Predictors of treatment dropout from a spouse abuse abatement program.

This study evaluated predictors of dropout among men who began and attended at least 1 session of a cognitive-behavioral, skills training oriented spouse abuse abatement counseling program. Based on prior research, a number of demographic, criminal justice, partner violence pattern, and personality characteristics were studied. Dropout prediction was assessed at 2 phases of program participation, during assessment (early drop) and during intervention (late drop). Overall, few of the variables studied predicted dropout. Early dropout was predicted by high rates of police contact for violent crimes, failure to self-report an alcohol problem, and paranoid personality characteristics. Late dropout was predicted by both high and moderate levels of police contact for violent crimes, and borderline personality characteristics. An Age x Violent Crime interaction suggested that young violent offenders are more likely to complete treatment. The overall model accounted for only 7.15% of the variance. Clinical and research implications are discussed.

Physician interaction with battered women: the women's perspective.

BACKGROUND: Programs that train health professionals to identify and treat battered women have not previously incorporated systematically obtained advice from battered women to guide physician behavior. OBJECTIVES: To survey battered women to (1) rate the desirability of specific physician behaviors, (2) describe their actual experiences with physicians while seeking abuse-related medical services, and (3) examine relationships between participants' demographics, history of victimization, history of seeking medical help, and ratings of physician behavior. PARTICIPANTS: One hundred fifteen women who had been battered by a male partner, recruited from support groups and other battered women's programs in a 5-county area in southeastern Wisconsin. METHODS: Self-report survey of demographic information, relationship history, observations of physician behavior, and ratings of desirability for those behaviors. Analysis used cross-tabulations, chi2, and multiple t tests with Bonferonni adjustments for multiple comparisons. RESULTS: Women identified specific physician behaviors as desirable and undesirable. Desirability ratings did not differ with history of victimization, history of seeking medical help, or most other demographic variables. African American and white women rated a few physician behaviors differently. CONCLUSIONS: We identified discrete sets of desirable and undesirable physician behaviors. Further research is needed to clarify racial differences found in this study. Findings can help guide both clinical practice and the development of physician training curricula.

Dating violence.

Dating violence presents many challenges to pediatric health care providers. It spans an age range from early high school to early adult years. Prevalence of dating violence appears to be greater than for violence among married couples. In addition, both males and females appear to be at risk for perpetration and victimization. Therefore, physicians and other health care providers need to screen all adolescent and young adult patients for dating violence. Primary prevention at the community level is also an important task to stem the tide of dating violence.

An empirical classification of motivations for domestic violence.

PIP: This study evaluates gender differences in self-reported motivations for use of violence. It was hypothesized that men would report motivations related to themes of domination and control, while women would report motivations related to self-defense or retaliation. Overall, the findings suggest more differences than similarities in the type of stated motivations of violence given by male and female perpetrators. Moreover, the hypothesis was generally supported. Female perpetrators were more likely than male perpetrators to report using violence to defend them from direct physical attack, escape from direct attack, or retaliate for prior physical and emotional abuse. In contrast, male perpetrators reported violence motivations related primarily to domination and control. These include domination and control, physical control, punishment for unwanted behavior, and imposing of coercive emotional control.^ieng

Sociodemographic predictors of violence.

A representative sample of 25 years of research relating sociodemographic variables to violence is reviewed. Generalizations from those studies are applied to the authors' more recent research on domestic violence. Factors limiting the ability of the studies to be synthesized into a more meaningful whole are identified. Strategies to enhance the value of future studies are discussed.

Partner violence: a systematic approach to identification and intervention in outpatient health care.

Although partner violence is a common source of injury for women, physicians and female patients rarely discuss this problem. We outline a systematic approach to clinical practice that includes screening, case finding, intervention, and changes in the office environment. The clinician can begin to address partner violence by artfully applying these techniques. Future health outcomes research will provide additional guidance to clinical practice. We conclude with a quote from a third year medical student at the Medical College of Wisconsin who has a clear and challenging vision of the future: "I look forward to helping victims of domestic violence and eradicating domestic violence from the face of the earth just as smallpox has been eliminated."

A large sample empirical typology of male spouse abusers and its relationship to dimensions of abuse.

A number of studies have described typologies of domestically violent men. Holtzworth-Munroe and Stuart (1994) recently proposed a theoretical model for predicting violence severity and generality from personality "type." The present study, using data from 833 identified abusive men, tested the model. Personality types were determined from cluster analysis of data from the Millon Clinical Multiaxial Inventory, and resulted in a three-cluster solution consistent with the Holtzworth-Munroe and Stuart model. The three main clusters included nonpathological, antisocial, and passive aggressive-dependent groups. Three other, smaller types were also identified. Multivariate and chi-square analyses comparing the main clusters on other variables generally supported the Holtzworth-Munroe and Stuart model. Nonpathological men had the lowest maximum violence and frequency. They restricted their violence primarily to intimate relationships and had the fewest police contacts. Antisocial and passive aggressive-dependent men did not differ in maximum violence, but antisocial men were the most generally violent and had the most police contacts. Passive aggressive-dependent men had the highest frequency of violence. Clinical, theoretical and methodological implications are discussed.

Issues of domestic violence unique to rural areas.

Domestic violence against women occurs within and across all socioeconomic, demographic, and geographic regions of the United States. Many of the dynamics related to domestic violence, and which trap women in violent relationships, also cross these boundaries. These dynamics include societal and community attitudes toward violence, isolation, fear of exposure, lack of resources to facilitate leaving a violent relationship, and lack of sufficient accessible services for victims of violence. This paper highlights that these and other issues of domestic violence are intensified in rural settings. As such, physicians working in rural areas may face unique challenges in helping battered women. Such challenges will require solutions based on knowledge of specific rural location. A number of rural-based solutions for physician interventions with rural battered women are discussed.

Psychosocial modifiers of psychopathology for domestically violent and nonviolent men.

Personality characteristics of 99 domestically violent and 71 nonviolent men were studied, using the Millon Clinical Multiaxial Inventory and controlling for premorbid history. Men with poor premorbid backgrounds from 3 groups (ns = 66, 12, and 23) showed more elevations on the Millon inventory than men with good premorbid backgrounds (ns = 33, 20, and 48). However, over-all, batterers showed more Millon elevations than nonviolent men. These findings point to the need to control psychosocial variables when studying personality characteristics of batterers.

Counseling heterosexual women arrested for domestic violence: implications for theory and practice.

With increasing emphasis in recent years on mandatory arrest for partner violence, there has been a concomitant increase in the number of females arrested for assaulting their partners. The present paper describes the process one community experienced to understand and appropriately intervene with women who had been arrested for domestic violence and referred to court-mandated treatment. Issues related to conceptualization of the problem, identifying intervention goals and defining the intervention targets were discussed. Research with the community sample of domestically violent indicated most were motivated by a need to defend themselves from their partner's assaults, or are retaliating for previous batterings. As such, the intervention focused on issues of victimization and oppression. It is further suggested that intervention programs for domestically violent women must take place in the context of a broader community intervention which involves training and interaction with law enforcement and criminal justice agencies to determine criteria for arrest and prosecution of battered women when they fight back to protect themselves.

Indicators of woman abuse based on a chart review at a family practice center.

OBJECTIVE: To identify demographic and health indicators of domestic violence. DESIGN: Anonymous questionnaire survey of patients regarding violence and a chart review regarding symptoms and diagnoses. SETTING: Community-based family practice residency training center in a midwestern city. PARTICIPANTS: Women 18 years of age or older visiting the center over a 2-month period in 1990. Of 476 eligible participants, 394 (82.7%) consented to complete the survey. MEASURES: A detailed, standardized measure of violence was used. Physical and psychological problems were given codes from the International Classification of Diseases, Ninth Revision (ICD-9). RESULTS: Younger women and those separated or divorced from their partners were more likely to have been victims. Never-married women also had substantially high rates of victimization. Depression was the strongest indicator of victimization, even when controlling for demographic factors. Back pain, ulcers, headaches, and anxiety were not strong indicators of abuse. A classification analysis showed that a combination of all variables could predict lifetime injury only about half the time and violence in the past year only about 20% of the time. CONCLUSIONS: Since neither demographic nor health factors could accurately predict who had been victimized, all women need to be asked about abuse. Physicians should also keep in mind that divorced and unmarried women are often affected by abuse, either immediately or by its long-term aftereffects.

Prevalence of domestic violence in community practice and rate of physician inquiry.

BACKGROUND: National surveys show that each year in the United States approximately 2 million women are battered by their husbands. Only a small percentage of these women are identified by physicians. The objective of this research was to determine the incidence and prevalence of spouse abuse among women seeking health care in a family practice clinic (or setting). METHODS: During a two-month period, all adult women seeking health care from a family practice clinic in a medium-sized Midwestern community were asked to complete an anonymous questionnaire about whether they had ever been physically assaulted by their partners. RESULTS: Of 476 consecutive women seen in practice, 394 (82.7%) agreed to participate. Of these, 22.7% had been physically assaulted by their partners within the last year. The lifetime rate of physical abuse was 38.8%. Only six women in the sample had ever been asked about abuse by their physician in a recent visit [corrected]. CONCLUSIONS: Although spouse abuse is common, physicians rarely ask about it. Physicians should be trained to detect and assess abuse among female patients.

Racial differences on the MCMI in an outpatient clinical sample.

In this study, we extended previous research on racial differences on the Millon Clinical Multiaxial Inventory (MCMI) which focused on psychiatric inpatients. Subscale scores were compared for Black and White outpatient males on the MCMI. Age, education, and employment status were controlled. Results showed that Blacks scored significantly higher than Whites on the Narcissistic, Aggressive, Paranoid, Drug, and Psychotic Delusion subscales. Results are interpreted in terms of the larger body of research on racial differences on personality instruments. Clinical implications and the need for further research are discussed.

The assessment of maritally violent men on the California Psychological Inventory.

This study assessed 87 maritally violent men (MV), 42 maritally nonviolent, maritally discordant men (NVD), and 48 maritally nonviolent, maritally satisfied men (NVS) on the California Psychological Inventory (CPI), a test of the normal personality. A MANOVA and subsequent range tests indicated that the NVD and NVS groups had significantly higher scores than the MV group on 10 of the 18 subscales: Responsibility, Socialization, Self-Control, Tolerance, Achievement via Conformance, Achievement via Independence, Good Impression, Intellectual Efficiency, and Psychological Mindedness. A discriminant analysis contrasting the MV group with the combined NVD and NVS group correctly classified 68% of the subjects and accounted for 20.94% of the variance between groups. Along with previous findings, the data indicated that maritally violent males exhibit different personality characteristics than maritally nonviolent men in three general areas: intimacy, impulsivity, and problem-solving skills. Many of these problem areas were significantly correlated with childhood violence experiences.

Recidivism following spouse abuse abatement counseling: treatment program implications.

This paper examined demographic and personality characteristics of violence-free completers (n = 74) and violence repeating completers (n = 32) of a spouse abuse abatement counseling program. Chi-square analyses on categorical data, and analyses of variance on personality test data revealed several predicted findings. Compared to violence-free completers, recidivists reported higher levels of substance abuse both before and after treatment. Recidivists also showed evidence of higher narcissism, measured by the Narcissistic, Gregarious and Aggressive subscales of the Millon Clinical Multiaxial Inventory. Referral source (self or court) did not differentiate the two groups, nor did record of criminal activity. Subsequent discriminant function analysis, entering all predicted variables, correctly identified 65.4% of the recidivists and 73.1% of violence-free completers. Clinical and research implications of the findings are discussed.

Counseling male spouse abusers: characteristics of treatment completers and dropouts.

This article examines differential demographic and personality characteristics of completers (n = 88) and dropouts (n = 68) from a spouse abuse abatement counseling program. Chi-square analyses on categorical data and multivariate analyses of variance on personality test data revealed several predicted findings. In general, treatment dropouts were younger and had lower employment levels than treatment completers. Dropouts also had higher pretreatment levels of police contact than completers for alcohol- and drug-related offenses, as well as miscellaneous offenses, but not for violent offenses. Personality data indicated greater borderline and schizoidal tendencies among dropouts, compared to completers, as measured by the Millon Clinical Multixial Inventory (MCMI). Moreover, completers evidence lower levels of overall psychopathology than dropouts. Discriminant function analyses correctly predicted 71% of dropouts with the following variables: volunteer status, race, employment, MCMI-Alcohol scale and pretreatment miscellaneous criminal offenses. The results of the present study are discussed in terms of victim safety planning and program policy implications.

Characteristics of male spouse abusers consistent with personality disorders.

Researchers and clinicians have tended to minimize the role of psychological characteristics of male spouse abusers, which has restricted the selection of potentially appropriate treatment interventions. A review of clinical literature on psychological characteristics of male batterers, including some studies incorporating psychometric testing, suggests that many of the characteristics of batterers are consistent with DSM-III criteria for personality disorders. Several authors have defined subtypes of batterers, which can be associated with specific types of personality disorders. Treatment programs for male spouse abusers should address the specific problems presented by patients with personality disorders, including alcohol-abusing batterers, a particularly difficult group to treat.