Women who are victims of intimate-partner violence have been identified by the mental health field for more than 30 years now.1-3 It is understood that domestic violence is part of gender violence, and that many more women than men are the victims of physical, sexual, and psychological abuse.4-6 Even when women strike back or engage in mutual violence, it is usually the woman who is most likely to be hurt—both physically and emotionally. Women who strike back in self-defense are often arrested along with the batterer.
It is further understood that gender violence is fostered by the socialization of men to be more powerful than women. In some men, this process creates the need to abuse power and to control women.5 While the term “victim” is not always considered politically correct, in fact, until battered women take back some control over their lives, they may not truly be considered survivors.7 Psychological symptoms, called battered woman syndrome (BWS), develop in some women and make it difficult for them to regain control. Mental health professionals have been able to assist these battered women with empowerment techniques and with accurate diagnosis and proper treatment, as described here.
BATTERED WOMAN SYNDROME
BWS has been identified as a subcategory of posttraumatic stress disorder (PTSD).8 Although not all battered women meet all the DSM-IV-TR criteria for PTSD,9 a sufficient number do; thus, a form of trauma treatment is most helpful.10
Table 1 lists 6 groups of criteria that recently have been found to be part of BWS.8
Begin by speaking with the woman without her partner present (if they are still together) and together form a safety plan. This can be difficult because batterers often want to be present during the entire examination so they can directly or even subtly remind the woman not to disclose their secret. It is not uncommon to feel as if the man were in the interview—even if he is waiting outside.
For a woman in a battering relationship, the most dangerous time is when she and her partner are discussing or thinking about separation.11,12 Even if the woman is no longer living with the batterer, she may not be safe. It is important to help her feel safer by making it clear that you will not take advantage of her. The clinician can set up boundaries between himself or herself and the woman by asking her permission to touch her, to write notes, and to discuss areas of confidentiality and privilege. Individual or group therapy rather than couples therapy is recommended, at least initially.
A battered woman needs to feel validated when she describes the abuse. This can be done by emphasizing the positive things she did to protect herself and her children if they were involved. Tell her that no matter what she may have done or said, no one deserves to be abused. Be careful not to ask or even intimate that she might have done something to provoke the batterer. Such questions will not create the rapport that facilitates empowerment—nor do they create a safe space for the woman.
Most battered women have been told of their faults over and over by the batterer. They also have experienced his jealousy, overpossessiveness, and attempts to isolate them from significant friends or family. They may need education about the impact of abuse on their physical as well as mental health.13
Therapy should emphasize the woman’s strengths so that she trusts herself and others again. Naming her a battered woman with BWS may help her accept that she is not “crazy” (as the batterer predicted her doctor would find).
Risk and assessment
It is important to do a risk assessment while also completing a mental status examination. Some battered women have other disorders in addition to PTSD and BWS.7,8,13
1. Bureau of Justice Statistics Selected Findings. Violence Between Intimates (NCJ-149259). Washington, DC: US Department of Justice; November 1994.
2. Brown LS. Subversive Dialogues: Theory in Feminist Therapy. New York: Basic Books; 1994.
3. Walker LE. The Battered Woman. New York: Harper & Row; 1979.
4. American Psychological Association Presidential Task Force on Violence and the Family. Violence and the Family. Washington, DC: American Psychological Association; 1996.
5. Goodman LA, Koss MP, Fitzgerald LF, et al. Male violence against women. Current research and future directions. Am Psychol. 1993;48:1054-1058.
6. Centers for Disease Control and Prevention. Costs of intimate partner violence against women in the US.Washington, DC: US Department of Health and Human Services; 2003. http://www.cdc.gov/ncipc/pub-res/ipv_cost/ipv.htm. Accessed May 19, 2009.
7. American Psychological Association. Final Report of APA Working Group on Investigation of Memories of Childhood Abuse. Washington, DC: American Psychological Association; 1996.
8. Walker LE. The Battered Woman Syndrome.3rd ed. New York: Springer Publishing Company; 2009.
9. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.
10. Briere JN, Scott C. Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment. Thousand Oaks, CA: Sage Publications, Inc; 2007.
11.Centers for Disease Control and Prevention. Behavioral risk factor surveillance system 2005 report; 2006. http://ftp.cdc.gov/pub/data/brfss/2005summarydataqualityreport.pdf. Accessed May 19, 2009.
12.Campbell JC, Webster D, Koziol-McLain J, et al. Risk factors for femicide in abusive relationships: results from a multisite case control study. Am J Public Health. 2003;93:1089-1097.
13. Centers for Disease Control and Prevention. Adverse health conditions and health risk behaviors associated with intimate partner violence—United States, 2005 [published correction appears in MMWR. 2008;57:237]. MMWR. 2008;57:113-117.
14. Charney DS, Deutch AY, Krystal JH, et al. Psychobiologic mechanisms of posttraumatic stress disorder. Arch Gen Psychiatry. 1993;50:295-305.
15. Babcock JC, Green CE, Robie C. Does batterers’ treatment work? A meta-analytic review of domestic violence treatment. Clin Psychol Rev.2004;23:1023-1053.
16. Walker LE. Abused Women and Survivor Therapy: A Practical Guide for the Psychotherapist. Washington, DC: American Psychological Association; 1994.
17. Browne A. Violence against women by male partners. Prevalence, outcomes, and policy implications. Am Psychol. 1993;48:1077-1087.
18. Walker LE. Feminist Therapy: Psychotherapy With the Experts Series.Needham Heights, MA: Allyn &Bacon; 1998.
19. Walker LE. The Abused Woman: A Survivor Therapy Approach. Assessment and Treatment of Psychological Disorders Video Series. http://www.psychotherapy.net/video/Abused_Woman. Accessed July 1, 2009.
20. Bancroft L, Silverman JG. The Batterer as a Parent: Addressing the Impact of Domestic Violence on Family Dynamics. Thousand Oaks, CA: Sage Publications, Inc; 2002.
21. Edleson JL. The overlap between child maltreatment and woman battering. Violence Against Women. 1999;5:134-154.
22. Clements CM, Sabourin CM, Spiby L. Dysphoria and hopelessness following battering: the role of perceived control, coping, and self-esteem. J Family Violence. 2004;19:25-36.
23. Bureau of Justice Statistics Special Report. Murder in Families (NCJ-143498). Washington, DC: US Department of Justice; 1994.
24. Bureau of Justice Statistics. Family Violence Statistics: Including Statistics on Strangers and Acquaintances. US Department of Justice. http://www.ojp.usdoj.gov/bjs/abstract/fvs.htm. Accessed May 19, 2009.
For More Information
• American Psychological Association Ad Hoc Committee on Legal and Ethical Issues in the Treatment of Interpersonal Violence. Potential Problems for Psychologists Working With the Area of Interpersonal Violence. Washington, DC: American Psychological Association; 1997.
• US Department of Justice. Violence Against Women Act (VAWA). 2005. http://www.ovw.usdoj.gov/regulations.htm.