Domestic violence knows no economic, educational, racial, religious, or age barriers. Abuse happens in intimate relationships between couples from all walks of life. It is most common in couples who are male and female.

This pamphlet will explain

types of abuse what to do if you or someone you know is abused how to get help

No woman has to live with abuse. There are choices and options. Your life can be better.

Warning to victims of abuse: Be careful not to leave this pamphlet where the abuser can find it. He or she will then know you have been getting information on domestic violence. If you can, place this pamphlet somewhere safe. You may want to leave it somewhere other than your home.

What Is Domestic Violence?

Domestic violence is a pattern of threatening or controlling behavior imposed on a woman by someone she loves without regard for her rights, feelings, body, or health. A woman is abused if she has had intentional, often repeated, physical, sexual, or emotional harm done to her by a person with whom she is or has been in an intimate relationship.

Domestic violence affects a woman's health and well–being. About 35% of women who go to emergency rooms are thought to be victims of abuse. More than one third of female murder victims are killed by their male partners.

Abuse can be actual or threatened. In most violent relationships, mental abuse and “bullying” go along with physical force. Abuse can take any of several forms:

• Battering and physical assault—Throwing objects at the victim, pushing, hitting, slapping, kicking, choking, beating, or attacking with a weapon
• Sexual assault—Forced sexual activity, including vaginal, oral, or anal intercourse
• Psychologic abuse—Forcing the victim to perform degrading acts, threatening to harm a partner or her children, attacking or smashing valued objects and pets, or trying to dominate or control a woman's life

Abuse During Pregnancy

Many pregnant women are abused by their partners. Abuse may begin or increase during pregnancy.

Abuse during pregnancy can pose a risk to both the woman and her fetus. At this time, the abuser is more likely to direct blows at the pregnant woman's breasts and belly. Dangers of this violence include miscarriage, vaginal bleeding, low birth weight, and fetal injury. The fear of harm to her unborn baby often may motivate a woman to leave an abusive relationship.

In other cases, abuse may decrease during pregnancy. In fact, some women feel safe only when they are carrying a child. They know from experience that “he never hits me when I'm pregnant.” In these cases, however, abuse may resume shortly after the baby is born. This may lead to repeated pregnancies as a way of escaping abuse.

Relationship to Child Abuse

Domestic violence may be the most important risk factor for child abuse. In more than one half of the families in which the woman is abused, her children also are abused.

Children who witness family violence or who are abused themselves can be deeply upset by what they see or experience. The fear, helplessness, and anger children feel in an abusive home often take a major toll. Children may have chronic headaches, stomach problems, or problems with nightmares, sleeping, and bed-wetting. Often, they have difficulty in school. Sometimes, they withdraw from their studies and their friends. Other times, they lash out in anger and get into frequent fights.

Children may come to believe that physical violence is a way of dealing with problems. Female children who are abused are more likely to get into an abusive relationship when they grow up. Male children are more likely to abuse their own partners.

The Abusive Relationship

Because women in abusive relationships are at risk for repeated physical and emotional injury, it is vital to know some of the traits that often characterize the men and women in these relationships. Partners in abusive relationships come from all racial, class, economic, and religious groups—from all walks of life.

Are You Being Abused? Women with a history of family violence, sexual assault or incest, or physical abuse from a male partner are at increased risk of being in an abusive relationship. Disagreements and arguments, even heated ones, are part of a normal relationship. Physical violence or other abusive behavior is not. Everyone has a right to get angry. But no one has the right to express anger violently, to hurt you. Does your partner ever frighten you with threats of violence or by throwing things when he is angry? say it is your fault if he hits you? promise it will not happen again, but it does? put you down in public or keep you from contacting family or friends? force you to have sex when you do not want to? If you answered "yes" to any of these questions, you may be involved in an abusive relationship. If so, you are not alone and you have choices. Remember, no one deserves to be abused.

A male abuser often has a family background of violence and may have low self–esteem and low self–confidence. However, he may appear to outsiders as a fun–loving, concerned person. He may be very jealous of his partner's relationships with others and blame his partner for his violent acts. Often, he has a problem with alcohol or drugs. This may seem like the cause of the problem, but it is really just an excuse. The abuse seldom stops when alcohol or drug use does.

An abused woman also may have low self–esteem and low self–confidence. Many women believe they somehow cause the abuse and that they can control the abuser by trying to please him or avoid getting him angry. Abusers often tell their partners that they are to blame.

Women stay in abusive relationships for a number of reasons. They often have conflicting feelings—love and loyalty, guilt, and fear of retaliation. They may be financially dependent on their abuser. Whatever her reasons for staying, the daily life of an abused woman is often hectic and scary.

The Cycle of Abuse

Many abused women find themselves caught up in a cycle of abuse that follows a common pattern in many relationships. Unless the woman takes some sort of action to break the cycle, the violence usually becomes more frequent and more severe over time:

• Phase 1—Tension mounts as the abusive partner increases his threats of violence, often calling the woman names or shoving her. During this phase, the abused woman may try to please the abuser or calm him down. Often, her efforts only delay the violence.
• Phase 2—The abuser becomes violent and throws objects at his partner; hits, slaps, kicks, or chokes her; rapes or sexually abuses her; or uses weapons, such as belts, knives, or guns.
• Phase 3—The abuser apologizes and expresses guilt and shame. He promises the violent behavior will not happen again. He often buys his partner gifts. Sometimes the abuser will blame the violence on the woman, saying it would not have happened if she had not said or done something to make him angry.

Over time, the man tends to put less time and effort into making up. He has learned that his violence is controlling his partner, and he will work less hard at being forgiven or at explaining away his behavior.

If You Are Abused

Break the Silence

Make a Safety Plan Having a safety plan can help you and your children get out of a violent situation quickly. You can take these steps ahead of time: Pack a suitcase—Keep a change of clothing for you and your children, bathroom items, and an extra set of keys to the house and car with a friend or neighbor. Keep special items in a safe place—Have important items handy so you can take them with you on short notice. These may include prescription medicines, identification, extra cash, checkbook, and credit cards. Also include medical and financial records, such as mortgage or rent receipts. Be sure to take a special toy or book for each child. Talk to your children—Let them know that it is not their role to try to stop the fighting. Tell them to call the police or get help from a family member, friend, or neighbor. Know exactly where you will go—Regardless of the time of day or night, know a friend's or a relative's home or a shelter for battered women where you can go. Try to avoid fighting in a kitchen or bathroom where your abuser may have access to weapons or where there is no escape. Know where you will go if you cannot escape the violence—Call your doctor or go to the emergency room if you are hurt. Give your doctor complete information about how you were injured. Ask for a copy of the medical record so you can file charges if you wish. Call the police—Domestic violence is a crime. Give the police complete information about the incident. Be sure to get the officer's badge number and a copy of the report in case you want to file charges later.

The first step in breaking a violent pattern in a relationship is to tell someone. Let someone know you are abused so you can contact them in case you need to leave a dangerous situation. The person you tell may be a nurse or doctor, counselor or social worker, a close friend or family member, or a clergy member.

At first, you may find it hard to talk about the abuse. But, many abused women feel a great sense of relief—and some sense of safety—once they have told someone outside the home.

Feelings of shame are common at this point. Keep in mind that no one deserves to be abused. Violent behavior is the fault of the one who is violent, not the victim.

Your Options

At some point you will have to think about the long-term situation. You will be faced with some tough decisions. No matter what choices you make, counseling can help you with matters that will arise as you begin to make changes in your life, such as finding a job or dealing with money concerns or children's problems.

Get Help Most areas have many resources that can help in a crisis. These resources include the police department, crisis hotlines, rape crisis centers, domestic violence programs, legal aid services, hospital emergency rooms, and shelters for battered women and children. Many counselors and health care providers are specially trained to deal with domestic violence. Check your local phone directory for listings or call the 24–hour, toll–free National Domestic Violence Hotline: 800–799–SAFE (7233) and 800–787–3224 (TDD).

Sometimes a woman who has been abused decides to break away from her partner for good. If this is the case and you are married to the abuser, get a lawyer who is experienced in dealing with abuse cases. If money is a concern, check out the resources in your area—many communities have legal aid services. Ask your doctor, counselor, or the staff of a hotline to recommend one.

There are hard decisions to be made if you are involved an abusive relationship. It will take time to sort things out. You may feel pressure from family or friends or have conflicts over your religious beliefs. Allow yourself the time you'll need to decide what to do.

Finally...

Domestic violence is a problem that is more widespread than most people think. It poses a serious health threat to the lives of many women. No woman has to live with abuse. There are choices and options.

If you think you may be involved in an abusive relationship, tell someone. Talk to your doctor or nurse or seek out a friend or counselor. Create a safety plan. Remember, no one deserves to be abused. Your life can be better.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as “superior.” To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © October 2008 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

ISSN 1074-8601

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