Mediators and moderator of the effects of early exposure to intimate partner violence on children's mental health.

Childhood intimate partner violence (IPV) exposure increases the likelihood of internalizing and externalizing problems. There is substantial variability in children's outcomes following IPV exposure, but the reasons behind this are unclear, particularly among preschool-age children. The current study aimed to examine the direct and indirect effects of IPV on preschoolers' mental health through parent factors (parenting and parental depression), exploring child temperament as a potential moderator of the relation between IPV and child outcomes. Participants were 186 children (85 girls) and their parents living in the United States. Data were initially collected when children were age three, with follow-up at ages four and six. Both parents' baseline IPV perpetration had adverse effects on child outcomes. Mothers' IPV was associated with greater paternal depression, paternal overractivity, and maternal laxness, whereas fathers' IPV was associated with more paternal overreactivity. Only paternal depression mediated the effect of mothers' IPV on child outcomes. Parenting did not mediate nor did child temperament moderate the relation between IPV and child outcomes. Results shed insight into the need to address parental mental health in families experiencing IPV and underline the need for a further exploration of individual- and family-level mechanisms of adjustment following IPV exposure.

Eight-year trajectories of behavior problems and resilience in children exposed to early-life intimate partner violence: The overlapping and distinct effects of individual factors, maternal characteristics, and early intervention.

Childhood exposure to intimate partner violence (IPV) can have lasting effects on well-being. Children also display resilience following IPV exposure. Yet, little research has prospectively followed changes in both maladaptive and adaptive outcomes in children who experience IPV in early life. The goal of the current study was to investigate how child factors (irritability), trauma history (severity of IPV exposure), maternal factors (mental health, parenting), and early intervention relate to trajectories of behavior problems (internalizing and externalizing problems) and resilience (prosocial behavior, emotion regulation), over 8 years. One hundred twenty mother-child dyads participated in a community-based randomized controlled trial of an intervention for IPV-exposed children and their mothers. Families completed follow-up assessments 6-8 months (N = 71) and 6-8 years (N = 68) later. Although intention-to-treat analyses did not reveal significant intervention effects, per-protocol analyses suggested that participants receiving an effective dose (eight sessions) of the treatment had fewer internalizing problems over time. Child irritability and maternal parenting were associated with both behavior problems and resilience. Maternal mental health was uniquely associated with child behavior problems, whereas maternal positive parenting was uniquely associated with child resilience. Results support the need for a dyadic perspective on child adjustment following IPV exposure.

Parsing between- and within-person effects: Longitudinal associations between irritability and internalizing and externalizing problems from early childhood through adolescence.

INTRODUCTION: This report examines between- and within-person associations between youth irritability and concurrent and prospective internalizing and externalizing symptoms from early childhood through adolescence. Distinguishing between- and within-person longitudinal associations may yield distinct, clinically relevant information about pathways to multifinality from childhood irritability. METHODS: Children's irritability and co-occurring symptoms were assessed across five waves between ages 3 and 15 years using the mother-reported Child Behavior Checklist (N = 605, 46% female). Parental history of depressive disorders was assessed with a clinical interview. RESULTS: Results demonstrated that between- and within-person irritability were uniquely associated with concurrent depressive, anxiety, and defiance symptoms, but not ADHD. Prior wave within-person irritability also predicted next wave depressive, anxiety, and defiance symptoms, controlling for prior symptoms; these prospective associations were bidirectional. Child sex and parental depressive disorders moderated associations. DISCUSSIONS: Findings identify pathways from within- and between-person irritability to later internalizing and externalizing psychopathology. Results demonstrate the importance of parsing within- and between-person effects to understand nuanced relations among symptoms over childhood.

Predictors of Intimate Partner Violence Victimization by Multiple Partners Over a Period of 8 Years.

Intimate partner violence (IPV) is a pervasive social issue with broad physical and mental health implications. Although 35%-56% of women report IPV victimization with more than one violent partner, few studies have identified factors that increase the risk of experiencing IPV across multiple partners (i.e., IPV reengagement). In the current study, multilevel modeling was used to examine the roles of trauma exposure, mental health, and sociodemographic factors in the risk for reengagement in a sample of women (N = 120) with IPV victimization. Participants were drawn from a randomized control trial of an intervention for mothers who had experienced IPV. The results revealed that more psychological but less sexual IPV was associated with increased reengagement. Higher degrees of posttraumatic reexperiencing symptoms were associated with less reengagement. Depressive symptoms were also significantly associated with reengagement such that lower levels of positive affect and increased somatic symptoms were associated with increased reengagement. Higher income levels and less housing instability were associated with more reengagement, ßrange = -.13-.16. Finally, compared to the control condition, participation in the intervention program was significantly associated with lower levels of reengagement at 8-year follow-up, ß = -.75, p = .001. These findings suggest that it is not what happened (i.e., experiences of abuse) but rather a woman's posttraumatic experience (i.e., posttraumatic stress and depressive symptoms) that creates risk for reengagement. The findings support the long-term effectiveness of a brief intervention in reducing reengagement.

Dyadic Profiles of Posttraumatic Stress Symptoms in Mothers and Children Experiencing Intimate Partner Violence.

Children who witness intimate partner violence (IPV) develop posttraumatic stress disorder at alarmingly high rates. Research suggests that caregivers' symptoms of posttraumatic stress (PTSS) often co-occur alongside children's PTSS, a phenomenon termed "relational posttraumatic stress." The goal of this study is to use dyad-centered analyses to examine heterogeneity in relational PTSS presentations in mother-child dyads, and to determine factors differentiating relational PTSS profiles. Data were drawn from a sample of 231 IPV-exposed, ethno-racially diverse mother-child dyads, with children ranging from ages 4 to 12. The results of a latent profile analysis indicated that a two-profile model was the best fit with the data. Both profiles indicated similar levels of PTSS across the dyad; however, they differed in overall symptom severity. Parenting and IPV severity significantly predicted profile membership; however, age did not. Results suggest that similarities in PTSS presentation should be expected in mother-child dyads, at least in families who experience IPV.

Moms' Empowerment Program participation associated with improved physical health among Latinas experiencing intimate partner violence.

OBJECTIVE: To evaluate whether participation in the Moms' Empowerment Program (MEP), a 10-week, 10-session intervention designed to provide support and increase access to available community resources for women experiencing intimate partner violence (IPV), enhanced the physical health of participants who self-identified as Latina. METHODS: Mothers of children ages 4-12 who self-identified as Latina and had experienced IPV within the past two years were recruited at three intervention sites in Michigan, Ohio, and Texas, via community postings and referrals from agencies serving IPV-exposed families. Selected study participants (n = 93) were assigned to one of two groups: Treatment (immediate enrollment in the MEP) or Control (placement on a waitlist with an invitation to participate in the MEP after the 10-week study period). Data were drawn from two structured interviews, one at the time of recruitment for the study (Time One), and one following the intervention or wait period (Time Two). RESULTS: After controlling for age, educational attainment, and partner residence (living with a violent partner at the time of the interview), multilevel modeling revealed that improvement in physical health over time was significantly greater among women who participated in the intervention relative to controls. CONCLUSIONS: These data suggest that enhancing interpersonal connectedness and access to resources positively affects physical health for Latinas experiencing IPV.

SLC44A2 single nucleotide polymorphisms, isoforms, and expression: Association with severity of Meniere's disease?

SLC44A2 was discovered as the target of an antibody that causes hearing loss. Knockout mice develop age related hearing loss, loss of sensory cells and spiral ganglion neurons. SLC44A2 has polymorphic sites implicated in human disease. Transfusion related acute lung injury (TRALI) is linked to rs2288904 and genome wide association studies link rs2288904 and rs9797861 to venous thromboembolism (VTE), coronary artery disease and stroke. Here we report linkage disequilibrium of rs2288904 with rs3087969 and the association of these SLC44A2 SNPs with Meniere's disease severity. Tissue-specific isoform expression differences suggest that the N-terminal domain is linked to different functions in different cell types. Heterozygosity at rs2288904 CGA/CAA and rs3087969 GAT/GAC showed a trend for association with intractable Meniere's disease compared to less severe disease and to controls. The association of SLC44A2 SNPs with VTE suggests that thrombi affecting cochlear vessels could be a factor in Meniere's disease.

Ethno-Racial Differences in Children's Attitudes and Beliefs About Violence.

One in 15 children in the United States are exposed to intimate partner violence (IPV) each year. Although much is known about the adverse effects of witnessing IPV on children, little attention has been given to the impact of IPV on children of diverse ethno-racial backgrounds. In particular, the association between IPV and children's attitudes and beliefs about violence across different ethno-racial populations remains to be explored. One hundred ninety children between the ages of 4 and 12 years of varying ethno-racial backgrounds who had witnessed recent IPV were interviewed regarding their attitudes and beliefs about IPV. Results show that younger children and White, Black, and Biracial children exhibited more deleterious attitudes and beliefs about violence after exposure to IPV than did older and Latina or Latino children. These findings may indicate the need for more tailored intervention programs that target the specific maladaptive beliefs expressed by children of various demographic groups.

Associations between childhood polyvictimization, intimate partner violence victimization and substance use among college students.

Objectives: Intimate partner violence (IPV) is associated with an elevated risk of substance use, but few studies have simultaneously examined other aspects of victimization history that may contribute to substance use. The current study examined the direct and moderating effects of childhood polyvictimization (i.e., multiple experiences of violence victimization before age 18) on the association between IPV subtypes (physical, sexual, psychological, and injury) and alcohol/drug use. Methods: A sample of 256 college students ages 18-25 (72% female, 68% white) completed a survey assessing past-year IPV, childhood polyvictimization, and past three-month substance use. Results: There were no direct or joint associations between IPV, childhood polyvictimization, and alcohol use. There were direct associations between psychological IPV, childhood polyvictimization, and drug use. No other forms of IPV were significantly associated with drug use. Conclusions: Results highlight unique direct associations between violence victimization and drug use risk compared to alcohol use risk in this context.

Nonpartner Violence Perpetration Among Emerging Adults: Associations With Polysubstance Use and Trait Mindfulness.

Objective: Violence is a leading cause of death among individuals ages 18-25, with alcohol misuse consistently linked with violence perpetration. However, the association between polysubstance use and violence perpetration is less clear, despite the frequency of use of alcohol with other drugs. Additionally, protective factors such as mindfulness that may reduce violence perpetration among emerging adults have been understudied. This cross-sectional study examined the association between substance use, trait mindfulness, and violence perpetration outside of romantic relationships, utilizing a compensatory model of resilience. Methods: Data were drawn from a sample of 665 emerging adults ages 18-25, recruited from an urban Emergency Department (68% men). Participants self-administered a computer survey that assessed non-partner violence perpetration (NPV), alcohol use, marijuana use, prescription drug misuse, and trait mindfulness. Fifteen percent reported non-partner violence perpetration over the past six months. Results: Multivariate logistic regression tested associations between violence perpetration, substance use, trait mindfulness, and demographic characteristics. Results showed that alcohol use alone (OR= 3.04), prescription opioid use alone (OR = 3.58), alcohol and marijuana use (OR = 3.75), and use of all three substances (OR= 7.78) were positively associated with violence perpetration. Post-hoc contrasts demonstrated the polysubstance use significantly increased risk over single substance use. Trait mindfulness (OR= 0.97) was negatively associated with violence perpetration after controlling for substance use. Conclusions: Findings suggest that polysubstance use may increase risk for violence. Interventions that address polysubstance use, potentially including mindfulness, could reduce non-partner violence perpetration among emerging adults and requires further study.

Risk factors for intimate partner violence victimization across 8 years: Contributions of the posttraumatic stress symptom domains.

OBJECTIVE: Although much remains unknown about what creates risk for women's intimate partner violence (IPV) victimization across time, trauma exposure and mental health are likely contributors. Specifically, posttraumatic stress (PTS) is a risk factor for IPV victimization, yet we know less about the unique contributions of PTS symptom domains to IPV risk. Identification of PTS symptom domains that confer risk for IPV has the potential to inform novel targets of intervention. METHOD: This study follows women with children (N = 118) across 8 years to identify the trauma exposure, mental health, and sociodemographic factors that contribute to IPV victimization risk using longitudinal multilevel modeling. RESULTS: Higher levels of PTS symptoms were associated with initially greater number of IPV victimization acts experienced (i.e., "IPV victimization"). However, across time, women with higher PTS symptoms decreased more quickly in IPV victimization than those with lower PTS symptoms. Higher levels of PTS arousal and reexperiencing were each associated with initially higher levels of IPV victimization. In addition, higher levels of PTS reexperiencing and arousal remained associated with higher levels of IPV victimization across time. Women's age was inversely related to IPV victimization over time only when accounting for the PTS symptom domains. CONCLUSIONS: Findings are that collapsing PTS symptoms into an overall construct may be too imprecise to identify key mechanisms for IPV victimization risk. IPV prevention should prioritize addressing reexperiencing and arousal symptoms to curb future IPV victimization. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Longitudinal Correlates of Maternal Involvement and Spanking in Spanish-speaking Latinas Who Have Experienced Intimate Partner Violence.

Mothers experiencing intimate partner violence (IPV) have been found to have negative long-term parenting outcomes, such as reduced maternal involvement and greater use of physical punishment, which represent potential pathways by which IPV negatively affects children. Factors influencing these parenting practices have not been examined in IPV-exposed Latinas. The aim of this study is to understand the factors that affect maternal involvement and spanking by Latinas to contribute to culturally-informed intervention development and refinement. A total of 93 Spanish-speaking Latinas who had experienced IPV completed standardized measures of maternal involvement, spanking, IPV, depression, and posttraumatic stress (PTS) and provided demographic information. Slightly over half of the women participated in an intervention program. Longitudinal multilevel modeling (MLM) demonstrated that higher levels of maternal depression predicted lower levels of involvement over time. PTS reexperiencing symptoms were positively related to involvement, such that mothers with higher levels of reexperiencing reported higher levels of involvement. An independent longitudinal MLM revealed that higher amounts of IPV exposure and higher levels of PTS arousal symptoms were associated with higher levels of spanking, while maternal employment was associated with lower levels of this same parenting behavior. Maternal involvement increased over time, where there was no significant change in spanking over time, and no effect of the intervention program on either parenting practice. Results suggest clinical interventions should target reductions in depression and specific PTS symptom subdomains as pathways to improving parenting in IPV-exposed Latinas. Continued study is needed to understand the relationship between reexperiencing and maternal involvement.

Preschoolers' Intimate Partner Violence Exposure and Their Speeded Control Abilities Eight Years Later: A Longitudinal Mediation Analysis.

Executive functioning (EF), or a set of related cognitive skills that facilitate goal-oriented behavior, is a critical aspect of adaptive development. Mounting research indicates that exposure to environmental threats during the preschool years jeopardizes EF; however, the extent and mechanisms through which early exposure to intimate partner violence (IPV) influences children's EF are unknown. Using data from an eight-year longitudinal investigation of mothers who had experienced IPV and their preschool-aged children (N = 120), this study examined the relative influence of recent and remote IPV exposure on speeded control-a component of EF influenced by processing speed-in late childhood. Results indicated that preschoolers' IPV exposure had a significant negative impact on their speeded control eight years later, and this relation was mediated by the remote effects of IPV on their mothers. Specifically, IPV was positively associated with maternal depression, which in turn contributed to greater use of negative parenting strategies when children were of preschool age. Children's IPV exposure during late childhood was not predictive of their concurrent speeded control. These findings lend further evidence to the notion that the preschool years are a sensitive period for the mastery of EF skills and that IPV exposure is a distinct risk factor that can have protracted effects on children's cognitive development. Further, this study points to modifiable environmental risk factors, which, through targeted prevention and intervention efforts, could promote EF across the lifespan.

Contributions to Depressed Affect in Latina Women: Examining the Effectiveness of the Moms' Empowerment Program.

Intimate partner violence (IPV) is a significant social and public health problem that includes physical violence, sexual violence, threats of physical or sexual violence, stalking, and psychological aggression by an intimate partner. Estimates suggest that 35% of Latinas living in the United States experience IPV in their lifetime, with known severe negative outcomes. One mental health consequence of concern is depression, which disproportionately affects IPV-exposed Latinas. The present study tested the effectiveness of the Moms' Empowerment Program (MEP), a culturally adapted intervention to reduce depressive symptoms among IPV-exposed Spanish-speaking Latina mothers. Additional psychosocial predictors of levels of depressed affect over time are examined, including levels of post-traumatic stress, IPV exposure, positive parenting, parental acceptance of children's negative emotions, and maternal employment. Participants (N = 72) were assigned to a treatment or a wait-list comparison condition, and those in the treatment group completed a 10-week group intervention addressing the unique problems associated with IPV exposure, mental health, and parenting among Spanish-speaking Latinas. Results of multilevel modeling revealed that participation in the MEP was associated with significant reductions in depressed affect. Lower levels of post-traumatic stress and higher levels of positive parenting, maternal acceptance of children's negative emotions, and maternal employment predicted lower levels of depressed affect. The amount of total IPV exposure was not significantly associated with the extent of depressed affect. The MEP represents a culturally tailored, evidence-based intervention to reduce depressed affect among Spanish-speaking Latinas. The clinical implications of the additional predictors of levels of depressed affect are discussed.

Predictors of Housing Instability in Women Who Have Experienced Intimate Partner Violence.

Although one in four women in the United States experience severe intimate partner violence (IPV) in their lifetimes and are at greater risk for homelessness and housing insecurity than women who have not experienced IPV, the factors increasing the vulnerability of women with an IPV history to housing instability have not been examined. This cross-sectional study utilized baseline data from interviews with 218 IPV-exposed women from diverse ethnoracial backgrounds participating with their children in the Kids' Club and the Mom's Empowerment Program, joint interventions designed to improve outcomes in families who have experienced IPV. Multiple regression was used to examine the predictors associated with housing instability, quantified as the number of times a participant had moved in the past 4 years. Demographic information was collected and exposure to violence was measured with the Conflict Tactics Scale (CTS); severity and prevalence of PTSD and depression symptoms were measured with the Posttraumatic Diagnostic Scale (PDS) and the Center for Epidemiologic Studies Depression Scale (CES-D), respectively. Results showed that level of education was positively associated with housing instability, while age of the participant, average monthly income, and increased severity of PTSD symptoms were negatively associated. Neither the participant's race nor the extent of reported violence significantly predicted participants' housing instability. The findings of this study may serve to better identify those who have experienced IPV that are most at risk of experiencing housing instability, and to inform future interventions and policy aiming to support their needs. In addition, these results further emphasize the importance of providing housing resources in addition to interventions designed to improve physical and psychosocial health in enabling women that have experienced IPV to gain independence from an abuser.

Profiles of Traumatic Stress Symptoms in Children Exposed to Intimate Partner Violence.

Childhood exposure to intimate partner violence (IPV) is associated with a host of problems, including the development of posttraumatic stress symptoms (PTSS). PTSS include a wide range of unique symptomatology and as a result, clinical presentations of PTSS can vary in both distribution and overall number of symptoms. Work in child and adolescent samples has largely focused on factors predicting the total number of symptoms (i.e., symptom severity), with less work focused on both patterns of symptom number and distribution. Furthermore, few studies have examined how functional impairment varies in relation to PTSS presentation. The goal of the current study is to (a) document patterns of PTSS severity and distribution in children with histories of witnessing IPV, (b) examine the factors that predict different PTSS presentations, and (c) investigate how PTSS presentation is associated with functional impairment. Data for this study were drawn from a sample of 236 children between the ages of 4 and 12 years and their mothers who had experienced recent IPV. Families reported high levels of IPV in the past year, and children reported moderate levels of PTSS. A latent profile analysis of PTSS revealed that three profiles were the best-fitting model for the data. The three profiles were differentiated between low, moderate, and high levels of PTSS, and membership in the profiles varied by children's age and trauma history. The results of this study give important information about the potential development of PTSS as well as clinically useful information about the relationship between children's PTSS and their functioning following exposure to IPV.

Examining the 8-Year Trajectory of Posttraumatic Stress Symptoms in Children Exposed to Intimate Partner Violence.

Millions of children witness intimate partner violence (IPV) each year, and the effects of these experiences are substantial. One of the more common sequelae of exposure to IPV is the development of posttraumatic stress symptoms (PTSS). Given the chronic nature of both IPV and PTSS, there is a need for prospective research on long-term mental health outcomes following IPV exposure in childhood. This study prospectively examines trajectories of PTSS over an 8-year period, beginning from the preschool period. This study also investigates factors that may be associated with these trajectories, including intervention participation, continued IPV exposure, and the caregiving environment. A total of 120 mother-child dyads participated in four study waves over an 8-year period, beginning when children were between the ages of 4 and 6. Mothers and children participated in an intervention between baseline and Time 2. At the onset of the study, all mothers reported experiencing IPV over the previous year. Findings demonstrate that, in general, children experienced worsening of their PTSS over the 8-year trajectory, and few factors were significantly associated with this trajectory. There were no associations between intervention participation, parenting behaviors, and long-term child PTSS outcomes; however, there were significant associations between amount of IPV exposure, mother's level of PTSS, and children's PTSS outcomes. These results underscore the need to better understand the impact of early-life exposure to IPV, as well as the need for interventions tailored to this developmental period. Furthermore, these findings highlight the long-term negative associations between chronic exposure to IPV and child well-being, as well as the significant connections between caregiver and child mental health.

Using Item Response Theory to Compare Irritability Measures in Early Adolescent and Childhood Samples.

Limited psychometric information is available to guide best practices for measuring youth irritability. This report compares performance of irritability measures using item response theory (IRT). Study 1 used a sample of 482 early adolescents and compared the parent- and youth-report affective reactivity index (ARI) and irritability factors derived from the parent-report Child Behavior Checklist (CBCL) and clinician-administered Kiddie Schedule for Affective Disorders (K-SADS). Study 2 combined data from three childhood samples (N = 811) and compared performance of the parent-report ARI and CBCL and the clinician-administered Preschool Age Psychiatric Assessment (PAPA). The ARI emerged as the best measure of childhood irritability across the developmental periods, while the CBCL and K-SADS provided an adequate amount of information in early adolescents. No measure reliably assessed irritability at modest severity levels. Using IRT across large pools of developmental samples and measures is needed to guide the field in the measurement of youth irritability.

Investigating the effects of the Moms' Empowerment Program on 8-year traumatic stress symptom trajectories in women with histories of IPV.

OBJECTIVE: Intimate partner violence (IPV) is a pressing issue, affecting nearly one-third of women in the U.S. over their lifetimes, and has been linked with a number of deleterious outcomes, including the development of posttraumatic stress disorder (PTSD). Although IPV is often chronic, few studies have prospectively examined trajectories of PTSD symptoms (PTSS) in this population. The goal of the present study was to assess the effects of the Moms' Empowerment Program-an IPV-specific intervention; as well as trauma exposure, domestic violence (DV) shelter use, and depression symptoms on PTSS trajectories in women with histories of IPV. METHOD: Data were drawn from a sample of 118 women who participated in a randomized controlled trial (RCT) of an intervention specifically designed for women and children experiencing IPV. Sixty-seven women from the original sample completed an assessment 8 years following the conclusion of the intervention. RESULTS: On average, women's PTSS decreased over time. Intervention group assignment did not affect these trajectories; however, women who attended more sessions had significantly fewer PTSS at the 8-year follow-up. Greater IPV exposure, higher depression symptoms, and shelter use were all associated with higher PTSS over time, with some variation across PTSS subdomains. CONCLUSIONS: These results provide preliminary evidence that brief intervention may have long-term effects. They also demonstrate how addressing ongoing IPV and concurrent symptoms of depression is likely an essential component of treating PTSS in this population. Finally, these results underscore the need for more research on relations between formal DV services and mental health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Social and Individual Characteristics of Women Associated With Engagement With Multiple Intimate Violent Partners.

Intimate partner violence (IPV) is a serious public health problem with known negative physical and mental health outcomes for women exposed. Studies have shown that with increased violence exposure, there are increased risks of negative outcomes for women. Likewise, chronicity of IPV across multiple partners is linked to more profound psychological suffering than acute exposure. However, little is known about the social- and individual-level characteristics of women that are correlated with engagement with multiple abusive partners. The current study (N = 164) identifies the characteristics of women that are associated with the number of violent partners with which they have been involved, with 35% of the sample reporting multiple IPV relationships. Participants reported on the number of violent partners, demographic characteristics, trauma history, current trauma and depressive symptoms, and exposure to IPV, including physical, sexual, and psychological violence. Results of multiple regression analysis indicate that trauma history (childhood sexual abuse, being held hostage, and torture) and current psychological violence were associated with women's engagement with multiple violent partners. Additional findings reveal that identification as African American and White was associated with greater re-engagement compared with identification as Latina. Finally, current exposure to sexual violence was associated with fewer violent partners. The clinical implications of these findings for treatment for women at risk for engagement with multiple partners in IPV relationships are discussed.