Chapter 81: Violence in the Family as a Public Health Concern

INTRODUCTION

Although the family can and often is a source of strength and support for many people, it can also be a source of victimization. Violence in family settings in the United States is believed to affect a large proportion of the population, although not all of this is severe violence. The Centers for Disease Control and Prevention (CDC) estimates that about 1.5 million women and more than 800,000 men are raped or physically assaulted by an intimate partner each year (http://www.cdc.gov/ncipc/factsheets/ipvfacts.htm).¹ Such violence can be fatal. More than 10% of homicide victims are killed by an intimate partner.² Other CDC data³ indicate that nearly 1 million children were confirmed by child protective agencies as victims of child abuse in 2002. This included neglect, physical abuse, sexual abuse, and emotional and psychological abuse.

In this article, several different types of family violence are discussed, including couple violence, child abuse, sibling violence, and elder abuse. As will be seen, the more extreme forms of these forms of family violence are often found together in the same family. In the following sections, we first present data on what is known about family violence and then discuss strategies for how we might intervene or prevent forms of abuse.

COUPLE VIOLENCE

Violence in couples is called intimate partner violence (IPV) by researchers today. Such violence can exist at various levels from extreme violence with serious injury, to relatively low-level forms of violence. In accord with the CDC definition, IPV can entail physical violence, sexual violence, threats of physical/sexual violence, and psychological or emotional abuse.⁴ The major public health concern is the most extreme and serious form of couple violence, now labeled as “intimate terrorism” by researchers.^5,6 This is the type of situation that most people would associate with the battered woman. In the most typical pattern of such violence, a husband or male partner has become extremely violent toward his wife or female partner, using physical violence as well as psychological abuse or belittling of his partner.⁷ Such violence has become routine, and the woman lives in constant fear that something she might do will initiate another round of such violence. The female victim develops low self-esteem, after hearing so often that she deserves the violence she receives. She may fight back, but typically her resistance is ineffective in stopping the violence, and she often receives a more severe beating when she does try to respond with her own violence. She may seek help from the police or escape from a particularly violent incident and go to a shelter for battered women, but this typically does not stop the violence.

Such violence and the high levels of stress generated in the battered woman result in a weakened immune system for her. Her injuries mean that she has a heightened risk of hospital visits ...