Domestic Violence: An Overview for Mental Health Practitioners

• Author: Sarah L. Desmarais and Donald Dutton
• Pages: 547-568

547

CHAPTER 26

Domestic Violence:

An Overview for

Mental Health Practitioners

Sarah L. Desmarais and Donald Dutton

I. INTRODUCTION

Domestic violence is a complex, multidimensional phenomenon comprising behaviours varying in preva-

lence and severity. It is without doubt a serious social issue that crosses sociodemographic boundaries,

aecting the young and old, rich and poor, and men as well as women. Individuals who are educated,

employed, and highly competent as well as individuals who struggle due to marginalization experience

domestic violence. Although typically used to describe behaviours occurring between intimate partners,

including physical, psychological, sexual, and even spiritual or nancial abuse, the term “domestic vio-

lence” can also refer to the abuse and neglect of elderly persons and children. In this chapter we focus on

behaviours occurring in the context of an intimate romantic relationship. Regardless of the name used

or specic denition, domestic violence has signicant impacts on both the physical and mental health

of victims, as well as costs to society, including increased demands placed on public assistance, child

welfare, and other health, education, legal, and social services.

With this chapter, our goal is to provide mental health practitioners with an overview of how they

may become involved in domestic violence cases, in capacities ranging from providing expert testi-

mony in the courtroom to engaging in clinical intervention. We begin with a review of what constitutes

domestic violence, including its denition, prevalence, and impact. We then situate the phenomena

within the Canadian legal context, highlighting those issues of particular relevance to clinical practice.

We conclude with a discussion of individual, community-level, and legal system approaches to treatment

and intervention.

A. Def‌initions

Even within our more restricted focus on behaviours occurring between intimate partners, there

still exists considerable inconsistency between the denitions and terminology used in criminal jus-

tice, health care, and academic contexts, as well as between jurisdictions. e Department of Justice

Canada, for instance, distinguishes between spousal abuse, dating violence, as well as child abuse, and

other forms of family violence. Specically, spousal abuse is dened as “violence or mistreatment that a

woman or a man may experience at the hands of a marital, common-law or same-sex partner . . . [that]

may happen at any time during a relationship, including while it is breaking down, or aer it has ended”

(Department of Justice Canada, 2001), whereas dating violence is described as “abuse or mistreatment

that occurs between . . . individuals who are having — or may be moving toward — an intimate relation-

ship” (Department of Justice Canada, 2003). In contrast, the United States Department of Justice broadly

denes domestic violence as “a pattern of abusive behavior in any relationship that is used by one partner

to gain or maintain power and control over another intimate partner” (US Department of Justice, n.d.).

e World Health Organization instead uses the term “intimate partner violence,” limiting the included

Sarah L. Desmarais and Donald Dutton

acts to behaviours occurring “within an intimate relationship that causes physical, psychological or sex-

ual harm to those in the relationship” (Krug et al., 2002, p. 89).

In this chapter, we dene domestic violence to include physical assault and homicide, as well as

psychological abuse and stalking, but focus on those behaviours which are arguably most likely to result

in the intersection of clinical and legal practice, namely assault and homicide. Stalking, found in the ma-

jority of violent intimate relationships (Melton, 2007), is reviewed in more detail in Chapter 25: Stalking

and Criminal Harassment.

B. Prevalence

Prevalence estimates vary considerably depending on the research methodologies and operational def-

initions, which may contribute to a distortion in perceptions and inconsistency in reports of the preva-

lence of chronic, severe domestic violence (Dutton & Nicholls, 2005). For instance, reviewing forty-eight

population-based studies, the World Health Organization (Krug et al., 2002) found lifetime prevalence

of domestic violence victimization reported by 10 to 69 percent of women across surveys. Generally,

crime surveys yield the lowest estimates, in contrast with “conict studies” which elicit the highest rates

of reporting. To clarify, crime surveys typically survey domestic violence prevalence within the context

of criminal victi mization. Because many victims do not label their experiences as a crime, or even abuse,

reported victimization rates are inhibited (Straus, 1999). For example, according to the General Social

Survey, approximately 4 percent of Canadian women and men are physically assaulted by their partners

each year (Laroche, 2005). e National Crime Victimization Survey in the United States yields similar

rates, reporting that less than 1 percent of men and about 5 percent of women are physically assaulted or

raped by an intimate partner (Rennison, 2003). In contrast, surveys framing domestic violence in terms

of interpersonal conict, rather than criminal victimization, result in signicantly dierent numbers.

Based on information provided by nearly 3,000 women in the 1985 National Family Violence Survey,

Straus (1989) found annual perpetration rates (by women and men) to be about 12 percent for any kind

of violence (including pushing or slapping) and 3 percent for “severe violence” (punching, kicking, or

worse).

C. Impact

Domestic violence, including both physical and psychological abuse, is associated with immediate and

continued negative health outcomes for victims, even aer the abuse has ceased (Campbell, 2002). In

addition to physical injury, repeated physical assaults can increase the risk for chronic diseases (e.g.,

chronic pain), as well as neurological (e.g., fainting), cardiopulmonary (e.g., hypertension), and gastro-

intestinal symptoms (e.g., loss of appetite) (Coker et al., 2002). Further, victimization is associated with

adverse reproductive health outcomes among women: increased prevalence of sexual risk taking, sex-

ual dysfunction, sexually transmitted infection, odds of spontaneous abortion, hemorrhage, poor fetal

growth, and preterm labour and delivery (Janssen et al., 2003).

Domestic violence also can result in signicant psychological injury for both men and women.

Compared to the general population, victims of domestic violence are more likely to meet diagnostic

criteria for major psychiatric disorders, including depression and post-traumatic stress disorder (Coker

et al., 2002), and victimization is a known signicant risk factor for self-harming and suicidal behav-

iour (Campbell, 2002). Psychological distress also may indirectly exacerbate acute and chronic physical

health conditions and lead to risk-taking behaviours, including substance abuse. As a result of domestic

violence, victims oen may experience employment and nancial problems as well; for example, they