Intimate partner violence (IPV) occurs at an alarmingly high rate. According to the most recent survey of US adults, almost 7 million women and 5.5 million men experience physical violence, stalking, or rape by an intimate partner each year.1 Psychological/emotional abuse, including threats of violence and a wide range of intimidating, denigrating, humiliating, and controlling behaviors, is also highly prevalent. Common physical health sequelae from IPV include contusions, soft tissue injuries, sprains, strains, fractures, maxillofacial injuries, and traumatic brain injuries.2 In addition, the prevalence of PTSD; depression; and anxiety, mood, and substance use disorders is elevated in victims of IPV.3,4
Table 1 provides a summary of salient points regarding IPV. Although the rates of physical IPV are roughly similar for men and women, the rates of physical injury and death are higher for women, and men are most frequently referred for treatment as perpetrators of IPV.5,6 “Common couple violence,” which is typically bidirectional, non-injurious, and an outgrowth of poor conflict resolution, is distinguished from “intimate terrorism,” which is often unilateral, injurious, intensely controlling, and more gender-based in nature.7 Nevertheless, the findings on gender similarity and mutuality of violence challenge the common assumption that IPV is solely a male-to-female problem.8,9
Although there is no singular profile of the IPV perpetrator, there are several well-documented risk factors and correlates. A high percentage of court-referred IPV perpetrators have been physically abused and/or witnessed inter-adult abuse in childhood.10,11 A history of conduct disorder in adolescence and antisocial personality traits or disorder have been found to confer risk for IPV, and adolescent and young adult couples with a history of IPV are characterized by a tendency of both partners to possess similar antisocial traits (ie, assortative partnering).12
PTSD is a substantial risk factor for IPV in veteran populations.13 A number of psychiatric disorders have been associated with men committing IPV, including depression, dysthymia, generalized anxiety, alcohol dependence, adult antisocial behavior, and nonaffective psychosis.14 A variety of indicators of negative emotion dysregulation are also associated with IPV, including borderline personality features, disorganized and insecure patterns of attachment, and anger problems.15,16 The incidence of IPV is typically greater than 50% among both men and women who seek treatment for substance use disorders as well as for couples in marriage therapy.17-21 The incidence of head injuries among IPV perpetrators is very high, as is that of subtle neurocognitive impairments that involve impulsivity, poor response inhibition, and deficits in executive functions.22
IPV is not commonly reported as a presenting concern, but it is readily detected through a brief structured interview or questionnaire. In addition to more extensive self-report measures, such as the Revised Conflict Tactics Scale, a number of brief IPV screening instruments have been developed and validated.23,24 Several appear to have good sensitivity for detecting IPV, including the Partner Violence Screen, the Woman Abuse Screening Tool, and the Abuse Assessment Screen.25-27 Although it is important to note that research on medical screening of IPV focuses almost exclusively on victims, clinical experience suggests that individuals seeking treatment for other problems, such as substance abuse, are often quite forthcoming about being abusive.
Psychosocial counseling for IPV perpetrators is widely available, with well over 1000 programs in the US. Most of these programs predominantly serve court-mandated populations and are focused on men who have assaulted women. Although a range of program philosophies and practices exist (Table 2), programs for perpetrators of IPV, often labeled batterer intervention programs (BIPs), tend to advocate an open admissions group modality and can last from 8 to 52 weeks.
There are 2 common types of BIPs. The first assumes a gender-themed root cause of IPV, such that the patriarchal nature of societal and institutional structures reward male domination and justify any means (including physical aggression) that reinforce male power, control, and privilege.28 For example, the widely adopted Duluth Abuse Intervention Project model aims to prevent IPV via largely didactic psychoeducational reprogramming of (male) offenders. This model focuses on exposing patriarchal/misogynistic attitudes, encourages accountability and personal responsibility, and promotes gender-egalitarian behaviors. Although this approach has been criticized because of theoretical inconsistencies and lack of empirical support, most existing intervention programs use some variation of this model.8,29-31
A second BIP model uses cognitive-behavioral therapy (CBT).32,33 This model aims to change behavior through a collaborative therapeutic relationship, exposure and disputation of distorted cognitions, and various problem-solving and mood-regulating techniques.34-38 Couples-based CBT that focuses on enhancing communication and problem-solving skills between partners remains controversial because of concerns about a heightened risk of injury to partners who remain with an abusive individual while simultaneously receiving treatment for potentially volatile relationship conflicts.
Dr Eckhardt is Associate Professor and Director of the Purdue Institute for Relationship Research and Mr Sprunger is an advocate doctoral student in clinical psychology in the department of psychological sciences at Purdue University in West Lafayette, Ind. Dr Murphy is Professor and Chair in the department of psychology at the University of Maryland, Baltimore County. They report no conflicts of interest concerning the subject matter of this article.
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