By John Messmer
Penn State Family and Community Medicine
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine
There are not many taboos these days. Just about any topic is common fare on television, radio and newspapers. Yet we see little commentary on a problem as old as civilization and which affects millions of Americans annually -- the problem of domestic or intimate partner violence (IPV). To be sure, women most often are the victims of IPV, which is considered separately from child abuse. IPV often is not reported for many reasons including embarrassment, concern over loss of support, fear of retribution and lack of understanding of the problem.
When people think of IPV, it is usually understood as physical assault, such as hitting or punching. Violent domestic behavior includes much more. Domestic violence is a method of control by the abuser and includes physical acts, such as punching, hitting, slapping, pushing, kicking and choking, but also includes forced sexual acts. Violence need not be physical -- intimidation, withholding household money, restricting activities, threats, refusal of participation in household decisions and manipulative behavior also can be forms of psychological violence used to control another person.
IPV does not always begin with actual physical violence. Early in the relationship, often in the dating phase, abusers tend to be excessively bossy or may try to control their partner's freedom to go out, work or attend school, wear certain clothing, or associate with friends and they make the victim feel as though it is her fault. Control can extend to wanting to know where his partner is at all times with excuses such as concern over her safety or well-being or being unable to live without her. Controlling activities worsen over time until physical violence erupts. The abuser almost always has remorse after an assault and promises never to do it again, but an abuser will almost never change without professional help.
Although men can be victims, 95 percent of perpetrators are men. An estimated 90,000 health-care visits annually are for domestic violence and one in four women report rape or physical assault by an intimate partner in their lifetimes. About one in 10 homicide victims between 1976 and 2002 were killed by an intimate partner -- a total of between 2,000 and 4,000 homicides per year. In addition to spouses, between one and two million elderly people experience abuse and/or neglect by family members.
Violence in a relationship should never be tolerated. Victims may be afraid or embarrassed to get help and make up stories about visible injuries. If she does want to get away, she may not know how. Unfortunately, only one in 35 cases of domestic violence is diagnosed by heath-care professionals, either due to not recognizing it, failure to ask or accepting the victim's denial.
Too often, friends and family consider it a private matter or may be afraid to confront either the abuser or the victim, but that may be just the support the victim needs. Help is a phone call away at the National Domestic Violence Hotline at (800) 799-SAFE (7233) or TTY (800) 787-3224. She may not seek help the first time, but with continued encouragement and support, a victim of IPV can be freed from the abusive relationship.
IPV is a crime in all 50 states, and protection from abuse orders from one jurisdiction are valid throughout the United States, its protectorates and tribal territories as a result of the federal Violence Against Women Act. However, unless a victim actually seeks help and protection, the act is of no use.
Children of abusers are more likely to become abusers themselves. Action is needed to break the cycle of violence. More information is available on the Web:
-- The Centers for Disease Control at http://www.cdc.gov/ncipc/factsheets/ipvoverview.htm online;
-- The Pennsylvania Coalition Against Domestic Violence at http://www.pcadv.org/ online, which also has links to other states' and territories' IPV Web sites; and
-- The National Domestic Violence Hotline Web site at http://www.ndvh.org/ online.