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Domestic violence and abuse

DVA is

  • Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass but is not limited to the following types of abuse: psychological, physical, sexual, financial, emotional
  • Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.
  • Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.
  • This definition includes so called "honour" based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group. [1]

DVA and gender

  • 89% of victims of the most severe ongoing violence are women (i.e. four incidents or more). [2]
  • In 4 out of 5 incidents of DVA the offender is male. [3]
  • 25% of women have experienced domestic violence. [4]
  • 54% of female murder victims aged 16 of over were killed by their partner, ex-partner or lover; in contrast, 5% of male victims aged 16 or over were murdered by their partner, ex-partner or lover. [5]

Violence against any person is unacceptable, whatever gender, age, race or social background, but domestic violence has a disproportionate effect on women and children. Women experience domestic violence, sexual abuse, and forced marriage to a far greater extent than men and it is essential to recognise that men and women have different needs. Men can also be victims of DVA and it is important that the suffering of all victims is taken seriously and that support and help is available when needed.

DVA and children

DVA is a major indicator of risk to children and young people. Department of Health figures indicate that nearly three quarters of children on the 'at risk' register live in households where domestic violence occurs (being on the at risk register is now known as being subject to a child protection plan). [6] In addition 75% of DVA incidents are witnessed by children. [7]

Children's responses to the trauma of witnessing DVA may vary according to a multitude of factors including but not limited to age, race, sex and stage of development. With support, children can make sense of what is happening and do not have to be scared permanently by their experiences.

DVA and Black, Asian, Minority Ethnic and Refugee (BAMER) women

Although there are similarities across all abusive relationships, many BAMER survivors are unable to access language or culturally appropriate services within a context that recognises and addresses their specific needs around social identity, discrimination and inequality. BAMER women identify general practice among the top three agencies to contact for help and support at the point of leaving the abuse.

BAMER women are likely to stay in abusive situations for longer before seeking help, are more likely to experience abuse from multiple perpetrators, are more prone to ongoing violence from extended family members and pressure from the wider community after they leave an abusive situation and often experience higher levels of isolation and marginalisation.

Women with insecure immigration status or no recourse to public funds will also experience additional barriers to seeking help. They are often coerced into remaining in an abusive relationship or face destitution. Findings show that BAMER women across all age groups are likely to experience depression, a sleeping disorder and panic and anxiety attacks. There is a higher incidence of self harm and suicide amongst young Asian women experiencing DVA. [8]

BAMER children are likely to experience a range of problems, the most common are related to schooling, a lack of interest or enjoyment in activities, aggression or anger towards adults and peers, eating disorders, being withdrawn or unable to make friends and sleep disorders.

DVA and diversity

DVA does not discriminate and happens in all groups and sections of society. It can happen to anyone regardless of race, gender, disability, age, culture, mental health, religion, socio-economic level, or sexual orientation. All of these may have an additional impact on the way DVA is experienced, dealt with and responded to.

Women from diverse groups and their children often face additional barriers and further oppression from society as a whole. Disabled women are at higher risk of sexual violence and are less likely to escape and more likely to be isolated. [9]

Physical barriers, racism or homophobia are examples of discrimination that make it even more difficult for women to seek help and support. It is important to approach each case without assumptions and prejudice.

Health care professionals are well placed to spot cases of abuse among their older patients. However, research has highlighted a general tendency for health care professionals to overlook domestic violence as a potential issue for older women. [10]

DVA and perpetrators

It is increasingly acknowledged that initiatives aimed at ending DVA need to target and engage men as the primary perpetrators of abusive behaviour. The widespread nature of DVA calls for preventative approaches that aim to change attitudes, values and behaviour at the level of the individual, community and professional.

When one relationship ends most perpetrators have other relationships creating new victims. One of the most common requests from survivors is for someone to work with their partner, to help him change and keep them safe from his violence.

Perpetrators are patients too and access the NHS. An exploratory study of intimate partner homicides suggests that depression, mental health and suicide risk should be core indicators of high risk perpetrators [11]. Health professionals are therefore well placed to refer perpetrators to appropriate services. Engaging with men requires a balance between communicating that DVA is never justified and providing a non-judgemental approach that signposts support.

The confidential and non-judgemental response offered in general practice is identified as a key inducement for abusive men to make use of this service. In fact GPs emerge as the second most likely source of support accessed by perpetrators after that offered by help-lines where advice can be sought anonymously. Where it is possible to see the same GP at every consultation, the relationship was also seen as one of trust born of familiarity. Even when the GP was not someone they had built a relationship with, they could be valuable in signposting an abusive man to a relevant source of help. As a facilitator for help seeking GPs can reduce the harm and misery experienced by so many patients and families [12].

  1. Home Office.www.gov.uk/government/publications/new-government-domestic-violence-and-abuse-definition
  2. Walby S, Allen J. Domestic violence, sexual assault and stalking: finding from the British Crime Survey. Home Office Research Study 276. London, Home Office, 2004
  3. Government Equalities Office.  homeoffice.gov.uk/equalities
  4. Walby S, Allen J. Domestic violence, sexual assault and stalking: finding from the British Crime Survey. Home Office Research Study 276. London, Home Office, 2004
  5. Smith K, editor. Homicide, fire arm offences and intimate violence 2009/10: Supplementary Volume 2 Crime in England and Wales 2009/10: London, Home Office; 2011
  6. Department of Health. Women's mental health: into the mainstream. London, Department of Health, 2002
  7. Royal College of Psychiatrists. Mental health and growing up, 3rd edition: Domestic violence: Its effect on children. Royal College of Psychiatrists, 2004
  8. Mouji A. A Matter of Life and death: A right to exist - a paper looking at the eradication of specialist services to BAMER women and children fleeing violence. London, imkaan, 2008
  9. Hague G et al. Making the links: disabled women and domestic violence. Women's Aid Federation England, 2008
  10. McGarry J et al. Exploring relationships between older people and nurses at home. Nursing Times, 2008; 104(28): 32-33
  11. Regan L et al. "If only we'd known": an explanatory study of seven intimate partner homicides in England and Wales. Child and Women Abuse Studies Unit, London Metropolitan University; 2007
  12. Stanley N et al. Strength to Change: Men's Talk. Research to inform Hull's social marketing initiative on domestic violence. Preston: University of Lancashire; 2009