Article

Women's experiences with battering: A conceptualization from qualitative research

This article is a reprint of a previously published article. For citation purposes, please use the original publication details: Coker AL, Davis KE, Arias I, et al. Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med. 2002;23(4):260–268.

Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men.

The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators.

A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores.

Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.

The construct of coercive control has been central to many conceptualizations of intimate partner violence (IPV), yet there is widespread inconsistency in the literature regarding how this construct is defined and measured. This article provides a comprehensive literature review on coercive control in regards to conceptualizations, definitions, operationalization, and measurement; and attempts to provide a synthesis and recommendations for future research. A summary and critique of measures used to assess coercive control in IPV is provided. At least three facets of coercive control are identified: 1) intentionality or goal orientation in the abuser (versus motivation), 2) a negative perception of the controlling behavior by the victim, and 3) the ability of the abuser to obtain control through the deployment of a credible threat. Measurement challenges and opportunities posed by such a multifaceted definition are discussed.

Discussions on intimate partner violence (IPV) often focus on physical abuse, ignoring psychological and sexual abuse and controlling behaviors. The damage of varied forms of IPV on mental well-being in its broader form have been far less explored, especially among low-income women. Our aim was to improve our understanding of self-perceptions of mental well-being among low-income women who have experienced IPV by considering a broader definition of mental well-being that includes self-esteem and self-identity as core components.

Using qualitative methods, we present findings from in-depth interviews with 41 low-income women currently or recently experiencing abuse and housing instability.

Women experienced varied types of violence (physical, sexual, emotional, psychological, social isolation, and controlling behaviors). Injuries resulting from physical abuse were viewed differently from those arising from emotional and psychological control. Physical injuries healed faster, whereas damage to self-esteem and identity lingered. The journey through and out of IPV is often marked by an initial erosion of sense of self (identity deconstruction) followed by the identity reconstruction through an extended process of change aimed at rebuilding self-esteem, mental well-being, self-efficacy, and ultimately self-identity.

IPV-related training for physicians and allied health professionals should emphasize the varied nature of IPV and its impact on identity, self-esteem, and self-efficacy. Treatment should be holistic to address comorbid needs, including physical injury, mental health, and addiction problems. Consider supportive programs that integrate those living with or leaving IPV with women with past lived experience who can help women to understand the process of change and support this change in a nurturing setting.