Intimate Partner Violence: Consequences

Cost to Society

• Costs of intimate partner violence (IPV) against women alone in 1995 exceeded an estimated $5.8 billion. These costs included nearly $4.1 billion in the direct costs of medical and mental health care and nearly $1.8 billion in the indirect costs of lost productivity (CDC 2003). This is generally considered an underestimate because the costs associated with the criminal justice system were not included.
• When updated to 2003 dollars, IPV costs exceeded $8.3 billion, which included $460 million for rape, $6.2 billion for physical assault, $461 million for stalking, and $1.2 billion in the value of lost lives (Max et al. 2004).
• The increased annual health care costs for victims of IPV can persist as much as 15 years after the cessation of abuse (Rivara et al., 2007).
• Victims of severe IPV lose nearly 8 million days of paid work-the equivalent of more than 32,000 full-time jobs-and almost 5.6 million days of household productivity each year (CDC 2003).
• Women who experience severe aggression by men (e.g., not being allowed to go to work or school, or having their lives or their children's lives threatened) are more likely to have been unemployed in the past, have health problems, and be receiving public assistance (Lloyd and Taluc 1999).

Consequences

Approximately, 29% of women and 10% of men in the U.S. have experienced rape, physical violence, and/or stalking by an intimate partner and reported at least one measured impact related to these or other forms of violence in that relationship (Black et al., 2011). In general, victims of repeated violence over time experience more serious consequences than victims of one-time incidents (Johnson and Leone, 2005). The following list describes some, but not all, of the consequences of IPV.

Physical

1 in 4 women (24.3%) and 1 in 7 men (13.8%) aged 18 and older in the United States have been the victim of severe physical violence by an intimate partner in their lifetime (Black et al., 2011). Nearly, 15% of women (14.8%) and 4% of men have been injured as a result of IPV that included rape, physical violence, and/or stalking by an intimate partner in their lifetime (Black et al., 2011). In 2010, 241 males and 1095 females were murdered by an intimate partner (U.S. Department of Justice, FBI, 2011).

Apart from deaths and injuries, physical violence by an intimate partner is associated with a number of adverse health outcomes (Black, 2011; Breiding, Black, and Ryan, 2008). Several health conditions associated with intimate partner violence may be a direct result of the physical violence (for example, bruises, knife wounds, broken bones, traumatic brain injury, back or pelvic pain, headaches). Other conditions are the result of the impact of intimate partner violence on the cardiovascular, gastrointestinal, endocrine and immune systems through chronic stress or other mechanisms (Black, 2011; Crofford, 2007; Leserman and Drossman, 2007).

Examples of health conditions associated with IPV include:

• Asthma
• Bladder/kidney infections
• Circulatory conditions
• Cardiovascular disease
• Fibromyalgia
• Irritable bowel syndrome
• Chronic pain syndromes
• Central nervous system disorders
• Gastrointestinal disorders
• Joint disease
• Migraines/headaches

Children may become injured during IPV incidents between their parents. A large overlap exists between IPV and child maltreatment (Appel and Holden 1998).

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Reproductive

• Gynecological disorders
• Pelvic inflammatory disease
• Sexual dysfunction
• Sexually transmitted infections, including HIV/AIDS
• Delayed prenatal care
• Preterm delivery
• Pregnancy difficulties like low birth weight babies and perinatal deaths
• Unintended pregnancy

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Psychological

Physical violence is typically accompanied by emotional or psychological abuse (Tjaden and Thoennes 2000). IPV–whether sexual, physical, or psychological–can lead to various psychological consequences for victims (Black, 2011; Coker et al. 2002; Heise and Garcia-Moreno 2002; Roberts, Klein, and Fisher 2003; Warshaw et al., 2009):

• Anxiety
• Depression
• Symptoms of post-traumatic stress disorder (PTSD)
• Antisocial behavior
• Suicidal behavior in females
• Low self-esteem
• Inability to trust others, especially in intimate relationships
• Fear of intimacy
• Emotional detachment
• Sleep disturbances
• Flashbacks
• Replaying assault in the mind

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Social

Victims of IPV sometimes face the following social consequences (Heise and Garcia-Moreno 2002; Plichta 2004; Warshaw et al., 2009):

• Restricted access to services
• Strained relationships with health providers and employers
• Isolation from social networks
• Homelessness

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Health Behaviors

Women with a history of IPV are more likely to display behaviors that present further health risks (e.g., substance abuse, alcoholism, suicide attempts) than women without a history of IPV.

IPV is associated with a variety of negative health behaviors (Heise and Garcia-Moreno 2002; Plichta 2004; Roberts, Auinger, and Klein 2005; Silverman et al. 2001). Studies show that the more severe the violence, the stronger its relationship to negative health behaviors by victims.

• Engaging in high-risk sexual behavior
• Unprotected sex
• Decreased condom use
• Early sexual initiation
• Choosing unhealthy sexual partners
• Multiple sex partners
• Trading sex for food, money, or other items
• Using harmful substances
• Smoking cigarettes
• Drinking alcohol
• Drinking alcohol and driving
• Illicit drug use
• Unhealthy diet-related behaviors
• Fasting
• Vomiting
• Abusing diet pills
• Overeating
• Overuse of health services

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References

1. Appel, A. E., & Holden, G. W. 1998. The co-occurrence of spouse and physical child abuse: A review and appraisal. J of Family Psychol, 12, 578–599.

2. Black, M.C. 2011. Intimate partner violence and adverse health consequences: implications for clinicians. Am J Lifestyle Med 5(5):428-439.
3. Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., & Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
4. Breiding MJ, Black MC, Ryan GW. 2008. Chronic disease and health risk behaviors associated with intimate partner violence—18 U.S. states/territories, 2005. Ann Epidemiol 18:538–544.
   Centers for Disease Control and Prevention (CDC). Costs of intimate partner violence against women in the United States. Atlanta (GA): CDC, National Center for Injury Prevention and Control; 2003.
5. Coker AL, Davis KE, Arias I, Desai S, Sanderson M, Brandt HM, et al. 2002. Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med 23(4):260–268.
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11. Lloyd S, Taluc N. 1999. The effects of male violence on female employment. Violence Against Women 5:370–392.
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13. Plichta SB. 2004. Intimate partner violence and physical health consequences: policy and practice implications. J Interpers Violence 19(11):1296–1323.
14. Rivara, F.P., Anderson, M.L., Fishman, P., Bonomi, A.E., Reid, R.J., Carrell. D., & Thompson, R.S. (2007). Healthcare utilization and costs for women with a history of intimate partner violence.
15. Roberts TA, Auinger P, Klein JD. 2005. Intimate partner abuse and the reproductive health of sexually active female adolescents. J Adolesc Health 36(5):380–385.
16. Roberts TA, Klein JD, Fisher S. 2003. Longitudinal effect of intimate partner abuse on high-risk behavior among adolescents. Arch Pediatr Adolesc Med 157(9):875–981.
17. Silverman JG, Raj A, Mucci L, Hathaway J. 2001. Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. JAMA 286(5):572–579.
18. Tjaden P, Thoennes N. Extent, nature, and consequences of intimate partner violence: findings from the National Violence Against Women Survey. Washington (DC): Department of Justice (US); 2000. Publication No. NCJ 181867. Available from: http://www.ojp.usdoj.gov/nij/pubssum/181867.htm
19. United States Department of Justice. 2011. Crime in the United States, 2010. Federal Bureau of Investigation, Uniform Crime Reports, Washington, DC.
    
20. Warshaw, C., Brashler, B., & Gil, J. (2009). Mental health consequences of intimate partner violence. In C. Mitchell & D. Anglin (Eds.), Intimate partner violence: A health based perspective (pp. 147-171). New York: Oxford University Press.