Dynamics of Partner Violence
and Types of Abuse and Abusers

Glenda Kaufman Kantor and Jana L. Jasinski
Family Research Laboratory, University of New Hampshire
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Introduction

There is little doubt that physical violence between spouses and intimate partners is a serious social problem. Questions about how much violence occurs in families, the severity of the violence, and the nature of victim-offender relationships in families are primary concerns of those engaged in efforts to reduce and control intimate violence. A number of studies have documented the severity and pervasiveness of violence against intimate partners in this country. When variations in rates or severity occur across studies, the inconsistencies often reflect differences in study design and methodology such as the population studied. Populations may differ in a number of ways including the extent to which they possess particular risk factors for violence such as youth, poverty, or family history of abuse. Johnson (1995), for example, made a distinction between common couple violence that is found in general population samples and the more extreme "terroristic" violence that is typically experienced by shelter populations of battered women. The ability to identify intimate offenders who pose an ongoing risk of future severe assaults is critical to establishing effective interventions (Straus, 1993). This chapter examines current research on the dynamics and patterns of family violence, the types of abuse, and the major known risk factors for partner violence because this knowledge is fundamental to prevention and intervention.

The two primary sources of prevalence figures on intimate physical violence that use scientifically selected national surveys- The National Family Violence Survey and the National Crime Victimization Survey- estimate that at least 2 million women are beaten by their partners each year (Bachman & Saltzman, 1994; Straus & Gelles, 1990). Evidence from the National Crime Victimization Survey (Bachman & Saltzman, 1994) also indicates that twenty percent of attacks on women by either a stranger or an acquaintance involved the use of a weapon. Although strangers who assaulted female victims were more likely to carry or use a weapon than were intimates, injuries were twice as likely to occur if the assault was perpetrated by an intimate rather than a stranger (Bachman & Saltzman, 1994). In addition, as many as half of all female homicide victims are killed by their husband or boyfriend (Kellerman & Mercy, 1992). It is rare for male homicide victims to be killed by intimate partners. Only about three percent of such homicides are perpetrated by wives, ex- wives or girlfriends (Bachman & Saltzman, 1995).

Although the incidence of lethal perpetration is greater for men, data from the 1975 and the 1985 National Family Violence Surveys indicate that women assault their partners at least as often as men (Stets & Straus, 1990; Straus, Gelles, & Steinmetz, 1980). However, parity between intimate partners may end with the similarity in occurrence of aggressive acts. The studies by Straus and associates (1980) found that assaulted women were several times more likely than men to require medical care after severe assaults and were significantly more likely than assaulted husbands to experience psychological injuries related to their abuse (Stets & Straus, 1990).

In this chapter we first examine current knowledge in the field on the types and dynamics of abusive relationships, including characteristics of batterers and victims. We then examine theoretical frameworks for marital assault and their relevant risk markers. We also consider particular aspects of the life course as risk markers for marital assault or the cessation of assault. Lastly, implications for policy and practice are considered.

Patterns and dynamics of abusive relationships

The patterns

A cycle of violence is often discussed as an integral component of the battered woman syndrome and the dynamics of partner assault. The cycle, first described by Walker (1979), is said to include a period of tension building followed by battering. The batterer may express remorse, and a period of relative calm ensues. The cycle is reactivated after a period when tensions increase or stresses resurface. There is an assumption underlying the cycle theory that all partner violence increases in frequency and severity over time. However, most of the evidence describing the cycle is clinical and anecdotal, or based on shelter populations. In fact, intimate violence which is relentless, cyclical, results in measurable physical injury, or which becomes progressively more severe over time may not be characteristic of the majority of intimate violence reported in general population surveys of families. Rather, these severe patterns may reflect the more extreme end of the intimate violence continuum. Johnson's exploration of these issues concluded that a pattern of battering that escalates in frequency and intensity may better characterize the patriarchal, terroristic form of wife abuse (Johnson, 1995). Dutton and Starzomski (1993) suggested that borderline personality disorder may account for the intermittent abusive rage of batterers described by the cycle theory of abuse.

Based on clinical observations, Douglas (1991), for one, found that in the early stages of the violence cycle, interim periods still include some good times and caring feelings between partners. Over time the pattern of conflict becomes set, recurring issues between partners are unresolved and are frequently replayed, and then the intensity of conflict increases. The ongoing violence erodes the relationship and any positive aspects of the relationship diminish. Next according to Douglas is the severe stage in which violence is "deliberate, dangerous, premeditated" and there is no relief from punishing, dominating behaviors, extreme jealousy and criticisms. The husband may become increasingly possessive and controlling, and may isolate the woman from her family and friends (Douglas, 1991; Frieze & Browne, 1989; Walker, 1979). However, as we discuss below, the forms and patterns of physical violence may not be the same in all families. A pattern of violence in which the severity escalates progressively over the course of the relationship may, in fact, represent one of the more severe and less common forms that intimate violence takes.

The psychodynamics of intimate violence

A common dynamic of conflicted intimate relationships is an inability of the couple to communicate or negotiate in rational, nonjudgemental ways. Verbal arguments occur in which the partners attack each other "in ways that diminish self esteem, create feelings of vulnerability, and activate fears of rejection and abandonment" (Douglas, 1991). Gelles and Straus (1988) also assert that such attacks on the partner's vulnerabilities often precipitate violence. This is illustrated by the following comment by a husband:

If I want to make her feel real bad, I tell her how stupid she is. She can't deal with this and she hits me (Gelles & Straus, 1988, pg 79).

Men, particularly those with low self esteem, may defend themselves against feelings of frustration, vulnerability, and personal attack by using violence against a partner. Male physical violence can also serve to intimidate, control and silence the partner in order to gain the upper hand in a relationship. Violence may serve to relieve tensions, create emotional distance because of fear of intimacy, impending loss of control or anxiety (Browning & Dutton, 1986), or as Douglas (1991) suggests, it may be used to facilitate intimacy as in the case of "making up" by engaging in sex or even forcing sex as a continuation of the violence. To some, this may make the sex appear to be more intense and exciting (Douglas, 1991). In another severe manifestation of violence, extreme episodes of rage can emerge with absolutely no apparent stimulus:

When I got violent, it was not because I really wanted to get violent. It was just because it was like an outburst of rage. I was a real jerk for almost a year. And anything would set me off ... I was like uncontrollably violent. I would slap her, knock her down, choke her, and call her a slut and a whore. (Ptacek, 1988, pg 143).

Male dominance, control, family power and societal norms

There is some evidence suggesting that the way the family unit is organized (e.g. male dominated versus equality between partners) plays an important role in family functioning (Coleman & Straus, 1986; Straus, et al., 1980). For example, the results from previous research suggest that wife beating is more common in households where power is concentrated in the hands of the husband or male partner (Coleman & Straus, 1990; Levinson, 1989; Straus, et al., 1980; Yllo & Straus, 1990). In these households, physical violence may be used to legitimize the dominant position of the male (Babcock, Waltz, Jacobson, & Gottman, 1993). At the societal level, cultural norms supporting unequal family power structures or traditional gender roles may help to explain some of the variations in rates of spousal violence. In other words, males are socialized to use violence in order to maintain control. Aggression can also emerge from frustration over an inability to control the female partner (Fagan & Browne, 1994). One might also consider normative approval of violence as a risk factor for spousal violence. Previous research has demonstrated a significant relationship between self reported approval of the use of violence toward a spouse and actually using violence (Kaufman Kantor, Jasinski, & Aldorondo, 1994; Straus & Gelles, 1990).

Other research on the more individual level concepts of dominance and power found that higher levels of dominance were associated with higher levels of violence (DePuy, 1995; Hamby & Sugarman, 1996). Studies comparing wife assaulters with non-assaultive men, matched on demographic characteristics, found that assaultive men demonstrated higher needs for power (Dutton & Strachan, 1987). One explanation for this phenomenon is that men who feel powerless because of low self esteem, or who feel little control over others or the events of their life have high needs for power. Another mechanism is suggested by Dutton and Strachan (Dutton & Strachan, 1987). They hypothesized that men who view intimacy with women as dangerous, threatening and uncontrollable can become highly anxious and angry. These feelings of psychological discomfort may then lead to behaviors such as violence against the partner to control women and to reduce men's anxiety and anger.

A further elaboration of the dynamics of power and control are provided by Prince and Arias (1994). They assessed the relationship between control and self esteem among abusive and non-abusive men and found two relationship patterns. In the first, men had high self esteem, but a poor sense of control over their life, and used violence with the intention of gaining control. In the second pattern, men had low self esteem and felt powerless, but became violent in response to frustration. The authors concluded that when different dimensions of control are examined--interpersonal control, on the one hand, and control over life events, on the other hand, the latter is a more significant predictor of wife assault. This finding is also important because it helps explain the importance of socioeconomic factors such as unemployment to intimate violence.

Female perpetrators and mutual violence between intimate partners

It has been suggested that offender-victim roles in intimate relationships are not sex- specific. However, the participants in intimate violence may be equally assaultive, men may be the sole perpetrators of violence against their partners or women may be the lone aggressor in the relationship. Given widely held beliefs that aggression is primarily a masculine behavior, it is not surprising that research on aggression by women is relatively recent. Aggression by wives has been studied less than that of husbands, and findings of equal rates of violence by wives (Stets & Straus, 1990; Straus, 1993; Straus, et al., 1980) have been regarded as controversial and have been challenged by some feminist scholars (Dobash, Dobash, Wilson, & Daly, 1992; Pleck, Pleck, Grossman, & Bart, 1978). Underlying the concerns of the feminist protest is the belief that such a focus detracts attention and resources from the more serious problems of battered women. Feminists maintain that historically and culturally rooted inequalities of power are the underlying cause of male violence against women, and that women are the real victims of intimate violence. It has been argued that physical violence by husbands and wives cannot be equated because of the greater potential for physical injury by husbands given their greater size and strength; women are six times more likely to require medical care for injuries sustained in family violence (Kaufman Kantor & Straus, 1987; Stets & Straus, 1990). Furthermore, women are less able to leave violent relationships than men because of numerous social constraints including greater economic dependency, and responsibility for children, and because women are socialized into believing that they are responsible for the well-being of the relationship. Culturally scripted messages persist that wives should stay in unhappy marriages "for the sake of the children". Culture and religion may also influence the organization of traditional gender roles in families, and family integrity may be valued more than the cost of enduring abuse. Cultural differences may also exist in the extent to which women engage in acts of aggression.

Research on gender and aggression. Maccoby and Jacklin's (1974) comprehensive review of gender differences in children found few sex differences other than more aggression by boys. More recent reviews investigating gender differences in aggressive behavior by adults suggest either inconsistencies or fewer sex differences in aggression, and identify factors which mediate gender aggression relationships (Eagly & Steffen, 1986; Frodi, Macaulay, & Thome, 1977). Eagly and Steffen's (1986) meta-analysis concluded that women's and men's beliefs about the consequences of their aggression was the major factor accounting for variability in sex differentiated aggressive behavior. Greenblat (1983) found greater tolerance for wives slapping husbands than the reverse and suggested this was due to the belief that women are less likely to do physical harm than men. This is illustrated by the following comment regrading hitting by a wife from a husband interviewed in the Greenblat study:

I'd say that it doesn't matter that much .... because it's rare that a wife can hurt her husband, just hurt his emotions. I wouldn't feel that bad as a husband, because I would say she's angry and it doesn't hurt me at all, so let her get her anger out. (Greenblat, 1983, pg. 254)

Many of the criticisms of the Conflict Tactics Scale (CTS) (Straus, 1979; Straus, 1990), the most widely used instrument for measuring spousal violence, were elicited in response to the findings on violence perpetrated by women. Over 30 studies examined gender differences in rates of violence in non-clinical populations. All found approximately equal rates of violence (in both frequency and severity of attacks) by the women (Gelles & Straus, 1988; Straus, 1993). These findings seem implausible to many because of the cultural image of women as less violent than men, which in turn is bolstered by women's much lower rate of violent crime outside of the family. It is also based on the fact that at least 90% of police reports of domestic violence involve male offenders.

Straus believes that the controversy over assaults by women largely stems from the implicit assumption by those doing community epidemiological survey research that their findings on comparable rates of spouse assault by men and women also apply to cases known to the police and to those that come to the attention of shelters. There are similar unwarranted assumptions by clinical researchers. Straus argues that the discrepancy between the findings from surveys of family problems (both those using the CTS and other measures) and findings based on criminal justice system data or the experiences of women in shelters for battered women does not indicate that one set of statistics is correct and the other not. Both are correct. However they apply to different groups of people and reflect different aspects of partner violence. Community and epidemiological data as well as clinical sample data are valid.

Is mutual combat a valid description of intimate violence?

Descriptions of marital assaults as mutual combat and of women as equal to men in their violent acts have resulted in extremely contentious debate. Fagan and Browne (1994), for example, argued that because of methodological problems in marital violence research, "it is misleading to characterize marital violence as mutual violence" (p.169). Recent empirical examination of the notion of reciprocality in marital violence needs to be considered. Generally, marriages described as mutually violent in the National Family Violence Surveys are those in which either the male or female respondent for a household reported that both they and their partner engaged in any minor or seriously assaultive act towards the other. Additionally, the 1985 National Family Violence survey included one context (incident) specific question to measure who initiated the physical conflict. Three national surveys of family violence have reported that between half and three-quarters of all intimate violence is mutual, though as mentioned, these are based on data from one partner per family household (Kaufman Kantor & Asdigian, in press; Straus & Gelles, 1990; Straus, et al., 1980). Moreover, an analysis of the specific incident data (Stets & Straus, 1990) found that gender made no difference in offender-victim roles as measured by initiation of minor physical conflicts (mainly slapping or throwing things). An often neglected point of this research is the fact that the study also found that men's acts of serious physical violence (punching, choking, use of weapons) were much higher when reported by women. This suggests that men under-report their severe assaults, and that interviews based solely on male reports must be treated cautiously.

Vivian's (1994) study elaborates on the mutuality issue by considering whether bi-directionally violent couples are mutually victimized. Their research sample consisted of 57 clinic couples (with communication problems as their presenting complaint) where both partners reported partner aggression. The findings of this study supported prior research regarding the more severe effects of male aggression on women victims. They found that wives had more injuries and more negative psychological effects from the husband's aggression. Additionally, their statistical analysis categorized couples into types based on evidence of different dimensions of aggression. Over half of the couples were categorized as belonging to a subgroup where both partners engaged in low levels of mutual violence. Among a second subgroup (26%) the wives reported higher levels of victimization than husbands, and in a third subgroup (18%) the husband reported higher victimizations than the wives. Additionally, the authors concluded that the greatest distress was found in the asymmetrical relationships among highly victimized men and women regardless of gender.

Johnson (1995) helps to reconcile some of the debate over women's physical violence and the mutuality of violence. As noted in the discussion above, he argued that two distinct forms of violence occur in American families. Data from large scale national surveys show a predominance of one form of violence, "common couple violence," largely reflecting more "minor" violence and a reciprocity of assaults between partners. In the second form of violence, data from shelter, clinical, and criminal justice samples reflect an interpersonal dynamic in which women are systematically terrorized and subjected to serious and frequent beatings, and women's violence is self-defensive in nature. Johnson views these two forms of assaults as virtually non-overlapping in nature.

Overall, though there is less evidence to document the patterns of women's violence in intimate relationships, it appears that women's violence towards intimate partners does exist, but that it is different in its nature from that of men. Indeed, the available evidence suggests that women's physical violence is less injurious and less likely to be characterized as motivated by attempts to dominate or terrorize the partner. For example, domination and control of women in intimate relationships may take multiple forms that can coexist. These multiple forms encompass abuse in physical, sexual, emotional or economic spheres of a woman s life. So, for example, battered women may be abused in other ways such as being kept under surveillance, or not permitted to work but provided only limited access to money (Hanmer, 1996). There is no evidence in the literature (that we are aware of) that describes a comparable system of victimization for men in intimate heterosexual relationships. The notion of different types or dimensions of intimate violence has important implications for policy and practice and needs to be examined in greater depth.

Assessing types of abusive relationships

Male perpetrators

A hit is a hit is a hit or is it? Although there is general consensus that no aggression by intimate partners should be tolerated, there is recent disagreement about whether the "one size fits all" approach to defining battering and batterers is appropriate. Often early research based on varying samples, or solely on the reports of battered women, depicted batterers as regular guys with poor impulse control and drug/alcohol problems or as sadistic psychopaths (Gondolf, 1988). The theoretical and clinical importance of distinguishing between different types of violent men has also been well documented in Holtzworth-Munroe and Stuart's (1995) review of the evidence on different typologies of male batterers. Their own typology distinguishes three types of maritally violent men: Family Only, Dysphoric/Borderline, and Generally Violent/Antisocial. The types differ in background and other characteristics, and in the nature of mental health and other services.

The family only abuser (perhaps similar to the common couple phenomenon described above) is described as less deviant or deficient on a number of indicators including impulsivity, substance abuse, criminal behavior, and social skill deficits. Relative to non- violent men, these abusers do have a history of exposure to aggression in the family of origin, and are hypothesized to have poor communication and social skills, high levels of dependence on their partner, and low levels of impulsivity.

The dysphoric/borderline batterer is hypothesized as having a history of parental rejection, and child abuse, some history of delinquency, high levels of dependency on the partner, poor communication and social skills, hostile attitudes towards women, positive attitudes towards violence, and low levels of remorse for their violence.

The generally violent/antisocial batterer represents the most aggressive, impulsive and antisocial behavior. Risk factors include family of origin history of abuse and involvement with delinquency. For these men, deficits in all the areas mentioned above are more profound than those found in the other types of batterers. These men likely view violence as an appropriate response to any provocation.

Assaultive Type Characteristics:

Dysphoric/Borderline:

Generally Violent/Antisocial:

The authors of 14 of the typologies reviewed by Holtzworth-Munroe and Stuart all conclude that the different types require different services. For example, it has been suggested that treatment for personality disorder is central to work with the Generally Violent/Antisocial type, but is rarely needed by the Family Only type of batterer. However, as is the case in child sex offender research, controlled studies examining different treatment strategies for the various offender typologies have rarely been conducted. Although the typologies provided by Holzworth-Munroe and Stuart need to be tested empirically, they appear to be consistent with other emerging research about different typologies of batterers. For example, Johnson's discussion of family violence types was addressed above and recent research on physiological differences among batterers (Gottman, Jacobson, Rushe, Shortt, Babcock, La Taillade, et al., 1995) (to be discussed below) adds to our understanding of the ways in which batterers vary.

Theoretical explanations for partner violence

Theories on the causes of partner violence provide a framework for understanding and responding to this phenomenon. Additionally, different theories point to particular variables or risk markers that might alert clinicians to the potential for partner violence in an intimate partnership. Thus, the more integrated and encompassing the theoretical model, the more valid the model will be for the purpose of predicting intimate violence. However, the latter approach is not without its critics and currently dispute ranges over the relative importance of one framework over another, e.g., a social-structural framework over an emphasis on psychopathology (Dutton, 1994; Miller, 1994; Renzetti, 1994). Early theoretical development on the causes of partner abuse (Gelles & Straus, 1978) identified fifteen theories, organized into three broad categories: intra-individual theory, social psychological theory, and sociocultural theory (Bersani & Chen, 1988) that provide guidelines for the risk factors that need to be considered.

Intra-individual theory has emphasized the role of alcohol and drugs and psychological traits such as self esteem (Hamberger & Hastings, 1986; Hudson & McIntosh, 1981; Roy, 1977) and anti-social personality disorder (Holtzworth-Munroe & Stuart, 1994) in partner violence. The contribution to later intrafamily aggression of individual biological and neurological factors such as childhood attention deficit disorders, or head injuries (Elliott, 1988; Warnken, Rosenbaum, Fletcher, Hoge, & Adelman, 1994) as risk markers for relationship aggression are not often incorporated into sociological, feminist or even psychological theories and research on intrafamily aggression. However, a growing body of research suggests the importance of including personality, neurological and even physiological factors in models of relationship aggression (Miller, 1994). Increasingly, attention is being drawn to variations in psychological pathology among batterers (Dutton, 1994; Gondolf, 1988; Holtzworth-Munroe & Stuart, 1994).

Sociocultural theories focus on the influence of social location (social class, education, income) on partner violence and have attempted to integrate social structural and family processes (Kaufman Kantor, et al., 1994; Straus, 1973). Feminist explanations of women's victimization are related to and also underscore sociocultural factors. In the feminist view, the central factors that foster partner assaults include the historically male-dominated social structure and socialization practices teaching men and women gender-specific roles (Pagelow, 1984; Smith, 1990; Yllo, 1984). The major constructs in a feminist analysis of wife abuse are the structure of relationships in a male dominated (patriarchal) culture, power, and gender (Bograd, 1988). Consequently, the units of analysis in feminist research may also be at the societal level, rather than the intrapersonal level. Social-psychological approaches have stressed social-learning through experience and exposure to violence in the family (Kalmuss, 1984; O'Leary, 1988; Straus, et al., 1980). For an example of the latter, O'Leary's (1988) social learning model of partner violence suggests five major variables, or risk factors for physical partner violence: 1) Violence in the family of origin; 2) Aggressive personality style; 3) Stress; 4) Alcohol use and abuse; and 5) Marital dissatisfaction. A major focus of our discussion in this chapter is on risk factors at the individual level, while we also take into account risk markers reflecting the three broad categories of intimate violence theory.

Theoretical Explanations
Risk Factors

Intra-individual
Factors within the individual: e.g., excess drinking; personality disorders, biological or neuro-physiological disorders

Socio-cultural:
Importance of social location: social class; education; income, employment status. Social structural and family processes: traditional gender roles in families

Social-psychological
Social Learning: Exposure to violence in the family one grows up in.

It is important to note that, for the most part the theories pertain to explanations of the perpetrator's violence. Thus our discussion which follows is mainly focused on the major risk markers associated with male perpetrated violence. Where the literature allows, risk markers related to characteristics of female victims are also addressed. What are the risk markers for partner violence?

Risk factors or risk markers refer to characteristics that are associated with an increased likelihood that a problem behavior will occur. However, an important caution is that the presence of one or more risk factors is not equivalent to a causal relationship. It simply means that the odds of an associated event (in this case, intimate assaults) are greater when one or more risk factors are present. Hotaling and Sugarman's (1986) analysis of risk markers for partner violence found that eight characteristics were consistent risk markers of the husband's violence towards the wife:

Analyses from three national U.S. surveys (Gelles & Cornell, 1990; Kaufman Kantor, et al., 1994; Straus, et al., 1980) also show that particular risk markers are enduring and generally consistent predictors of intimate violence across several years of survey research, conducted among several thousand families in the general population. These risk markers include cross-generational violence (childhood abuse, witnessing parental violence), occupational status, excessive alcohol use and socioeconomic status (Aldarondo & Sugarman, 1996; Kaufman Kantor & Asdigian, in press; Kaufman Kantor & Straus, 1989; Straus & Gelles, 1990; Sugarman, Aldarondo, & Boney-McCoy, 1996). Whereas research based on clinical populations, such as male batterers in treatment for relationship violence, has supported the significance of the latter sociological risk factors from survey populations, the body of clinical, mainly psychological, research has also emphasized the importance of personality variables as major risk factors (Dutton, 1994; Gondolf, 1988; Holtzworth-Munroe & Stuart, 1994). In this chapter, in our discussion of risk markers, we emphasize violence across generations (parental violence), socioeconomic risk factors (income, education, occupational status), and alcohol and personality factors (sexual aggression is discussed Chapter 5). We also consider additional risk markers (gender, biology, the life course) that have emerged from current research as notable areas of inquiry.

Gender as a risk factor

Are women placed at risk for victimizations by the same complex of factors that place their partners at risk for perpetrating the violence? Our ability to answer this question is limited because most research on risk factors for intimate violence has focused on the male perpetrator. Some have argued that research on victim characteristics is an inappropriate focus, and constitutes a form of blaming the victim. For the most part theories of partner violence pertain to explanations of the perpetrator's aggression. This theoretical emphasis on the perpetrator is supported by analyses of risk markers that revealed eight characteristics consistently associated with being an abuser; whereas only one factor (witnessing violence as a child or adolescent) was consistently associated with being a victim of wife abuse (Hotaling & Sugarman, 1986). Yet, stereotypes persist that partner abuse occurs because of the victims' masochism or because women do things to provoke an assault. The question commonly asked by the general public, "Why do they stay?" implicitly suggests that victimization occurs because something is wrong with battered women. In fact, women remain in abusive relationships for many complex reasons including economic dependency, ambivalent feelings towards their violent partner, and because of their traditional socialization. Moreover, Dobash and Dobash (1979) point out that blaming the victim of wife beating provides a justification for batterers' violence. As a result, when women nag, or try to have an equal say in family decisions, or refuse sex, husbands may feel they are justified in using force (LaRossa, 1980) to keep women in line. In these cases, the woman is blamed by her husband for her own victimization (e.g., She had it coming).

For these reasons, there is scant research examining characteristics of victims that may be risk markers for abuse. The research that does exist is subject to erroneous attribution that is really the effects of abuse on women's personality and mental health (See Chapter 2). In other words, it has not been clear whether the personality characteristics of battered women are the effects, correlates or causes of abuse (O Leary and Murphy, 1992 , pg. 37). However, O Leary and Murphy (1992 have also argued that personality similarities are often the rule among married partners.

Violence across generations

A history of violence in the family of origin is probably the most widely accepted risk marker for the occurrence of partner violence (Arias, 1984; Kalmuss, 1984; Straus, et al., 1980). Based on their initial study of 2,000 American families, Straus and associates (1980) presented strong empirical evidence for the social learning of violence within families. A basic thesis underlying this work is that the family is the training ground for violence, and that even the use of ordinary physical punishment such as spanking is associated with child abuse and wife beating. The two National Family Violence Surveys found increased rates of physical punishment, child abuse, and wife abuse by male and female partners subjected to high rates of physical punishment as children. Thus, multiple forms of family violence relate both across generations and within generations. Additionally, witnessing interparental violence is significantly associated with adult marital assaults. Studies based on clinical populations, usually battered women in shelters, support the national survey data and report high proportions of cross-generational violence in 42% to 81% of the families of male batterers (Bowker, 1983; Fagan, Stewart, & Hansen, 1983; Walker, 1984).

The primary mechanism believed to be involved in intergenerational transmission is that of modeling the parental behaviors observed (Arias, 1984; O'Leary, 1988). Stith and Farley's (1993) analysis expands on the dynamics of this process. Their analysis of male spousal violence in a treatment sample of male batterers and male alcoholics indicates that observation of parental violence in childhood diminishes men's self esteem. In turn, they suggest, lowered self esteem increases marital stress, alcoholism, and approval of marital violence. Normative approval of marital violence was also directly influenced by the process of social learning in the study findings. Alexander, Moore and Alexander (1991) suggest that the development of attitudes towards women is also affected by having witnessed parental marital violence.

Abuse in childhood or exposure to marital violence in the family of origin may similarly increase women's risks of victimization. For example, women who have been assaulted by their partners are at least twice as likely to have grown up in a violent home when compared to non-assaulted women (Kaufman Kantor & Straus, 1989). However, O'Leary (1988) suggests that this relationship is a less consistent predictor of women's victimization than it is a predictor of men's violence. Where intergenerational effects exist, the mechanism may be that repeated attacks by parents can lead to damaged self esteem and suppression of rage. These effects may be different for men and women, and may be compounded by the current life situation. Women who were harshly punished in childhood or who witnessed parental violence are more likely to be victimized as adults because they have low self esteem, and have learned that assaults from a loved one are legitimate, or because they are more likely to engage in mutual assaults with their spouses (Straus & Kaufman Kantor, 1994).

An important conclusion of research on the intergenerational transmission of partner violence is that many of the risk markers for current partner violence are interwoven in family of origin experience. For example, because alcoholism and family violence are so intertwined, both women and men exposed to violence at home may also have suffered the effects of parental alcoholism (Widom, 1993). There can also be intergenerational transmission of parental rejection and depressed mode (Whitbeck, Hoyt, Simons, Conger, & Elder, 1992). Abuse and the proclivity for violence may be transmitted along with problems such as having had a cold and unresponsive father (Shupe, Stacey, & Hazlewood, 1987). One study concluded that women subjected to abusive parenting may develop a "hostile, rebellious orientation" and, consequently, be more likely to affiliate with and marry similar men (Simons, Johnson, Beaman, & Conger, 1993). However, this mechanism could also be mediated by the partners' shared history of similar delinquent behavior (e.g., drug and alcohol use) or current shared lifestyle factors.

Can the cycle of abuse be broken?

Discussions of intergenerational violence are often frustrating because they imply an unbreakable chain of events. Of course, there are few absolutes in social behavior; what is transmitted is a vulnerability to victimization or perpetration of aggression. The vulnerability is heightened by the double whammy effect of exposure to both parental child abuse and witnessing parental spousal assaults. Widom (1989) suggests that protective factors include the following:

In regard to cognitive issues, perceptions of the abuse as caused by external reasons rather than internal reasons such as rejection are associated with more positive outcomes. Similarly, Caesar's research (1988) comparing maritally violent and non-maritally violent men (both family history positive for violence) found that non-violent men were less likely than batterers to view their mothers as victims in marital fights between parents that they had witnessed. Non-violent men seemed to have been more aware of parental shortcomings. That is, they didn't idealize and weren't protective of violent parents as were the batterers. They also didn't choose sides between parents. Additionally, Caesar described those men who broke the cycle of abuse as having better coping mechanisms. For example, they had constructive outlets for their emotions such as sports or running.

Personality as a risk factor

Our discussion of violence across generations provides some understanding of how personality is shaped by the family of origin experience and contributes to future attributes and behaviors conducive to both victimization and violence. For example, the excessive controlling behaviors of maritally violent men may be due to their feelings of helplessness, and dependency stemming from abusive childhoods (Shupe, et al., 1987).

The literature on personality factors associated with male battering is very large. Men who batter are often emotionally dependent, insecure, low in self-esteem and empathy, and exhibit low impulse control, poor communication and social skills (Gondolf, 1988; Holtzworth-Munroe, 1992; Holtzworth-Munroe & Stuart, 1994; Rounsaville, 1978; Shields, McCall, & Hanneke, 1988) and are often irritable and belligerent (Dutton, 1988; Gottman, et al., 1995; Margolin, John, & Gleberman, 1988; Shupe, et al., 1987), Aggressive and hostile personality styles are also reliably found in many studies of maritally violent men (Heyman, O'Leary, & Jouriles, 1995).

Neidig, Friedman and Collins (1986) used assessments of self esteem, attitudes towards women and others, and assessments of empathy and authoritarianism in their study of male military personnel. Their findings revealed that abusive men differed from non-abusive men only in regard to the lower self esteem of abusive men and their low trust in others.

Use of MMPI (Minnesota Multiphasic Personality Inventory, Hathaway & McKinley, 1967 and MCMI (Millon Clinical Multiaxial Inventory; Millon, 1987 evaluations or other psychological inventories used with batterers reveal elevations on measures of borderline symptomatology, passive aggressive and aggressive tendencies, narcissistic and antisocial characteristics, anxiety, depression and somatic complaints (Dutton & Starzomski, 1993; Else, Wonderlitch, Beatty, Christie, & Staton, 1993; Flournoy & Wilson, 1991; Hastings & Hamberger, 1988; Maiuro, Cahn, Vitaliano, Wagner, & Zegree, 1988; Murphy, Meyer, & O'Leary, 1993). An important caution in summarizing or generalizing from the results of standardized assessment tools is that scale elevations vary across studies. Consistent with our discussion of typologies, there is not a singular profile that defines all abusive men (Hamberger & Hastings, 1986). Furthermore, men without any abnormal findings in clinical assessment tools may engage in violence towards their partners.

Personality risk factors in male batterers

Substance abuse as a risk factor

What role do drugs and alcohol play in intimate violence? Alcohol is the drug most commonly associated with violence (Fagan, 1990; Fagan, 1993), and substance abuse is a consistent finding in many of the profiles of abusive men. Other psychoactive drugs have been associated with aggression such as barbiturates, amphetamines, opiate (withdrawal), phencyclidine, cocaine, and alcohol-cocaine combinations (Fagan, 1990; Goldstein, Belluci, Spunt, & Miller, 1989). Altogether, the aggressive effects of psychoactive drugs other than alcohol have been investigated less, and the results have been inconsistent. Taylor and Chermack's review (1993) finds that drugs with depressive effects are most likely to facilitate aggression, and Fagan (1990) finds solid evidence of a psychopharmacological basis only for the combined effects of an alcohol-cocaine combination. Aldarondo and Kaufman Kantor (in press) found that a life time history of any hard drug use (e.g., cocaine, amphetamines, heroin, etc) by the husband was associated with a more persistent pattern of abuse in intimate relationships. However, physical violence is not an inevitable consequence of any intoxicant usage. Because of the consistency with which alcohol as emerged as a risk marker in general research on aggression, and specific research on wife assault, our primary focus in this section will be alcohol-related wife assault.

Conventional wisdom about the alcohol-violence linkage has emphasized alcohol's powers as a disinhibitor or drunkenness as an excuse for violence (see Kaufman Kantor and Straus (1989)). However, attributing alcohol's effects on marital aggression to disinhibition, understates the complexity of the relationship. Experimental laboratory studies examining alcohol effects on aggression have generally demonstrated both direct effects of alcohol on aggression, and indirect effects mediated by beliefs about alcohol's ability to change behavior (Bushman & Cooper, 1990; Gustafson, 1986; Lang, Goeckner, Adesso, & Marlatt, 1975; Pihl, Zeichner, Niaura, Nagy, & Zacchia, 1981; Taylor & Leonard, 1983; Zeichner & Pihl, 1979). However, reviews of research on alcohol and wife assaults yield wide ranging estimates suggesting that from 6% to 85% of wife assaults are alcohol involved. One or both of the parties is more likely to be intoxicated at the time of an assault when the husband is a heavy daily drinker or binge drinker (Kaufman Kantor, 1993; Kaufman Kantor & Straus, 1987; Leonard, 1993). This was found to be the case for about half of the violent families interviewed in the 1985 National Family Violence Survey (Kaufman Kantor & Straus, 1987).

Alcohol-related family assaults have been explained in many ways pointing to the importance of social context, e.g., fights over a spouse's drunkenness which lead to partner's violence. Kaufman Kantor's (1990) and (1993) previous examination of the relationship between alcohol consumption patterns and intra-family violence revealed significant effects of a family history of violence and current family alcohol use on the incidence of child abuse and wife abuse. The interpretation of these findings concluded that aggressive beliefs about the effects of alcohol and the appropriateness of inflicting violence while under the influence, may both be learned from the family. For example, an adult may recall being beaten by an intoxicated parent, or recall violent encounters between parents when one or both were drinking. One result of such exposure is an increased likelihood that these experiences will be reenacted in the second generation, due to modeling influences.

Kaufman Kantor and Asdigian's research (in press) found that although there is some evidence to support contentions that men drink in order to be violent (Gelles, 1974), this represents only one possible scenario. Furthermore, it assumes harmful intention, and ignores the many factors potentially present in a drinking situation, such as the drinking or aggression by the other partner. In addition, it is possible to simultaneously hold competing expectancies about alcohol's effects (Rohsenow & Bacharowski, 1984). For example, individuals may choose to drink or get drunk in order to forget their troubles. But because each drinking situation is comprised of many situational variables such as the amount drunk, partner's drunkenness, and issues that are raised by either partner when drinking, aggression does not necessarily follow from drunkenness.

The pharmacological effects of alcohol often tend to be minimized in much of the research and theorizing about alcohol's importance to wife assaults. Despite ongoing debate about the precise pharmacological effects, there is consensus that alcohol disrupts cognitive functioning by diminished ability to reason, reduced ability to perceive or calculate consequences of aggressive behaviors, and by enhanced perception of threat (Pihl, Smith, & Farrell, 1983; Taylor & Chermack, 1993). All of the latter mechanisms bear upon the process of social interaction, and are likely mechanisms that could increase the risk of partner violence. It is clear that aggression may be a consequence of alcohol's impairment of perception, judgement and memory. Distorted perceptions increase the likelihood of miscommunications, developing resentment, and the ability to take into account the consequences of aggressive actions (Kaufman Kantor & Asdigian, in press).

Heavy drinking by women is found infrequently in surveys based on general population samples (Kaufman Kantor & Straus, 1987). However, research examining clinical samples of alcoholic women does suggest that such women have high rates of victimization over multiple relationships. A review of the research on intoxication and women's victimization concluded that such victimizations appear to be more of a function of the male partner's drinking and propensity to violent behavior (Kaufman Kantor & Asdigian, in press).

Biology and physiology of intimate violence

Is there a biochemical basis for intimate violence? Aside from alcohol's acknowledged importance to aggression and family assaults, the contributions of biology or physiology to violence in the family have received little attention. Few studies attempt to integrate biological, social and psychological perspectives (McKenry, Julian, & Gavazzi, 1995). However, at least one treatment program for violent men incorporates a diet for hypoglycemia (low blood sugar). Deschner (cited in Shupe and associates (1987)), suggests a link between blood sugar level, and neurochemical imbalance leading to depression, rage and other emotional disturbances. Shupe and associates (1987)) caution that male batterers provided such treatment tend to use the hypoglycemia notion to rationalize their violence. Research on the biochemical links to aggression have considered other physiological pathways.

Lindman and associates (1992) conducted serum analysis of ethanol (an alcohol by- product), testosterone (hormone), cortisol (a hormone elevated in stress), and glucose (blood sugar) in 16 men arrested by police after spousal assault incidents. They found elevated levels of ethanol and glucose, low serum testosterone, and high cortisol levels in the arrested men compared to their sober state later. However, they also caution readers that cortisol may have been temporarily elevated by hangover or withdrawal stress, or that economic hardship and frequent marital conflicts can pose chronic stressors that increase cortisol levels. The authors conclude that there is little effect of intoxication because no differences were found in ethanol levels in a non-aggressive control group of men drinking in a bar. They also did not find effects of testosterone, but believe that their findings do not preclude the possibility that high testosterone levels contributed to aggressive coping styles before the onset of alcohol abuse patterns. Moreover, they concluded that aspects of the conflict, drinking and arrest situation were most likely responsible for changes in blood chemistry.

Elliot (1988) has acknowledged that neuropsychological causes of wife assault are often overlooked. We know that organic deficits can affect cognition, perceptions, emotions, and behaviors, but rarely relate these factors to the occurrence of intimate violence. Elliot's review of this literature identified a wide range of causes of neuropsychological disorders associated with persistent criminal aggressive behavior including borderline syndromes, schizophrenia, antisocial personality disorders, and brain defects. He also identified other important potential organic causes of violence including temporal lobe epilepsy, and head injuries. He hypothesized that organically based minimal brain dysfunction might be related to violent behavior because the associated cognitive problems can interfere with communication patterns. Two other potentially disruptive types of behavior patterns fall into the latter group: episodic dyscontrol (unpredictable attacks of rage) and Antisocial Personality Disorder. These have been discussed above as factors affecting the dynamics and patterns of abuse. Attention Deficit Disorder is also linked with an early onset type of aggressive behavior that can continue into adulthood. This syndrome includes attention deficits, hyperactivity, impulsivity, learning defects and some associated neurological symptoms.

There is little systematic research on the prevalence of organic and neurological problems among batterers. Elliot's data on the prevalence of Minimal Brain Dysfunction among batterers suggests that it was present in 40% of cases of episodic dyscontrol in the family. However, his was a sample of patients seen in specialized clinics, for reasons other than family violence raising questions about generalizability. Therefore no conclusions about prevalence can be accurately drawn from these data. A recent study by Rosenbaum and associates (1994) compared three groups of men (53 partner abusive men; and 32 maritally discordant men) and found that head injury significantly increased the odds of marital assaults by male batterers. Slightly more than half of abusive husbands had experienced a head injury compared to a quarter of the other men studied. Although these authors conclude that head injury may play a role in marital aggression, they also caution that a third variable cause, antisocial behavior disorder, may actually be increasing the rate of both head injuries and marital aggression because antisocial men may be more likely to get into fights with others leading to head injuries, as well as engage in assaults on their wife.

One recent experimental laboratory study examined the relationship between physiological indicators, emotionally aggressive behavior and general violence in batterers. Gottman and associates (1995) used changes in the male batterer's heart rate reactivity to differentiate types of violent men. Men designated as Type I batterers decreased their heart rates during marital conflicts while Type II men increased their heart rates during laboratory conflict situations. Type I men were described as more verbally aggressive towards their wives, more belligerent and violent towards others, rated as high in antisocial behavior and sadistic aggression, more often drug dependent and were lower in dependency than Type II men. Type I men were also more likely to have witnessed violence between their parents. On two year follow-up, none of the Type I marriages had ended. Type II men were not less violent in their marriages compared to Type I men, but they were not likely to be violent towards others. Interestingly, the separation-divorce rate for Type II men at two years was 27% while none of the Type I men had gotten separated or divorced. Gottman and associates (1995) suggest that the reason for the greater stability of the Type I marriages, a seemingly paradoxical finding in light of the sadistic aggression and drug dependence, is that firstly women are more fearful of leaving such men, and are less likely to express anger towards them. Secondly, the authors indicated that women married to Type I men are themselves, more often antisocial and may be more conditioned to a violent relationship than other women.

The results of the body of research on the biology and physiology of aggression show some promising areas for future consideration. However, there is also a need consider the total picture including the fact that social factors can shape biology and physiology related to antisocial behavior and family assaults.

Socioeconomic risk factors

What is the relationship between educational attainment and violence? The relationship between educational attainment and partner violence is complex and inconsistent. Hotaling and Sugarman's (1986) review of over 400 empirical reports on husband to wife violence found that higher educational level was associated with less violence in more than half of the studies that examined in their analyses. Other research has found a mixed relationship between educational attainment and partner violence. Straus and associates (1980), for example, found that partner violence was most common among individuals with high school diplomas or at least some high school education. More recent research suggests that the absence of a college education is associated with a high frequency of both moderate and severe violence (Downs, Miller, & Panek, 1993). Rollins and Oheneba- Sakyi's (1990) research on Utah households, however, found no differences between violent and non-violent families based on education. Education may be most important as it relates to the likelihood of finding employment in a stable and well paying job.

Are employment and occupational status risk markers for violence? Previous research has suggested that households in which the husband is unemployed or employed only part time have increased rates of violence, particularly severe violence (Gelles, 1978; Gelles & Straus, 1978; Hornung, McCullough, & Sugimoto, 1981; Jasinski, 1996; Kaufman Kantor, et al., 1994; McLaughlin, Leonard, & Senchak, 1992; Steinmetz & Straus, 1974). Unemployment or part time work with few, if any, benefits is very stressful economically for families and may increase the likelihood of partner violence. Other research, however, has found no relationship between employment status and violence among intimates (Hotaling & Sugarman, 1990; Rollins & Oheneba-Sakyi, 1990). In addition to unemployment, there is also evidence to suggest that occupational class or status is related to partner violence. For example, rates of violence between husbands and wives have been found to be twice as high in families of blue collar workers than for white collar workers (Kaufman Kantor & Straus, 1987; Stets & Straus, 1989; Straus, et al., 1980). McLaughlin, Leonard, and Senchak (1992) also found that rates of moderate aggression were twice as high among working and middle class husbands compared to upper class husbands.

Occupational and social status discrepancies. Occupational and social status discrepancies have also been established as risk markers for partner violence. There is some evidence to suggest that households in which there are status incompatibilities are at a greater risk for partner violence than those without incompatibilities. Smith (1988) for example found that households in which the wife works, or works more than her male partner, may be at a greater risk for spousal violence. One explanation for this finding suggests that men may use physical violence to compensate for their inability to be the primary breadwinner in the family (Straus, et al., 1980). There is also some evidence, however, which finds that violence is more likely to occur in couples where the husband has a much higher status than his wife (Hornung, et al., 1981). Yllo and Straus (1990) have suggested that in couples where the wife has the higher status the husband may feel threatened by this and use violence to restore his authority. On the other hand, in couples where the wife has a much lower status than that of her husband, he may use violence as a mechanism of control and dominance. The results of these studies provide strong evidence that inequalities of status and power are undesirable in marriages at minimum, and at maximum, increase the probability of partner assaults.

Income. Existing research evidence also suggests that income, particularly poverty, is an important risk factor for partner violence (Dibble & Straus, 1980; Hotaling & Sugarman, 1986; Kaufman Kantor, 1990; Straus & Smith, 1990). Straus and associates (1980) found that families living at or below a family income of $20,000 had a rate of violence 500% greater than families with incomes greater than $20,000. Families living in poverty may suffer from stress due to an inability to meet their needs with the resources that are available to them. This stress may then lead to frustration and possibly aggression (Conger, Elder, Lorenz, Conger, Simons, Whitbeck, et al., 1990). Stress producing events such as unemployment and other economic problems associated with it such as the stresses of daily survival are also more likely to occur in low income families (Gelles & Straus, 1978) who may be ill-equipped to deal with them.

As with many of the other risk markers considered thus far, economic, educational and occupational deprivation are strong predictors, but they are not sufficient causes for intimate violence. Our discussion above on the dynamics of power and control suggested that multiple dimensions often come into play such as the combination of low self esteem, feelings of lost interpersonal control from unemployment and not enough money to support the family s needs. When these factors coexist with a history of violence in the family of origin then the risks of intimate violence are increased.

Life course risk markers

An analysis of life course dynamics provides a useful framework for examining changes in marital conflict resolution patterns over the life span of a relationship. For example, courtship, early marriage, pregnancy, middle and late marriage may each carry differential risks for the likelihood of marital assaults. Unfortunately, there is little prospective research that explicitly examines the effects of life course transitions on marital violence trajectories. However, analyses, primarily of cross-sectional studies, based on large national surveys, supports the existence of greater violence in the earlier phases of marriage and a decline in marital violence across the life course (Suitor, Pillemer, & Straus, 1990).

The stability of violence patterns over the course of a relationship is an important area that requires further investigation. O'Leary and associates (1989) study of stability in marital patterns, for example, found a moderate association between aggressive behavior in courtship and similar behavior 30 months after marriage. Aldarondo (1996), however, found that in many relationships physical assaults against women may stop completely or may occur inconsistently over the course of the relationship. Other researchers have found relatively high rates of desistance (cessation of the assaults) among perpetrators of partner violence (Feld & Straus, 1990; Woffordt, Mihalic, & Menard, 1994).

Patterns of desistance may differ vastly for criminal justice samples of batterers or the terroristic batterer, as described above. Studies assessing the reoccurrence of violence among men who have undergone either voluntary or court-mandated treatment for wife battering find that treatment effects, at best, range from small to moderate, and are dependent on a host of individual and program-related factors. Reviewers of this research (Burns, Meredith, & Paquette, 1991; Shepard, 1992) report re-arrest rates for spousal assaults ranging from 4 to 20% for post-treatment periods between 6 months and 5 years. These rates are conservative and most likely underestimate the true incidence of recidivism since all spousal assaults are not reported to, or acted on by the police. Indeed, studies examining partner reports of violence have found that up to 54% of men continue to be physically abusive within a 6 month to 1 year period following treatment

It is difficult to make any definitive conclusions about the stability of partner violence over the life course due to the lack of longitudinal research and the methodological problems associated with locating severely violent individuals, and differences that exist across samples. It is possible, however, to make some generalizations based upon research that specifically focuses on one stage of the life course. This body of literature is examined below.

Courtship violence

What is the prevalence of courtship violence? Most studies addressing partner violence have focused primarily on married couples. However, the study of marital violence has expanded to include intimate non-familial relationships such as cohabiting and dating or courtship relationships. We prefer the term "courtship violence" for the phenomenon to be discussed in this section because it seems more applicable to the initial relationship phase of adult intimate partners. While dating/"courting" relationships may involve a high degree of intimacy they are often not considered official relationships either socially or legally (Deal & Wampler, 1986). A review of seventeen separate studies (Sugarman & Hotaling, 1989) on lifetime prevalence estimates of dating violence among college students reported an average of about one third of students surveyed report dating violence involvement. Although these estimates are informative, much of the research examining courtship violence uses nonrandom samples of college or high school students making it impossible to generalize about the actual extent of courtship violence. Additionally, respondents are often asked to recall instances of physical aggression that may have occurred in their most recent dating relationship even if it was several years prior.

There are discrepant views about whether the theoretical model used to describe marital violence is applicable to the courtship period. Notably, dating couples are not economically or contractually bound, nor bound by children (Carlson, 1987). Also, despite substantial evidence for the existence of sexual inequality and cultural norms favoring violence against women (Straus, 1976), some authors argue against the applicability of this theoretical model to courtship-violence (Arias, Samios, & O'Leary, 1987; Lloyd, Koval, & Cate, 1989). The reason for this differing view is related to the findings of some studies that many women admit to aggression against dating partners. However, there is also evidence that females suffer more injuries than males (Makepeace, 1984), females are more likely than males to describe their aggressive behavior as self defensive, and males are more likely than women to describe their aggressive behavior as motivated by needs to intimidate, control or coerce the other (DeMaris, 1987; Makepeace, 1984; Olday & Wesley, 1983). The discrepant views of appropriate theoretical explanations of dating violence, and the finding of reciprocal aggression in dating violence, suggests to us that a more integrated theoretical model is needed which includes gender inequalities, and cultural norms as well as the social earning of violence.

What are the risk factors for courtship violence? Studies examining the etiology of courtship violence have established a number of risk factors for abusive behaviors similar to those discussed for marital violence, e.g., societal norms, along with exposure to violence in the home, parental divorce, and contextual factors such as stress, jealousy, alcohol, drug use, and the seriousness of the relationship (DeMaris, 1987; Makepeace, 1983; Riggs & O'Leary, 1989; Sugarman & Hotaling, 1989; Tondonato & Crew, 1992). However, research examining dating violence has lacked consensus on the importance of a history of abuse to adolescent relationship violence (Smith & Wiliams, 1992), although several studies do show that having experienced child abuse increases the likelihood of being violent towards dating companions (Laner, 1983; Marshall & Rose, 1988; Sigelman, Berry, & Wiles, 1984)

Relationship length. Both the number of dating partners and frequency of dating have been found to increase the risk for violence (Bergman, 1992). This is most likely a function of greater time at risk, as well as the greater odds of increasing intimacy developing with frequent contacts. The more time spent together, the greater the possibility of conflict occurring. However, intimacy may also carry with it a " greater presumed right to influence the partner" (Laner, 1983). Generally, more serious and emotionally intense relationships have greater chances of conflicts developing, but even relationships of short duration carry with them the chance of serious violence (Makepeace, 1989).

Does courtship violence carry over into marriage? An important area of investigation that we need to be concerned with here is the continuity of violence into the marital or cohabiting relationship. Evidence from shelter samples of women abused in their marriages indicates that a half or more had been physically assaulted in a courtship relationship as well (Roscoe & Benaske, 1985; Star, Clark, Goetz, & O'Malia, 1979). A study of couples in their first marriage found that 31% of the men and 44% of the women reported engaging in aggression against a courtship partner prior to their marriage (O'Leary, Arias, Rosenbaum, & Barling, 1985). Thirty percent of the respondents said that they eventually married someone who had abused them in courtship.

The phase of early marriage

Youth is probably one of the strongest risk markers for aggression, and therefore we might expect that the prevalence of marital assaults is highest among youthful partners in the early phase of marriage. In a longitudinal study of couples surveyed one month prior to their marriage, and at 18 and 30 months thereafter, O'Leary and associates (1989) found that 27% of men and 36% of women indicated that they had engaged in aggression 1 1/2 years after their marriage. After another year, prevalence rates decreased slightly to 25% and 32% respectively. Other research has found similar rates of partner violence among young adults (Elliot, Huizinga, & Morse, 1986). These rates are three to four times higher than those found by Straus and associates (1980) and Kaufman Kantor and associates (1994), neither of whom focused exclusively on the early marriage period. However, others (McLaughlin, et al., 1992; Straus, et al., 1980) did find that the highest rates of partner violence were among those 30 years old and younger, and in particular the group aged 18 to 24 years (Fagan & Browne, 1994).

In addition to youth, other factors may be associated with higher rates of violence in early marriage. Leonard and Senchak (1993) examined alcohol, marital aggression, and relationship satisfaction among young couples (age 18 to 29) applying for a marriage license. This study conducted in an urban setting found that higher levels of relationship aggression in early marriage were associated with the husband's heavy alcohol use, marital dissatisfaction, husband's hostility, and beliefs that alcohol excuses aggression. This study illustrates that other risk factors may interact with life course status to affect the probability of intimate violence.

Pregnancy and marriage

An important stage in the course of a relationship occurs if and when the woman becomes pregnant. There is some evidence that the changes taking place with pregnancy have implications for marital violence. Prevalence estimates of violence during pregnancy range from 7% (Amaro, Fried, Cabral, & Zuckerman, 1990; Campbell, Poland, Walder, & Ager, 1992) to 20% (Bullock & McFarlane, 1989). Moreover, evidence from the 1985 National Family Violence Survey (NFVS) suggests that a pregnant woman's risk for violence is 28% greater than that for a non-pregnant woman and that her risk of abusive violence is 61% greater (Gelles, 1990).

The dynamics of violent relationships during pregnancy. Although evidence does exist indicating that pregnant women are at risk for marital violence, there is little agreement as to the dynamics of these violent relationships. There is some evidence, for example, that suggests that pregnancy is a time of respite for previously abused women, and that violent attacks by their partner stop while they are pregnant (Campbell, Harris, & Lee, 1995; Campbell, Oliver, & Bullock, 1993). Other evidence, suggests that violence may actually escalate with pregnancy (Campbell, et al., 1992; Campbell, et al., 1995; Helton, 1986) or during post -partum (Stewart, 1994). Campbell 1989 has reported that many victims of marital rape report sexual assaults during pregnancy or soon after delivery (See Chapter 5 for more information on marital rape.)

Existing research has indicated a number of motives for men who abuse their pregnant partners. Campbell and associates (1993) and (1995), found that jealousy of the unborn child and anger toward the unborn child were two motives. These were occasionally manifested in the type or location of the abuse (e.g. beatings aimed at the woman's abdomen). The results of their research also indicated that men may see pregnancy as interfering with the woman's roles and duties as a wife such as her caretaking of the male. Using this line of thought, the violence, although pregnancy specific, is not directly aimed at the child. Men may also see pregnancy as a threat to their definition of manhood which does not include taking care of babies (Campbell, et al., 1995). For some men, pregnancy may not change the amount or type of violence they inflict upon their partner (Campbell, et al., 1993).

Regardless of the dynamics of abuse against pregnant women, one consequence is that women involved in violent relationships enter prenatal care later in their pregnancy than do women in non-violent relationships (Parker, 1993). They are also twice as likely to begin prenatal care in their third trimester (McFarlane, Parker, Soeken, & Bullock, 1992). Battered women are more likely than non-battered women to give birth to preterm and low-birth-weight infants (Bullock & McFarlane, 1989), to have miscarriages (Berrios & Grady, 1991; Stark & Flitcraft, 1995; Webster, Chandler, & Battistutta, 1996) and to incur preterm labor, fetal injury, and fetal death (Bohn, 1990).

Separation and divorce

Divorce and remarriage represent important stages in some relationships and could have important implications for partner violence. There is some evidence to suggest that divorced individuals are more likely to report violence (Levinger, 1966) or that separation may be due to partner violence (Fagan, et al., 1983). The termination of an intimate relationship may also pose an increased risk for violent behaviors, or more serious violence by partners who may not want the relationship to end (Ellis, 1987; Feld & Straus, 1990). Risks for sexual violence (Finkelhor & Yllo, 1985)and serious or lethal violence may also be greater when individuals try to leave a relationship (Browne, 1987; Wallace, 1986; Wilbanks, 1983; Wilson & Daly, 1993). There is evidence that this risk is disproportionately incurred by women (Wilson & Daly, 1993). Moreover death threats may extend to other individuals outside the couple as an attempt to prevent one member from leaving (Browne, 1987). Victims of partner violence may even stay in abusive relationships out of fear of retaliation or death (Browne, 1987).

After a separation or divorce individuals may enter new relationships creating new family units. This also represents an important stage in the life course that may be associated with partner violence. Individuals who were violent in previous relationships may also be violent in subsequent relationship because of the patterned nature of behavior. Another interpretation is that the stress of a new family may increase the risk for partner violence. Kalmuss and Seltzer (1986), using a national survey found that violence was twice as likely to occur in remarried compared to intact families.

Late stage marriage

What is the prevalence of elder partner abuse? Limited empirical research exists documenting the extent to which elderly persons are abused by their spouses or partners. Much of the research on elder abuse focuses on abuse by caretakers such as adult children (Goldstein, 1995; Wolfe, Zak, Wilson, & Jaffe, 1986) or in institutional settings (Shiferaw, Mittelmark, Wofford, Anderson, Walls, & Rohrer, 1994). Moreover, such research often includes financial abuse and neglect as well as physical violence. Two surveys that have examined partner abuse, one conducted in the United States (Pillemer & Finkelhor, 1988) and one in Canada (Podnieks, 1992) have found rates of physical violence ranging from 5/1000 (Podnieks, 1992) to 20/1000 (Pillemer & Finkelhor, 1988). Other research has found that anywhere from 23% to 33% of abusers of elderly persons were spouses (Hageboeck & Brandt, 1981; Wolf & Pillemer, 1989; Wolf, Strugnell, & Godkin, 1982). The limited amount of research on partner violence among elderly persons may be partly due to a lack of consensus and clarity of the definition of abuse (Lachs & Pillemer, 1995; McCreadie & Tinker, 1993; Wolf, 1988). It has also been suggested that older abused women are essentially an invisible population (American Association of Retired Persons, 19xx). Although the actual extent of elder partner abuse is unknown, some researchers estimate that it is lower than other forms of violence in the family (Pillemer & Finkelhor, 1988).

What are the risk factors for elder partner abuse?

There is some debate about whether elder abuse is a unique phenomenon (Wolf & Pillemer, 1989) or simply a continuation of physical abuse that began at an earlier point in the relationship (Matlaw & Spence, 1994). Assaults against older women may also begin as a result of age related stresses such as retirement, failing health, caregiver burdens, or increased dependency (American Association of Retired Persons, 1992). Wolf and Pillemer (1989) argue that the vulnerability of the elderly to abuse, the nature of the abuse suffered, and the relationship of the elderly to society make elder abuse a separate category from partner abuse. Others have compared abuse of the elderly to child abuse (American Association of Retired Persons, 1992; Johnson, 1979). A number of the risk factors for abuse of the elderly have also been established as risk factors for partner violence of non-elderly persons (Harris, 1996). These include substance abuse (Pillemer & Finkelhor, 1989; Wolf, Godkin, & Pillemer, 1986), intergenerational transmission of violence (Steinmetz, 1977), external stress (Pillemer & Finkelhor, 1989; Podnieks, 1992), social isolation (Pillemer, 1985), and dependency (Paveza, Cohen, Eisdorfer, Freels, Semla, Ashford, et al., 1992; Pillemer, 1985; Wolf, et al., 1986). Other risk factors such as disabilities may be more particular to older individuals (Lachs, Berkman, Fulmer, & Horwitz, 1994). Wolf and Pillemer (1989) for example, found that almost half of the 328 elderly victims of abuse they studied used a walker, cane, or wheelchair.

Older victims of partner assaults may not self-identify as victims, thus creating a barrier to achieving safety. Other barriers include fear of retaliation, having to appear in court, of being placed in a nursing home, having decision making rights taken away, and of having to leave home. Health concerns and problems associated with aging may also make victims dependent on their assaultive partners for such things as transportation, mobility, and socialization (American Association of Retired Persons, 19xx).

What is the prevalence of spousal homicide?

The most serious outcome of partner violence is spousal homicide. In 1988 540 spouse murder cases were reported in the United States' 75 largest counties (U.S. Bureau of Investigation & U.S. Department of Justice, 1995). In 1993, 5% of the murders and non- negligent manslaughters known to the police were of spouses and 4% were of dating partners (U.S. Department of Justice, 1995). Most of what we know about spousal homicide comes from studies of police records, or from data bases such as the Uniform Crime Reports. This information, although valuable, is somewhat limited in its ability to provide the context in which the murder took place. The Uniform Crime Reports also rely on the ability of police departments to consistently categorize victim-offender relationships and to provide this information to the national collection center. The information that does exist, however, has demonstrated that there are important gender differences in the risk of lethal assault by a spouse (Browne, 1987; U.S. Department of Justice, 1995; Wilson & Daly, 1993). In particular, wives are 1.3 times more at risk than husbands (Mercy & Saltzman, 1989). Several studies have also examined gender differences in perpetration of homicide and found that men were more likely to kill acquaintances and strangers and women were more likely to kill intimate partners (Browne & Williams, 1989; Jurik & Winn, 1990; Kellerman & Mercy, 1992; Wilbanks, 1983)

What are the risk markers for spousal homicide?

The information obtained from official records and other sources has indicated that there are a number of risk markers for murder of a spouse. Mercy and Saltzman (1989) for example found that homicides increased with a gap in age between the husband and the wife (Mercy & Saltzman, 1989). Alcohol has also been established as a risk marker for partner homicide (Wilbanks, 1983). Other research has suggested that homicides are often preceded by a domestic quarrel (Jurik & Winn, 1990). Aldarondo and Straus (1994) reviewed clinical studies of extreme marital violence and summarized a number of factors associated with life-threatening violence including:

Browne (1987) found a similar pattern of variables as did Aldarondo and Straus (1994). Her research identified seven variables that distinguished between battered women who killed or seriously injured their abusive partner from battered women in the non-homicide group:

The complex dynamics and characteristics of intimate partner violence that have a lethal ending are similar regardless of gender of the perpetrator. It should also be noted that the risk factors for lethal violence by men are consistent with the characteristics of Type I batterers identified by Gottman and associates (1995) as discussed above.

Implications for practice and policy

What can professionals do?

Screening for victimization and assessment of risk. A number of risk markers for partner violence can be identified by professionals who might come into contact with individuals or couples involved in violent relationships. Physical signs of abuse, such as bruises or other questionable injuries should be noted and inquired about. In addition, general questions about marital satisfaction and quality can also be asked in a non- judgmental and non-victim-blaming manner. Questions about violence, both current and in the family of origin, should become part of the documented family history as they indicate elevated risk. The mental health practitioner should also routinely ask questions such as the following:

  1. Is anyone in your family hitting you?
  2. Does your partner threaten you? your life?
  3. Does your partner prevent you from leaving the house, from getting a job or returning to school?
  4. What happens when your partner doesn't't get his way?
  5. Does your partner threaten to hurt you when you disagree with him?
  6. Does your partner destroy things that you care about, i.e. your family photographs, your clothes, your pets?
  7. Are you forced to engage in sex that makes you feel uncomfortable?
  8. Do you have to have intercourse after a fight to "make up"?
  9. Does your partner watch your every move? Call home 10 times a day? Accuse you of having affairs with everyone? (Schecter, 1987).

Other risk markers that should be assessed include excessive alcohol/illicit drug use by one or both partners and the presence of life stressors such as a change in employment status (e.g., more responsibility at work, reduction in work load, reassignment to another job), pregnancy, and problems with children. Affirmative responses to threats of violence and of death, and destruction of property and pets are signs of potentially lethal violence. Immediate intervention may be necessary in such cases. In a group therapy session, professionals should watch for the relationship dynamics of the couple and guard against one partner controlling the other. Signs to watch for include one partner constantly speaking for the other and the demand by one partner to always be present when discussing the relationship. If possible, partners should be interviewed separately to allow each to feel free to speak openly about their relationship.

Professionals who deal with pregnant women are in a unique position to screen for marital violence and to initiate intervention if needed because pregnant women must come in periodically for check-ups (Sampselle, Petersen, Murtland, & Oakley, 1992). During these visits, professionals can note any physical signs of abuse such as bruising, as well as ask questions regarding abuse as part of both an oral and written history (Campbell, et al., 1993). Research evidence suggests that this process should involve more than one question regarding abuse. For example, Helton (1986) found that of 68 self-identified battered women, 78% checked "no" to the first abuse focused question in a written history. Since many batterers may attend doctor's visits with their partner, written questions or a private interview may be a more appropriate mechanism for assessing risk for abuse (Campbell, Pugh, Campbell, & Visscher, 1995).

A particularly risky period for women in violent relationships occurs when they try to leave (Ellis, 1987; Feld & Straus, 1990). In particular, risks for lethal violence may also be greatest when individuals try to leave a relationship (Browne, 1987; Wilbanks, 1983; Wilson & Daly, 1993). Professionals who are counseling victims of partner violence should watch for signs of escalating abuse including more frequent and severe episodes of violence and should be aware of any threats of violence or use of weapons. Such behavior may indicate an increased risk for lethal violence.

The ability of therapists to recognize the risk markers for lethal violence is extremely important. There is some evidence, however, which suggest that more training is needed in this area. Hansen and associates (1991) for example, found that in a sample primarily comprised of family therapists who were presented with case studies containing evidence of violence, almost half did not address this violence as a problem.

Assessment of male partners. Counselors of abusive men suggest that a number of specific questions are needed to assess the extent of violent behavior (Emerge). Guidelines developed by counselors from EMERGE, the first program in the United States for treating male batterers, suggest the need for concrete questions such as "And what happens when you lose your temper", and "Did you become violent?" "What about grabbing or shaking?" "Have you hit her?" When you hit her, was it a slap or a punch?". They also suggest that violence needs to be defined to the men as any actions that force their partner to do things that she does not wish to do, or that makes her afraid. Therefore, questions should be posed about whether he ever threatened her, took her car keys away, threw things in her presence, damaged her property or punched walls or doors. He should also be asked about when the violence occurred, and to whom it was directed against. Aldarondo (in press) also cautions about the need to use language carefully. Because men often do not consider pushing and shoving as violent behavior, the therapist should avoid using the term violent . Many of the behavioral items mentioned above are already included in the Conflict Tactics Scale (Straus, 1990); clinicians may wish to use or adapt this most frequently used assessment tool for couple violence or to use the recently revised version of the CTS (Straus & Hamby, 1996). Counselors should ask direct questions about his violence to help him take responsibility for his actions as well as to understand the nature and extent of the abuse.

Assessment Tools

Aldarondo (in press) suggests several tools for assessing abusive behavior in addition to the Conflict Tactics Scale, noted above. They are as follows:

Assessment of Alcohol and Drug Use

One limitation of the above assessment tools is that none of the tools mentioned include measures of other risk factors such as drug and alcohol use. Because of the importance of substance abuse as a risk factor in serious intimate assaults, we recommend that clinicians routinely identify drug and alcohol use patterns and continue to monitor them during treatment, as well.

Measures of Substance Abuse

Problem Drinking Measures. There are several ways to assess problem drinking. One approach is to use the Michigan Alcoholism Screening Test (MAST) (Selzer, 1971). Shortened versions of the MAST (10 items) have been found to be as effective as the complete instrument in discriminating between alcoholics and non-alcoholics (Pokorny, Miller, & Kaplan, 1972). This inventory of alcohol-related drinking problems includes items such as, "Have you ever attended a meeting of Alcoholics Anonymous, or A.A. for your own drinking problem?"; "Have you ever gotten into fights when drinking?" , and "Have you ever neglected your family or your work for 2 or more days in a row because of your drinking?

Another important assessment tool is to use standard beverage specific questions about the quantity, frequency and variability of alcohol consumption. By beverage specific questions we mean that persons should be asked the same series of drinking questions for wine, beer, and then again for distilled alcohol beverages.

Illicit Drug Use. In our own research, we have used standard items measuring the type and frequency of illicit drug use in the past year or ever. The items are based on those used in the National Household Drug Survey (Miller, Cisin, Gardner-Keaton, Harrell, Wirtz, Abelson, et al., 1982), and by drug researchers (Elinson & Nurco, 1975). The Diagnostic Interview Schedule (Gleason, 1993) also is a potential source of items that measure drug dependency. Questions may be repeated to assess the partner's usage.

Summary

This chapter examined current research on the dynamics and patterns of family violence, the types of abuse, the major risk factors for intimate assaults, and emphasized implications of these findings for assessment. Major findings included:

Implications for intervention, policy and research

The information presented on the different types of abuse points to the need for varying interventions. The most important distinction is whether the abuse patterns fit the common couple dynamic or the terroristic dynamic. The limitations of traditional family systems therapy, couple therapy or even psycho-educational approaches are all too evident when the abuser fits the terrorist profile (Walker, 1995). The research on psychological characteristics, alcohol abuse patterns and biological risk factors point to the need for both a variety of assessments as well as a variety of approaches to intervention. Because more severe and injurious abuse is likely to be associated with numerous psychological problems and with alcohol or other drug abuse problems, specialized clinical skills are required. It should not be assumed that a program focused mainly on anger management is sufficient to end the more serious types of intimate violence, or for that matter, that substance abuse focused treatment alone is sufficient. Sobriety may not be enough to end the assaults by all batterers. At the same time, there is a need for more and better research on effective treatment and other deterrence strategies.

The Vivian and Langhinrichsen-Rohling (1994) study, in particular, pointed to the need to characterize offender-victim relationships. The findings of this research while documenting the rarity of women as the sole "batterers", also showed that victimization of either spouse, even by low levels of aggression, significantly increased psychological distress. The authors went on to suggest that instances where victimizations are truly mutual and mild may be amenable to couples therapy. However, there is still a need to address the specific issue of marital aggression. In cases of asymmetrical aggression (one perpetrator, or one primary aggressor), gender specific treatment of individual partners is advisable.

Our review of the research found little systematic examination of victim characteristics, risk factors, or research on victim-specific interventions. This gap in the research suggests that more information on victims is needed. Women who have experienced abuse, particularly severe or long-term abuse may need assistance in understanding and processing their experience, so that they can move ahead with their lives (Walker, 1995). There is also a need to assess whether the welfare of victims has improved or declined longitudinally (McCord, 1992). Research to date, has rarely considered the well-being of women in the follow-up. However, clinical evidence based on reports of battered women service providers suggest that the safety mechanisms and psychological counseling provided by battered women's shelters are central to women's recovery (Walker, 1995).

We identified particular gaps in the literature in regard to batterer-specific and victim- specific interventions, and victim risk factors. At the same time, the discussion of this chapter drew on almost three decades of research that clinicians can use to enhance their practice with clients at risk for intimate violence. The strengths of our knowledge base as detailed above include improved ability to identify offenders that pose an ongoing risk; improved understanding of the psychodynamics of violent relationships; better understanding of gender similarities and differences in the forms that partner violence takes, and gains in knowledge about how to break the cycle of abuse.

Implications for military families

The major implications for practice that arise from this chapter are in the areas of assessment of risk, and relatedly, assessment of where the abuse falls on the common couple violence to terrorist continuum. The same issues of assessment hold true for both military and non-military families alike. However, certain patterns of risk may be more prevalent among the military. For example, it is possible that those with certain violence-prone personality styles may be more attracted to the military. By violence prone , we mean those who grew up witnessing or experiencing their parents violence. When such individuals are also trained to use violence in their professional careers, there are greater risks that the violence will spill over into family life. Secondly, because both violence and problem drinking are often linked, and because both run in families , substance abuse related intimate violence may be a particular problem in military families. One study, conducted among alcoholics using a Veterans Administration facility found that half of the men had been assaultive towards their wife in the year prior to treatment (O'Farrell & Choquette, 1990). Careful assessment of both substance abuse and marital violence are important at intake, throughout treatment, and post-treatment, as well. As mentioned above, achieving sobriety may not be sufficient to end entrenched assaultive behavior patterns in families.

When both members of a couple are assaultive, it can be difficult to distinguish clear victim and aggressor roles. The literature we reviewed suggested a need to consider the characteristics of both individuals as well as the interactional dynamics, and the symmetry of abuse. A careful history of conflict resolution styles over the course of the relationship is essential to establishing victim/perpetrator roles. Women are at greater risks for psychological and physical injury, and the safety of women and children in the family needs to be a primary goal in risk assessment and treatment planning.

We noted above that family structure and family role conflicts may contribute to intrafamily violence. Certain aspects of the military such as the necessity for an authoritarian structure (e.g., giving and taking orders), may lead to confusion about where the boundaries of this structure end. For example, if the authoritarian power structure is brought into the family, then the risks for violence are increased. Clinicians need to be sensitive to the presence and the potentially adverse effects of this role structure in families.

Our discussion of life course events as risk factors suggested that life stressors can increase frustration and anger levels, and thus increase the risks that violence may be used to resolve intimate conflicts. Military families can experience a number of unique stressors such as relatively low pay, extended family separations, frequent changes in locations, isolation from extended family, lack of privacy, and stressful, difficult assignments in an area of violent conflict. These stressors need to be assessed at intake and taken into account in clinical interventions, and in making future military assignments (For more information on partner violence among military families see chapter 6).

Finally, in assessing risk for intimate violence, many factors should be weighed. These should include the severity of maltreatment or the potential for severity as measured by the acts committed by the offender, along with the number and degree of risk factors, and the potential for lethality as discussed above.

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