I read “Battered Woman Syndrome: Key Elements of a Diagnosis and Treatment Plan” by Lenore Walker, EdD1 and a response to it by Arnold Robbins, MD2 who pointed out some inaccuracies and distortions.

What I did not see was any comment on Dr Walker’s claim that battered woman syndrome (BWS) is a subcategory of PTSD. This should be news to the psychiatric community for 2 reasons.3 First, no DSM even mentions BWS, let alone lists it (or any other stressor) as a subtype. It might be argued that domestic violence is listed as a possible stressor (precipitant) to PTSD, but then so is a car accident. No one would presume to proffer a car accident subtype to PTSD. The symptoms are not trauma- specific. Second, the whole BWS research paradigm is based on convenience samples without appropriate control groups.

Battered women deserve better.

— Michael McGrath, MD Webster, NY

 

Dr Walker Responds
 
It is interesting that both of these commentators focus on the use of the term Battered Woman Syndrome rather than the issue of recognizing and properly intervening with women who have experienced domestic violence and who come to their doctors for help—which was the major point of my article.


My research put a name on a group of signs and symptoms commonly seen by both researchers and clinicians that fill the psychological literature. The term Battered Woman Syndrome was first recognized from a National Institute of Mental Health (NIMH) funded study in which I was principal investigator from 1978-1981. Some continue to question the adequacy of the methodology because there was no experimental and control group. However, statistical advances have made it possible for computerized programs to hold variables constant while manipulating those to be studied so our virtual control groups will suffice statistically. Some of your readers may not realize that every funded study by NIMH (now part of SAMHSA) is carefully critiqued by an interdisciplinary panel of scientists who awarded me the grant and then carefully monitored our progress and actually recommended further funding (which, unfortunately, was not available in 1981 when we were supposed to continue our research). Fortunately, my university had some support for me to continue these investigations. The NIMH documents are available from the Freedom of Information Act for anyone who wishes to review the committee’s deliberations and decisions. Nonetheless, the term Battered Woman Syndrome has appeared in the psychological and medical literature since the early 1980s.
 

Dr McGrath comments that Battered Woman Syndrome cannot be a legitimate category because it is not listed by name in the DSM-IV-TR, which is true. However, it is listed in the World Health Organization’s International Classification of Diseases (ICD-10) as a medical disorder. ICD-10 apparently has decided to break with the DSM-V and produce its own psychiatric nosology for the ICD-11, looking toward psychological research for its scientific basis. I was an official representative of the American Psychological Association to the DSM-III-R and DSM-IV and know first hand the politics that compete with science to produce those nosologies. Interestingly, the DSM-V Task Force has apparently become even less transparent in their deliberations, sacrificing scientific scrutiny perhaps to protect from politics.
 

Publication in that nosology does not make the final decision in the health community about whether a disorder does or does not exist. In fact, Battered Woman Syndrome and its research appeared as early as 1977 in the psychological literature. A complete bibliography can be found in the latest edition of the Battered Woman Syndrome (Third Edition) published by Springer in 2009.
 

Dr Robbins comments that there is no support for the fact that I report that our society trains men to dominate and control women. Again, the psychological and sociological literature is replete with references to empirical studies about the different gender socialization of men and women, girls, and boys. Thirty years of attempts to reach equality in all areas of society still bring women only about $0.80 on the dollar in pay for equal work, and still keep women out of the top echelon in our nation’s corporations. As Hillary Clinton so eloquently stated, we have cracked some of the glass ceilings, but we still keep some women dependent on their husbands for fear of being alone.
 

As the Washington State Supreme Court stated in the Wanrow decision, the long and unfortunate history of sex role socialization has taught men to use parts of their bodies as weapons necessitating women to equalize their need for safety with guns and knives. No one is advocating for women to arm themselves against men, but the truth about domestic violence is that women are far more likely to experience physical injuries than are men. Even those who have attempted to study the impact of domestic violence on men have provided risk assessments that permit health professionals to help protect women from further abuse. 
 

Finally, I’d like to address the comments about children who witness domestic violence. Although there was insufficient space in my article to discuss the damage that is done to these children psychologically, I do devote an entire chapter to the subject in my Battered Woman Syndrome book, and I have just completed a chapter in the soon-to-be-published Oxford University Press book on child abuse and neglect. Dr Robbins omits the fact that mothers are most likely to be found guilty of neglect while fathers are most likely to be the perpetrators of severe physical abuse that causes death of children. Further, the data show that boys are most likely the victims of physical abuse and girls are most likely to be sexually abused. Even more frightening are some statistics that suggest that up to 60% of men who batter women also physically or sexually abuse their children. The strongest risk factor for a boy to use violence in his life is witnessing his father battering his mother. Further, boys who witness their fathers battering their mothers were found to be 700 times more likely than those who were not exposed to domestic violence to batter in their own homes. If those boys were also abused themselves, it raised their risk to 1000 times the norm.
 

If domestic violence was considered a disease, those who spread violence would be quarantined. Let’s all learn how to work together to eradicate domestic violence in our lifetime. We know what to do. Let’s stop arguing over language and who does what to whom and offer the help that these families need from us.

—Lenore E. Walker, EdD, ABPP-Cl & Fam
Board Certified in Clinical and Family Psychology
Professor & Coordinator
Clinical Forensic Psychology Concentration
Nova Southeastern University
Center for Psychological Studies
Fort Lauderdale, Florida