Mary Ann Dutton

Childhood victimization and lifetime revictimization

OBJECTIVE To examine the fundamental hypothesis that childhood victimization leads to increased vulnerability for subsequent (re)victimization in adolescence and adulthood and, if so, whether there are differences in rates of experiencing traumas and victimizations by gender, race/ethnicity, and type of childhood abuse and/or neglect. METHODS Using a prospective cohort design, participants are individuals with documented cases of childhood physical and sexual abuse and neglect from the years 1967 through 1971 and a matched control group. Both groups were interviewed in-person (mean age 39.5 years) in 2000-2002 using a new instrument to assess lifetime trauma and victimization history. RESULTS Abused and neglected individuals reported a higher number of traumas and victimization experiences than controls and all types of childhood victimization (physical abuse, sexual abuse, and neglect) were associated with increased risk for lifetime revictimization. Significant group (abuse/neglect vs. control) by gender and group by race/ethnicity interactions were found. Childhood victimization increased risk for physical and sexual assault/abuse, kidnapping/stalking, and having a family friend murdered or commit suicide, but not for general traumas, witnessing trauma, or crime victimization. CONCLUSIONS These findings provide strong support for the need for early intervention with abused and neglected children and their families to prevent subsequent exposure to traumas and victimization experiences.

Intimate Partner Violence, PTSD, and Adverse Health Outcomes

The high prevalence of adverse health outcomes related to intimate partner violence (IPV) is well documented. Yet we know little about the pathways that lead to adverse health outcomes. Research concerning the psychological, biological, neurological, behavioral, and physiological alterations following exposure to IPV—many of which are associated with posttraumatic stress disorder (PTSD)—represents a promising area of empirical discovery. New technologies and interdisciplinary collaborative efforts are required to integrate diverse methodologies and to apply new findings to improving the health and well being of those affected by IPV. This article focuses on victimization by IPV and addresses the most important research findings in the last 20 years (health and mental health burden of IPV), the most important research issue for the next decade (pathways between IPV and adverse health outcomes), and the most promising methodological innovation for the study of IPV (integrated, interdisciplinary, biobehavioral methodology).

The Intimate Partner Violence Strategies Index Development and Application

Although research has documented the myriad ways that victims of IPV struggle to keep themselves safe, little research has gone the next step to investigate patterns in women’s use of strategies, the factors that influence choice of strategies, or which strategies are most effective. One obstacle to conducting such research is the absence of an instrument to measure the nature and extent of battered women’s strategic responses to violence across specific domains of strategies. This article describes the development of such an instrument, the Intimate Partner Violence Strategies Index, in the context of a longitudinal study of battered women’s experience over time.

Women’s Resources and Use of Strategies as Risk and Protective Factors for Reabuse Over Time:

Using a longitudinal and ecological approach, we investigated the relationships between women’s material and emotional resources and strategies and their ability to stay safe over time in a sample of 406 help-seeking African American women. The multivariate analysis demonstrated that social support served as a protective factor and resistance strategies as risk factors for reabuse during a 1-year period. It also showed an interaction between social support and history of violence such that for participants who had experienced the most severe violence, social support did not serve as a protective factor; however, for the other participants, those with the least amount of social support had a 65% predicted probability of reabuse during the next year, compared to a 20% predicted probability for women reporting the highest level of social support. Policy and programmatic implications of these findings are discussed.

Abortion and Mental Health: Evaluating the Evidence.

The authors evaluated empirical research addressing the relationship between induced abortion and womens mental health. Two issues were addressed: (a) the relative risks associated with abortion compared with the risks associated with its alternatives and (b) sources of variability in womens responses following abortion. This article reflects and updates the report of the American Psychological Association Task Force on Mental Health and Abortion (2008). Major methodological problems pervaded most of the research reviewed. The most rigorous studies indicated that within the United States, the relative risk of mental health problems among adult women who have a single, legal, first-trimester abortion of an unwanted pregnancy is no greater than the risk among women who deliver an unwanted pregnancy. Evidence did not support the claim that observed associations between abortion and mental health problems are caused by abortion per se as opposed to other preexisting and co-occurring risk factors. Most adult women who terminate a pregnancy do not experience mental health problems. Some women do, however. It is important that womens varied experiences of abortion be recognized, validated, and understood.

Court-Involved Battered Women's Responses to Violence: The Role of Psychological , Physical, and Sexual Abuse

Failure to understand the importance of psychological abuse as a component of domestic violence can result in little appreciation for the complexity of victims’ experience and thus a failure to provide the most effective intervention. This study examined the role of psychological abuse, physical violence, injury, and sexual abuse in predicting court-involved women’s (1) prior attempts to seek help from the justice system and to leave the battering relationship, (2) use of criminal prosecution and civil protection orders, and (3) traumatic stress reactions. At the univariate level, each abuse variable was significantly associated with at least one strategic response and all traumatic responses to violence. Multivariate analyses revealed that strategic responses were largely predicted by injury and physical assault, whereas traumatic responses were mainly predicted by psychological abuse. Taken together, these findings demonstrate the important role of both physical and psychological abuse in shaping women’s responses to domestic violence.

Ethnic differences in battered women's formal help-seeking strategies: a focus on health, mental health, and spirituality.

The primary goal of this study was to identify ethnic differences in battered womens use of health, mental health, and spiritual coping strategies, as well as differences in the perceived helpfulness of each strategy. The authors recruited a sample of 376 African American and Caucasian victims of interpersonal violence from various sites. In comparison with Caucasian women in the sample, African American women were significantly more likely to report using prayer as a coping strategy and significantly less likely to seek help from mental health counselors. The 2 groups did not significantly differ in terms of the extent to which they sought help from clergy or medical professionals. African American women found prayer to be more helpful than did Caucasian women.

Child abuse and neglect and intimate partner violence victimization and perpetration: A prospective investigation

This paper describes the extent to which abused and neglected children report intimate partner violence (IPV) victimization and perpetration when followed up into middle adulthood. Using data from a prospective cohort design study, children (ages 0-11) with documented histories of physical and sexual abuse and/or neglect (n=497) were matched with children without such histories (n=395) and assessed in adulthood (Mage=39.5). Prevalence, number, and variety of four types of IPV (psychological abuse, physical violence, sexual violence, and injury) were measured. Over 80% of both groups - childhood abuse and neglect (CAN) and controls - reported some form of IPV victimization during the past year (most commonly psychological abuse) and about 75% of both groups reported perpetration of IPV toward their partner. Controlling for age, sex, and race, overall CAN [adjusted odds ratio (AOR)=1.60, 95% CI [1.03, 2.49]], physical abuse (AOR=2.52, 95% CI [1.17, 5.40]), and neglect (AOR=1.64, 95% CI [1.04, 2.59]) predicted increased risk for being victimized by a partner via physical injury. CAN and neglect also predicted being victimized by a greater number and variety of IPV acts. CAN and control groups did not differ in reports of perpetration of IPV, although neglect predicted greater likelihood of perpetrating physical injury to a partner, compared to controls. Abused/neglected females were more likely to report being injured by their partner, whereas maltreated males did not. This study found that child maltreatment increases risk for the most serious form of IPV involving physical injury. Increased attention should be paid to IPV (victimization and perpetration) in individuals with histories of neglect.

Patterns of intimate partner violence: correlates and outcomes

Battered women experience different constellations of violence and abusive behavior characterized by various combinations of physical violence, sexual violence, psychological abuse, and stalking. The goals of the current study were to determine whether it was possible to identify empirically derived and meaningful patterns of intimate partner violence (IPV) and to examine correlates and outcomes of the IPV patterns. Three IPV patterns were identified using cluster analysis. Pattern 1 was characterized by moderate levels of physical violence, psychological abuse, and stalking but little sexual violence. Pattern 2 was characterized by high levels of physical violence, psychological abuse, and stalking but low levels of sexual violence. Pattern 3 was characterized by high levels of all violence types. IPV Pattern 3 was associated with the highest prevalence of posttraumatic stress disorder and depression, and IPV Pattern 2 had the highest levels of revictimization during the year following recruitment. The clinical and policy implications of the findings are discussed.

Longitudinal factor structure of posttraumatic stress symptoms related to intimate partner violence.

Confirmatory factor analysis (CFA) studies have suggested that a model of posttraumatic stress disorder (PTSD) that is characterized by 4 factors is preferable to competing models. However, the composition of these 4 factors has varied across studies, with 1 model splitting avoidance and numbing symptoms (e.g., D. W. King, G. A. Leskin, L. A. King, & F. W. Weathers, 1998) and the other including a dysphoria factor that combines numbing and nonspecific hyperarousal symptoms (L. J. Simms, D. Watson, & B. N. Doebbeling, 2002). Using the PTSD Checklist (F. W. Weathers, B. T. Litz, D. S. Herman, J. A. Huska, & T. M. Keane, 1993) and CFA, the authors compared these models with competing models. A model of PTSD with 4 intercorrelated factors of Intrusions, Avoidance, Dysphoria, and Hyperarousal was found superior among 396 medical patients who screened positive for intimate partner violence (IPV) and 405 women seeking services for IPV. Structural invariance testing indicated that this 4-factor model remains stable across service setting and time.