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Women’s narratives on the psychological impact of domestic violence

Dr June Keeling,

Senior Lecturer, Faculty of Health and Social Care,

University of Chester.

Email: j.keeling@chester.ac.uk

Abstract

This is a qualitative study involving fifteen women who had experienced domestic violence. The participants were resident or supported by women’s refuges within the United Kingdom, and consented to a narrative interview. Following verbatim transcription, the process of thematic analysis assisted in the development of themes. Findings from the general literature are considered. This paper focuses on the psychological effects of such violence centring around three discrete yet interlinking themes: feeling afraid, suicidal feelings, and a self-dislike.

Introduction

Violence against women is increasing on a global scale, identified by the World Health Organisation as a problem of pandemic proportions (World Health Organization, 2011). Globally, approximately one in three women have been physically assaulted, abused or coerced into sex at some stage in their life, by a known perpetrator in the majority of incidents (United Nations Human Rights, 2011). The World Health Organization (2009) identifies higher prevalence rates of family violence within societies that embrace traditional gender norms, those that ensure a lack of autonomy for women and where there are restrictive laws on divorce, suggesting that this form of violence emerges from a male dominated domain. Within developing and industrialised countries, women experience a divergence in both their experiences of, and responses to domestic violence (Ceballo, Ramirez, Castillo, Caballero, & Lozoff, 2004). The accountability for these discrepancies may lie within their specific ethnic groups (Goodwin, Gazmararian, Johnson, Gilbert, & Saltzman, 2000); commissioning of services (Goulding & Duggal, 2011) and lack of inter-agency coordination (Keeling & Wormer, 2011).
In the USA, it has been estimated that 9.8% of women have experienced abuse within the previous two years (Walton-Moss, Manganello, Frye, & Campbell, 2005). However in the UK, the British Crime Survey of 2009-2010 identified 29% of women experienced some form of domestic violence during their lifetime (Hall, 2011), whilst Feder et al (2009) identified rates of between 13 to 31%. The effects of domestic violence also have significant cost implications, in excess of £1.2 billion (Walby (2004).

Effects of domestic violence

The negative effects of the domestic violence on the biopsychosocial aspects of a woman’s life (O'Campo et al., 2006; Stanko, Crisp, Hale, & Lucraft, 1997) have been illuminated in much of the literature and include physical, sexual, emotional and economic abuse (Walby, 2004). Women may experience some of these forms of domestic violence, or all of them, dependent upon their relationship. It is widely recognised that the effects of these forms of abuse pervade all aspects of daily living (Dienemann et al., 2000). The effects of domestic violence and the longevity of its effects are detrimental to the health and wellbeing of the survivor (Department of Health, 2005).

The physical impact of domestic violence may result in serious physical harm, injuries or even death. There are a multitude of physical symptoms that suggest that the woman is being abused and many injuries that necessitate medical treatment. These include burns which may lead to permanent disfigurement, bites, wounds inflicted by an implement such as a knife, fractures of the jaw and other bones, and joint and internal injuries (Stanko et al., 1997). Furthermore, in societies where access to firearms is widespread it is not surprising that these weapons are often used by the perpetrator of domestic violence, and that these communities have higher rates of murder (Bailey et al., 1997)

There is some evidence of male coercive control regulating women’s fertility and pregnancy (Campbell, Woods, Choauf, & Parker, 2000; Moore, Frohwirth, & Miller, 2010), and has also been identified as being closely aligned with women attending a pregnancy counselling clinic (Keeling, Birch, & Green, 2004) . However, this coercion extends beyond the boundaries of controlling a woman’s gestational occurrences. It permeates through all aspects of her sexuality and may result in sexual abuse and violence, enforced prostitution and rape (Watts & Zimmerman, 2002).

Mental health sequalae to domestic violence include anxiety, depression and post traumatic stress disorder (Bonami et al., 2006), often presenting with co-morbidities such as self-harm, and drug and alcohol misuse (Kaysen et al., 2007; Mrazek & Haggerty, 1994). Additionally, women may experience low self-esteem, anxiety and depression, passivity and learned helplessness (Stewart & Cucutti, 1993), as well as post traumatic stress disorder and suicidal feelings (British Medical Association, 1998). The significant annual costs associated with treating mental disorders due to domestic violence has been estimated at £176 million (Walby, 2004).

Psychological abuse within the context of domestic violence is perhaps one of the most difficult areas to both prove and prosecute due to a lack of a common definition. The emphasis appears to be on recognition of behaviours that constitute this type of abuse, clearly defined by the Duluth Model (Pence & Paymar, 1993). This paper contributes to the body of knowledge of the effects of psychological abuse in the context of domestic violence.

Research Aim

The aim of this study was to gain a deeper understanding of the psychological impact of domestic violence and how this affects a woman’s perceptions towards herself.

Method

The study was initially discussed with the managers of two refuges at different locations within the United Kingdom. Due to the experiences of subordination and coercion by an abusive and controlling partner in the context of domestic violence, the autonomy of the woman remained of concern. Therefore, any woman who chose to participate self-referred to the manager who then contacted the primary researcher, ensuring an autonomous choice in participation.

A qualitative approach using a single narrative interview was chosen for this study. With no preset questions, this approach enabled the woman herself to decide on what to disclose and when to terminate the interview with the locus of control remaining with the woman. Supported by Riessman (1993), this approach is relevant for exploring difficult life transitions, gender inequalities and other practices of power.

Ethical issues

The World Health Organisation (1999) considerations when researching violence against women were implicit in the research study development, focusing on autonomy, confidentiality and anonymity. Verbal consent to participate and audio record their stories were obtained prior to participation. Ethical approval was granted by the author’s academic institution. No compensation was offered for participation and the study was independent of the refuge. Anonymity was assured with women choosing their own pseudonym.

Participants

A total of fifteen women aged between twenty one and fifty four participated in the study, all of whom had lived with domestic violence perpetrated by a male partner. Twelve of the women had left their violent relationship in the preceding twelve months; whist three had left longer than twelve months before. All of the women had children by the violent partner, or a previous partner. The duration of this violence lasted between twelve months and thirty six years. Based on women being classified into socio-economic groups based on either their current or previous jobs, all were from a lower socio-economic group.

Data Collection

Using a narrative approach to interviewing, all participants were interviewed once, with the audio-recorded interviews lasting up to one and a half hours. All interviews were conducted within a women’s refuge which offered twenty four hour security.

Data Analysis

Following verbatim transcription, Braun and Clarke’s (2006) six phases to thematic analysis was used to analyse the transcripts. After immersion within the data by reading and re-reading the transcripts, initial codes were generated. From these initial codes, themes were developed in a continuous and iterative process. The use of a thematic map enhanced the clarity of the developing themes, which were themselves checked for relevance to the coded data and entire data set by the principle investigator and a supervisory team. Through the iterative process of analysis, the themes emerged from the data itself, each theme remained strongly linked with the data itself (Patton, 2002)

Findings

The findings presented are main themes that emerged from the data. The headings within the findings sections represents three discrete yet interlinking themes; feeling afraid, feeling suicidal, and how these manifest as a dislike of the self.

Feeling afraid

The threats directed against the women and their children were significant episodes in the women’s lives, creating an environment of intense fear and acting as an inhibitory factor to disclosure. The psychological abuse of threats, ‘mind games’ and the use of children within these threats had clear negative effects on the women’s decision making capabilities and lifestyles. Furthermore, the erosion of self-esteem and the removal of socialisation are implicit in the lack of contacts to share experiences, leading to further social isolation of the women. The resultant effect ensured that the perpetrator was the primary, possibly only, source of support for the woman, leaving her dependent upon him. These excerpts are clear, vivid stories of how each perpetrator used social power to ensure his partner remained subjugated:

He had threats that he would kill me; kill the children, erm, he would tell people that I’d been sleeping with people, erm, threats like towards my family.
He has said he is going to kill himself if I don't get back with him. He has threatened to kill me and the kids if I didn’t get back with him and just loads.

We were walking and got bundled in the car and took straight home and that's like why this time he's [ex-partner] saying he's saying he’s getting the big boys in you know ‘they will find you and this is the last time and they will do the job proper’.

He told me if I didn't make a statement against the kid’s dad saying that it was him that done all the bruises he would beat the hell out of my kids and I would be watching, and he would get a knife from the side and he said he would slash me to pieces. So I had to do a statement against the kid’s dad.

They [threats] are quite scary because he is capable of anything really so I couldn't say if he would or if he wouldn't do it. He threatened me with a knife when I had hold of my daughter. I think she was only two. He held a knife to my throat.

I was always scared of him and I used to say to him I'm scared of you. He’d be working during the day and I would be off somewhere and if I didn't get a text I would be thinking there was something wrong. It's all going to happen when I go home. If we used to go out, because we worked in a working man's club we used to get home and the older ones were there they would whisper and say quick let's go upstairs because if he started I didn't want them to see it all. I would say ‘can you go upstairs to make sure the others aren't awake, keep them quiet’.

The women were familiar with their male partner’s behaviour, being able to recognise subtle changes that may be indicative of an impending attack. The last excerpt revealed the woman’s emotional acumen, the anticipation or premonition of an assault became clear due to her partners’ behaviour. She revealed an intuitive knowing of an impending attack by her partner. The other women’s excerpts revealed threats, a psychological intimidatory technique used by the partner to continue subjugation. Jeremy Bentham’s panopticon prison produces parallels to these women’s behaviours: self-regulation as an act of compliance to the coercive control they are experiencing. As in the panopticon prison the ongoing exercise of coercive control required only the creation of a belief that the threatened consequence would be delivered, not its actual delivery. This self-regulation was due to the women’s belief that they are being watched by their perpetrator.

Suicidal feelings

Many of the women expressed suicidal feelings as a result of the experiences of domestic violence.

I wasn’t worth being on this planet, I shouldn’t be here, and no one would notice if I was gone anyway... I have tried overdose myself with tablets, I have tried slitting my wrists, tried hanging myself and nothing has ever worked.
I don’t want to be here. I mean I have attempted suicide a few times and (pause) it has just ruined my life really.
The suicidal thoughts are the worst…If I am sitting in the house and something comes into my head, or something comes up on telly that reminds you of something that has happened to you, it just makes you start thinking then (pause).

Dislike of self

A psychological revulsion to the women’s own bodies was a direct consequence of the physical abuse and associated scarring. The longevity of the psychological effects of these injuries affected the way the women perceived themselves, with an evident dislike towards specific parts of their body that had been targeted by the perpetrator.

I wouldn’t show my legs and I wouldn’t show a bit of my body… I'm all horrible with all the scars on me basically from the violent relationship.
I hate myself. I hate my body... I have scars on me and my legs have permanent bruises…I hate my body.
I hate it [body]. I hate everything about me. I think it is probably the way he has made me feel… I feel disgusting. I think you know how much you have washed, they are still there. You want a new body to get rid of them… and the fact of being a perfect size that he [partner] wanted me to be, I don’t like my waist, I don’t like my chest. I don’t like nothing about me

The women spoke about a negative perception of their own bodies, relating to specific incidences of domestic violence, of injuries that had resulted in scarring, a zonal body dysmorphia relating to the site of the physical violence perpetrated by their male partner. They also spoke of a more generalised dislike for themselves physically, and the need to cover up with clothing.

To explain this phenomenon, in the context of a violent relationship, Weaver argues that a woman’s appearance may be altered due to scarring and injury following domestic violence, and this may result in an appearance-related residual injury (Weaver, Resnick, Kokoska, & Etzel, 2007).

Discussion

Domestic violence incorporates a range of behaviours that constitutes abuse and violence including psychological abuse. Additionally the use of control and coercion limits the autonomy and undermines self-confidence of a survivor of this abuse (Harne & Radford, 2008). Physical violence has been acknowledged as a component of domestic violence (Krug 2002), and been the focus of contemporary literature (Bacchus, Mezey, & Bewley, 2004; Beck, Freitag, & Singer, 1996). The women in this study spoke of their experiences of the psychological impact of living with an abusive partner and experienced domestic abuse. Their suicidal feelings appeared to be associated with low morale. Additionally, the resultant effects of domestic violence appeared to have impacted on a psychological revulsion to a part or parts of the women’s body, a negative perception of their body with revulsion to specific parts of it. The women talk of their perceptions of their body following injuries sustained from the physical violence revealing an appearance related dislike to the areas targeted and scarred. These findings may be considered as significant markers of the resultant effects of physical assault associated with a violent relationship.

Limitations
The main limitation with this study is the small sample size. However despite this study’s limitations in generalizability, the women’s narratives do offer a useful insight into the psychological effects of domestic violence and how this then negatively affected their perception of their physical self.

Conclusion

Psychological abuse within the context of domestic violence is perhaps one of the most difficult areas to both prove and prosecute due to a lack of a common definition. O’Leary (1999) argues that amongst policy makers and researchers, there is an implicit assumption that the sequalae to physical abuse overrides the experiences of psychological abuse. However, Mullender’s (1996) work highlights the nature of psychological abuse, and further, that it is often accompanied by physical and sexual violence which reinforces the perpetrator’s control over the woman.

Acknowledgments

The author wishes to gratefully acknowledge the contribution by the women who participated in the study.

References

Bacchus, L, Mezey, G, & Bewley, S. (2004). Domestic violence: prevalence in pregnant women and associations with physical and psychological health. European Journal of Obstetrics and Gynaecology and Reproductive Biology, 113(1), 6-11.
Bailey, J E, Kellermann, A L, Somes, G W, Banton, J G, Rivara, F P, & Rushforth, N P. (1997). Risk Factors for Violence Death of Women in the Home. Archives of Internal Medicine 157(7), 777-782.
Beck, S R, Freitag, S K, & Singer, N. (1996). Ocular injuries in battered women. Ophthalmology, 103(7), 148-151.
Bonami, A E, Thompson, R S, Anderson, M, Reid, R J, Carrell, D, Dimer, J, & Rivara, F. (2006). Intimate partner violence and women’s physical, mental and social functioning. American Journal of Preventative Medicine, 30(6), 485-466. doi: 10.1016/j.amepre.2006.01.015
Braun, V, & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.
British Medical Association. (1998). Domestic Violence: a health care issue? London: British Medical Association.
Campbell, J C, Woods, B A, Choauf, K L, & Parker, B. (2000). Reproductive health consequences of intimate partner violence: A nursing research review. Clinical Nursing Research, 9(3), 217-237. doi: 10.1177/10547730022158555
Ceballo, R, Ramirez, C, Castillo, M, Caballero, G A, & Lozoff, B. (2004). Domestic Violence and Women's Mental Health in Chile. Psychol of Women Quarterly, 28(4), 298-308. doi: .1111/j.1471- 6402.2004.00147.x
Department of Health. (2005). Responding to domestic abuse: a handbook for health professionals. Retrieved 31st March, 2011, from http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4126619.pdf

Dienemann, J, Boyle, E, Baker, D, Resnick, W, Wiederhorn, N, & Campbell, J. (2000). Intimate partner abuse among women diagnosed with depression. Issues in Mental Health Nursing, 21(5), 499-513. doi: 10.1080/01612840050044258
Goodwin, M M, Gazmararian, J A, Johnson, C H, Gilbert, B C, & Saltzman, L E. (2000). Pregnancy intendedness and physical abuse around the time of pregnancy: findings from the pregnancy risk assessment monitoring system, 1996-1997, PRAMS Working Group. Pregnancy Risk Assessment Monitoring System. Maternity and Child Health Journal, 14, 85-92.
Goulding, N, & Duggal, A. (2011). Commisioning Services for Women and Children who experience violence or abuse-a guide for health commissioners. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_125900

Hall, P. (2011). Intimate violence: 2009/10 BCS. In K. Smith (Ed.), Homicides, Firearm Offences and Intimate Violence 2009/10. Supplementary Volume 2 to Crime in England and Wales 2009/10 (Vol. 2, pp. 71). London: Home Office.
Harne, L, & Radford, J. (2008). Tackling domestic violence-theories, policies and practice. Suffolk: McGraw Hill.
Kaysen, D, Dillworth, T M, Simpson, T, Waldrop, A, Larimer, M E, & Resick, P A. (2007). Domestic Violence and Alcohol Use: Trauma-Related Symptoms and Motives for Drinking. Addictive Behaviors, 32(6), 1272-1283. doi: 10.1016/j.addbeh.2006.09.007
Keeling, J, Birch, L, & Green, P. (2004). Pregnancy Counselling Clinic; a questionnaire survey of intimate partner abuse. Journal of Family Planning and Reproductive Health Care 30(3), 165-168. doi: 10.1783/147118904322995500
Keeling, J, & Wormer, K van. (2011). Social Worker Interventions in Situations of Domestic Violence: What we can learn from Survivors’ Personal Narratives. British Journal of Social Work, 41, 1-17. doi: 10.1093/BJSW/BCR137
Moore, A M, Frohwirth, L, & Miller, E. (2010). Male reproductive control of women who have experienced intimate partner violence in the United States. Social Science and Medicine, 70(11), 1737-1744. doi: 10.1016/j.socscimed.2010.02.009
Mrazek, P J, & Haggerty, R J. (1994). Prevention of Physical Illness. In P. J. Mrazek & R. J. Haggerty (Eds.), (pp. 50). Washington DC: National Academy Press.
Mullender, A. (1996). Rethinking Domestic Violence: The social worker and probation response. London: Routledge.
O'Campo, P, Kub, J, Woods, A, Garza, M, Snow-Jones, A, Gielen, A, . . . Campbell, J. (2006). Depression, PTSD and Co-morbidity Related to Intimate Partner Violence in Civilian and Military Women. Brief Treatment and Crises Intervention, 6, 2. doi: 10.1093/brief-treatment/mhj010
O'Leary, K D. (1999). Psychological Abuse: A Varibale Desreving Critical Attention In Domestic Violence. Violence and Victims, 14(1), 3-23.
Patton, M. (2002). Qualitative evaluation and research methods. Thousand Oaks, Ca: Sage Publications Ltd.
Pence, E, & Paymar, M. (1993). Education groups for men who batter. New York: Springer.
Stanko, E, Crisp, D, Hale, C, & Lucraft, H. (1997). Counting the costs: Estimating the impact of domestic violence in the London Borough of Hackney. In B. M. Association (Ed.), Domestic violence: a health care issue? London: British medical Assciation.
Stewart, D, & Cucutti, A. (1993). Physical abuse in pregnancy. Canadian Medical Association Journal, 149, 1257-1263.
United Nations Human Rights. (2011). Reports on the Special Rapporteur on violence against women, its causes and consequences. General Assembly. http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G11/130/22/PDF/G1113022.pdf?OpenElement
Walby, S. (2004). The cost of domestic violence. In G. a. E. Office (Ed.). London: Women and Equality Unit.
Walton-Moss, B J, Manganello, J, Frye, V, & Campbell, J C. (2005). Risk factors for intimate partner violence and associated injury among urban women. Journal of Community Health, 30, 377-389.
Watts, C, & Zimmerman, C. (2002). Violence against women: global scope and magnitude. The Lancet, 359(9313), 1232-1237.
Weaver, T L, Resnick, H S, Kokoska, M S, & Etzel, J C. (2007). Appearance-Related Residual Injury, Posttraumatic Stress, and Body Image: Associations Within a Sample of Female Victims of Intimate Partner Violence. Journal of Traumatic Stress, 20(6), 999-1008.
World Health Organisation. (2009). Violence against women Fact sheet N°239. Geneva: World Health Organisation.
World Health Organization. (2011). International Day for the Elimination of Violence against Women.

First publsihed August 2014

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