Dr. Francis SANWO

Intimate partner violence (also called domestic violence, domestic abuse, spousal abuse, and intimate partner abuse) is  any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviours (WHO).

It is a major public health problem, due to its affecting more than 2 million women and 800,000 men and resulting in homelessness, injury, or death of victims, billions of dollars in health care costs, and lost work productivity. It strikes couples of all races, religions, social economic status, and sexual orientations. 

The violence may be by a current or former spouse or partner in an intimate relationship against the other spouse or partner. Domestic violence may be reciprocal, in which both partners are violent, and non-reciprocal violence, in which one partner is violent.

The most extreme form of such violence may be termed battering, intimate terrorism, coercive controlling violence, or simply coercive control, in which one person is violent and controlling; this is generally perpetrated by men against women, and is the most likely of the types to require medical services and the use of  women's shelter. Men are less likely to report domestic violence perpetrated by their female intimate partners.

Intimate partner violence may occur between heterosexual or homosexual couples and victims can be male or female. Couples may be dating, cohabiting or married and violence can occur in or outside of the home.

Both men and women could be abusers or victims of domestic violence. Women are more likely to act violently in retaliation or self-defense and tend to engage in less severe forms of violence than men whereas men are more likely to commit long-term cycles of abuse than women.

About 30% of women globally aged 15 and older have experienced physical and/or sexual intimate partner violence. Although there is no specific cause for domestic violence, women at the highest risk for being the victim of domestic violence include those with male partners who abuse drugs (especially alcohol), are unemployed or underemployed, afflicted by poverty, have not graduated from high school, and are or have been in a romantic relationship with the victim. A mind-set that gives men power over women puts individuals at risk for becoming involved in an abusive relationship, either as a perpetrator or as a victim.

Regular attendance at religious services is apparently associated with less reported intimate partner abuse. Research shows that those who grew up in a household in which domestic violence took place or in which a parent suffered from alcoholism are more likely to become either perpetrators or victims of intimate partner violence as adults. 

 Warning signs and symptoms of intimate partner abuse for friends, family members, and co-workers for recognizing people who may be victims of intimate partner abuse includes  absence from school or work or have numerous injuries they try to explain away, like bruises or black eyes. Individuals with low self-esteem, who show a change in their personality, have a fear of conflicts, engage in passive-aggressive behavior, blame themselves, seem isolated, or demonstrate stress-related physical symptoms (for example, headaches, stomach upset, sleep problems, or skin rashes) may be experiencing abuse in their relationship.

 

Forms of intimate partner violence are as follows:

Physical violence, sexual violence, stalking, and psychological aggression.    

Physical violence is the intentional use of physical force with the potential for causing death, disability, injury, or harm. Physical violence includes, but is not limited to: Scratching, pushing, or shoving, throwing, grabbing, or biting, choking, shaking, aggressive hair pulling, slapping, punching, hitting or burning. Others are use of a weapon, use of restraints or one’s body, size, or strength against another person. Physical violence also includes coercing other people to commit any of the above acts.

Physical violence is often accompanied by psychological abuse and, in one-third to one-half of cases, by sexual abuse.

Women experience more chronic and injurious physical assaults at the hands of intimate partners than do men.  More severe physical injuries may occur depending on severity and frequency of abuse. Physical violence can lead to death.

Sexual violence is divided into five categories, any of which constitute sexual violence, whether attempted or completed. These are rape or penetration of victim, victim was made to penetrate someone else, non-physically pressured unwanted penetration, unwanted sexual contact and non-contact unwanted sexual experiences. Additionally, all of these acts occur without the victim’s consent, including cases in which the victim is unable to consent due to being too intoxicated (e.g. incapacitation, lack of consciousness, or lack of awareness) through their voluntary or involuntary use of alcohol or drugs.

Stalking is a pattern of repeated, unwanted, attention and contact that causes fear or concern for one’s own safety or the safety of someone else (e.g. family member or friend). Some examples include repeated unwanted phone calls, emails, or texts; leaving cards, letters, flowers, or other items when the victim does not want them; watching or following from a distance; spying; approaching or showing up in places when the victim does not want to see them; sneaking into the victim’s home or car; damaging the victim’s personal property; harming or threatening the victim’s pet; and making threats to physically harm the victim.

Psychological aggression is the use of verbal and nonverbal communication with the intent to harm another person mentally or emotionally, and/or to exert control over another person. Psychological aggression can include: Expressive aggression (e.g. name-calling, humiliating), coercive control (e.g. limiting access to transportation, money, friends, and family; excessive monitoring of whereabouts), threats of physical or sexual violence; control of reproductive or sexual health  and presenting false information to the victim with the intent of making them doubt their own memory or perception (e.g. mind games).

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Intimate terrorism

Intimate terrorism, or coercive controlling violence (CCV), occurs when one partner in a relationship, typically a man, uses coercive control and power over the other partner, using threats, intimidation, and isolation.  Often, threats are alternated with acts of kindness from the perpetrator, making it difficult for the victim to break free of the cycle of violence.

Intimate terrorism is more likely to escalate over time, not as likely to be mutual, and more likely to involve serious injury. Severity tends to increase with multiple incidents, especially if the abuse comes in many forms. Consequences of physical or sexual intimate terrorism include chronic pain, gastrointestinal and gynecological problems, depression, post-traumatic stress disorder, and death. Other mental health consequences are anxiety, substance abuse, and low self-esteem.

Situational couple violence

Situational couple violence, also called common couple violence, is not connected to general control behavior, but arises in a single argument where one or both partners physically lash out at the other. This is the most common form of intimate partner violence, particularly in the western world and among young couples, and involves women and men nearly equally.

In situational couple violence, acts of violence by men and women occur at fairly equal rates, with rare occurrences of injury, and are not committed in an attempt to control a partner. It is estimated that approximately 50% of couples experience situational couple violence in their relationships.

. Consequences of Domestic Violence.

In general, victims of repeated violence experience more serious consequences than victims of one-time incidents. Women with a history of intimate partner violence are more likely to display behaviors that lead to further health risks such as substance abuse, alcoholism, and suicide attempts.

Some victims may engage in high-risk sexual behaviors such as unprotected sex, early sexual initiation, choosing unhealthy or multiple sexual partners, or trading sex for food, money, or other items. There is often an increased use of harmful substances and illicit drug use, alcohol abuse, and driving while intoxicated. Victims of intimate partner violence may also engage in unhealthy diet-related behaviors such as smoking, fasting, vomiting, overeating, and abuse of diet pills. They may also overuse health services.

Psychological Consequences of Intimate Partner Violence includes Inability to trust others, fear of intimacy, emotional detachment, sleep disturbances, flashback, anxiety and depression. Others are antisocial behavior, suicidal behavior in females and low self-esteem.

Children exposed to domestic violence may be the victims of co-occurring maltreatment. In particular, domestic violence is a significant risk factor for verbal abuse, physical punishment, and physical abuse of children.

There is evidence that children who are exposed to domestic violence and also experience maltreatment are at risk for poor development.

Intimate partner violence is often associated with the abuse of children. This is an important public health issue because witnessing violence in the home as a child is a strong risk factor for involvement in abusive relationships as an adult. In addition, experiencing abuse as a child has been associated with other risk factors such as depression, substance abuse, poor school performance, and high-risk sexual activity.

 Prevention and Treatment.

Getting and keeping the victim of domestic violence safe is an essential part of treating domestic abuse. Many legal and mental health professionals who work with victims recommend the development of safety plans, both for home and in the workplace. Such a plan includes encouraging the victim to keep a charged cell phone in his or her possession at all times, maintaining active peace, protective, or restraining orders against the batterer, keeping a copy of the order at all times, along with distributing copies of the order to the victim's supervisor, workplace reception area, and security, as well as to schools and day care providers for children. It is important for battered men and women to realize that abusers sometimes escalate in their abusiveness when first served with a protective order and to take appropriately heightened safety precautions. Other elements of a safety plan may include the victim changing his or her work site, parking, or work schedule, having an emergency contact person, and establishing danger signals to alert neighbors or co-workers that the victim is in immediate danger. 

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