COMMENTARY

Domestic Violence (DV) and all its consequences is a terribly sad, troubling, and potentially destructive part of our national life and identity. DV not only poses physical dangers but also takes a terrible toll on families and the important relationships of our lives. One would have thought that we, as a nation, would use reason, science and logic to solve--as much as full solution is possible--this scourge. Perhaps naturally and understandably, considering how emotional these issues are, science, perspective, study, and thoughtfulness have often been put aside while warring camps, political concerns and emotions have carried the day. Domestic violence can be seen in many different ways but certainly a medical/scientific approach is warranted, with much to offer if real solutions are to be found.

A variety of women’s groups have seen it as central to their mission to highlight domestic violence, and have generally couched the issues in a gender specific way. Women, in their view, are the victims of DV; and men, the perpetrators. By extension, the more radical of these groups saw all men as potential abusers, waiting for certain conditions before striking. (“All men are potential rapists and that’s all they are”, said Marilyn French, author of The Women’s Room).

In the view of such groups, there was no room for studies of varying motives, circumstances, or perpetrators. The act was criminal, and the motivation was assumed to be exclusively the patriarchal attempt at dominance over women. By extension, since these were criminal acts, they should be dealt with through the criminal justice system; eg, by means of arrests, restraining orders, and the registration of males accused of being “batterers” (accused, not proven). Furthermore, in this view, these alleged batterers should be removed from their homes, their mates, and their children. Increasing criminalization was thus seen as the means of preventing and coping with DV.

Men were seen as hopelessly aggressive by nature -- predatory, and controlling. Many men reacted by joining the cause and becoming the “enforcers”--outdoing women in their zeal to protect womanhood and rid society of batterers at all costs. Other men reacted passively, unaccustomed to being adversarial toward women. And still others reacted sympathetically, but were outraged by the attack on civil liberties and constitutional rights such branding of men as batterers entailed, often with minimal due process. (“Men who are unjustly accused of rape can sometimes gain from the experience” said a Vassar College Assistant Dean of Students). Many men felt themselves, as a group, being degraded and bashed, much as blacks had been a generation before-- when, if you were black, you were a priori deemed capable of any crime, any aggression. Men felt themselves discredited--many of whom had fought for years, and through their families, for generations, for equality and justice for all.

In this climate, there were always a very few who did not view DV as gender specific at all, but rather, as part of the difficulties in relationships that develop in life, especially when we are most vulnerable.1-3 But their voices were muted and unheard, and their influence small. And then, with one monumental and very well conceived study, everything changed. For in May 2007, in the American Journal of Public Health, a well respected and peer reviewed journal, a study appeared by Daniel Whitaker and his colleagues Tadesse Haileyesus, Monice Swahn, and Linda Saltzman.4 In this beautifully executed study, the authors sought to examine the prevalence of reciprocal (ie, perpetrated by both partners) and nonreciprocal intimate partner violence (IPV), and to determine whether reciprocity is related to violence frequency and injury. All in all 18,761 respondents were studied.

The results showed that almost 24% of all relationships had some violence, and half were reciprocally violent. In non-reciprocally violent relationships, women were the perpetrators in more than 70% of cases. Reciprocity was associated with much more frequent violence among women, but not men (adjusted odds ratio 2.3 for women and 1.26 for men). Regarding injury, men were more likely to inflict injury (adjusted odds ratio 1.5 and 1.1), and reciprocal intimate partner violence was associated with greater injury than was nonreciprocal IPV, regardless of the gender of the perpetrator. The authors discuss a recent meta-analysis with the finding that a woman’s perpetration of violence was the strongest predictor of her being a victim of partner violence. And included in the conclusions of the study was the very important finding that the context of the violence (reciprocal vs nonreciprocal) is a strong predictor of reported injury. As one of its conclusions the authors state that prevention approaches that address the escalation of partner violence may be needed to address the reciprocal violence (Italics mine). The authors further state they were surprised to learn that with violence that was not reciprocal, women were the perpetrators in a majority of cases.

Other groups set out to replicate or refute the conclusions of the Whitaker group. A recent article in the current issue of the Journal Violence and Victims reported research funded by the National Institute on Drug Abuse and the National Institute of Mental Health and conducted by researchers affiliated with the University of Washington’s Social Development Research Group.5 This group reviewed the social and antisocial behavior of more than 800 participants. Their findings:

o Nearly twice as many women as men said they perpetrated domestic violence in the past year including kicking, biting, or punching their partner, threatening to hit or throw something at their partner, and pushing, grabbing, or shoving their partner.

o A link was found between chronically aggressive adolescents, male or female, and domestic violence at later periods of life.

o Though most investigators find a positive correlation between alcohol/substance abuse and DV, this study did not substantiate that.

o A diagnosis of an episode of major depression was significantly related to committing DV.

o Being on welfare was significantly related to committing DV.

o Having a partner who used drugs heavily, sold drugs, had a history of violence toward others, had an arrest record, or was unemployed was significantly related to committing DV.

o Disorganized neighborhoods where attitudes toward drug sales and violence were favorable also increased person’s likelihood of committing DV.

In their conclusions, the authors state that “The take home message from this study is that it may be possible to prevent some forms of domestic violence by acting early to address youth violence. Our research suggests the earlier we begin prevention programs, the better, because youth violence appears to be a precursor to other problems including domestic violence.”

In a paper from the American Journal of Orthopsychiatry, Anne Conway6 summarizes her important study on “Girls, Aggression, and Emotion Regulation” as follows: “Many studies have demonstrated that boys are more aggressive than girls (see J.D. Cole & K. Dodge, 1997, for a review) and that emotion regulation difficulties are associated with problematic behaviors. However, recent findings indicate that gender differences in aggressive behavior disappear when assessments are broadened to include relational aggression-behaviors designed to harm the relationship goals of others by spreading rumors, gossiping, and eliciting peer rejection of others (The author has heard the term “Soul Murder” given to such behaviors and the results can often be deadly.) Moreover, although difficulties regulating emotions have been reported for physically aggressive children, little research has examined these processes in relationally aggressive children.”

According to a 2006 Harris Poll, 88% of Americans have seen or heard of a male DV victim in the past year, and 76% of Americans believe DV against men is a “serious” problem.7

The foregoing studies provide evidence that DV is not gender-specific and also show clearly that DV is not a single, monolithic structure with one cause; rather, DV occurs in a multiplicity of situations with multifocal causation. The black-and-white, simplistic “criminalization” view of DV has left us in the dark as to psychiatric factors that may cause or contribute to DV. The above studies lend credence to this view and open important avenues to prevention.

Depression has already been noted as a risk factor for DV. In addition, my own clinical experience suggests that those with significant untreated mood dysregulation and reduced impulse control--under certain conditions of intense situational or relational stress--may be more prone to commit DV. For example, untreated borderline personality disorder, ADHD (a form of which by its definition and very nature includes impulsivity), Bipolar 2 disorder, or any combination of these disorders, could in some cases be factors in DV, and need to be studied.

Several mediating variables may help explain my observations. We know, for example, that adults with ADHD are almost twice as likely to be divorced and 23% more likely to be unemployed than those who do not have ADHD--and that unemployment, as shown above, can contribute to DV incidence. We also know that substance abuse is at least twice as likely to occur in untreated adults with ADHD than in those without this disorder.8-10. ADHD is variously estimated to be 4 or 5 times more common in boys and men than in girls and women. It is estimated by the Department of Justice Statistics that 42% of non-fatal DV was associated with alcohol and drugs at the time of the DV incident. This does not include the presence of a chronic substance abuse problem that preceded the DV incident.

Other socioeconomic factors may also increase the risk of DV. Thus, the Department of Justice’s Bureau of Justice Statistics reported that females living in households with lower annual incomes experienced the highest annual rates of IPV, and that average annual rates were higher for persons living in rental housing than other types of housing, regardless of the victim’s gender.11 Moreover, males residing in rental housing were victimized by an intimate partner about 3 times more often than males living in owned housing. (Most experts agree that DV statistics on men are very difficult to obtain because of shame on the part of men in reporting such abuse, and to poor record-keeping by police and other agencies that often dismiss complaints of abuse by men).

Further evidence for the non-gender specificity of IPV and DV comes from the study of lesbian couples.12 Ironically, although many founders of the battered women’s movement were lesbians, the issue of battering between women often remains deeply buried, ignored or denied by heterosexual women and lesbians alike. The recognition that women engage in battering challenges an analysis of heterosexual DV that links male socialization with violence. Since its inception, the battered women’s movement has conceptualized the problem of domestic violence in terms of a male-female phenomenon, linking violent behavior to male gender roles. Acknowledging that women also perpetrate intimate violence raises new theoretical questions and challenges some deeply-rooted cultural beliefs about women.

Nor is the incidence of DV among lesbian cohorts minimal. In fact, abuse among lesbians occurs with far greater frequency than among heterosexuals (given as 24% by the study above), and far more frequently than male-on-female abuse. Estimates of abuse have ranged between 47% and 73% (Coleman, 1990; Bologna, Waterman, Dawson, 1987; Lie. et al. 1991) among lesbian subjects who responded to questionnaires assessing prevalence of some form of physical, sexual, or emotional-psychological abuse in at least one relationship. Estimates of verbal abuse in lesbian relationships have been as high as 95% (Kelly & Warshafsky, 1987). About half of lesbian subjects who participated in research surveys indicated they had experienced 10 or more abusive incidents during their relationships, and about three-quarters had experienced 6 or more (Renzetti 1992).

Many who study DV feel there is another form of violence besides IPV that rightly should be termed DV and included in DV statistics; namely, violence against children. Here too, as in IPV, abuse of children appears not to be gender-specific. In a 2002 survey by the Department of Health and Human Services, approximately two-fifths (40.3%) of child victims were maltreated by their mothers acting alone.13 Another 19.1% were maltreated by their fathers alone, while 18% were abused by both their mothers and fathers. Victims abused by a non-parental perpetrator accounted for 13% of the total. The national rate of victimization was a worrisome 12.3 per 1000 children. Importantly, there are many different motivations for such behaviors, ranging from psychosis to psychopathy (including a wish to hurt third parties). Frequently, there is a history of traumatic and difficult childhoods in such offenders. These findings highlight the importance of understanding the individual emotional states that underlie violence against children. In principle, support services may avert such behavior, but these services are often unavailable.

In her seminal study, Male and Female, the renowned anthropologist Margaret Mead14 states the following: “There are even those who have argued that women are inherently more peaceful than men. On further examination, it would seem that there is little evolutionary basis for this argument. There seems very little ground for claiming that the mother of young children is more peaceful, more responsible, and more thoughtful for the welfare of the human race than is her husband and brother.”

Complicating the entire field of DV is the role of divorce and custody proceedings. Often, a claim of DV “. . . is the quick and cheap way to get a divorce--it’s becoming the trend now,” says Manuel Leiva, a practicing attorney in Virginia.15 Leiva has represented a number of divorcing men who are repetitively cleared of abuse charges, and who don’t want to give up custody of their children. “Men are thrown out of their houses and separated from their children,” Leiva said, because “a lot of judges grant protective orders too quickly--seemingly without seeing the potential harm in such actions.”15 Indeed, the Director of the Baltimore County Office of Family Mediation states that allegations of domestic abuse are “misused an awful lot because a lot of people will use it quickly to get custody of children”.15

The pressure of DV cases is pushing the various advocates and academics closer in some ways. Many women and men want evaluation and mediation rather than punishment, even with the presence of violence in the home. This course has been followed successfully and fruitfully for many years by child advocate agencies, such as Departments of Social Service and Departments of Child and Families. In this model, the evaluation, treatment and stabilization of the family--not arrests and removals-- are the cornerstones of the intervention. Perpetrators are often offered support rather than simply condemnation and punishment. Skilled evaluations, counseling, and psychotherapeutic or psychopharmacologic approaches are engaged. Frank mental illness or emotional problems are referred to appropriate practitioners or even inpatient evaluation at psychiatric hospitals. Mood disorders, such as major depression, can be diagnosed and treated. Substance abuse can be uncovered and treatment initiated. Finally, assistance with housing, financial, and vocational problems can be instituted. Of course, where there is likelihood of serious, imminent harm, the family is separated, and even criminal charges may be entered--but there is a concerted effort to avoid this.

Of course, such approaches are not perfect nor is it likely that dealing with such complex human problems will ever be perfect. But the principles described could be used for DV in general and not just for violence involving children. Indeed, many experts in the field believe the way to ameliorate the national DV problem is through just such a “family conflict” approach-- a perspective that sees many cases of relatively less severe violence as stemming from routine family disagreements and pressures and from the stress of daily life.

I hope it is clear from the above discussions that DV emerges from a host of causes and motivations, and that each case deserves individual attention and solutions. No one gender, race, or age group is solely responsible or solely victimized. The Human Services approach is already established and, in very short order, could be adapted to deal with the vast majority of DV cases--each one, bearing its own tragedy. With this approach, men and women could unite in an attempt to uncover the root causes of DV; educate the public about them; and eradicate these causes through individualized investigation, treatment, protection and concern.

References:

1. Straus MA. Victims and aggressors in marital violence. American Behavioral Scientist. 1980;23:681-704.

2. Mark Rosenthal. Personal Communication; 12/4/2000

3. Farrell w. The Myth of Male Power. Berkeley Trade, 2001.

4. Whitaker D, Haileyesus T, Swahn M, Saltzman L. Differences in frequency of violence and reported injury between relationships with reciprocal and nonreciprocal intimate partner biolence. Am. J Public Health. 2007;97:197-198.

5. Williams JH, Van Dorn RA, Hawkins JD, Abbott R, Catalano RF. (2001). Correlates contributing to involvement in violent behaviors among young adults. Violence and Victims. 2001;16:371-388.

6. Conway C. Girls, Aggression, and Emotion Regulation. Am J Orthopsychiatry. 2005;75:334-339.

7. Harris Poll, #49, June 15, 2006, Tables 1 and 3 (Dr Edward Bartlett, personal communication, January 27, 2007.

8. Biederman J, Faraone SV, Spencer TJ, et al. Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. J Clin Psychiatry. 2006;67:524-540.

9. Handelman K. The Psychiatric Practice of Kenny Handelman. http://www.drhandelman.com/

10. US Department of Justice Office of Justice Programs. Office of Juvenile Justice and Delinquency Prevention. OJJDP FACT SHEET. 2001. http://www.ojp.usdoj.gov/bjs/pub/pdf/cvus/current/cv0102.pdf.

11. Dept. of Justice, Bureau of Justice Statistics “Intimate Partner Violence in the United States. http://bjs.ojp.usdoj.gov/content/intimate/ipv.cfm

12. Kaschak E. Intimate Betrayal: Domestic Violence in Lesbian Relationships. Routledge, 2002.

13. Child Maltreatment. US Dept of Health and Human Services, 2002. http://www.acf.hhs.gov/programs/cb/pubs/cm02/

14. Mead M. Male and Female. Quill (Harper Collins), 1996:xxiv, xxv.

15. Munro N. “Domestic Politics.” National Journal;2008. http://www.news.nationaljournal.com/articles/080407nj1.htm



Additional Reading

o Block HS. Psychic War in Men and Women. New York University Press, 1976.

o Brooks DR. Maternal cigarette smoking during pregnancy and child aggressive behavior. Am J Addictions. 2006;15:450-456.

o Mills L. Insult to Injury.Princeton University Press, 2003.

o Mamet D. In Defense Of Men. Best Life. December 2007/January 2008:94-96.

o Nathanson P, Young K. Spreading Misandry.McGill-Queens University Press, 2006