Excerpted from the CE Course Domestic Violence: Child Abuse and Intimate Partner Violence Professional Development Resources, 2012.

The essential paradox of family violence is that – while it affects so many individuals so adversely in all sectors of society – it is only minimally discussed because of the stigma and is only poorly understood and confronted by the legal, professional, and social systems that are responsible for protecting and treating victims. Individual cases of abuse frequently go undetected for many years, largely due to the shroud of shame and silence that still persists today, in spite of all efforts to bring domestic violence to light and to justice. It crosses all social and cultural boundaries, including demographic, socioeconomic, and religious strata. The status of family abuse victims has even been compared to that of individuals who had HIV/AIDS in the early 1980s when the disease was barely recognized, hardly discussed, highly stigmatized, and often ignored or denied. While we have made impressive strides in the battle against HIV/AIDS in the last three decades, we have made relatively little progress in the area of family violence.

Child Abuse

Child abuse, in spite of progress in protecting the rights of children, remains a dire social issue. One study cited government data indicating that in just one year in the U.S., substantiated cases of child abuse totaled over 700,000 children – about 1.3% of the population of children. To make matters worse, the long-term sequelae include a wide range of serious consequences, such as physical injuries, impaired brain development, behavioral disturbances, substance use disorders, and a variety of psychological disorders. In addition, there are a number of mechanisms by which children who are abused may grow up to create disturbed relationships with their own children and their spouses.

Child abuse continues to occur at significant rates in U.S. society. Nearly 1½ % of children were victims of child abuse in a single year (2008). Approximately 72% of them experienced neglect, 16% were physically abused, 9% were sexually abused, and 7% were psychologically/emotionally abused. More than half of these children were under 8 years of age. Disturbing as these numbers are, they probably represent only the tip of the iceberg. Not all incidents of abuse are reported or substantiated. The actual prevalence of child maltreatment is much higher than the substantiated rate.

Studies have estimated that one in seven, or nearly 15% of youths are maltreated at some point in childhood or adolescence. The number of unreported instances is far greater, because the children are afraid to tell anyone what has happened, and the legal procedures for validating an episode can be difficult. The long-term emotional and psychological damage of physical and/or sexual abuse can be devastating to the child. The problem needs to be identified, the abuse stopped, and the child and family offered professional help.

Child abuse can take place within the family, by a parent, stepparent, sibling or other relative; or outside the home, for example, by a friend, neighbor, childcare person, teacher, or stranger. When abuse has occurred, a child can develop a variety of distressing feelings, thoughts and behaviors.

Do Abused Children Become Abusers? The concept of intergenerational transmission of family violence should be viewed with caution. First, it is very important for abused children to avoid developing the expectation that they are bound to repeat history. Second, there is no reliable empirical consensus in support of the idea that children who are abused are likely to become abusers. As Hall (2011) warns, “Although there is empirical data that parents who have been abused have higher rates of abusing their own children, the idea that family violence can be directly linked to abuse in the next generation has become controversial because definitions of abuse and rates of reporting are inconsistent and methodological challenges for child abuse research abound…. My research suggests that there may be gaps in these theories….. some children may learn not to do something they that they see is harmful or ineffective.” Hall advocates shifting to a strengths-based framework of intervention that places the focus of treatment on individual competencies in order to give individuals the opportunity to avoid repeating dysfunctional patterns.

Intimate Partner Violence (IPV)

Intimate partner violence (IPV) is, unfortunately, also a pervasive part of life in U.S. society. In surveys, over 35% of women and nearly 28% of men say they have been raped and/or physically assaulted and/or stalked by a current or former spouse, cohabiting partner, or date at some point in their lifetime. Survivors of these forms of violence may experience physical injury, mental health consequences like depression, anxiety, low self-esteem, and suicide attempts. Other health consequences like gastrointestinal disorders, substance abuse, sexually transmitted diseases, and gynecological or pregnancy complications are also common. These findings suggest that intimate partner violence is a serious concern in mental health, criminal justice and public health.

As is the case with child abuse, intimate partner violence is a widespread social issue. In surveys, over 35% of women and 28% of men say they have been raped and/or physically assaulted and/or stalked by a current or former spouse, cohabiting partner, or date at some time in their lifetime. According to the National Intimate Partner and Sexual Violence Survey [NISVS], “Sexual violence, stalking, and intimate partner violence are major public health problems in the United States. Many survivors of these forms of violence can experience physical injury, mental health consequences such as depression, anxiety, low self-esteem, and suicide attempts, and other health consequences such as gastrointestinal disorders, substance abuse, sexually transmitted diseases, and gynecological or pregnancy complications. These consequences can lead to hospitalization, disability, or death.”

Current findings consistently indicate that IPV is a pattern, not an isolated event. In a nationally representative sample of 8,000 women and 8,000 men, aged 18 and older, the National Violence against Women Survey reported that two thirds of women physically assaulted by a partner had been victimized multiple times.

One positive note is that there seem to be indications that some forms of IPV may be on the decline in recent years. For example, the National Crime Victimization Survey indicated that the rate of intimate partner violence for females decreased from 4.2 individuals per 1,000 in 2009 to 3.1 individuals per 1,000 in 2010.

Definitions of Terms

Five types of intimate partner violence are described in the NISVS. These include sexual violence, stalking, physical violence, psychological aggression, and control of reproductive/sexual health.

1. Sexual violence includes rape, being made to penetrate someone else, sexual coercion, unwanted sexual contact, and non-contact unwanted sexual experiences.

2. Physical violence includes a range of behaviors from slapping, pushing or shoving to severe acts such as being beaten, burned, or choked.

3. Stalking victimization involves a pattern of harassing or threatening tactics used by a perpetrator that is both unwanted and causes fear or safety concerns in the victim.

4. Psychological aggression includes expressive aggression (such as name calling, insulting or humiliating an intimate partner) and coercive control, which includes behaviors that are intended to monitor and control or threaten an intimate partner.

5. Control of reproductive or sexual health includes the refusal by an intimate partner to use a condom. For a woman, it also includes times when a partner tried to get her pregnant when she did not want to become pregnant. For a man, it also includes times when a partner tried to get pregnant when the man did not want her to become pregnant.

Domestic violence, in the form of child abuse and intimate partner violence, remains a pervasive part of contemporary life in the U.S. Its effects are deep and far-reaching. As noted throughout the course, it crosses all social and cultural boundaries, including demographic, socioeconomic, and religious strata. This course has endeavored to help health professionals to understand the far-reaching effects of violence on child development, on individuals, families, and society. In consideration of the very high prevalence of domestic violence, they need to maintain a high state of vigilance and to be well prepared with immediate and appropriate responses when abuse is disclosed. In particular, professionals need to appreciate the complexity of an abuse victim’s decision about if and when to leave an abuser. As stated in the course, leaving a relationship is a process that occurs over time. The challenge to clinicians is to detect abuse when they see it, screen for the particulars, and respond with definitive assistance in safety planning, community referrals, and individualized treatment plans.

If you would like the full text of this publication, it is available at Amazon.com in Kindle format at http://www.amazon.com/Domestic-Violence-Child-Intimate-Partner-ebook/dp/B00I2WYFW2

If you would like to read this entire article and receive two hours of continuing education credit, visit Professional Development Resources at https://pdresources.org/course/index/1/1111/Domestic-Violence-Child-Abuse-and-Intimate-Partner-Violence

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