The Partner Abuse State of Knowledge Project Manuscripts and Online Data Base
Overview of Findings by the Authors

# 9 The Impact and Consequences of Partner Abuse on Partners
Erika Lawrence, Rosaura Orengo-Aguayo, Amie Langer & Rebecca Brock
93 pages.  Full manuscript available in Partner Abuse Vol. 3, Issue no. 4 (2012),  pp. 406-428

The purpose of the current study was to review and critique the existing literature on the psychological and physical consequences of psychological and physical abuse on partners. In the current study, a comprehensive review of the literature was conducted using a variety of search engines and key terms (e.g., abuse, aggression, violence; intimate partner, relationship, partner, spousal; psychological, emotional, physical). We included studies examining male and/or female abusers and we included studies examining male and/or female victims. Within our review of physical consequences, we included studies that examined victims’ health behaviors (e.g., smoking) as a possible consequence of abuse.

We narrowed our review to studies published from 1989-2012, studies published in English, studies published in peer-reviewed journals, and studies containing empirical data. Consequently, we excluded book chapters that did not include empirical data and excluded doctoral dissertations. We also excluded studies examining the consequences of sexual abuse, as that type of abuse was reviewed in another section of this project. We also excluded studies examining the consequences of abuse on children or on parenting behaviors, as those consequences were reviewed in another section of this project. Finally, we did not include studies that focused exclusively on economic or social consequences for victims or society; however, we did include economic consequences to victims in our tables if those consequences were investigated as part of a study we were already including in our review.

The application of these inclusion and exclusion criteria resulted in 122 empirical articles and 10 review articles on this topic. The empirical articles were categorized by the nature of the abuse and the nature of the consequences as follows: psychological consequences of psychological abuse, psychological consequences of physical abuse, and physical consequences of physical and psychological abuse. Physical consequences of physical abuse and physical consequences of psychological abuse were combined into one table because these consequences were almost always examined in the same study. Within each of these tables we also organized the studies by the nature of the sample they assessed as follows: large population samples, smaller community samples, university/school samples, treatment-seeking samples, and legal/criminal/justice-related samples. We also created a table of previously published review articles on this topic. For each review article, we listed the articles those authors reviewed and the main findings from those reviews. In our own review we included the relevant papers from those review articles as well. All studies included in this published review were entered into an on-line summary table that includes the full reference for the study, the sample size and its characteristics, the study method and design, the measures used, and the results relevant to the question of the psychological and physical consequences of psychological and physical abuse on victims.

Given that 10 review articles have been published in the last two decades on this topic, the current review was approached differently than the approaches taken in other manuscripts from the Partner Abuse State of Knowledge Project. Reporting prevalence rates, conducting additional analyses, or conducting a meta-analysis or other detailed review summarizing the findings in our 122 empirical studies would have been redundant with the existing published reviews on this topic. In brief, the multitude of basic research studies examining the impact of abuse on partners yields strong and consistent evidence of two facts. First, psychological and physical abuse have serious physical and psychological consequences for victims and the consequences are, with some exceptions, generally greater for female victims compared to male victims. Second, with regard to the physical consequences of physical abuse, injuries are similar across samples of female victims (e.g., community samples, clinical samples, shelter samples).

Physical victimization has both negative physical and psychological consequences on its victims. The most striking finding was the consistent and strong correlation between physical victimization and poorer physical health outcomes for female victims. Specifically, physical victimization was associated with increased chronic pain, gynecological problems (e.g., greater probability of cervical cancer, pelvic pain, UTIs, abdominal pain, menstrual cycle changes, child-birth delivery complications), gastrointestinal problems (e.g., Irritable Bowel Syndrome, stomach pain), cardiovascular problems, compromised immunological functioning (e.g., lower hemoglobin levels), vision and hearing difficulties, and nutritional deficits (e.g., low iron levels). Physically victimized women were more likely to suffer from longstanding illnesses and chronic diseases, to suffer physical injuries including potentially lethal injuries (e.g., burns, broken bones, gunshot or knife wounds, facial injuries, concussions, losses of consciousness, traumatic brain injury), to visit emergency rooms, and to be seen by physicians compared to women who were not victimized.

The psychological consequences of physical victimization have also been well documented in the literature. Experiencing physical abuse in a romantic relationship significantly decreases female victims’ psychological well-being and increases the probability of suffering from depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol or other substance abuse. Physical victimization is also associated with higher rates of suicidal ideation and attempts and with more memory and other cognitive impairments. Finally, compared to non-victimized women, physically victimized women are more likely to report higher than normal levels of stress and more visits to mental health professionals, and are more likely to take medications to treat their depression and anxiety, including painkillers and tranquilizers.

Our review also demonstrated that psychological victimization leads to a variety of consequences for female victims’ psychological health, physical functioning (e.g., migraine, stomach ulcers, indigestion, pelvic pain, chronic pain, chronic disease), and cognitive functioning. Higher levels of psychological victimization are strongly associated with current depressive and anxiety symptoms, insomnia, suicidal ideation, lower self-esteem, higher levels of self-reported fear, and increased perceived stress. Moreover, the evidence suggests that psychological victimization is at least as strongly related to depression, PTSD, and alcohol use as is physical victimization, and that the effects of psychological victimization remain even after accounting for the effects of physical victimization.

There was a relative dearth of research examining the consequences of physical and psychological victimization in men, and the studies that have been conducted have focused almost exclusively on sex differences in injury rates. When sex differences were examined, physical violence demonstrated more deleterious physical consequences for women than men. Women were more likely to suffer severe and potentially life threatening injuries, and to visit an emergency room or hospital as a result of intimate partner violence. However, the severity of the physical abuse seemed to moderate these sex differences in injury rates. When mild-to-moderate aggression is perpetrated (e.g., shoving, pushing, slapping), men and women tend to report similar rates of injury. When severe aggression has been perpetrated (e.g., punching, kicking, using a weapon), rates of injury are dramatically higher among women than men, and those injuries are more likely to be life-threatening. Relatedly, there is limited research on the psychological consequences of abuse on male victims, and the research that does exist has yielded mixed findings (some studies find comparable effects of psychological abuse across gender, while others do not.)  As such, we believe it is premature to draw conclusions about the psychological consequences of violence for male victims.

In addition to the findings delineated above and in past reviews, we uncovered several findings that had not been discussed in past reviews. First, there is a small but critical group of studies examining the effects of abuse on health behaviors (as opposed to physical health itself). For example, researchers have examined the effects of abuse on diet, exercise, alcohol and other substance use, and smoking. Physically abused women have been found to engage in poorer health behaviors, including a greater likelihood of smoking, engaging in sexually risky behaviors, and having poor eating habits. Psychologically victimized women also have been found to engage in poorer health behaviors, including a greater likelihood of smoking and engaging in risky sexual behaviors. Second, in addition to the physical and psychological consequences, physical victimization has serious economic and social consequences for victims and society at large. Physically victimized women are more likely to miss work or be unemployed, have lower educational attainment, have lower marital or relationship satisfaction, have fewer social and emotional support networks, be less involved in their communities, and experience more negative life events. They are also less likely to be able to take care of their children and perform household duties. Similarly, psychological victimization among women is significantly associated with poorer occupational functioning and social functioning. Third, all of the consequences found for victims of psychological and physical abuse are significantly worse for victims who are of low income, are ethnic minorities, and/or are unemployed.

Despite the multitude of studies examining the consequences of abuse for victims, a variety of conceptual and methodological limitations to existing research hinder our understanding of the consequences of abuse for victims. For example, with regard to the content of prior studies, the research has been limited largely to studies of main effects, there is a lack of basic research on the physical consequences of violence for male victims other than basic sex differences in injury rates, and there exists little research on (mal)adaptive coping mechanisms among victims, a potentially key point of intervention. In terms of conceptual limitations, basic research on the consequences of abuse for victims has been largely atheoretical, the construct of psychological aggression has been inconsistently and poorly defined, and the relation between psychological and physical aggression has rarely been taken into account. With regard to methodological limitations, we found an overreliance on self-report questionnaires, the use of  psychological violence measures that suffer from poor discriminant validity, and a reliance on cross-sectional designs to investigate purported consequences of abuse. (Please see full published manuscript for a more detailed discussion of these issues.)

Given these limitations, we recommend that future research be framed within a temporally dynamic view of violence and its consequences, employing multi-wave longitudinal designs. We also encourage researchers seek to clarify mediating processes of the well-known main effects in order to guide interventions for victims. We call for an emphasis on low income, ethnic minority and/or unemployed victims given the uniformly stronger consequences for these victims. We also encourage researchers to integrate investigations of multiple types of violence (psychological, physical, sexual), multiple victims of violence (partners, children), and multiple factors (personality, relationship, situational) into their studies in order to elucidate the nature of family violence. Finally, we recommend that interventions targeting partner violence be based on acceptance and mindfulness techniques. Preliminary evidence from the authors’ own research demonstrates the effectiveness of such techniques at reducing psychological and physical aggression among male perpetrators. We are confident that the field is ready to move into a new phase of basic research, one in which more nuanced questions can be answered and more effective interventions can be implemented.