Domestic Violence: A Major Problem and Public Health Issue

The prevalence of domestic violence in the United States is alarming, transcending geographic, socioeconomic, and cultural boundaries.

On average, nearly 20 people per minute are physically abused by an intimate partner, according to National Coalition Against Domestic Violence. This equates to more than 10 million men and women annually.

"Domestic violence is not exclusive to physical harm; it also encompasses emotional abuse, such as manipulation, control, and isolation," said Maja Bergman, PhD, a clinical psychologist and researcher at the New York State Psychiatric Institute whose work focuses on trauma. "These experiences can lead to long-lasting psychological trauma."

Dr. Bergman began her career in Sweden doing clinical work focused on trauma, particularly within families. Her desire to pursue trauma research brought her to New York 10 years ago, where she found a research interviewer position at NYSPI and began doctoral studies at Fordham University. Maintaining her focus on traumatic stress, Dr. Bergman conducted research at the PTSD Research and Treatment Program led by Yuval Neria, PhD, professor of clinical medical psychology (in psychiatry and epidemiology), where she has worked since 2017.

In honor of Domestic Violence Awareness Month, Columbia Psychiatry News spoke with Dr. Bergman about the types of challenges domestic violence survivors face, the most effective therapies for those who experience domestic abuse, and warning signs that someone may be an abuser.

What is domestic violence? In what forms does it present itself?

Domestic violence occurs in the home and family domain in many forms. Most often the term is used to refer to intimate partner violence, such as being physically abused or assaulted by a sexual or romantic partner, but it can also include witnessing this type of violence between parents or physical abuse between other family members. When parents are violent toward their children, we more typically refer to it as child abuse, but domestic violence may also include an adult child in the household who is violent toward one or both of their parents.

Are women its primary victims?

Domestic violence can affect anyone regardless of age, race, gender, sexual orientation, socioeconomic background or education level. A common misconception about domestic violence is that males are always the perpetrators and females are victims. There is violence in same sex relationships—from women to women, men to men—as well as women to men in heterosexual relationships.

What percentage of people are victims of domestic abuse? 

The statistics concerning domestic violence can be hard to interpret due to varying definitions, but it is estimated that 1 in 3 women and 1 in 4 men have experienced some form of physical violence by an intimate partner, and 1 in 7 women and 1 in 25 men have been injured by an intimate partner. Across the U.S., more than 10 million domestic violence incidents are estimated each year, and in 2021 the National Domestic Violence Hotline responded to over 400,000 calls, chats, and texts. In many of these cases, children are present in the household and approximately 1 in 15 children are exposed to intimate partner violence each year. Of the children exposed to domestic violence, 90% directly witness the violence.

New York City recently amended its definition of domestic violence to include  economic abuse and extended protections to victims. How does this invisible form of domestic violence typically present itself? What effects can it have on victims?

It is unfortunately a very common form of abuse and often implemented to maintain power and keep abused partners from leaving the relationship by way of financial dependence. Economic abuse can take the form of controlling access to money or preventing people from earning money—either by keeping someone from going to work or seeking employment, sabotaging existing employment, or demanding that someone gives up employment. It can also take the form of accruing debt in someone's name, coerced debt accrual, or destroying a person's credit. In addition to making it difficult to leave the abusive relationship, economic abuse often continues to create problems for survivors—such as debt, poor credit history, and lack of funds to continue rebuilding their lives—even after they have left the relationship.

What sort of challenges do domestic violence survivors face?

In addition to physical injuries, financial abuse and financial stress are common in the context of domestic violence and further contribute to the psychological burden. Typical psychological effects of domestic violence include post-traumatic stress reactions and depression. Domestic violence is also associated with increased suicidal behaviors. Incidents of domestic are rarely isolated and usually escalate in frequency and severity without interventions.

What types of therapy are helpful to work through the trauma of domestic abuse? 

There are many forms of psychotherapy that can be helpful following domestic abuse. If a survivor is experiencing post traumatic reactions, such as intrusive memories, flashbacks, physical reactivity to reminders, and avoidance of things that may remind them of the abuse, a trauma-focused treatment such as prolonged exposure may be the best option. If more depressive symptoms and feelings of shame or guilt are central, an affect-focused therapy, such as interpersonal psychotherapy, may be better suited.

Are there any warning signs that someone may be an abuser? 

Because domestic violence is widespread and not limited to particular social groups, it can be impossible to tell beforehand, yet many survivors will feel shame and guilt about not having been able to tell sooner. The physical abuse is usually not the first form of control or abuse. Signs to look out for may include:

Your own feelings: Are you afraid of your partner? If you are afraid to speak freely or say no to sex, this could be a important warning sign that something is going on in the relationship that should be addressed.
Behaviors that may precede violence include your partner accusing you of having an affair; becoming critical or controlling (such as telling you what to wear and how you should look); threatening you or someone close to you with violence or harm; destroying items when angry; and controlling your money or cutting you off from other important relationships in your life.

What can we do to stop domestic abuse and promote domestic violence awareness? 

There are many good national and local campaigns to promote awareness, but we may also want to look for signs that it may be happening to someone close to us. Such signs may include:

Unexplained injuries or excuses for bruises and injuries that don't match up to the stories behind them
Personality changes, particularly decreased self-esteem
Never having money on hand despite being gainfully employed
Intense worry about how their partner will react
Wearing clothes that don't fit the season, like long sleeves or scarves in summer to cover bruises

If you expect that someone is experiencing domestic violence, don't be afraid to ask. Talk to them and let them know that they have support. I think we have a lot of work to do in terms of reducing stigma and shame as well as availability of services, including help for victims and abusers to find their way to healthy, respectful, and nonviolent relationships.

If you, or someone you know, is affected by domestic violence, a good place to start may be to call to the National Domestic Violence Hotline at 1-800-799-SAFE (1-800-799-7233), where trained counselors can listen and help to figure out next steps.

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