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.

Obstacles to victims' cooperation with the criminal prosecution of their abusers: the role of social support.

Over the last 20 years, diminishing tolerance for domestic violence has triggered significant criminal justice reforms designed to facilitate the prosecution of abusers. Prosecutors, for example, have adopted policies requiring that cases go forward even if the victim later has second thoughts. Although increasingly common, these "no drop" policies reflect a profound irony about domestic cases that is well known but little understood: the most formidable problem in prosecuting such cases is often the victim's own unwillingness to bring the abuser to justice. This prospective study explored a range of factors potentially predictive of domestic violence victims' cooperation with the prosecution of their abusers. Although the study focused on interpersonal and institutional social support, it also investigated the influence of violence severity, victim demographic factors, and victim mental health characteristics, including the presence of depressive symptoms, emotional dependence on the abuser, and substance abuse. Findings showed that tangible support, severity of violence in the relationship, and the presence of children in common with the abuser all significantly predicted victims' cooperation with the prosecution of their abusers. Substance abuse significantly predicted victims' noncooperation with prosecution. The research and policy implications of these findings are discussed.

The relationship between violence dimensions and symptom severity among homeless, mentally ill women.

Little is known about the relationship between violence and symptomatology in the lives of homeless, mentally ill women. This study investigates the possibility that specific dimensions of violence-frequency, recentness and type-may be associated with severity of psychiatric symptomatology in this population. Results indicate that each of the abuse dimensions is associated with a broad range of psychiatric symptoms and, in combination with substance abuse, account for almost one third of the variance in overall distress. These findings suggest the possibility that intensity of exposure to violence contributes to the severity of psychiatric symptoms even in women who already suffer an overwhelming number of intrapsychic and social difficulties; and that multiply traumatized women do not become desensitized to the impact of new violence. This article discusses the clinical and policy implications of these conclusions.

Symptom severity and diagnoses related to sexual assault history.

The current study examines associations between a history of sexual assault or abuse and severity of symptoms and diagnostic categories in an adult clinical outpatient sample. Twelve of 68 men (18%) and 71 of 120 women (59%) reported a history of sexual trauma. Abuse history was associated with mood and anxiety disorder diagnoses. Women were also more likely to receive these diagnoses; abused women were particularly likely to be diagnosed with an anxiety disorder. Abused subjects showed higher scores on every subscale of the SCL-90-R; there were no interactions between sex and history of abuse. Women scored higher than men on subscales indicating anxiety, phobia, and general distress. The results indicate an association between history of sexual trauma and symptom severity across a broad range of psychopathology, and with mood and anxiety disorders. There is no indication of differential gender effects of sexual assault.

The emergency department as a violence prevention center.

No longer confined to the criminal justice system alone, violence is now regarded as a major health care issue in America. Changes are apparent not only in health care delivery, but also in medical school curricula, residency training board examinations, and accreditation. Although tertiary prevention demands the most acute attention, opportunities for secondary prevention are important and often neglected, especially when the immediate health care issue is not related to violence. This article describes the development of the Emergency Department as a Violence Prevention Center program, established at The George Washington University Medical Center. The program moves beyond responding to acute cases of violence only and considers the hospital emergency department as an active player in a community-wide effort to end violence. It does this through universal screening, assessment, treatment and other interventions, documentation, and patient and professional education.

The relationship between victimization and cognitive schemata among episodically homeless, seriously mentally ill women.

This study explored the extent to which specific aspects of violent victimization are associated with cognitive schemata in the context of ongoing, often lifelong, trauma and negative life events. Specifically, we examined the relationships between cognitive schemata (safety, self- and other esteem, intimacy, and trust) and three dimensions of physical and sexual assault histories (recentness, frequency, and variety) among 91 predominantly African American, episodically homeless, seriously mentally ill women. Findings indicated that even in the context of pervasive violence, more frequent, recent, and varied abuse was associated with more negative cognitive schemata. We discuss these findings in the context of research and practice with disenfranchised populations at high risk for violent victimization.

Episodically homeless women with serious mental illness: prevalence of physical and sexual assault.

Three aspects of physical and sexual assault in the histories of 99 episodically homeless, seriously mentally ill women were assessed: lifetime prevalence; severity, co-occurrence, and recency; and associations between levels of this victimization and specific characteristics of the women. Results indicate that the life-time risk for violent victimization was so high (97%) as to amount to normative experiences for this population.

Traumatic responses among battered women who kill.

This study compared levels of violence, social support, and post-traumatic stress between battered women charged with a violent crime against an abusive partner and those seeking help from a mental health clinic. Results indicated that forensic battered women were more likely than clinical battered women to report experiencing severe violence, including sexual abuse, in their relationships. Women in the forensic sample also reported less social support and greater post-traumatic stress than women in the clinical sample. However, when social support and level of violence were accounted for, levels of general post-traumatic stress indicators (MMPI-PTSD, CR-PTSD, GSI) were no longer different between groups, although levels of specific post-traumatic stress indicators (intrusion, avoidance) remained higher for battered women in the forensic sample. Implications for understanding battered women's response to violence and their post-traumatic reactions to it are discussed.

Posttraumatic stress disorder among battered women: analysis of legal implications.

The diagnosis of posttraumatic stress disorder (PTSD) has recently been applied to the psychological experiences of victims of intimate violence, including physical and sexual assault. The use of trauma theory to explain battered women's responses to violence has laid a foundation for expert testimony on PTSD, where relevant, within more general testimony concerning partner violence. This article discusses the relevance of the PTSD diagnosis within the legal context for explaining battered women's responses to violence.

Battered women's cognitive schemata.

This study examined battered women's cognitive schema in relation to their cognitions about violence (i.e., the "meaning" attached to the violence), post-traumatic reactions to violence, and sexual victimization histories. Seventy-two battered women seeking help from an outpatient family violence clinic were subjects. The meaning of the violence (e.g., expectations of recurrent violence and of severe/lethal violence, causal attribution) was found to explain variance in cognitive schemata about SAFETY, SELF, AND OTHER (McCann and Pearlman, 1990a). All measures of cognitive schemata were significantly related to various global and specific measures of posttraumatic stress (GSI, MMPI-PTSD, IES). No differences were found for cognitive schemata based on histories of sexual victimization. Results point to the importance of assessing the impact of traumatic experiences on core cognitive beliefs as a component in the constellation of post-traumatic sequelae.

Sexual assault history in a community mental health center clinical population.

One hundred and twenty-two adult outpatients, 81 women and 41 men, in a community mental health center responded to a survey of history of sexual assault and abuse. Overall, 48% reported they had been sexually assaulted or abused, 59% of women and 24% of men. Forty-two percent of women and 17% of men reported they had been raped, 27% of women and 7% of men reported attempted rape, and 31% of women and 10% of men reported molestation. Characteristics of assaults and assailants were examined. Implications for training clinicians in the treatment of victims of sexual assault and abuse are discussed.

A breastfeeding protocol.

Specific guidelines for assisting patients in breastfeeding their infants are outlined, beginning in the prenatal period and continuing through initiation of nursing and established lactation. Prevention of possible problems is emphasized, but included are methods for relieving difficulites encountered during breastfeeding, such as flat nipples, sleepy babies, sore nipples, oversupply, engorgement, multiple births, forceful expulsion of milk, and breast infections.