may call her racist names.

CHILDREN USED:  He may threaten to take her children away from the United States, or to report her children to the INS. Or he may threaten to hurt them.

LANGUAGE BARRIERS:  When a battered immigrant woman tries to get assistance from a domestic violence agency, she may not be able to use the help that is offered because it is not in her language and no one is available to translate.

CULTURAL ISSUES:  Services provided by domestic violence programs may not address relevant cultural issues, so the agency may propose ideas that are not culturally appropriate or may not be able to offer her the right kind of assistance.

LACK OF ACCESS TO SERVICES:  Domestic violence agencies may not understand immigration laws and issues, and therefore be unable to help her solve her problems. Immigration agencies or attorneys may not recognize the signs of domestic violence, or know how to help.

Abuse Dynamics and Stats

  • Two-thirds of victims who suffered violence by an intimate reported that alcohol had been a factor.  Among spousal victims 3 out of 4 incidents were reported to have involved an offender who had been drinking.  By contrast, an estimated 31% of stranger victimizations where the victim could determine the absence or presence of alcohol as perceived to be alcohol-related.

  • Family members were most likely to murder a young child -- About one in five child murders was committed by a family member -- while a friend or acquaintance was most likely to murder an older child age 15 to 17.

  • A child’s exposure to the father abusing the mother is the strongest risk factor for transmitting violent behavior from one generation to the next.

Domestic Violence and Its Impact on Children

Domestic violence can affect children in many ways. Young people may witness terrible acts of violence against their parents or caregivers. Some children may never see the violence, but they may feel the tension, hear the fighting, and see the injuries left behind. Young people may be physically injured themselves if they try to intervene to stop the violence. Children may be asked to call the police or to keep a family secret. No matter the details of a family’s situation, children and young people bear the burden of domestic violence, too.

Children react in many different ways to violence in their homes. Individual children may respond differently even within the same family. Some children may become violent themselves, while others may withdraw. Some may "act out" at home or at school, while others constantly try to act like the perfect child.

Although domestic violence impacts children tremendously, it is only recently that domestic violence has been taken into account when determining child custody in families where domestic violence has occurred. The laws regarding child custody in families with domestic violence histories are still different from state to state. Even when a violent relationship has ended, the abuser may continue to have contact with the children. It is important to plan for the safety of the children and adults in the family at all times.

Children often appear:

  • sad, fearful, depressed and/or anxious;

  • aggressively defiant or passively compliant

  • to have limited tolerance for frustration and stress;

  • to become isolated and withdrawn;

  • to be at risk for drug and alcohol abuse, sexual acting out, running away;

  • to have poor impulse control;

  • to feel powerless;

  • to have low self-esteem;

  • to take on parental roles.

Domestic violence may be kept from relatives, neighbors, clergy and others, but the children of violent partners know what is happening. In one home there may not be any physical violence against a child whose adult caretakers have an abusive relationship, while in another home there may be physical abuse of the child as well. Either way, a child who lives in a house where domestic violence occurs is a victim all the same.

A home that is characterized by physical, emotional, sexual or property abuse is a frightening, debilitating and unhealthy place. The children in such a home are often unable to be children. They worry about protecting their parents. They are concerned that they not become an additional source of stress or problem, and fear for their own safety and security. They have the burden of carrying around a tremendous family secret.

Children from violent homes often suffer from depression. Some become isolated. Many do not want to bring friends home because of the shame and unpredictability of violence. They may spend much time away from home and get into trouble for truancy, petty crimes or disturbances. Children from violent homes often experience nightmares, sleep disturbances and nighttime bed wetting. A child's ability to handle his or her school work the next day is often adversely affected. Domestic violence incidents often occur during late evening hours, just at the time a child is getting ready for bed, and often wakes them up with shouts and noise.

Children from violent homes often feel responsible for everything bad that happens to themselves or to their parents. If they were neater, quieter, helped more or were smarter in school, maybe the violence would stop.  Children of abused moms have more internalizing, externalizing and behavior problems.

Same Sex Relationships:

What is NCAVP?

The National Coalition of Anti-Violence Programs (NCAVP) is a coalition of 25 lesbian, gay, bisexual, and transgender victim and documentation programs located throughout the United States. Before officially forming in 1995, NCAVP members collaborated with one another and with the National Gay and Lesbian Task Force (NGLTF) for over a decade to create a coordinated response to violence against our communities. Since 1984, members have released an annual report every March, promoting public education about bias-motivated crimes against lesbian, gay, bisexual, and transgender people. As the prevalence of domestic violence in our community has emerged from the shadows, NCAVP member organizations have increasingly adapted their missions and their services to respond to violence within the community as well. The first annual domestic violence report was released in October 1997. This is the second report and is released in conjunction with National Domestic Violence Awareness month.

Research Questions, Methods, and Definitions

The purpose of this report is to investigate the following research questions and to summarize our findings:

  • How prevalent is domestic violence among lesbian, gay, bisexual, and transgender people?

  • Do state statutes permit victims of same-sex domestic violence to obtain domestic violence protective orders?

The first question was selected because domestic violence in this community is an ignored, even invisible phenomenon that most people have never considered; the second, to determine whether or not equal legal protection was available to sexual minority victims. In answering these questions, we reviewed academic literature on same-sex battering, conducted a survey of state domestic violence statutes and significant, relevant case law, and conducted our own member survey, described below.

Domestic violence encompasses a broad range of relationships including but not limited to romantic partner abuse, abuse of elders, abuse from an HIV caregiver or to other caregiver, abuse occurring in other intimate relationships. For the purposes of this report, however, we limited the definition of domestic partnerships that were romantic in nature.  Similarly, domestic violence typically includes many forms of abuse, often occurring simultaneously and in a pattern that escalates over time. For the purposes of this report, abuse is defined as any non-consensual behavior that causes another fear, causes another emotional, financial, or physical harm, or restricts another's freedom, rights, or privacy. Common forms of abuse, including threats, emotional or psychological abuse, physical abuse, sexual abuse, financial abuse, and stalking.

The Prevalence of Lesbian, Gay, Bisexual, and Transgender Domestic Violence

The Number of Cases NCAVP documented during 1997 rose by 975 cases or 41% compared to 1996. During calendar year 1996, a total of 2,352 cases were documented by NCAVP compared to 3,327 during 1997, an increase of 975 cases or 41%. Of the twelve locations, nine (75%) reported increases, two (22%) reported decreases, and one (11%) stayed the same.

  • The risk of losing their children is even greater for lesbian and gay couples when domestic violence is involved.

  •  In same sex relationships violence can be physical, sexual, emotional and psychological.

Definition and Types of Marital Rape

Marital rape is the term used to describe nonconsensual sexual acts between a woman/man and her husband/wife, ex-husband/wife, or intimate long-term partner. These sexual acts can include: intercourse, anal or oral sex, forced sexual behavior with other individuals, and other unwanted, painful, and humiliating sexual activities. It is rape if one partner uses force, threats, or intimidation to get the other to submit to sexual acts.

It is important to note that, although battered women are more at risk for marital rape than their non-battered counterparts, some men will rape their wives and never beat them and vice versa. These issues may be inter-linked or seemingly unrelated. Don’t make assumptions about their victimization based on partial facts.

Types of Marital Rape:

Battering Rape

This involves forced sex combined with beatings. This type of sexual assault is primarily motivated by anger towards the victim. The sexual abuse is either part of the entire physical abuse incident or is a result of the husband later asking his wife to prove she forgives him for the beating by having sex with him.

Force-Only Rape

The husband uses only as much force as necessary to coerce his wife into sexual activity. This type of sexual assault is primarily motivated by the need for power over the victim. In his mind, he is merely asserting his right to have sex with "his" wife on demand. This is the most common type of marital rape.

Obsessive Rape

The husband’s sexual interests run toward the strange and perverse, and he is willing (or even has a   preference) to use force to carry these activities out. This is the least common, yet arguably the most physically damaging, type of marital rape.

DEVELOPING A SAFETY PLAN

If and when a victim is able to leave her battering environment, it is essential that she has a "safety plan" to increase her opportunity for a successful departure. Advance planning is crucial. Start by assessing the battered-generated and life-generated risks with her. Based on this information, concerns and actions may need to include the following:

  • Does she have family and friends with whom she can stay?

  • Would she find a protective or restraining order helpful?

  • Can a victim advocate safely contact her at home? What should the advocate do if the batterer answers the phone?

  • Does she know how to contact emergency assistance (i.e., 911)?

  • If she believes the violence might begin or escalate, can she leave for a few days?

  • Does she know how to contact a shelter? (If she doesn't, provide her with information for future use.)

  • Does she have a neighbor she can contact or with whom she can work out a signal for assistance when violence erupts or appears inevitable?

  • If she has a car, can she hide a set of keys?

  • Can she pack an extra set of clothes for herself and the children, and store them--along with an extra set of house and car keys--with a neighbor or friend?

  • Can she leave extra cash, checkbook, or savings account book hidden or with a friend for emergency access?

  • Can she collect and store originals or copies of important records such as birth certificates, social security cards, drivers' license, financial records (such as banking and other financial accounts, mortgage or rent receipts, the title to the car, etc.), and medical records for herself and her children?

  • Does she have a concrete plan for where she should go and how she can get there regardless of when she leaves?

  • Does she have a disability that requires assistance or a specialized safety plan?

  • Does she want access to counseling for her children or herself?

  • Are there any other concerns that need to be addressed?

The Duluth Domestic Abuse Intervention Project

In 1981, the Domestic Abuse Intervention Project was the first multi-disciplinary program designed to address the issue of domestic violence. This experiment, conducted in Duluth, involved coordinating the actions of a variety of agencies that deal with domestic situations. The policies and activities of diverse elements of the system, from police officers on the street, to shelters for battered women and probation officers supervising offenders, were coordinated with each other. This program has become a model for other jurisdictions seeking to deal more effectively with domestic violence. More and more jurisdictions are mandating that suspects in domestic violence incidents be arrested if there is probable cause to believe that an assault occurred. Victim advocates intervene directly with victims by providing them with counseling about the court process, how to obtain and use restraining orders and how to formulate and implement safety plans. Corrections/probation agencies in many areas supervise domestic violence offenders more closely, and pay attention to the victim's needs and safety issues.

It should be noted, however, that the Duluth framework depends on a strict "patriarchal violence" model and presumes that all violence in the home and elsewhere has a male perpetrator and female victim. It explicitly rejects any concept of mutuality or symmetry in abusive relationships.

Criticism

The exclusive focus on men as perpetrators and the rejection of system dynamics models has been criticized from perspectives influenced by psychology, education or remedial therapy. The fields of psychology, psychiatry, and social work all provide for application of skill learning, improved social understanding and practiced behavioral mastery to provide for corrected and alternative behaviors. By contrast, the Duluth Model presents only "once an abuser, always an abuser" constructions to this important social problem. However, the inconvenient fact, as reported by FBI crime statistics, is that 65 to 70% of all child (abuse-related) deaths occur at the hands of their mothers or female caretakers. This very broad and clear example of female initiated violence clearly moderates any "anti-patriarch" model of interpersonal violence.

More states are now recording abuse statistics regarding the marital state of both the perpetrator and the victim. In all jurisdictions with reports available, the rate of interpersonal violence for co-habiting couples exceeds that of married couples by a margin of ten to one.

The Duluth program is widely used but clear evidence of success is limited.

Treatment and support

Publicly available resources for dealing with domestic violence have tended to be almost exclusively geared towards supporting women and children who are in relationships with or who are leaving violent men, rather than for survivors of domestic violence per se. This has been due to the purported numeric preponderance of female victims and the perception that domestic violence only affected women. Resources to help men who have been using violence take responsibility for and stop their use of violence, such as Men's Behavior Change Programs or anger management training, are available, though attendees are ordered to pay for their own course in order that they should remain accountable for their actions.

Men's organizations, such as ManKind in the UK, often see this approach as one-sided; as Report 191 by the British Home Office shows that men and women are equally culpable, they believe that there should be anger management courses for women also. They accuse organizations such as Women's Aid of bias in this respect saying that they spend millions of pounds on helping female victims of domestic violence and yet nothing on female perpetrators. These same men's organizations claim that before such help is given to female perpetrators, Women's Aid would have to admit that women are violent in the home. This they seem reluctant to do.

One of the challenges for lay observers, victims, perpetrators and treatment providers is demonstrated by the tendency to describe perpetrator treatment as men's "anger management" groups.

Comprehensive and accountable behavior change programs are seen as far more appropriate and effective interventions in male violence in the home than anger management groups.

Inherent in anger management only approaches is the assumption that the violence is a result of a loss of control over one's anger. While there is little doubt that some domestic violence is about the loss of control, the choice of the target of that violence may be of greater significance. Anger management might be appropriate for the individual who lashes out indiscriminately when angry towards co-workers, supervisors or family. In most cases, however, the domestic violence perpetrator lashes out only at their intimate partner or relatively defenseless child, which suggests an element of choice or selection that, in turn, suggests a different or additional motivation beyond simple anger. Most experienced treatment providers have probably observed that for various reasons, many of which may be cultural, the perpetrator has a sense of entitlement, sometimes conscious, sometimes not, that leads directly to their choice of target.

Men's behavior change programs, although differing throughout the world, tend to focus on the prevention of further violence within the family and the safety of women and children. Often they abide by various standards of practice that includes 'partner contact' where the participants female partner is contacted by the program and informed about the course, checked about her level of safety and support and offered support services for herself if she requires them. Many of these programs have both a male and female facilitator and follow a program designed to highlight the impact of his behavior, examine the attitudes, values and behaviors. that lead to his choice to use violence and aim to support and challenge the man to take responsibility for his use of violence.

Although modern understanding of relational aggression arose from the study of cliques of girls in school, and despite the fact that the term "female bullying" is often used synonymously with "relational aggression", relational aggression is seen at times in women and men of all ages in spousal, familial, sexual, social, community, political, and religious settings.


The Violence Against Women Act of 1994 (VAWA) is a United States federal law. It was passed as Title IV and signed as Public Law by President Bill Clinton on September 13, 1994. It provided $1.6 billion to enhance investigation and prosecution of the violent crime perpetrated against women, increased pre-trial detention of the accused, provided for automatic and mandatory restitution of those convicted, and allowed civil redress in cases prosecutors chose to leave unprosecuted.

The National Organization of Women heralded the bill as "the greatest breakthrough in civil rights for women in nearly two decades." The American Civil Liberties Union derided the Act as "troubling", saying that the increased penalties were rash, the increased pretrial detention was "repugnant" to the US Constitution, the mandatory HIV testing of those only charged but not convicted is an infringement of a citizen’s right to privacy and the edict for automatic payment of full restitution was non-judicious in their paper "Analysis of Major Civil Liberties Abuses in the Crime Bill Conference Report as Passed by the House and the Senate", dated September 29, 1994. However, the ACLU has supported its reauthorization on the condition that the "unconstitutional DNA provision" be removed.

VAWA and the 1994 Crime Bill in general was supported by Congressional Democrats and President Clinton and opposed by then minority Congressional Republicans with a few exceptions.

Ironically, Paula Jones' attorneys Susan Carpenter-McMillan, Gilbert Davis and Joseph Cammarata would use VAWA in winning arguments one year later to allow a civil suit against President Clinton for sexual harassment to proceed. Eventually President Clinton paid an out of court settlement of $850,000 for the harassment of Jones.

In 2000, the Supreme Court of the United States held part of VAWA unconstitutional in United States v. Morrison. Only the civil rights remedy of VAWA was struck down. The provisions providing program funding were unaffected.

VAWA was reauthorized by Congress in 2000, and again in October 2005, when it passed the Senate unanimously. The bill was signed into law by President George W. Bush on January 5, 2006. It is due for further reauthorization in 2010.

World Health Organization Multi-country Study on Women's Health and Domestic Violence against Women 2005

The World Conference on Human Rights, held in Vienna in 1993, and the Declaration on the Elimination of Violence against Women in the same year, concluded that civil society and governments have acknowledged that violence against women is a public health policy and human rights concern. Work in this area has resulted in the establishment of international standards, but the task of documenting the magnitude of violence against women and producing reliable, comparative data to guide policy and monitor implementation has been exceedingly difficult. The World Health Organization Multi-country Study on Women’s Health and Domestic Violence against Women is a response to this difficulty. Published in 2005 it is a groundbreaking study which analysed data from 10 countries and sheds new light on the prevalence of violence against women. It seeks to look at violence against women from a public health policy perspective. The findings will be used to inform a more effective response from government, including the health, justice and social service sectors, as a step towards fulfilling the state’s obligation to eliminate violence against women under international human rights laws.

In the summary publication of the first World Report on Violence and Health, the authors see their mission clearly: ‘the purpose of the first World report on violence and health is to challenge the secrecy, taboos and feelings of inevitability that surround violent behavior’. It is a thoughtful exposition, recognizing the difficulties of such basic demands as defining and measuring violence. Furthermore, while ambitious in proclaiming the message that violence can be prevented, it is modest in recognizing that ‘[r]aising awareness of the fact that violence can be prevented is, however, only the first step in shaping the response to it’.

THE PUBLIC HEALTH APPROACH

The crucial stance of the public health approach is to focus on prevention: that is, preventing disease or illness from occurring, rather than dealing with the health consequences. The further shift is to try to think of violence in these terms. The arguments are seductive and it would be churlish for someone who has advocated more ‘upstream’ thinking (to use a term pervasive in the report) to challenge the basic tenets of the report — that is, that prevention is better than cure. However, mission statements are produced by missionaries, and missionaries rarely point out the underlying problems of their mission. In this respect, in reading the report, I realized that I am an academic, not a missionary and perhaps not even a scientist. A scientist, as Kuhn (1962) has explained, works within a paradigm, and challenges to a paradigm — especially a new one — are often met with stiff resistance. The task of an academic is perhaps rather different. Irritatingly, the academic will tend to identify tensions and problems rather than consensus and solutions. For the missionary and perhaps for the scientist, in contrast, all will be resolved if one accepts their vision of the world.

The public health approach is not new, as McKeown (1976) pointed out when he first stimulated the debate in the 1970s about the effects of medical intervention on human health. In fact, over the past 150 years or so, one can identify three phases of activity. The first phase began in the industrialized cities of northern Europe as a response to the appalling toll of death and disease among the working classes living in abject poverty. The response to this situation was the gradual development of the public health movement, such as the appointment of sanitary inspectors and their staff, supported by legislation such as the National Public Health Acts of 1848 and 1875 in England and Wales. The second phase was a more individualistic approach ushered in by the development of the germ theory of disease and the possibilities offered by immunization and vaccination. The third phase has been identified as the therapeutic era, dating from the 1930s, with the advent of insulin and other drugs. The beginning of this era coincided with the apparent demise of infectious diseases on the one hand and the development of ideas about the welfare state on the other. This all meant a shift of power and resources to hospital-based services and the downgrading of the public health approach. In fact, the individualization of illness — whether orchestrated by the medical profession or by the government — was one of the crucial ingredients of the health policies of the 1980s and early 1990s. Such an approach masks the social causes of ill-health. However, the Acheson Report (Acheson, 1998) laid the foundations for a wider and more inclusive approach emphasizing a variety of solutions to health problems. The World Report on Violence and Health is part of the recent shift of focus towards seeing problems within a wider framework.

THE PREVENTION MODEL

At first glance violence would seem to excite less controversy than health. After all, the ‘health police’ encouraging us to stop smoking seem to be on a stickier wicket than anyone trying to prevent violence. More will support the freedom to continue smoking than to continue committing violence. However, psychiatrists have recognized that espousing the prevention model is perhaps not so straightforward as some missionaries would have us believe. Locking up people who are highly likely to commit serious violence but who have not yet done so is a facet of the prevention model. In doing so, however one dresses up the language, there is some compromise to the notion that everyone is innocent until proven guilty. This strikes at the heart of the underlying philosophical assumptions that a prevention model appeals to.

A prevention model is essentially forward-looking, whereas a more reactive model, where symptoms or injuries are presented, is backward-looking. This is familiar territory in discussing philosophies of punishment where normative theories of punishment are typically classified as either ‘consequentialist’ or ‘non-consequentialist’. As Duff & Garland remind us, a consequentialist holds that the rightness or wrongness of any action or practice depends solely on its overall consequences. It is right if its consequences are good (at least, as good as those of any available alternative) and wrong if its consequences are bad (worse than those of some available alternative). This is utilitarianism, in which practices are seen as right or wrong in so far as they promote or destroy ‘the greatest happiness of the greatest number’. It is to this philosophy that one might appeal if a potential serial killer were to be incarcerated prior to committing an actual crime. In contrast, a non-consequentialist insists that actions may be right or wrong by virtue of their intrinsic character, independently of their consequences. In this approach it is the guilty, and only the guilty, who deserve to be punished. The potential serial killer must be allowed to become an actual killer, in the absence of overt evidence of any suffering that the person has actually caused.

Forensic psychiatrists know that neither of the alternative stances produces much comfort. The protection of civil liberties, may seem a high price to pay for local carnage. However, at the national and international level the dilemmas and tensions are even more stark. The problem here is that it is the powerful who may be the perpetrators of the most violence, just as it is at the domestic level.

DENYING REALITY

In a groundbreaking study which is as thought-provoking as it is disturbing, Stanley Cohen's book States of Denial: Knowing about Atrocities and Suffering deals with public reactions to information, images and appeals about inhumanities. He explores the various states of denial that exist in modern society. ‘Turning a blind eye’ and ‘burying one's head in the sand’ are two expressions of denial frequently used at an individual and societal level. With worrying regularity, we are saturated with media images of atrocities and suffering from all over the world. These images have become normalized. They are commonplace. So, too, is our apparent indifference.

Moving from the personal to the political, Cohen examines how organized atrocities, such as the Holocaust and other genocides, are denied by both perpetrators and bystanders. Bystander nations are those who do nothing, frequently claiming in the aftermath of an event that they were unaware of what was taking place. As for the perpetrators, one of the strategies they use is what Cohen describes as ‘interpretive denial’, claiming that what is happening is really something else. This is particularly evident in the euphemistic language used by organizations devoted to committing atrocities. The Nazi ‘euthanasia’ program for killing those with mental disabilities and other supposedly unworthy people was renamed the Charitable Foundation for Institutional Care. Such deliberate misrepresentation is not unique.

There is much else that is unpleasant and questionable in the exercise of power beyond genocide alone. Mary Daly, a radical feminist, in a classic study pointed to the male domination of women (patriarchy), which she suggests is everywhere expressed through the systematic destruction or mutilation of women. Different cultures express this — both historically and in the contemporary world — in different ways: suttee (the burning alive of widows) in India; foot-binding in China; female circumcision in Muslim Africa; the burning of witches in Europe; and gynecological therapies such as hysterectomy in modern America (‘genocide’, as Daly terms it). Perhaps more universally there is domestic violence, which is still frequently denied. Should there be international intervention to stop practices that reflect the male domination of women?

Concerns over the threats posed by international terrorist organizations took center stage with the horrific events at the World Trade Center and the Pentagon in the USA on 11 September 2001. Terrorists represent a real threat to us all, yet there is a danger that politicians will use this to justify introducing increased powers of surveillance for the state, which may be at the expense of individual civil liberties. Here, we are perhaps less comfortable about intervention that affects our own lives. International terrorism is being fought by global alliances, a reminder that we have newer versions of crimes committed against the physical environment itself: for instance, pollution, the threat of chemical warfare, the aftermath of weapons used in previous engagements such as the Gulf War and Kosovo. Is this violence against humanity? These are complex matters (Soothill et al, 2002).

Although the World Report on Violence and Health provides an invaluable and welcome service in trying to strip away some of the myths about violence and to expose the facts about violence, this is — as the authors recognize — only a beginning. So what is the warning? The warning is that there are massive moral and political issues to confront in shaping our response to violence. Assuming that consensus is easily achieved — or even achievable — may be a way of burying our head in the sand and turning a blind eye to some very real issues.

Stalking

Stalking is causing pervasive and intense personal suffering and is an area of psychiatry that is currently overlooked. Stalkers are best thought of as a heterogeneous group whose behavior can be motivated by different forms of psychopathology, including psychosis and severe personality disorders.

There is a clear need to arrive at a consensus on a typology of stalkers and associated diagnostic criteria. The effectiveness of psychological and pharmacological treatments have not yet been investigated. Treatment may need to be supplemented with external incentives provided by the legal system.

Stalking gained major media attention by the often-spectacular accounts of celebrity stalking. Well-known cases from the United States include the stalkers of Madonna and Jodie Foster. However, repeated intrusive communication and harassment is by no means limited to fans targeting the rich and famous. Much more common is the scenario in which stalker and ‘stalkee’ had some sort of ‘real’ prior relationship: they were often prior acquaintances or intimates, but professional contacts can also give rise to stalking later (e.g. by clients of psychiatrists or lawyers; or by rejected job applicants).

Forensic psychiatry has given scant attention to the phenomenon of stalking. Few studies have investigated the psychological make-up of stalkers, and to date only one study has reported on the psychological impact of stalking on its victims. There are no reports of the development of any specific treatment programs, either for stalkers or for their victims. This article aims to give an overview of stalking and its clinical ramifications. 
 
Partly as a result of publications in the media on stalking of celebrities, research into marital violence, and anti-stalking laws in some countries, mental health workers have recently started to study stalkers. It became apparent that a proportion of stalkers suffered from erotomania. Originally, erotomania was a term reserved for women who held the delusional belief that a man, typically of a higher social class or social esteem, was deeply in love with them. However, a delusional disorder of the erotomanic type, as it is currently classified in DSM-IV (American Psychiatric Association, 1994), only accounts for a very limited subset of episodes of stalking; stalking can result from many different motivations and constellations of psychopathological symptoms.

As often found with recently developed behavioral concepts, there is no consensus about the exact definition of stalking. Most of the disagreement seems to center on the degree of emphasis placed on the extent to which the stalking evokes a subjective sense of threat. Generally, the various definitions have the following elements in common: (a) a pattern of intrusive behavior, akin to harassment; (b) an implicit or explicit threat that emanates from the behavioral pattern; and (c) as a result, the target experiences considerable real fear. In this article we use Meloy and Gothard's definition: "Stalking is typically defined as the wilful, malicious, and repeated following or harassing of another person that threatens his or her safety".

NATURE AND PREVALENCE OF STALKING 
 
Stalking behavior typically consists of intrusive following of a ‘target’: for example, by placing one's self in front of the target's home, or other unexpected and unwelcome appearances in their private domain. Stalkers most often persecute their targets by unwanted communications, which can consist of frequent (often nightly) telephone calls, letters, e-mail, graffiti, notes (e.g. left on the target's car), or packages (e.g. gifts, pictures). Somewhat more extreme forms include ordering goods and services in the victim's name and charging to the victim's account, placing false advertisements or announcements, ordering funeral wreaths, spreading rumors about the victim, starting numerous frivolous law suits, smearing the victim's home or destroying or moving their property, threatening the victim with violence, or actually attacking them. Stalkers sometimes involve third parties, which leads to victimization by association of their family, friends, colleagues, lawyers, psychiatrists or psychologists, etc. Stalking can be of brief duration, but it can also last for many years. Research from the United States shows that in slightly over half the cases, stalking ceases within one year, while in one-quarter of the cases it lasts for 2-5 years.

In some cases, the violence may escalate until the stalker actually murders the victim and/or his/her children. In the United States, it is estimated that between 21% and 25% of forensic stalking cases culminate in significant violence. The incidence of murder or manslaughter in stalking cases in the United States is estimated at 2%. Fritz (1995) showed that 90% of women killed by their ex husband had previously been stalked. These numbers should probably not be extrapolated unreservedly to the European situation: for one reason, because of differences in the availability and possession of firearms.

Obtaining reliable data regarding the prevalence and incidence of stalking is a formidable international problem. Inconsistent definition and demarcation of the concept is partly responsible for this state of affairs. In some European countries stalking by itself is not considered a distinct legal offence which compounds the problem of monitoring and tracking cases for both police and forensic researchers. As a result, estimates of prevalence and incidence are based on very few, predominantly American studies. The US National Violence Against Women Survey contacted 8000 women and 8000 men by telephone, and asked them about stalking experiences: 8% of the women and 2% of the men had been stalked at some point in their life. This research also illustrates that criminal stalking cases merely reflect the tip of the iceberg: only 50% of stalking cases were reported to the police, of which 25% led to an arrest, and only 12% resulted in criminal prosecution.

Some research has focused on the prevalence of stalking within specific groups. Among 178 randomly sampled American university counseling center professionals, one in every 18 therapists reported having been harassed or stalked by a previous or current patient (Romans et al, 1996).

In sum, there is a great international need for systematic monitoring of stalking cases, based on some consensual definition, to arrive at reliable estimates of the magnitude of the problem.

Zona et al (1993) distinguished the following stalkers: (a) the ‘classic’ erotomanic stalker, who is usually a woman with the delusional belief that an older man of higher social class or social esteem is in love with her; (b) the love-obsessional stalker, who is typically a psychotic stalker targeting famous people or total strangers; and, most common, (c) the simple obsessional stalker, who stalks after a ‘real’ relationship has gone sour, leaving him with intense resentment following perceived abuse or rejection. Wright et al (1996) present a slightly different classification. They distinguish the domestic stalker and the nondomestic stalker: the former is comparable to Zona et al's ‘simple obsessional stalker’, whereas the non-domestic stalker comes in two types: the organized stalker and the delusional stalker. The delusional stalker corresponds with Zona et al's ‘erotomanic stalker’ and ‘love obsessional stalker’. The organized stalker targets previously unknown persons through anonymous communication. The victims usually have no knowledge of the identity of the stalker. Finally,

Mullen et al (1999) distinguish five types of stalkers: (a) the rejected stalker, who has had a relationship with the victim and who is often characterized by a mixture of revenge and desire for reconciliation; (b) the stalker seeking intimacy, which includes individuals with erotomanic delusions; (ac) the incompetent stalker — usually intellectually limited and socially incompetent individuals; (d) the resentful stalker, who stalks to frighten and distress the victim; and finally (e) the predatory stalker, who is preparing a sexual attack. In addition to these categories, there are reports on the so-called ‘false victimization syndrome’, during which the ‘victim’ pretends to have been stalked, by pursuing herself, in order to gain attention.

There is a clear need to derive a consensus on a typology of stalkers, with associated diagnostic criteria. At present, there is no evidence that one proposed typology is superior to another. The typology eventually agreed upon should have clear implications for treatment.

Personality of stalkers

To date, no systematic research has investigated the motivations and personality of stalkers. Reconciliation and reunion on the one hand v. revenge and intimidation on the other, are frequently mentioned as motivating stalkers. Tjaden & Thoenness found that stalkers' most common motivation was the desire to maintain control over their victims. Again, it deserves mention that most of these findings are based on stalking cases associated with ‘romantic relations gone sour’. Reflections on the personality and intrapsychic functioning of stalkers are predominantly psychodynamic in nature, and are focused on the simple obsessional subgroup. The central feature in these theories is an intense narcissistic reaction to rejection and loss, in combination with borderline defence mechanisms such as splitting, initial idealization, subsequent devaluation, projection and projective identification. The stalker is thought to defend him/herself against intense feelings of humiliation, shame and sadness by narcissistic rage, during which he/she starts devaluing and torturing the love object to maintain the narcissistic linking fantasy (Meloy, 1996).

A related perspective is to describe the stalker's dynamics from the point of view of pathological mourning: stalkers cannot adequately process the traumatic object loss, and as a result cannot move on to build new connections, and thus they remain ‘stuck’. Several authors have proposed that attachment pathology underlies the disturbed behavior Most notably, Meloy (1998) has formulated a tentative model which assigns to attachment pathology the pivotal role in developing stalking behaviors. Some evidence consistent with this line of theorizing comes from inspection of stalkers' childhood histories and life-events which immediately preceded stalking. For example, Kienlen found that a large proportion of stalkers had experienced significant discontinuity in their childhood (e.g. loss of a carer) and that many incidences of stalking immediately follow object loss.

Despite considerable effort, the current body of evidence is insufficient for the accurate prediction of stalking cases and of subsequent violent behavior (including murder). Some stable risk factors have been identified: a history of (domestic) violence, psychiatric history, antisocial personality disorder and a criminal record. An expert witness testimony predicting violence is not to be recommended, given the current shortage of research data. This statement signals no more than one of the most urgent and difficult problems in forensic psychiatry: how to predict dangerousness.

Numerous movies (e.g. Fatal Attraction, Play Misty for Me), documentaries and books give (often quite dramatic) accounts of the experience of being harassed, followed or stalked. The ‘typical’ victim of stalking is a woman of approximately the same age as the stalker, with whom he previously had a superficial relationship. Another frequent and particularly pernicious scenario is stalking following a history of domestic violence. Research by Wilson & Daly shows that the probability of getting killed by a spouse is 2-4 times as great after a divorce or separation than when continuing to live together.

It is not hard to imagine that months or years of exposure to persecution and threats can lead to serious psychological consequences. In particular, it is the constancy of threat into the private domain that causes the greatest distress to victims of stalking. The protracted and intense sense of intrusion and violation, by definition without an escape haven, is what seems to set stalking distress apart from other more or less traumatic types of stress. However, there is a remarkable lack of solid data on victim psychomorbidity following stalking. In their sample of stalking victims, Pathé & Mullen found predominantly depression, anxiety and traumatic psychomorbidity. On the basis of self-reports, 37% of the respondents qualified for a diagnosis of post-traumatic stress disorder (PTSD). This percentage is much the same as the proportion of PTSD cases in victims of domestic violence, which varies from 40% to 60% between different studies. Hall found that victims of stalking perceived personality changes in themselves as a result of the ordeal they had suffered. Increases in caution, suspiciousness, anxiety and aggression were noted most frequently.

Victims of stalking also reacted by making significant changes in their social and professional life. Nearly all victims adjusted their daily routines (routes, habits), and a majority took additional safety precautions such as getting a secret telephone number, house alarm, etc. Four out of ten stalking victims changed their job or moved away in order to escape the stalking terror. About half reported a partial or total loss of productivity (work or study) and decreased social activity. The perceived lack of safety also led many to carry weapons, including firearms.

As was emphasized earlier, stalking describes a behavioral problem, not a psychiatric classification per se. Several authors have reflected on the diagnostic assessment of stalkers, and generally made a distinction between psychotic stalkers (Axis I) and stalkers with severe personality pathology (Axis II). The psychotic stalker can exhibit primary erotomania, but erotomanic delusions can also result from multiple other DSM-IV disorders, including schizophrenia, bipolar disorder, and major depression (American Psychiatric Association, 1994). Stalking is predominantly associated with cluster B personality pathology (narcissistic and borderline personality disorders) and to a lesser extent with dependent, schizoid, and paranoid features. There are relatively few reports of stalking by classic psychopaths, and these cases are almost without exception extensions of (long) histories of domestic violence. In addition to these primary disorders, comorbid conditions, such as substance abuse or dependence and affective disorders, are frequently mentioned. It is worth noting that almost all diagnostic hypotheses were based on clinical impressions from uncontrolled studies. Controlled research into personality characteristics and psychopathology (based on, for example, structured interviews and standard personality inventories) is sorely lacking.

Since research into the treatment of stalkers is notably absent, there are no clear guidelines for treatment. The best methods of opposition to, and treatment of, stalking will depend on the stalker's idiosyncratic psychological profile. Erotomanic or otherwise psychotic stalkers will prove to be extraordinarily resistant to treatment. Primary erotomanic delusions are typically unflagging, which leads one to believe that investment in legal means for deterring such stalkers would probably be the most efficient. Involuntary commitment, trespassing orders and street prohibitions are among the options available in several European countries. Unfortunately, such interventions often appear to incense the stalkers and stimulate them to even more malicious and intense persecutory behavior To stop stalking in secondary erotomania, the treatment will have to focus on the underlying disorder, and probably involve neuroleptics. Neither of these types of stalker is likely to benefit from psychotherapy. However, the third and most prevalent group consists of obsessed, rejected stalkers with (usually) severe personality disorder; and this group is likely to be best served with a mix of judicial and psychotherapeutic interventions.

A primary problem in treating stalkers is to motivate them for therapy. By the very nature of the problem, stalkers are unlikely to report themselves for psychiatric or psychological treatment. In sum, there is a clear need for controlled studies into the effectiveness of psychotherapy and drug therapy for stalkers.

Primary prevention should receive more attention in one particular subset of stalking cases. As discussed, a large proportion of stalking cases follows from histories of domestic violence (Kurt, 1995). Earlier intervention in domestic violence and family counseling can promote a more satisfactory end to relationships and thus prevent subsequent resentment spilling over in stalking.


Intimate Partner Violence

Occurrence

Statistics about intimate partner violence (IPV) vary because of differences in how different data sources define IPV and collect data. For example, some definitions include stalking and psychological abuse, and others consider only physical and sexual violence. Data on IPV usually come from police, clinical settings, nongovernmental organizations, and survey research.  

Most IPV incidents are not reported to the police. About 20% of IPV rapes or sexual assaults, 25% of physical assaults, and 50% of stalkings directed toward women are reported. Even fewer IPV incidents against men are reported (Tjaden and Thoennes 2000a). Thus, it is believed that available data greatly underestimate the true magnitude of the problem. While not an exhaustive list, here are some statistics on the occurrence of IPV. In many cases, the severity of the IPV behaviors is unknown.

  • Nearly 5.3 million incidents of IPV occur each year among U.S. women ages 18 and older, and 3.2 million occur among men. Most assaults are relatively minor and consist of pushing, grabbing, shoving, slapping, and hitting
  • In the United States every year, about 1.5 million women and more than 800,000 men are raped or physically assaulted by an intimate partner. This translates into about 47 IPV assaults per 1,000 women and 32 assaults per 1,000 men
  • IPV results in nearly 2 million injuries and 1,300 deaths nationwide every year
  • Estimates indicate more than 1 million women and 371,000 men are stalked by intimate partners each year.
  • IPV accounted for 20% of nonfatal violence against women in 2001 and 3% against men
  • From 1976 to 2002, about 11% of homicide victims were killed by an intimate partner (Fox and Zawitz 2004).
  • In 2002, 76% of IPV homicide victims were female; 24% were male .
  • The number of intimate partner homicides decreased 14% overall for men and women in the span of about 20 years, with a 67% decrease for men (from 1,357 to 388) vs. 25% for women .
  • One study found that 44% of women murdered by their intimate partner had visited an emergency department within 2 years of the homicide. Of these women, 93% had at least one injury visit .
  • Previous literature suggests that women who have separated from their abusive partners often remain at risk of violence.
  • Firearms were the major weapon type used in intimate partner homicides from 1981 to 1998.
  • A national study found that 29% of women and 22% of men had experienced physical, sexual, or psychological IPV during their lifetime.
  • Between 4% and 8% of pregnant women are abused at least once during the pregnancy.

Consequences

In general, victims of repeated violence over time experience more serious consequences than victims of one-time incidents. The following list describes just some of the consequences of IPV.

Physical

At least 42% of women and 20% of men who were physically assaulted since age 18 sustained injuries during their most recent victimization. Most injuries were minor such as scratches, bruises, and welts (Tjaden and Thoennes 2000a).

More severe physical consequences of IPV may occur depending on severity and frequency of abuse; These include:

 

References:

Tjaden P, Thoennes N. Extent, nature, and consequences of intimate partner violence: findings from the National Violence Against Women Survey. Washington (DC): Department of Justice (US); 2000.

Trabold N.: Screening for intimate partner violence within a health care setting:a systematic review of the literature. State University of New York at Buffalo, 685 Baldy Hall, Buffalo, NY 14260-1050, USA.

Lyn Shipway: Domestic Violence: A Handbood for Health Care Professionals, Family & Relationships, 2004

Tamara L. Roleff: Domestic Violence: Opposing Viewpoints, Family & Relationships, 2000

Dawn Bradley Berry; The Domestic Violence Source Book, Family and Relationships, 2000

Ellyn Kaschak; Intimate Betrayal: Domestic Violence in Lesbian Relationships, Social Science, 2002

Blasko, Kelly A, Winek, Jon L, Bieschke, Kathleen J, Journal of Marital and Family Therapy, Apr 2007

U.S. Department of Justice. Stalking, January 2004