Jennifer Focht and Amanda Chu, National Center for Health Research
About 1 in 3 women and 1 in 10 men in the U.S. experience domestic violence, and 1,500 of them die each year. These numbers may be higher; domestic violence remains an underreported issue, and many victims do not seek help. Research shows that victims of domestic violence suffer negative physical and mental health consequences.[1]
If you or someone you know is experiencing domestic violence, this article includes useful information, and the National Domestic Violence Hotline is listed at the end of this article.
What is Domestic Violence?
Domestic violence is any action done to harm, scare, or force an individual to do things they do not want to do. The abuser is often someone the victim intimately knows or lives with. Domestic violence does not have to be physical assault. It can include stalking, neglect, or emotional, psychological, economic, and sexual abuse. Children, family members, partners, and cohabitants can all be victims of domestic violence. Intimate partner violence, child abuse, and elder abuse are different types of domestic violence.[2]
Physical violence is only one form of domestic violence. There are other less obvious forms of abuse, usually involving power and control, that occur simultaneously and exacerbate the situation. The graphic below can help you to identify and understand 8 different tactics used to assert power and control.[3] Examples are included for each one. These tactics are worse when there is the threat or use of physical and sexual violence, the outer ring of the wheel.
Physical and Mental Health Consequences of Domestic Violence
Victims of domestic violence, whether male or female, suffer short and long-term physical and mental health consequences. Common physical health effects include broken bones, bruising, lacerations, and cardiovascular and gastrointestinal problems.[2,4] Women may also experience gynecological problems such as pelvic inflammatory disease, pelvic pain, sexually-transmitted disease, vaginal bleeding, pain with menstruation, and bladder infections. Domestic violence is one of the most common causes of injury among women[4]; less is known about the impact on male victims.
Many domestic violence victims also experience mental health problems, such as depression and post-traumatic stress disorder (PTSD). Domestic violence has also been associated with suicidal behavior, sleep and eating disorders, social dysfunction, worsening of psychotic symptoms, and drug and alcohol abuse.[4]
Children who have been around domestic violence feel greater distress and are more likely to have behavioral problems, abuse drugs and alcohol, and face depression and anxiety. Child abuse is also common in families experiencing intimate partner violence. In about 30-60% of families where intimate partner violence takes place, child abuse also takes place.[2]
Why Do People Stay in Abusive Relationships?
The Cycle of Domestic Violence
Domestic violence often repeats a cycle of behavior within each relationship that may prevent the victim from leaving. Not every abusive relationship follows this pattern, but many victims describe their relationships in this way:
Tension Building Phase
When tension builds in the relationship, victims may feel like they are “walking on eggshells” around the abuser. This phase can last for a few hours or for months, or anything in between. The longer it lasts, the more inevitable a blow-up can start to feel, and the victim can’t be sure what will be the last straw.
Abusive Incident
The abusive incident usually occurs when the tension finally breaks. This can play out in many different ways. Usually, this part of the cycle is when the abuser physically lashes out at the victim. The abuser may hit, rape or attempt to rape the victim. Other cases of physical abuse and neglect include denying the victim access to basic necessities (by changing the locks on the house or cutting off access to a shared checking account, for example). In relationships where the abuse is primarily psychological, the abuser may deny the victim access to family and friends, call the victim humiliating names, or make threats of violence.
Honeymoon Phase
During the honeymoon phase, the abuser may apologize, buy gifts, or be extra affectionate to “make up” for the abuse. Many will promise to change, promise to stop the abuse, or promise that it will never happen again. These assurances are intended to persuade the victim to stay in the relationship. Not all abusive relationships have a honeymoon phase. For some, the abusive incident is immediately followed by increasing tension before the next incident.
Once the honeymoon phase is over, the tension-building phase begins again, and the comforting promises the abuser made will be broken.
Other Factors
There are numerous other reasons that may make it difficult for a victim to leave. Fear of how the abuser will react, fear of losing custody of children, fear of losing the acceptance of their family, and embarrassment and shame are some reasons victims stay in abusive relationships. Victims may also face cultural or religious stigmas or financial barriers. The victim may be financially dependent on the abuser and lack the financial security to leave. If a victim has a disability, they may be physically dependent on their abuser for support. For LGBTQ+ couples, a victim who has not come out to everyone may fear of being outed. They may also be less likely to be believed or be less likely to believe they themselves are being abused due to the lack of education about the topic. If a victim is undocumented, they may be afraid of seeking help or fear their abuser will use their citizenship status against them.
Bottom Line
Despite promising it “will never happen again,” in most cases, the abuser will not change, and the only way to end the abuse is for the victim to end the relationship. Unfortunately, the most dangerous time in an abusive relationship is when the victim tries to leave. That is when they are most likely to be seriously injured or even killed by the abuser, so it is important to get the help you need to safely escape harm.[5] Homicide is one of the top 10 causes of death for women aged 20-44,[6] and nearly half of female victims are killed by a current or former male intimate partner.[7]
If you are in an abusive relationship, you can call the National Domestic Violence Hotline at any time of day or night to speak to someone trained to help you. The Hotline operates 24 hours a day, seven days a week. All calls are confidential and anonymous, and interpreter services are available for more than 170 languages.
National Domestic Violence Hotline
1-800-799-SAFE (7233)
1-800-787-3224 TTY
All NCHR articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.
References
[1] Huecker MR, Smock W. Domestic Violence. [Updated 2020 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499891/. Accessibility verified September 18, 2020.
[2] Cronholm PF. Intimate Partner Violence and Men’s Health. Primary Care: Clinics in Office Practice. 2006;33(1):199-209. Available from: https://www.researchgate.net/publication/7260775_Intimate_Partner_Violence_and_Men’s_Health. Accessibility verified September 18, 2020.
[3] Domestic Abuse Intervention Programs. The Power and Control Wheel. Available from: https://www.theduluthmodel.org/wheels/. Accessibility verified October 12, 2020.
[4] Howard LM, Trevillion K, Agnew-Davies R. Domestic violence and mental health. International Review of Psychiatry. 2010;22(5):525-534. Available from: https://pubmed.ncbi.nlm.nih.gov/21047164/. Accessibility verified September 18, 2020.
[5] National Coalition Against Domestic Violence. Why do victims stay? Available from: https://ncadv.org/why-do-victims-stay. Accessibility verified September 23, 2020.
[6] Centers for Disease Control and Prevention. Leading Causes of Death – Females – All races and origins – United States, 2017. Available from: https://www.cdc.gov/women/lcod/2017/all-races-origins/index.htm. Accessibility verified September 18, 2020.
[7] Centers for Disease Control and Prevention. Racial and Ethnic Differences in Homicides of Adult Women and the Role of Intimate Partner Violence—United States, 2003-2014. Morbidity and Mortality Weekly Report. 2017; 66(28): 741-746. Available from: https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6628a1.pdf. Accessibility verified September 18, 2020.