Domestic abuse

Overview
Domestic abuse is any type of threat or behavior within a family or intimate relationship intended to control, coerce, humiliate or degrade another person. To maintain power, the abuser may use fear, intimidation, threats, physical violence or sexual assault. He or she may isolate the victim and deprive him or her of food, money, transportation and access to health care. If the behavior is violent, it's specifically called domestic violence.
Domestic abuse affects people from all social, racial, economic, educational and religious backgrounds, as well as sexual orientations. It occurs in both adult and adolescent relationships and among people who are dating, married and separated -- although it's most common when factors such as unemployment, poverty, alcoholism and substance abuse are present. Domestic abuse affects family members as well, not just the person who is the target of the violence.

Separation violence refers to attacks in the context of a divorce or separation. This type of violence is often fueled by an abuser's belief that he or she is entitled to control the other person's behavior, even after separation or divorce. Women who leave abusive relationships have a 75 percent greater risk of being killed in an episode of domestic violence than women who stay.

An estimated 20 to 30 percent of marriages in the United States have been characterized at one point by overt physical aggression. Up to 4 million women in the United States are physically abused by their partners every year. An estimated 20 to 30 percent of women and about 7 percent of men are physically or sexually abused by intimate partners at some point in their lives. While men generally use violence to maintain power and control, women typically use violence in self-defense, anticipation of violence or retaliation. Women who are being abused report tremendous fear of violence and injury by their partner

Domestic abuse may take a variety of other forms in addition to physical violence, including:

psychological abuse: instilling fear or degradation by threatening to do bodily harm
emotional or verbal abuse: hurting another person's feelings through cruel, unfair comments, name calling or threatening to embarrass the person in front of others
sexual abuse: forcing any unwanted sexual acts or behaviors on another person
financial abuse: managing or withholding money to control another person
legal abuse: using the legal system to control another person, such as dragging the person through a vicious court battle and amassing large legal fees during a divorce or refusing to pay child support or alimony
social isolation: attempting to block a person from outside contact, either through friends, family, work or other activities
Some abusers lash out physically only once in a while. In some cases, the mere threat of violence may reinforce the power of other abuse tactics, such as emotional abuse or isolation. Together, the separate types of abuse often undermine the abused person's ability to act autonomously.

Violence cannot be justified as an impulse control disorder or a symptom of another mental illness. Substance use aggravates the occurrence, frequency and severity of domestic abuse.


Domestic abuse and older adults
Domestic abuse can occur at any age. The risk may increase after retirement. Elderly adults who have medical conditions, especially elderly women, may rely on the abuser for health care coverage and transportation, making disclosure of the abuse less likely. Compounding the issue, domestic violence as a cause of injury for older adults is often overlooked. Although elder abuse may be related to caregiver stress, this should not be assumed in all cases.

Domestic abuse and sexual orientation
People who are homosexual often face additional challenges when confronted with domestic abuse. If they haven't disclosed their sexual identity to their families or co-workers, their only support network may be the abusive partner. This can make it especially difficult to leave the abusive relationship. The abuser may also threaten to reveal the partner's sexual orientation if he or she leaves. In some cases, this may result in the loss of health care, employment or housing. The person being abused may also risk losing contact with children he or she has parented if the abuser is the legally recognized parent.
Dispelling the gender assumptions about victims and perpetrators, domestic violence among the gay and lesbian population highlights that men can be victims and women can batter. In fact, an estimated one in four gay men experience domestic violence.


Impact of domestic violence on children
Adults who experience domestic violence are more likely to have a number of children in the home -- typically children under age 5. Children account for 70 percent of people who enter domestic abuse shelters. Sadly, domestic violence can teach children that violence toward a loved one is acceptable behavior. After age 5 or 6, a child might begin to identify with the aggressor and/or lose respect for the person being abused.
Children who experience domestic violence may develop a range of emotional, behavioral, social or academic problems. For example, they may become afraid to go to school or even leave the house. They may experience low self-esteem, sadness, depression and fear, as well as a risk of being harmed through trying to stop the violence. They may become lonely and feel powerless. Bedwetting, insomnia and nightmares are other possible reactions to domestic violence. Eventually, children who grow up in violent situations may develop poor impulse control and face an increased risk of alcohol use, drug use and suicide.

Boys who experience violent situations may become disobedient and behave aggressively, defiantly and destructively. Adolescent boys who witness family violence may be especially likely to assault the parent being abused and/or their siblings. Girls in the same situation tend to become withdrawn, clingy and dependent.


Impact of domestic violence on the workplace
The effects of domestic violence do not fade when the abused person reports to work. American businesses lose money every year due to lost wages, sick leave, absenteeism and lowered productivity related to domestic violence. Domestic violence also impacts the abused person's co-workers. As other employees begin to suspect domestic violence, their own levels of fear and distraction may increase.

Domestic abuse and medical consequences
Domestic violence is a leading cause of injury for women. In the United States, an estimated 22 to 35 percent of emergency room visits by women are a direct result of domestic violence. Up to 50 percent or more women in the emergency room report physical or emotional abuse by their partners. These women often seek emergency care due to poor control of chronic conditions -- not the injuries sustained from the abuse.

Domestic abuse and pregnancy
An estimated 20 percent of pregnant women experience domestic violence during pregnancy. Four to 8 percent report an increase in violence during pregnancy. Sadly, domestic violence during pregnancy can lead to maternal and fetal injuries, preterm labor and other complications. Poor nutrition and poor prenatal care are more common among women who are being abused.

Characteristics
Physically, a person who is being abused may have unexplained or frequent injuries, fatigue, weight loss or gain, or tense muscles. Psychologically, he or she may be in denial or experience flashbacks or outbursts of irritability or anger. The person may feel trapped or stuck, as well as isolated and lonely. Many people who are abused by a loved one have feelings of self-blame, self-doubt or shame. Eventually, he or she may feel detached or numb. It may become easier to simply avoid new people, activities or situations.
Behaviorally, the abused person may try to hide signs of abuse, often by wearing heavy makeup, long sleeves or sunglasses. He or she may avoid medical care, become overly guarded and switch health care providers often. Many people who are abused try to keep the peace by pleasing everyone, while others simply give up. There might be attempts to fade into the background to avoid calling attention to himself or herself. The person may even rationalize the abuse by thinking that someone else's situation is worse.

For batterers, the need to control and socially isolate their partners is common. Batterers may be jealous or emotionally dependent on their partners, as well as unable to sustain emotional attachments. Batterers often have low self-esteem and a tendency to minimize or deny the abuse. They often use aggression to regulate feelings of shame or abandonment.

If you've been abused, consult a doctor for a medical evaluation. Symptoms such as sleep disturbances, decreased energy, changes in appetite, anxiety, depression, inability to concentrate and hopelessness may also warrant further evaluation by a health care professional.


Obstacles that may prevent victims from leaving
Leaving an abusive relationship can be very difficult. Feeling ashamed or somehow responsible may stop a person from leaving an abusive relationship. Others may hope the abusive partner will change. Often, a fear for personal safety or the safety of others is a factor. Immigrant women may be fearful of deportation. Other obstacles may include a desire to keep children in an intact home, economic dependence on the abuser, cultural or religious constraints, lack of resources or support, low self-esteem, or fear of losing status in the community.

Coping strategies
If you're being abused, remember the abuser is responsible for his or her behavior. Violence is a behavior of choice -- a dysfunctional, destructive choice with negative consequences. You cannot cause the violence or eliminate it. Provocation does not provide justification for violence, nor can violence be justified as an emotional disorder. Although violence is a learned behavior, nonviolent alternatives can be learned as well.

Legal and financial issues
You may want to seek legal or financial services. For example, it may be helpful to file an order for protection or a restraining order, learn how to protect yourself and your property, learn the implications of leaving the home, or seek assistance with general separation, divorce or custody concerns.

Emotional issues
It's common to feel conflicted or ambivalent, sometimes out of love, fear, confusion or grief. People who are abused often feel guilty and shameful as well. Guilt is a rational emotion based on what you do or fail to do. To ease guilt, take steps to correct the problem. Shame is an irrational emotion based on a faulty perception of who you are. Shame breaks down your self-esteem. To combat shame, challenge any irrational assumptions you're making.
Make an effort to build on your strengths, even if you've been told you're incapable of making good decisions. Such destructive statements are simply part of the pattern of abuse. If you plan to leave, don't tell your partner ahead of time -- just go. You may be at increased risk if you give your partner advance warning.


Safety issues for leaving
If you're considering leaving, develop a safety plan and review it on a monthly basis. Keep copies of any important documents (such as birth certificates, medical records, separation agreements, protection orders, insurance information and credit card account numbers) in a safe place inaccessible to the abuser, such as a concealed place in your home or at the home of a trusted friend or relative.
It's also important to make a survival kit. Keep anything you need for an overnight stay (such as car keys, a change of clothes, medication and other personal items) in a bag that can be easily accessed if you need to leave in a hurry. Plan a method of escape and, if possible, rehearse the escape routes.

Know your destination before you go, such as a safe house, shelter, or the home of a trusted friend or family member. Finally, keep important phone numbers handy, such as a domestic violence hotline. If feasible, carry a cellular phone and keep it charged.

To remain safe after leaving, don't return home alone. If you must return, it's preferable to be escorted by a law enforcement official. If you're employed outside the home, it's generally a good idea to inform your employer of your situation and, if necessary, request an escort in and out of the workplace. If you have children, provide instructions with anyone who cares for them, including child care providers, teachers and coaches, regarding who has permission to pick up the children and what type of information should be kept confidential.

If you're in the position of needing to evade an abuser, it may be helpful to get a new Social Security number. This is a major step that should not be taken lightly, of course. Contact the Social Security Administration for more information.


Safety issues for remaining in the home
If you decide to stay for now, know how to protect yourself even if you don't think there will be a "next time." However, don't wait until more violence erupts or you sustain further injury before leaving the abusive situation. On a practical level, stay out of the kitchen, bathroom, garage or any room that doesn't have an outside access during an argument. These rooms have the highest likelihood of physical injury. Don't escalate conflict, and don't attempt to get "the last word" in an argument. Disengage from the argument at the first sign of violence or threatened violence by walking away and leaving your home. Don't stop to explain your actions.
Whether you decide to stay or leave, you may want to seek individual, family or group counseling, as well as attend a support group for people coping with abusive situations.


Summary
If you're being abused, remember that no one has the right to hurt or threaten you or your children. The abuse is not your fault and it's not under your control. However, you can control how much you will tolerate. Remember that you have the power to improve your life. The first step is to reach out and ask for help.