This document discusses intimate partner violence (IPV), including definitions, prevalence, impacts, risk factors, assessment, treatment, and prevention. It defines IPV as physical, sexual, or psychological harm by a current or former partner. National statistics in the US indicate 25% of women and 15% of men experience severe physical IPV, and 50% experience emotional IPV. IPV is associated with mental health issues like PTSD as well as physical health problems. Risk factors include childhood abuse and attachment issues. Treatment focuses on perpetrator intervention, couples therapy in some cases, and preventing revictimization through education and economic resources.

1. Intimate partner violence: Prevalence, impact, treatment, prevention
ALIYA R. WEBERMANN, B.A.
M.A. CANDIDATE, CLINICAL PSYCHOLOGY
TOWSON UNIVERSITY

2. Overview
 This presentation will discuss the following topics:
Definition of intimate partner violence (IPV) and typologies
U.S. national IPV prevalence
Impact and outcomes of victimization, including psychiatric comorbidities
Risk factors for IPV
IPV and identity
Assessment and treatment of IPV
Preventative and protective factors
Trigger warning: this presentation will provide examples of IPV perpetration and consequences of IPV victimization, which may cause emotional distress.

3. Definition
 Physical, sexual, psychological, or emotional harm from a current or former partner or spouse
 A pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another partner
(CDC, 2013)

4. Typologies
 Physical: Intentional use of physical force- kicking, using a weapon, grabbing
 Sexual: Force, coercion, assault/rape, involvement with incapacitated person
 Psychological: Threats, intimidation, isolation, controlling behavior
 Emotional: Insults, put-downs, humiliation
 Financial (not in CDC definition): Limiting access to money and resources, identity theft, sabotaging career opportunities, incurring debt
(CDC, 2013; NNEDV, 2014a)

5. Typologies, continued
 Based on physiological differences in heart rate reactivity that may indicate differences in intent and motivation:
Characterological violence (Type 1): heart rate lowers during interactions, behavior stems from desire for power and control
Increased verbal and facial expressions of anger
Situational violence (Type 2): heart rate increases during interactions, behavior stems from emotion dysregulation and physical loss of control
Situational aggression increases more over time
Equally violent within romantic partnerships as Type 1
(Babcock et al., 2004; Gottman et al., 1995; Meehan et al., 2001)

6. Prevalence: Victimization
 Lifetime prevalence:
Severe physical IPV: 1 in 4 women and 1 in 7 men
Rape: 1 in 5 women and 1 in 71 men
Emotional IPV: 1 in 2 women and men
 One day of victim services:
66,581 victims served
36,348 in emergency shelter
30,233 receiving non-residential services such as counseling and court advocacy
20,267 hotline calls answered
9,641 unmet requests for services
(CDC, 2011; NNEDV, 2014b)

7. Prevalence: Perpetration
 Lack of similar epidemiological U.S. national statistics on IPV perpetration
 Physical IPV: 19.2% of males are perpetrators
 Gender of perpetrators:
Toward male victims:
Physical and emotional IPV: Female
Stalking: Mix of male and female
Sexual violence: Male
Toward female victims:
Physical and emotional IPV: Male
Stalking: Male
Sexual violence: Male
(CDC, 2011; Singh et al., 2014)

8. Impact: Adult victims
 Mental health
PTSD: Greater than 60%
Depression and anxiety disorders
 Physical health
Chronic health conditions: asthma, diabetes, gastrointestinal issues
 Substance use
Alcoholism
Illicit and intravenous drug use
 81% of women and 35% of men report 1 or more adverse health or safety outcomes (emergency medical treatment, shelter stays, fear for one’s life)
2003: $8.3 billion spent on physical and mental health services and lost productivity
(CDC, 2011; Dube et al., 2002; Goodman & Epstein, 2007; Max et al., 2004)

9. Impact: Child victims
 Mental health
PTSD
Personality disorders: Borderline personality disorder , antisocial personality disorder
Dissociative disorders
 Physical health
Chronic health issues: Heart disease, cancer, gastrointestinal issues
Sexually transmitted diseases
Obesity
 Linked to other forms of childhood maltreatment
Physical, sexual, emotional, psychological abuse
(American Psychiatric Association, 2013; Dube et al., 2002; Putnam et al., 2013)

10. Risk factors: Perpetration
 Childhood maltreatment and witnessing of domestic violence
 Multiple types of IPV (engaging in an IPV type increases likelihood of other types)
 Marital dissatisfaction
 Illicit drug use and alcoholism
 Traditional gender and sex role ideology
 Implicit attitudes condoning violence
 Physical health issues: Insomnia, gastrointestinal issues
 Mental health issues: Personality disorders, depression
 Insecure/disorganized attachment style
(Alexander & Warner, 2003; Eckhardt & Crane, 2014; Heise & Garcia-Moreno, 2002; Singh et al., 2014; Stith et al., 2004; Tjaden & Thoennes, 2000; Whitfield et al., 2003;)

11. Risk factors: Victimization
 Childhood maltreatment and witnessing of domestic violence
 Mental health issues: Personality disorders, depression, dissociative disorders
 Economic disempowerment
 Youth: 80% of female sexual assault victims are under 25
 Insecure/disorganized attachment style
 Predictors of escalation in abusive relationships:
Female victims perpetrating violence toward male perpetrators
Partner threats to harm and/or kill
(Alexander, 2009; CDC, 2011; Goodman & Epstein, 2007; Stith et al., 2004; ; Tjaden & Thoennes, 2000; Whitfield et al., 2003)

12. IPV and identity
 Race
Institutionalized racism (criminal justice system)
“Traitor” to community
 Gender identity
Male and transgender victims
 Religion
Taboo of divorce
 Sexual orientation
“Outness” of victim v. perpetrator
Female perpetrators

13. IPV and identity
Income level
Financially dependent on perpetrator
Difficult to access resources
Immigration status
Fear of deportation
Need to report perpetrator/assist in prosecution to receive visa
Language abilities
Disability
Dependent on perpetrator for survival
Lack of resources

14. Assessments
 Revised Conflict Tactics Scale (CTS2)
Assesses perpetration and victimization typology/severity/frequency, and negotiation
More often used in research, but appropriate for clinical practice
 Timeline Followback Spousal Violence Interview (TLFB-SV)
Daily calendar method documenting typology and frequency of violence
 Proximal Antecedents to Violent Episodes (PAVE) Scale
Context and functions of IPV incidents
 Guidelines
Screen IPV separately with each partner
Complete a lethality assessment to determine appropriate services
Screen IPV again later, as it may initially be denied due to shame, fear, and guilt
If IPV is identified, creating a safety plan is crucial
(Fals-Stewart et al., 2003; McCloskey & Grigsby, 2005; Babcock et al., 2004; Straus et al., 1996)

16. Treatment: Perpetration
 Treatment as usual: Duluth Model/Derivative
Grounded in theory of patriarchal dominance
Goal = behavior change via psychoeducation and in-group processing and modeling of healthy relationships and conflict resolution
Limited effectiveness, likely due to lack of addressing comorbid psychiatric and substance abuse issues and trauma history
(Babcock et al., 2000; Easton, 2013)

17. Power and Control Wheel- Duluth Model/Derivative

18. Treatment: Perpetration, continued
 Couples therapy
Only recommended with situational common-couple violence, rather then characterological violence perpetrated by one partner
Behavioral couples therapy shown to be effective with substance using couples
Multi-couple group therapy
Demonstrated success with mild to moderate situational common-couple violence
 Group therapy
Batterer/abuser intervention programs
Most effective if comorbid psychiatric and substance use issues are addressed
Demonstrated success utilizing CBT and MI modalities and in conjunction with individual therapy
(Connors, Mills, & Gray, 2013; Easton, 2013; Fals-Stewart & Clinton-Sherrod, 2009; Gottman et al., 1995; Stare & Fernando, 2014; Stith et al., 2004)

19. Preventative and protective factors
 Preventing child maltreatment, including witnessing of domestic violence
 Promoting flexible gender roles, egalitarian relationships, non-violence, and feminist identity
 Treating comorbid substance use and psychiatric disorders
 Training physical and mental health care providers to a) identify the effects of IPV on patients presenting to treatment and b) accurately and appropriately assess IPV
 Targeted education about intimate partner violence, sexual assault, and healthy relationships
 Economic independence, vocational opportunities, affordable housing
 Social supports
(Backus & Mahalik, 2011; Easton, 2013; Goodman & Epstein, 2007; McCloskey & Grigsby, 2005)

20. References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Alexander, P. C. (2009). Childhood trauma, attachment, and abuse by multiple partners. Psychological Trauma: Theory, Research, Practice, And Policy, 1(1), 78-88. Alexander, P. C., & Warner, S. (2003). Attachment theory and family systems theory as frameworks for understanding the intergenerational transmission of family violence. In P. Erdman, T. Caffery (Eds.) , Attachment and family systems: Conceptual, empirical, and therapeutic relatedness (pp. 241-257). New York, NY, US: Brunner-Routledge. Babcock, J. C., Green, C. E., & Robie, C. (2004). Does batterers' treatment work? A meta-analytic review of domestic violence treatment. Clinical Psychology Review, 23(8), 1023-1053. Backus, F. R., & Mahalik, J. R. (2011). The masculinity of Mr. Right: Feminist identity and heterosexual women’s ideal romantic partners. Psychology of Women Quarterly, 35(2), 318-326. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention (2013). Intimate Partner Violence. Retrieved from http://www.cdc.gov/violenceprevention/intimatepartnerviolence/.

21. References, continued
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention (2011). National Intimate Partner and Sexual Violence Survey 2010. Retrieved from http://www.cdc.gov/violenceprevention/pdf/cdc_nisvs_overview_insert_final-a.pdf.
Conners, A. D., Mills, J. F., & Gray, A. L. (2013). Intimate partner violence intervention for high-risk offenders. Psychological Services, 10, 12-23.
Dube, S. R., Anda, R. F., Felitti, V. J., Edwards, V. J., & Williamson, D. F. (2002). Exposure to abuse, neglect and household dysfunction among adults who witnessed intimate partner violence as children: Implications for health and social services. Violence And Victims, 17(1), 3-18.
Easton, C. J. (2013). Treatments for offenders of intimate partner violence. In M. McMurran (Ed.) , Alcohol-related violence: Prevention and treatment (pp. 171-185). Wiley-Blackwell.
Eckhardt, C. I., & Crane, C. A. (2014). Male perpetrators of intimate partner violence and implicit attitudes toward violence: Associations with treatment outcomes. Cognitive Therapy And Research, 38(3), 291-301.
Fals-Stewart, W., Birchler, G. R., & Kelley, M. L. (2003). The Timeline Followback Spousal Violence Interview to Assess Physical Aggression Between Intimate Partners: Reliability and Validity. Journal Of Family Violence, 18(3), 131-142.
Fals-Stewart, W., & Clinton-Sherrod, M. (2009). Treating intimate partner violence among substance-abusing dyads: The effect of couples therapy. Professional Psychology: Research And Practice, 40(3), 257-263.

22. References, continued
Goodman, L. A., & Epstein, D. (2007). Listening to battered women: A survivor-centered approach to advocacy, mental health, and justice. Washington, D.C.: American Psychological Association.
Heise, L., & Garcia-Moreno, C. (2002). Violence by intimate partners. In E. Krug, L. L. Dahlberg, J.A. Mercy, et al. (Eds.), World report on violence and health (pp. 87-121). Geneva, Switzerland: World Health Organization. Retrieved from http://www.who.int/violence_injury_prevention/violence/ global_campaign/en/chap4.pdf.
Max, W., Rice, D. P., Finkelstein, E., Bardwell, R. A., & Leadbetter, S. (2004). The Economic Toll of Intimate Partner Violence Against Women in the United States. Violence And Victims, 19(3), 259-272.
McCloskey, K., & Grigsby, N. (2005). The Ubiquitous Clinical Problem of Adult Intimate Partner Violence: The Need for Routine Assessment. Professional Psychology: Research And Practice, 36(3), 264-275.
Meehan, J. C., Holtzworth-Munroe, A., & Herron, K. (2001). Maritally violent men's heart rate reactivity to marital interactions: A failure to replicate the Gottman et al. (1995) typology. Journal Of Family Psychology, 15(3), 394-408.
National Network to End Domestic Violence (2014a). About Financial Abuse. Retrieved from http://nnedv.org/resources/ejresources/about-financial-abuse.html.
National Network to End Domestic Violence (2014b). Domestic Violence Counts National Summary 2013. Retrieved from http://nnedv.org/downloads/Census/DVCounts2013/DVCounts13_NatlSummary.pdf.

23. References, continued
Putnam, K. T., Harris, W. W., & Putnam, F. W. (2013). Synergistic childhood adversities and complex adult psychopathology. Journal of Traumatic Stress, 26(4), 435-442.
Singh, V., Tolman, R., Walton, M., Chermack, S., & Cunningham, R. (2014). Characteristics of men who perpetrate intimate partner violence. Journal of Behavioral Family Medicine, 27(5), 661-668.
Stare, B. G., & Fernando, D. M. (2014). Intimate partner violence typology and treatment: A brief literature review. The Family Journal, 22(3), 298-303.
Stith, S. M., Smith, D. B., Penn, C. E., Ward, D. B., & Tritt, D. (2004). Intimate partner physical abuse perpetration and victimization risk factors: A meta-analytic review. Aggression And Violent Behavior, 10(1), 65-98.
Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17(3), 283-316.
Tjaden, P., & Thoennes, N. (2000). Extent, nature, and consequences of intimate partner violence: Findings from the National Violence Against Women Survey. Washington (DC): Department of Justice. Retrieved from: http://www.ojp.usdoj.gov/nij/pubs-sum/181867.htm.
Whitfield, C. L., Anda, R. F., Dube, S. R., & Felitti, V. J. (2003). Violent childhood experiences and the risk of intimate partner violence in adults: Assessment in a large health maintenance organization. Journal Of Interpersonal Violence, 18(2), 166-185.