Ethnic background and alcohol use of the spouse emerge as major risk factors for domestic violence: An observational study from Turkey.

OBJECTIVE: To assess the prevalence and risk factors of domestic violence in a multi-cultural region of Turkey. METHODS: The cross-sectional study was conducted in Tepecik district of Izmir, Turkey, from February to June 2013, and comprised women aged 15 years or above. A 21-item questionnaire was used to collect data through interviews. The primary outcome variable was history of domestic violence. RESULTS: There were 602 subjects with a mean age of 42.8±14.3 years. The mean age of spouses was 45.5±13.4 and the mean marriage duration was 19.6±4.4 years. The prevalence of any kind of violence within the preceding month was reported by 355(59%) women. Alcohol use of spouse had an odds ratio of 2.7 compared with non-users (p=0.007). Compared with Turkish background, Kurds had a 3.2-fold risk of being exposed to violence within the preceding year (p=0.010). CONCLUSIONS: Independent of other demographic factors, race and alcohol use of the spouse were important factors in domestic violence.

Modeling Daily Partner Violence and Substance Use Based upon Couple's Reporting.

While agent-based models (ABMs) have successfully modeled violence and women's decision-making, they relied upon studies of her daily reports of violence and household environment; these models were not based upon descriptions of his emotions and perceptions. The purpose of this study was to improve our understanding of the triggers of violent events within violent relationships through agent-based modeling by including men's perceptions and emotions. An agent-based model was created of couples with history of violence based upon results of a study involving multiple time series of partner violence, including couples' daily reports of their emotions and perceptions. To explore factors that may alter model results, seven continuous variable parameters were created based upon significant (p ≤ .05) but discrepant (opposite directions) in prior studies. To assess the potential impact that influencing factors such as random stress as well as his and her feelings and behaviors could have on violence and stalking, the impact of these factors was also assessed. Results found that, at baseline, which included no extremes in variable parameters, no violence emerged. One prior-day→same-day relationship (HerConcern→HerConcern) was particularly important in this ABM. Men's and women's drug use and refraining from arguments had little impact on any outcome, but his and her alcohol use, his sense of insult and her violence all had significant effects. In fact, women's alcohol use interacted with other influencing variables and was a source of atypical patterns. In conclusion, incorporating men's perceptions into an ABM of partner violence resulted in important differences compared with ABMs based solely on women's input. Not only were women's daily concerns about the effect of violence on children was critical to results, but this ABM demonstrated the complexity of partner violence in response to influences as illustrated by contextual dependence, interaction effects and synergy.

Addressing battering during pregnancy: reducing low birth weight and ongoing abuse.

It has been established that battering during pregnancy is a frequently occurring and significantly deleterious phenomena. This article reviews the evidence regarding dynamics, prevalence, outcomes, and cultural and other influences on this issue. Although tested interventions for abuse during pregnancy are limited, there are clear indications from research with other battered women for directions to be taken.

PIP: Battering during pregnancy is a frequently occurring and significantly deleterious phenomenon and has received increasing attention in the areas of both research and practice. This article reviews the research conducted in the US related to battering during pregnancy, along with implications for interventions. In particular, the paper outlines the results of these studies concerning the prevalence of battering, its dynamics, health-related correlates, outcomes, and cultural influences. Although tested interventions for abuse during pregnancy are limited, there are clear indications from research with other battered women for directions to be taken. Addressing abuse during pregnancy is both a significant health enhancement and an important aspect of confronting other serious threats to maternal and infant health.

A medical student's perspective on education about domestic violence.

Medical students, as physicians of the future, are well aware of the impact of violence and abuse on the health of patients and the well-being of society and are eager to learn all they can about family and intimate violence while in medical school. Yet, most academic and practicing physicians-the "experts" who teach students the art and science of medical practice-have received little or no education themselves in this area. In order for medical students to enter practice feeling more comfortable with their important roles in the prevention of and intervention in family and intimate violence, they need to receive comprehensive, integrated education during all four years of medical school. This article outlines the rationale for such education from the student's perspective, describes the impact of such efforts on medical students, and suggest specific strategies for implementing curricular reforms designed to fully train medical students in the knowledge, skills, and attitudes necessary to practice effectively in this area.

PIP: Comprehensive, integrated education on domestic violence during all 4 years of medical school is essential if physicians are to play a role in the prevention and detection of intimate partner violence. However, it is not uncommon for women to present to US hospitals multiple times over a period of years with injuries such as broken bones and stab wounds and not be questioned about the possibility of partner violence. Questions about partner violence should be included in every patient history. Unfortunately, physicians have not been taught what questions to ask and how to ask them with sensitivity. The use of survivors of domestic violence in small group seminars is especially effective for offering medical students the opportunity to overcome biases and practice interviewing skills. Finally, it is essential that residents and attending physicians who work with medical students model a commitment to domestic violence prevention and intervention.

Intimate partner abuse: developing a framework for change in medical education.

Addressing domestic violence presents unique challenges for individual physicians and for the institutions that shape medical education and practice. In addition to the need to acquire new knowledge and skills, clinicians must confront the feelings and social beliefs that shape their responses to patients, develop new frameworks for understanding complex social issues, and generate collaborative models for working in partnership with community groups. Educators, in turn, must provide training experiences that foster the development of those understandings and skills, institutional structures that support their integration into routine practice, and faculty who model nonabusive behaviors in all aspects of training and medical care. Expanding traditional medical paradigms to address the multiple dimensions of abuse can lay the groundwork for such a process. In addition, students need to be encouraged to develop awareness of the larger social forces that affect all of our lives and health, and to recognize their potential roles as community members in ending domestic violence. This article offers suggestions for changes in the structure of medical education as part of generating a health care system contribution to ending abuse in this society. Creating a model for fostering nonabusive relationships at individual and institutional levels within the health care system can provide a paradigm for transforming the conditions under which abuse is tolerated.

PIP: Physicians' effectiveness with victims of domestic violence requires a model based on the principles of prevention, safety, empowerment, advocacy, accountability, and social change. The incorporation of these principles into clinical practice requires, in turn, a paradigm shift in the structure of medical education from biomedical models to a more comprehensive framework. Such a model would include recognition of the individual and societal forces that generate and sustain abuse, contextual factors that mediate women's experiences of abuse and shape their options, and individual and systemic factors that shape providers' responses. This perspective makes it easier to consider, for example, that psychiatric symptoms may actually be adaptive coping methods or survival strategies. Traditional medical teaching formats do not provide opportunities to address the attitudes and feelings that may affect a clinician's ability to provide appropriate care or to acquire the skills necessary for an optimal response. Role plays, faculty modeling, video and in-person observation, and simulated patients are useful tools for helping medical students learn to interact in ways that are not retraumatizing or disempowering to patients. Recognizing the potentially abusive aspects of medical training and creating environments that do not permit such behavior are important both to improving the health sector's response to domestic violence and creating a society that does not tolerate abuse. Informed by a broader perspective, medical students are less likely to accept the constraints of their practice environments and may join with others to bring about social change.

The women's mental health research agenda. Violence against women.

The focus of this article is violence against women: scope, impact, community response, clinical treatment, and prevention. Conclusions include the following: (a) Nationally representative data on the scope of violence are lacking. (b) The mental health implications of violence are not currently addressed by the practices of mental health professionals. (c) Discontinuity exists between clinical understanding of the impact of violence and empirical treatment research. (d) Victim services are proceeding in program development without direction from empirical data. (e) Prevention efforts have been isolated from the social context in which violence against women occurs. Nine directions for future research are highlighted that intersect with the stated priorities of the National Institute of Mental Health.

PIP: This article explores the scope, impact, community response, prevention, and treatment of violence against women. For the past several years, 38% to 67% of adult women experienced violence before reaching the age of 18. Despite the different violent events which women experienced, its impact on the mental health status of women remained similar. Victims of violence develop an immediate "postvictimization distress response" characterized by fear and avoidance, constriction of affect, self-concept and self-efficacy disturbances, and sexual dysfunction. Moreover, the traumatic experience affects their belief in personal vulnerability and perceptions on the meaning of the world. Several conclusions were drawn from the information presented and included the following: 1) there is lack of nationally representative data to determine the scope of violence; 2) mental health professionals are not addressing the mental health implications of violence; 3) programs directed towards the victims of violence were developed without basing on empirical data; and 4) efforts to prevent violence against women were isolated from the social context. Finally, a research agenda which contains directions for future research were presented to address the gaps in existing literature that were previously identified.

The effects of woman abuse on health care utilization and health status: a literature review.

Estimates of the physical abuse of women by husbands or boyfriends in the United States range from 85 per 1000 couples to 113 per 1000 couples per year. Victims of abuse are much more likely than nonvictims to have poor health, chronic pain problems, depression, suicide attempts, addictions, and problem pregnancies. Abused women use a disproportionate amount of health care services, including emergency room visits, primary care, and community mental health center visits. Despite its high prevalence and the disproportionate use of health care services it causes, woman abuse is rarely recognized by health care providers. Even when the abuse is recognized, health care professionals often provide inappropriate or even harmful treatment. Because many abused women pass through the health care system, it is important that providers learn how to identify those who are abused, treat all the effects of the abuse, and make appropriate referrals.

PIP: This article presents a literature review on the effects of abuse on health care utilization and health status of women in the US. The abuse of women is defined as any physical abuse of a woman by an intimate male partner. Several studies have estimated that abuse of women remains prevalent in the US and often results in serious physical and mental injuries. Victims are more likely to have poor health, chronic pain problems, depression, suicide attempts, addiction, and pregnancy problems. This review indicates that abused women use a disproportionate amount of health care services including emergency rooms visits, primary care, and community mental health center visits. Despite its high prevalence and the disproportionate use of health care services it causes, woman abuse is rarely recognized by health care providers. Even when health care professionals detect woman abuse, they often provide inappropriate or harmful treatment. Thus, health providers need to educate themselves about women abuse, know community and legal sources to which to refer abused women, and develop protocols for identifying and caring for such women.

Verbal abuse and physical violence among a cohort of low-income pregnant women.

We report on the occurrence of verbal abuse and physical violence during pregnancy for 358 low-income women. Overall, 65% of the women in our study experienced either verbal abuse or physical violence during their pregnancies. Twenty percent of the women in our sample experienced moderate or severe violence. Perpetrators, although primarily male partners, included family members and friends. These rates varied by age, with younger women experiencing significantly higher rates of verbal abuse and physical violence. There was no association between verbal abuse or physical violence and birth weight or gestational age. Prenatal care may be one of the only opportunities that women, and especially disadvantaged women, may have to get proper assistance with domestic violence. We conclude that enhanced screening, counseling, and referral by obstetricians and other health care providers are some of the immediate activities that could be implemented in prenatal care settings to address the compelling problems of violence during pregnancy.

PIP: This study examines the frequency, perpetrators, and impact of verbal abuse and physical violence among low-income pregnant women. A cohort of 358 low-income pregnant women attending the Johns Hopkins Hospital Adult Obstetric Clinic between December 1989 and September 1990 were included in the study. Information gathered through interview and descriptive analysis revealed that 65% of the women experienced verbal abuse and physical violence during pregnancy; 20% had been through moderate to severe violence. Violence was primarily inflicted by male partners and also by other family members and friends. Moreover, the occurrence of verbal abuse and physical violence were significantly higher among younger aged women, but no association was noted between violence and birth weight and gestational age. Due to the fact that prenatal care may be the only opportunity for low-income women to obtain medical assistance and referral services, prenatal care should include enhanced screening, counseling, and good referral by obstetricians and other health providers in order to address this problem.

WomanKind: an innovative model of health care response to domestic abuse.

PIP: This article focuses on the role of the WomanKind program in creating opportunities for discussing domestic violence and training health professionals. The WomanKind program is based on the belief that without such discussion, health care providers will continue to treat the medical and mental health problems that bring women to their doors without addressing the underlying pattern of abuse that is the root cause. WomanKind has evolved to integrate case management/advocacy services for victims of domestic abuse, in addition to education and consultation for health professionals. It also provides case management and advocacy services, including crisis intervention, assessment and evaluation, and ongoing assistance to battered women who suffer from physical, emotional, or sexual abuse by a current or former partner. The WomanKind staff consists of a director who oversees the program, including marketing and public relations, education and training, as well as assisting the full-time program coordinators at each of the three hospital sites. An intensive 40-hour training program provides the new WomanKind volunteers with an understanding of the issues of domestic abuse and violence, as well as knowledge of community resources. The program goals are elaborated in this article as well as the program marketing techniques.^ieng

Physical therapists' recognition of battered women in clinical settings.

BACKGROUND AND PURPOSE: The purposes of this study were to describe physical therapists' knowledge regarding battered women and to determine whether physical therapists recognize these patients in clinical settings. SUBJECTS AND METHODS: Two hundred questionnaires were distributed to outpatient physical therapists in northern California. One hundred fifty-one usable questionnaires (76%) were returned. RESULTS: Although 43% of the respondents reported treating a patient they identified or strongly suspected as having been battered, only two respondents (1%) reported they routinely asked patients about physical abuse. Less than 50% of the respondents correctly identified that battering injuries are more likely to occur in a central pattern (ie, head, neck, chest, abdomen). DISCUSSION AND CONCLUSION: The results of this survey suggest that physical therapists have treated patients who are battered. Many physical therapists, however, may not be fully educated to detect the signs of abuse. This study is the first step in initiating physical therapy research in domestic violence identification and education.

PIP: Domestic violence from a spouse or an intimate partner has become a public issue as well as criminal justice, since it was known to be a leading cause of death, in the US. Physical therapists (PTs) play a critical role in prevention, treatment, and rehabilitation in health care of a battered patient. This study describes the knowledge of PTs regarding battered women and determines whether PTs recognize these patients in clinical settings. 200 questionnaires were distributed to 25 outpatient PT facilities in northern California. 151 usable questionnaires were returned. Results showed that out of the 151 respondents (121 females, 30 males), 43% dealt with women whom they strongly suspected or identified as being physically battered; however, only 1% of the respondents routinely inquired about physical abuse. Furthermore, 42% correctly identified the neck, head, chest, and abdomen as the most common location of injuries, and having depression as a psychological symptom resulting from the abuse. The results of the survey suggest that the detection of battered patients by a PT was very low. This could be due to the PT's lack of domestic violence education; and reluctance to ask patients whether they were abused; or beliefs that domestic violence was an uncommon occurrence in their patients' lives.

Female suicide and wife abuse: a cross-cultural perspective.

Data from a number of societies, including North America, indicate that wife abuse may be one of the most significant precipitants of female suicide. Anthropological analysis indicates that in some societies female suicide is a culturally recognized behavior that enables the weak to influence the strong and/or take revenge on those who oppress them. Case studies from West New Britain Province in Papua New Guinea and comparisons with data from other societies suggest that if a woman's support group does not defend her when she is the victim of violence that passes the bounds of normative behavior, her suicide may be revenge suicide, intended to force others to take vengeance on the abusive husband. Research focused on the relationship between domestic violence and female suicide should be a priority of anthropologists as well as suicidologists.

PIP: This article focuses on the relationship between wife abuse and female suicide in the Melanesian societies through a presentation of case studies. In Papua New Guinea, domestic violence was found to be a normal part of marital relationships, and the major context in which suicide occurred was after severe and physically violent domestic arguments. Abused, shamed, and powerless wives take their own lives to shift the burden of humiliation from themselves to their tormentors. In West New Britain, Fiji, and South American societies, suicide associated with marital violence were also common. Data from a number of societies indicate that wife abuse remains to be one of the most important precipitants of female suicide and suicide attempts. An understanding of the dynamics that exists between wife abuse and female suicide should be of great value to professionals who deal with women faced with said problems.

Evaluating domestic partner abuse in a family practice clinic.

BACKGROUND AND OBJECTIVES: Although national surveys indicate that approximately 2 million women are victims of severe physical aggression by their partners each year, these women are underidentified by physicians. The assessment by medical personnel of partner abuse is hampered by lack of a simple and reliable instrument that systematically and quickly determines the occurrence and effect of abuse among patients. METHODS: Ninety (58% of an eligible pool) consecutive, consenting, eligible female patients at a suburban family practice clinic at a tertiary university hospital completed the Partner Abuse Interview to evaluate the 1-year prevalence and effect of abuse. RESULTS: The Partner Abuse Interview required as little as 3 minutes to administer. Results obtained with the interview instrument were internally consistent. Interrater reliability was high for the diagnosis of partner relationship problems with physical abuse by males, as reported by females. Approximately 15% of the women reported having sustained injury or being fearful of their partners as a result of their partners' physical aggression in the past year. CONCLUSIONS: The Partner Abuse Interview is a simple and reliable instrument that could be adapted for use by medical personnel to assess incidents of abuse among patients.

PIP: Physicians' assessment of domestic partner abuse is hindered by the lack of a simple, quick, reliable instrument that determines the occurrence and effect of abuse among female patients. The Partner Abuse Interview, a modified version of the Conflict Tactics Scale, has the potential to meet this need. This instrument was tested in 90 consecutive female patients who presented to a suburban family practice clinic at a US university hospital in 1993. The interview took 3 minutes to complete when there was no domestic violence and 10-15 minutes when violence was detected. Inter-rater reliability was above 90% for all three definitions of partner abuse: any physical aggression, severe violence, and partner abuse. 32%, 16%, and 13% of respondents, respectively, fell into these categories. Pushing, grabbing, and shoving were the most frequently reported abusive behaviors. Compared with women in nonabusive relationships, women in relationships characterized by fear/injury had a lower family income, lower marital satisfaction scores, and less education. More widespread use of this interview is recommended by physicians to identify women in need of treatment and counseling.

Stressful events among pregnant Salvadoran women: a cross-cultural comparison.

OBJECTIVE: To compare stressful events, including violent episodes, experienced by pregnant Salvadoran women with those experienced by two other groups of low-income, pregnant women living in the United States (non-Salvadoran Hispanics and non-Hispanics) and to examine the association between episodes of violence and drug or alcohol use among the three groups. DESIGN: Comparative, descriptive study. SETTING: Public health prenatal clinics. PARTICIPANTS: One hundred four Salvadoran, 69 non-Salvadoran Hispanic, and 187 non-Hispanic pregnant women. MAIN OUTCOME MEASURES: Difficult Life Circumstances (DLC) scale and psychosocial history assessment. RESULTS: Statistically significant differences were found among the three groups in total DLC scores, F(2, 357) = 14.98, p < .001; reported episodes of violence, F(2, 357 = 17.82, p < .001; and drug or alcohol use, F(2, 357) = 6.33, p < .001. A significant difference was found to the extent that alcohol or drug use accounted for the variance in violence among the three groups, F(3, 360) = 6.28, p < .001. CONCLUSIONS: Cross-cultural comparisons revealed group differences in the number of stressful events, including episodes of violence and alcohol or drug use.

PIP: A comparative, descriptive study was conducted among 104 Salvadoran, 69 non-Salvadoran Hispanic, and 187 non-Hispanic pregnant women concerning the stressful events including episodes of violence experienced. Furthermore, it also compared the relationship between episodes of violence and drug or alcohol use among the three groups. The measures used are the Difficult Life Circumstances scale and psychosocial history assessment. Results showed that stressful events were found to occur more frequently among the non-Hispanic mothers than among either Hispanic subgroups. However, cultural distinctions between Salvadoran and non-Salvadoran Hispanic mothers did not emerge. Alcohol and drug use differed significantly among the groups in this study. In conclusion, cross-cultural comparisons revealed group differences in the number of stressful events, including episodes of violence and alcohol or drug use.

Safety behaviors of abused women after an intervention during pregnancy.

OBJECTIVE: To evaluate an intervention protocol, administered during pregnancy, for increasing safety-seeking behaviors of abused women. DESIGN: Prospective, ethnically stratified cohort analysis. SETTING: Public prenatal clinics. PARTICIPANTS: Pregnant women reporting physical or sexual abuse in the year before or during the present pregnancy. One hundred thirty-two women met study criteria, received the intervention, and were followed for 1 year after the completion of the pregnancy. INTERVENTION: Three education, advocacy, and community referral sessions that included information on safety behaviors. MAIN OUTCOME MEASURE: Adoption of safety behaviors by abused women. Safety behaviors were measured before the intervention, twice during pregnancy, and at 2, 6, and 12 months after completion of the pregnancy. RESULTS: Repeated measures analysis of variance showed a significant increase in adoption of each safety behavior (p < .0001), with most behaviors showing a significant increase after the first intervention session. CONCLUSIONS: Pregnant women who were abused and were offered an intervention protocol report a significant increase in safety behavior adoption during and after pregnancy. Abuse during pregnancy is common. Identification of abuse and immediate clinical intervention that includes information about safety behaviors can result in safety behavior adoption that may prevent future abuse and increase the safety and well-being of women and infants.

PIP: This study evaluates an intervention protocol administered during pregnancy for encouraging safety-seeking behaviors of abused women. The participants were 132 pregnant women recruited from public prenatal clinics that reported physical or sexual abuse prior or during the present pregnancy. Data were collected from an assessment on pregnant women using the Abuse Screen and Safety Assessment. After completion of the Safety Assessment, the women received an intervention protocol. Each woman received the intervention three times during pregnancy: at entry into the study; and two additional times evenly spaced throughout pregnancy. In this group of 132 pregnant women who were abused, adoption of safety behaviors significantly increased after the first intervention session. Furthermore, the adoption of safety behavior occurred across all ethnic groups. Pregnant women, who were abused, were offered an intervention protocol report showing a significant increase in safety behavior adoption during and after pregnancy. Abuse during pregnancy is common and the identification of abuse and immediate clinical intervention that includes information about safety behaviors can result in safety behavior adoption that may prevent future abuse and increase the safety and well-being of women and infants.

Physical abuse, smoking, and substance use during pregnancy: prevalence, interrelationships, and effects on birth weight.

OBJECTIVE: To establish the singular and combined occurrence of physical abuse, smoking, and substance use (i.e., alcohol and illicit drugs) during pregnancy and its effect on birth weight. DESIGN: Prospective cohort analysis. SETTING: Urban public prenatal clinics. PARTICIPANTS: 414 African American, 412 Hispanic, and 377 white pregnant women. MAIN OUTCOME MEASURE(S): Occurrence of physical abuse was 16%; smoking, 29.5%; and alcohol/illicit drug use, 11.9%. Significant relationships existed between physical abuse and smoking for African American and white women. For African American women, 33.7% of women who were not abused smoked, versus 49.5% of women who were abused (chi 2 = 8.21; df = 1; p < 0.005). Alcohol/illicit drug use was 20.8% for nonabused women compared with 42.1% for abused women (chi 2 = 18.18; df = 1; p < 0.001). For white women, 46.6% of women who were not abused smoked, versus 59.6% of those who were abused (chi 2 = 5.22; df = 1; p < 0.005). As a triad, physical abuse, smoking, and alcohol/ illicit drug use were significantly related to birth weight (F[3, 1040] = 30.19, p < 0.001). CONCLUSIONS: Physical abuse during pregnancy is common, readily detected with a five-question screen, and associated with significantly higher use of tobacco, alcohol, and illicit drugs. Clinical protocols that integrate assessment and intervention for physical abuse, smoking, and substance use are essential for preventing further abuse and improving smoking and substance cessation rates.

PIP: Using a prospective cohort analysis, this study established the singular and combined occurrence of smoking, physical abuse, and substance use during pregnancy and its effect on birth weight among African American, Hispanic, and White women. The sample consisted of 1203 African American (n = 414), Hispanic (n = 412), and White (n = 377) pregnant women from urban public prenatal clinics in Houston and Baltimore. In the results, occurrence of physical abuse was 16%; smoking, 29.5%; and alcohol/illicit drug usage, 11.9%. Among African American and White women, significant relationships existed between physical abuse and smoking. About 33.7% of African American women, who were not abused, smoked compared with 49.5% of women who were abused. Alcohol/illicit drug use was 20.8% for nonabused women compared with 42.1% for abused women. Moreover, the three characteristics--physical abuse, smoking, and alcohol/illicit drug use--were significantly related to birth weight. The results indicate that abuse during pregnancy is associated with increased smoking, and use of alcohol and illicit drugs. Thus, clinical protocols integrating assessment and intervention for physical abuse, smoking, and substance use are needed to achieve healthy outcomes for pregnant women and their infants.

Woman battering in Israel: the relative contributions of interpersonal factors.

Interpersonal factors were examined in 60 couples who reported violence by male against female partner and in 60 couples who did not. Violent men reported lower partnership quality and less social support than did nonviolent men. Battered women reported lower partnership quality but more positive social support than did women with nonviolent partners. Level of violence was predicted by level of child-rearing conflict and the availability of social support for the violent men.

PIP: This paper seeks to examine whether Israeli couples who report interpersonal violence would also report low-quality lives, conflict child-related interactions, and unsatisfactory social support outside the marriage. The sample included 60 violent men and their partners, matched with 60 nonviolent couples. Analyses were performed to determine differences between violent spouse and nonviolent spouse. Men's use of physical violence in relation to intimate and social relationships was also examined. Findings indicated that violent men and battered women tend to live with distinctly lower-quality marital relationships. Moreover, violent men had less social support than nonviolent men; whereas battered women had more positive social support than women with nonviolent partners did. Men's physical violence toward women was found to be associated with men's perception of high conflict over child rearing and the availability of close social support. Finally, the results of this study emphasize the importance of interpersonal relationship factors, both within and outside the marriage, when understanding relationships wherein men abuse their women partners.

Medicine and patriarchal violence: the social construction of a "private" event.

Our objectives are to describe the pattern of abuse associated with battering and to evaluate the contribution of the medical system and of broader social forces to its emergence. A pilot study of 481 women who used the emergency service of a large metropolitan hospital in the U.S. shows that battering includes a history of self-abuse and psychosocial problems, as well as repeated and escalating physical injury. In addition, although the number of battered women using the service is 10 times higher than medical personnel identify, the pattern of abuse that constitutes battering emerges only after its initial effects are presented and in conjunction with specific medical intervnetions and referrals. Examination of intervention and referral patterns suggests a staging process by which battering is socially constructed. At first, the physical trauma associated with abuse is medicated symptomatically. But the patient's persistence, the failure of the cure, and the incongruity between her problems and available medical explanations lead the provider to label the abused woman in ways that suggest she is personally responsible for her victimization. Although secondary problems such as depression, drug abuse, suicide attempts, or alcoholism derive as much from the intervention strategy adopted as from physical assault or psychopathology, they are treated as the primary problems at psychiatric and social service referral points where family maintenance is often the therapeutic goal. One consequence of this referral strategy is the stabilization of "violent families" in ways that virtually insure women will be abused in systematic and arbitrary ways. The use of patriarchal logic by medical providers ostensibly responding to physical trauma has less to do with individual "sexism" than with the political and economic constraints under which medicine operates as part of an "extended patriarchy." Medicine's role in battering suggests that the services function to reconstitute the "private" world of patriarchal authority, with violence if necessary, against demands to socialize the labors of love.

PIP: A pilot study of 481 women who used the emergency service of a large metropolitan hospital in the US shows that battering includes a history of self-abuse and psychosocial problems, as well as repeated and escalating physical injury. In addition, although the number of battered women using the service is 10 times higher than medical personnel identify, the pattern of abuse that constitutes battering emerges only after its initial effects are presented and in conjunction with specific medical interventions and referrals. In this paper, the pattern of abuse associated with battering is described and the contribution of the medical system and of broader social forces to its emergence is evaluated. In a series of reviews, final analysis showed an alignment process, what might be termed "the socialization of medical perception," which marks the medical construction of battering as social and which was observed, at various stages, in the medical histories of battered women.

Killing the beast within: woman battering and female suicidality.

This article explores the importance of woman battering for female suicidality, with special attention to the link among black women. Suicidality has classically been framed with a distinctly male bias. As a result, suicide attempts (a predominantly female event) have been defined as "failed suicides" and the distinctive social context of suicidality among women has been missed. The authors propose that suicidality among battered women is evoked by the "entrapment" women experience when they are subjected to "coercive control" by abusive men. A literature review highlights the probable importance of male violence as a cause of female suicidality. Pursuing this possibility, we assess the significance of battering in a sample of women who have attempted suicide, the characteristics of battered women who attempt suicide, and the appropriateness of the medical response. The results indicate that battering may be the single most important cause of female suicidality, particularly among black and pregnant women. The implications of this finding for theory and clinical intervention are discussed.

PIP: This article explores the importance of woman battering for female suicidality, with special attention to the link among Black women. It examines data from women's medical records to illuminate a clinical dilemma and to critique the gender bias in current formulations of the problem. The authors propose that suicidality among battered women is evoked by the ¿entrapment¿ women experience when they are subjected to ¿coercive control¿ by abusive men. A literature review highlights the probable importance of male violence as a cause of female suicidality. Pursuing this possibility, the authors assessed the significance of battering in a sample of women who have attempted suicide, the characteristics of battered women who attempt suicide, and the appropriateness of the medical response. The results indicated that battering may be the single most important cause of female suicidality, particularly among Black and pregnant women. The implications of this study for theory and clinical intervention are discussed.

When your patient is a batterer. What you need to know before treating perpetrators of domestic violence.

PIP: This article describes the three types of male perpetrators of domestic violence, their behavioral patterns, and the steps for providing them appropriate treatment. Batterers manifest the same cyclical behavior and express the same brutal and irrational rage, no matter what language they speak; they still communicate the same hate words and accusations of blame. There are three types of batterers identified by Dutton and Golant. First is the cyclical emotionally volatile type. This involves a constellation of feelings involving rage and jealousy. The second type comprises the overcontrolled batterers. This group of batterers exhibits less physical aggression, but more psychological abuse compared to the first group. These men receive extremely high score on the dominance isolation factor of abusiveness. Overcontrolled abusers are divided into active control freaks and the passive abusers. The third type includes the psychopathic batterers. This group of batterers lack emotional responsiveness and exhibit no remorse about their behavior. These men engage in criminal activities and are often violent with friends, strangers, co-workers, and employers as well as with their wife. They often reflect antisocial behavior and sadistic aggression. Domestic violence thrives on silence. Physicians can help penetrate this silence by discussing the issue with their patients, listening to patients' direct or indirect references to their own experiences with domestic violence, and making referrals for treatment. Furthermore, group therapy has proven to be the best option for treating a battering behavior.^ieng

Recent or imminent separation and intimate violence against women. A conceptual overview and some Canadian examples.

PIP: The link between recent or imminent separation and violence against female partners is discussed. Interviews were conducted among 87 divorced, separated and domestic violence survivors during 1985-88 to study violence perpetrated by men against their female intimate partners. Various bodies of literature are reviewed to establish the fact that separation heightens the risk of violence. The conceptual contributions of social learning and power and control theories are presented as they pertain to intimate violence against women. An expanded version of the power-and-control model is used to underscore the violence proneness of separations, especially when women initiate separations. To illustrate the expanded model, numerous Canadian examples are provided, drawn from interviews with divorced women, survivors of intimate violence, and news media reports. Finally, different strategies to break the cycle of violence are summarized.^ieng