Violence Against Women
Medically Reviewed by Kelly Gray-Eurom, MD
Department of Emergency Medicine
Shands Jacksonville Medical Center
What Is It?
Violence against women, also known as interpersonal violence, is a crime of power and control. It occurs in the context of many different types of relationships and takes many forms.
Violence against women, also known as interpersonal violence, is a crime of power and control. It occurs in the context of many different types of relationships and takes many forms. It can happen within marriages, between siblings, roommates, dating couples and those in lesbian and gay relationships. Elderly members of a family can also be the objects of abuse by relatives.
In the majority of intimate partner violence incidents, men are the primary abusers. According to findings from the National Center for Injury Prevention and Control at the U.S. Centers for Disease Control and Prevention (CDC), about 1.5 million women and more than 800,000 men are raped or physically assaulted by an intimate partner every year. And the U.S. Department of Justice reported in 2000 that 25.5 percent of women and 7.9 percent of men reported being raped, physically assaulted and/or stalked by anintimate partner in their lifetimes.
According to the CDC's National Center for Injury Prevention, almost 5.3 million intimate partner victimizations of women age 18 and over take place each year, and 3.2 million occur among men. These attacks result in approximately two million injuries and 1,300 deaths each year. In 2001, intimate-partner violence accounted for 20 percent of all nonfatal violent crime experienced by women. In addition, one study showed that almost all (93 percent) of the women who were murdered by their intimate partner had been treated for at least one injury at the hands of that same person. Generally, victims of repeated physical violence experience more serious consequences than victims of isolated incidents.
The abuser may use a number of tactics other than physical violence in order to maintain power and control over his or her victim. There are three categories of abuse:
- Psychological abuse: Sometimes called mental violence, this type of abuse may include constant verbal abuse, harassment, stalking, excessive possessiveness, isolating the woman from friends and family, depriving her of physical and economic resources and destroying her personal property. The abuser may destroy objects or harm pets in front of the victim, and it may escalate to physical abuse. Psychological abuse can lead to psychological consequences for the victim, including depression, low self esteem, fear of intimacy, inability to trust men, anxiety, antisocial behavior and, in some cases, attempted suicide.
- Physical abuse: Physical abuse may begin with grabbing, pinching or shoving and often escalates into more serious and more frequent attacks including kicking, punching, biting, throwing objects, holding down, driving recklessly, blocking exists and sexual assault. Physical attacks and aggressive behavior, although they may not be life threatening at first, are not trivial and should not be excused or ignored. This abuse becomes life threatening when the attacks include choking, breaking bones or the use of weapons.
- Sexual abuse: Any time a woman is forced to take part in unwanted sexual activity, it is considered sexual violence. Physical abuse may be accompanied by, or culminate in, sexual violence, but there is a clear and distinct line between physical domestic violence and sexual abuse. Although some intimate partner abuse culminates in sexual abuse, the majority does not. And although perpetrators of sexual abuse sometimes physically harm their victims, it is unusual for sexual abuse perpetrators to be chronic intimate partner violence abusers.
Certain groups of women are at higher risk for becoming victims of abuse and violence. According to the National Center for Injury Prevention and Control, these include women who:
- are single, separated or divorced (or planning a separation or divorce)
- are between the ages of 17 and 28, especially under age 24
- abuse alcohol or other drugs or whose partners do
- have partners who are excessively jealous or possessive
- have a history of prior physical abuse
- have partners who are verbally abusive
- have a history of childhood abuse
- are unemployed or experiencing economic stress
- have experienced prior injury from the same partner
- have a low level of academic achievement
- lack social networks and tend to be socially isolated
There are also various relationship risk factors for violence and abuse, including the following:
- A male belief in strict traditional gender codes, such as the woman should stay at home and be submissive
- Couples with educational, income or job status disparities
- Male or female dominance in the relationship
Another form of violence against women is dating violence (sometimes called "date rape"). In this form of violence, one person purposely causes physical or psychological harm to another person they are dating. Dating violence can manifest itself as physical abuse, sexual assault and/or psychological/emotional abuse.
A victim of dating violence might unknowingly be given alcohol or slipped "date rape" drugs like Rohypnol in her drink. Alcohol and date rape drugs can make you unable to resist assault. You experience a type of amnesia so you're uncertain about what happened. This means you're left to cope with not only the trauma of the sexual assault, but the uncertainty surrounding the specifics of the crime. Unfortunately, most cases of dating violence are not reported to the police.
Like other forms of violence against women, dating violence is a serious crime that occurs in both casual and serious relationships, as well as in both heterosexual and same-sex relationships.
The physical and psychological health consequences of intimate partner and dating violence are very serious. Affected women experience more reported chronic health problems than unaffected women, including:
- Pain, gastrointestinal disorders and irritable bowel syndrome
- Higher rates of sexually transmitted diseases, central nervous system disorders and cardiac problems, although no history of cardiac disease.
- Gynecological disorders and unwanted pregnancies.
- Headaches and back pain
- Symptoms of post-traumatic stress disorder, including emotional detachment, flashbacks and sleep disturbances
In 2000, the U.S. Department of Justice reported on the extent, nature and consequences of intimate partner violence in the U.S. According to its findings, approximately 1.8 million women and one million men reported being raped and/or physically assaulted by an intimate partner in the past 12 months. These statistics do not take into account the occurrences of psychological abuse, which is harder to identify than physical or sexual abuse. Additionally, stalking by intimates is more prevalent than previously thought. According to CDC estimates, more than one million women and 371,000 men are stalked by an intimate partner every year.
An abuser can be anyone involved in a relationship with the victim: husbands, boyfriends, dating partners, same-sex partners and others. Many abusers were involved in or exposed to abusive relationships during their childhood. However, exposure to abuse is not a prerequisite for abusive behavior later in life.
The physical and psychological health consequences of intimate partner violence are very serious. Affected women have 60 percent more reported chronic health problems, including:
If you know someone who is involved in an abusive relationship, it may be difficult for you to understand why she doesn't just leave. The answer as to why women stay in violent relationships is complex.
Part of the reason is that domestic violence often occurs as a pattern of behavior known as the "cycle of violence." The cycle involves three phases:
- Phase 1: Tension builds. The abuser may threaten or push and shove the victim. The victim often reacts by working harder to keep the abuser calm. During this phase, the victim may believe that she can prevent a violent incident, but she is walking on eggshells. Her efforts typically fail.
- Phase 2: Violence occurs. The abuser may hit, beat, sexually abuse or use weapons against his partner. Women's lives are most often in danger during phase two.
- Phase 3: The "Honeymoon" Phase. The abuser apologizes to the victim and promises he won't harm her again. He may also blame his actions on her behavior. Often the partner accepts the abuser's apologies and forgives his behavior. The tension-building phase begins again, renewing the "cycle of violence."
If you or someone you know is trapped in this cycle of violence, talk to someone at the National Domestic Violence Hotline. Dial toll-free: 1-800-799-SAFE (7233) or TDD 1-800-787-3224 24 hours a day, 365 days a year in English, Spanish and other languages. If you think you are being stalked, call the Stalking Hotline at the National Center for Victims of Crime at 1-800-FYI-CALL (394-2255).
There are also many external barriers to women leaving a violent relationship. Reasons why women stay include:
- Lack of resources. Many women have children to support, yet they are not employed outside the home. Often the car, house, bank accounts and credit cards are in the abuser's name.
- Institutional responses. Clergy and secular counsel are often trained to save the marriage at all costs, despite the fact that abuse is occurring. Police officers often treat women not as victims of violent crime, but rather as participants in a domestic dispute. However, in most jurisdictions police can file charges against the perpetrator if women are afraid to. Prosecutors are sometimes reluctant to take legal action against abusers and when they do, the courts rarely levy heavy sentences. Restraining orders often do little to prevent an abuser from returning and repeating the assault. However, many women do not believe they will get support if they leave.
- Traditional ideology. MMany women do not believe divorce is an alternative to an abusive marriage. When children are involved, they may believe that an abusive father is better than no father at all. Also, women often feel responsible for the failure of their marriage. Because abused women may become isolated from family and friends by a jealous abuser, they may feel they have no one to turn to. Many times women will rationalize their partner's abusive behavior, blaming it on drugs, alcohol, stress or other factors. During non-violent "honeymoon" phases within the cycle of violence, the abuser may convince his victim that he is truly sorry and will not hurt her again. She may believe that her abuser is "basically a good person."
- Losing children. This is an enormous fear for women with children. They believe that in leaving they will lose their children.
Reaching out to a woman who is in an abusive relationship can be difficult. Here are some things you can say to her:
- I'm afraid for your safety
- I'm afraid for the safety of your children
- It will only get worse
- You deserve better than this
- Let's figure out a safety plan for you
- Reflect and recall the pattern of events (to stop the cycle of violence)
You may also call the National Domestic Violence Hotline toll-free at 1-800-799-SAFE (7233) or TDD 1-800-787-3224 for advice on helping a victim escape a violent relationship. You can help someone who thinks they are being stalked by telling her to call the Stalking Hotline at 1-800-FYI-CALL (394-2255).
Prevailing myths about intimate-partner violence often encourage denial about abusive situations and prevent women from getting the help they need. Remember: Domestic violence can happen in any type of relationship, income level, environment or culture. Common myths associated with domestic and intimate partner violence include:
Myth: Family violence is rare. Truth: Although statistics on family violence are not precise, it's clear that millions of children, women and even men are abused physically by family members and their closest relations or partners.
Myth: Family violence is confined to the lower classes. Truth: Reports from police records, victim services and academic studies show domestic violence exists in every socioeconomic group, regardless of race or culture.
Myth: Alcohol and drug abuse are the real causes of violence in the home. Truth: Because many male batterers also abuse alcohol and other drugs, it's easy to conclude that these substances may cause domestic violence. Substance abuse increases the risk for and lethality of the violence. But for some men, battering begins when they come off of drugs and other substances. Substance use and abuse are not excuses for a batterer's behavior or for his failure to take responsibility for his behavior, however. In addition, successful completion of a drug treatment program does not guarantee an end to battering. Domestic violence and substance abuse are two different problems that both require treatment.
Myth: Battered wives like being hit, otherwise they would leave…Truth: The most common response to battering—"Why doesn't she just leave?"—ignores the economic and social realities facing many women. Shelters are often full; and family, friends and the workplace are frequently less than supportive. Faced with rent and utility deposits, day care, health insurance and other basic expenses, the woman may feel that she cannot support herself and her children. Moreover, in some instances, the woman may be increasing the chance of physical harm, death or losing her children if she leaves an abusive partner.
Are you in an abusive or potentially abusive relationship? Here are some questions to ask yourself about how you are being treated by your partner and how you treat your partner.
Does your partner:
Embarrass or make fun of you in front of your friends or family?
Put down your accomplishments or goals?
Criticize you for little things?
Constantly accuse you of being unfaithful?
Control your use of needed medicines?
Make you feel like you are unable to make decisions?
Use intimidation or threats to gain compliance?
Tell you that you are nothing without him or her?
Control how you spend money?
Treat you roughly—grab, push, pinch, shove or hit you?
Call you several times a night or show up to make sure you are where you said you would be?
Use drugs or alcohol as an excuse for saying hurtful things or abusing you?
Blame you for how he or she feels or acts?
Pressure you sexually for things you aren't ready for?
Make you feel like there "is no way out" of the relationship?
Destroy your property or things you care about?
Prevent you from doing the things you want, like spending time with your friends or family?
Try to keep you from leaving after a fight or leave you somewhere after a fight to "teach you a lesson?"
Sometimes feel scared of how your partner will act?
Constantly make excuses to other people for your partner's behavior?
Believe that you can help your partner change if only you changed something about yourself?
Try not to do anything that would cause conflict or make your partner angry?
Feel like no matter what you do, your partner is never happy with you?
Always do what your partner wants you to do instead of what you want?
Stay with your partner because you are afraid of what your partner would do if you broke up?
If you answered yes to any of these questions, you may be in an abusive or potentially abusive relationship. If you do not seek help, the abuse will continue.
Ultimately, you can take the first step toward getting help by confiding in your health care professional. If you find yourself in a health care professional's office, an emergency room or clinic for treatment as a result of abuse, take the opportunity to talk to the health care professional about why you're there. Today, many health care professionals are trained to notice signs and symptoms of abuse, and they know how to help you. It might be up to you, however, to bring up the topic.
Emotional and verbal abuse, attempts to isolate and threats and intimidation within a relationship may be an indication that physical abuse is to follow. Even if these behaviors are not accompanied by physical abuse, they must not be minimized or ignored.
If you are dating, learn how to minimize your risk of becoming a victim of dating violence before you find yourself in an uncomfortable or threatening situation.
If you are already in an abusive relationship, take the following actions to prevent the violence from escalating:
Share your situation with someone you can trust. Tell a family member or friend what's going on.
Prepare NOW for your escape. Make plans for what you will do if you are attacked again.
Locate a safe place for you and your children to go—a friend's house or a shelter. A crisis hotline or your local police can help you find a shelter.
Have a back-up plan in mind just in case your first plan doesn't work.
Build a survival kit including a spare set of keys, clothes, birth certificates, passports, divorce/custody/separation agreements, protection orders, prescriptions, bank cards and money. Ask someone you trust to keep these items for you.
Contact your local family court or domestic violence court for information about getting a civil protection order.
Try not to let the abuser trap you in a kitchen with potential weapons or in small places like a bathroom.
If you are injured, go to a hospital or health care professional's office, tell the health care professional who treats you what happened and make sure he or she writes it in your medical records.
Try to open a savings account in your own name. Ask someone you trust to keep the account statements, and have the statements sent directly to that person. Keep some emergency cash in a safe place near an escape exit.
Know your rights. Contact the shelter or women's center in your area to find out about your legal rights and what resources are available in the community.
If you are in immediate danger, don't wait—call 911.
Facts to Know
Help is available by calling the National Domestic Violence Hotline at 1-800-799-SAFE (7233) or TDD 1-800-787-3224. You can reach the National Sexual Assault Hotline at 1-800-656-4673. And the Stalking Hotline number is 1-800-FYI-CALL (394-2255).
Women living with female intimate partners experience less intimate-partner violence than women living with male intimate partners. However, men living with male intimate partners experience more intimate-partner violence than do men who live with female intimate partners.
Unmarried couples are at greater risk of intimate partner violence than married couples.
According to the U.S. Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control, women who experience intimate partner violence are more likely to have been unemployed in the past and are more likely to be receiving public assistance. Ironically, however, women with an education level higher than their partners' are also more likely to become victims of intimate partner violence.
Women are primarily raped and/or physically assaulted by intimate partners and are more likely than men to be injured during an assault. Approximately 1,300 women are murdered every year by an intimate partner, according to the U.S. Department of Justice.
The CDC reports that people with disabilities are four to 10 times more likely to become victims of abuse than people without disabilities, and that women with disabilities report a greater number of perpetrators of physical violence, emotional abuse or sexual abuse—and for longer periods of abuse—than women without disabilities.
A batterer may be pleasant and charming between periods of violence, and is often seen as a "nice person" to outsiders. Some behavioral warning signs of a potential batterer include extreme jealousy, possessiveness, a bad temper, unpredictability, cruelty to animals and verbal abusiveness.
Women and men who were physically assaulted as children by adult caretakers are significantly more likely to report being victimized by their current partner. One-third of women who are physically abused by a husband or boyfriend grew up in a household where their mothers were similarly abused. About one in five were abused themselves as children or teenagers. Children who witness violence at home or who are abused themselves are more likely to abuse their own children when they become parents
Information from the U.S. Department of Justice shows that violence perpetrated against women by intimate partners is rarely prosecuted.
It is important to realize that a woman who begins to talk about her situation is reaching out for help and making an effort to involve someone in her situation. Family and friends should be supportive of her attempts to escape her abuser, since there are often financial and psychological barriers standing in her way.
Questions to Ask
Review the following Questions to Ask about violence against women so you're prepared to discuss this important health issue with your health care professional.
Will you keep a record of all my injuries as a result of abuse?
Will you provide a copy of my medical records, including a documented history of abuse?
What domestic violence resources are available in my community?
What can I say to my friend to help her recognize that she is in a violent relationship?
What are the warning signs of an abusive relationship?
How can I prepare to leave my abuser?
How can I explain to my children why we are leaving my abuser?
What precautions should I take after leaving my abuser?
When does normal strife within a relationship become psychological abuse?
Should I seek psychological treatment to help me deal with the long-term effects of being a victim of abuse?
If things are so bad, why doesn't she just leave her abuser?
Shelters often are full, and family, friends and the workplace are frequently less than fully supportive of a woman fleeing an abusive relationship. Faced with rent and utility deposits, day care, health insurance and other basic expenses, she may feel that she cannot support herself and her children. In some instances, the woman may be increasing the chance of physical harm or even death if she leaves an abusive partner.
What can I do to convince my friend that she needs to leave her abusive partner?
Explain to her that you are afraid for her safety and the safety of her children. Assure her that the abuse will likely continue to escalate and will definitely not go away. Tell her that she deserves better than this and offer to help her devise a plan for escape.
What if she will not or does not want to leave?
Encourage her to investigate local resources for counseling and temporary shelter, or other social services she or her family may need. Sometimes abusers can be persuaded, or court-ordered, to enroll in anger-management programs for intensive therapy aimed at rechanneling rage. Additionally, the woman needs continued support—it may take a victim months or even years before she feels safe enough to leave.
Is it still considered abuse even if he doesn't physically harm her?
Yes. Psychological abuse, sometimes called mental violence, may include constant verbal abuse, harassment, excessive possessiveness, isolating the woman from friends and family, deprivation of physical and economic resources and destruction of personal property in her presence. The abuser may destroy objects or harm pets in front of the woman. Psychological abuse often escalates to restraining, pushing, slapping and/ or pinching.
If I can get my partner to stop drinking so much, will that help calm his abusive behavior?
Probably not. Although abuse is often blamed on alcohol and drug use, abusers rarely stop their abusive behavior even after completion of a drug or alcohol treatment program. Abusive behavior and substance abuse are two separate issues that both require treatment.
How can I prepare for the day when I finally leave for good?
Begin now to build a survival kit containing a spare set of keys, clothes, birth certificates, passports, divorce/custody/separation agreements, protection orders, prescriptions, bank cards and money. Ask someone you trust to keep these items for you. If you are concerned about leaving important items and money with someone, get a safety deposit box.
How can I leave my husband when he always seems so sorry after he hits me?
Your husband's apologies may seem sincere for the moment, but they are part of the cycle of violence. After a violent incident, most abusers apologize and promise to stop hurting their victims. But soon after the "honeymoon" is over, violent tension begins to build again and will inevitably result in more abuse.
Am I doing something to provoke my husband's rage?
Like other abusers, your husband would like for you to believe that his violent behavior is your fault. It is not. And by the same token, there is nothing you can do or say to prevent the abuse from continuing, except to leave. Its important to understand that one reason the abuser attacks you is because he sees you as vulnerable, not because he has a tendency to attack all women.
Can sexual abuse occur between husband and wife?
Yes. Sexual abuse is any type of unwanted sexual activity. Sexual abuse can occur within a marriage or between lovers. Physical abuse may accompany or culminate in, sexual violence. However, a few states still don't allow women to charge their husbands with a sexual crime. Sexual abuse can include the abusers' insistence on total control of the woman's sexual life, including the type of contraception she is "allowed" to use, or the insistence that she cannot use any contraception. Today, more contraception choices are available to women and may be used without detection. Every woman should also know about and have access to emergency contraception, the so-called "morning-after" pill that can prevent a pregnancy from occurring after unprotected sex
Organizations and Support
American Women's Self-Defense Association
Address: 556 Route 17 North, Suite 7-209
Paramus, NJ 07652
Hotline: 1-888-STOP-RAPE (1-888-786-7727)
Email: [email protected]
End Violence Against Women
Address: Johns Hopkins University Center for Communication Programs (JHU/CCP)
111 Market Place, Suite 310
Baltimore, MD 21202
Email: [email protected]
Institute on Violence, Abuse and Trauma
Address: 10065 Old Grove Road
San Diego, CA 92131
Phone: 858-527-1860 x. 4160
National Domestic Violence Hotline
Address: P.O. Box 161810
Austin, TX 78716
Hotline: 1-800-799-SAFE (1-800-799-7233)
National Resource Center on Domestic Violence
Address: 6400 Flank Dr Suite 1300
Harrisburg, PA 17112
Office on Violence Against Women
Address: 800 K Street, N.W., Suite 920
Washington, DC 20530
Rape, Abuse and Incest National Network (RAINN)
Address: 2000 L Street NW, Suite 406
Washington, DC 20036
Hotline: 1-800-656-HOPE (1-800-656-4673)
Email: [email protected]
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