INTERSECTION OF CHILD ABUSE AND CHILDREN’S
EXPOSURE TO DOMESTIC VIOLENCE
TODD I. HERRENKOHL
University of Washington
ROY C. HERRENKOHL
CARRIE A. MOYLAN
University of Washington
This review addresses research on the overlap in physical child abuse and domestic
violence, the prediction of child outcomes, and resilience in children exposed to
family violence. The authors explore current findings on the intersection of physi-
cal child abuse and domestic violence within the context of other risk factors,
including community violence and related family and environmental stressors.
Evidence from the studies reviewed suggests considerable overlap, compounding
effects, and possible gender differences in outcomes of violence exposure. The data
indicate a need to apply a broad conceptualization of risk to the study of family vio-
lence and its effects on children. Further testing of competing theoretical models
will advance understanding of the pathways through which exposure leads to later
problems in youth, as well as protective factors and processes through which
child abuse; exposure to domestic violence; co-occurrence; youth outcomes; resilience
AUTHORS’ NOTE: Work on this project is supported by funding from the National Institute of Child Health and Human Development
and the Office of Behavioral and Social Sciences Research (Grant 1 RO1 HD049767-01A2). Correspondence concerning this article
should be sent to: Todd I. Herrenkohl, University of Washington, School of Social Work, Box 353900, 4101 15th Ave. NE, Seattle, WA
98105-6299; e-mail: email@example.com.
TRAUMA, VIOLENCE, & ABUSE, Vol. 9, No. 2, April 2008 84-99
© 2008 Sage Publications
CHILDREN SUBJECTED TO CHILD ABUSE
are often exposed to other forms of risk, includ-
ing co-occurring exposure to domestic violence
(DV) and environmental stressors. Often, these
different sources of risk are examined separately
in research studies. For example, studies of
developmental outcomes for youth typically
focus on child abuse apart from childhood
exposure to DV. Consequently, little is known
about how these and other risks “work” in the
Herrenkohl et al. / ABUSE AND DOMESTIC VIOLENCE85
whether their effects on later development are
comparable in strength, and whether gender
influences the associations between risk factors
and outcomes. There are also children, referred
to as resilient, who appear to experience the
same risks without significant or long-term
impairment, but why? In this literature review,
we examine research on these issues and high-
light implications for practice and areas for fur-
To identify relevant research articles, we used
known resources on the identified topics (e.g.,
reference lists of books, current reviews of
research) and searched several databases for rel-
evant empirical studies, including PsycInfo
(OVID), Social Work Abstracts, and Medline.
Search terms included child abuse and exposure to
domestic violence, co-occurrence, double whammy,
dual effects, and family violence. These terms were
used separately and in combination to arrive at
well over 500 articles. Articles were examined
initially to determine their fit and relevance to
of developmental outcomes,
KEY POINTS OF THE RESEARCH REVIEW
• Co-occurrence of child abuse and domestic vio-
lence (DV) exposure
— There is considerable evidence that DV and
child abuse often co-occur.
— The rate of overlap or strength of association
varies, though the relationship remains consistent.
• Factors associated with child abuse and exposure
— Family factors include poverty, parental unem-
ployment, substance abuse, mental illness,
crime, financial or parenting stress, poor
health, and lower education.
— Environmental factors include poverty, neigh-
borhood disadvantage, and violence outside
• Consequences of child abuse and children’s
exposure to DV
— Emotional consequences include isolation,
shame, fear, guilt, and low self-esteem.
— Psychological consequences include post-trau-
matic stress disorder, anxiety, and depression.
— Behavioral consequences include eating disor-
ders, teen pregnancy, school dropout, suicide
attempts, delinquency, violence, and substance
— Relational consequences include less secure
attachments, poor conflict resolution skills, and
vulnerability to further victimization or perpe-
tration of violence.
• Unique effects of child abuse and DV exposure
— Few studies have sought to disentangle the
unique and combined effects of child abuse and
— Evidence is mixed, with some studies showing
that certain outcomes may be more strongly
linked with one or the other risk factor.
• Compounding effects of child abuse and DV
— Several studies show a “double whammy”
effect, in which children exposed to both DV
and child abuse fare worse than those exposed
to only one risk factor.
— Whether exposure to violence outside the home
further compounds such effects is unclear.
• Gender differences
— Few studies have systematically investigated
whether effects of DV exposure and child abuse
differ between male and female children.
— Existing evidence is inconsistent, although
suggestive of male–female differences for some
• Protective factors and resilience
— Individual characteristics include high intelli-
gence, internal locus of control, positive self-
image and self-esteem, a determination to be
different from one’s abusive parent(s), and a
strong commitment to school.
— Family or abuse-related characteristics include
a positive perception of one’s mother, at least
one stable caregiver, sporadic as opposed to
chronic child abuse by an otherwise supportive
parent, and positive parenting characteristics.
— Community characteristics include a positive
relationship with a caring, nonabusive adult;
having parents or peers who disapproved of
antisocial behavior; involvement with religious
community; and peer support.
• Developmental studies and mechanisms related
to the transmission of violence and related
— Family violence and other risks for children are
rarely studied as part of a specified theory or
— Some studies have looked at cognitive or social
processes as moderators.
— Hypotheses emerge from attachment theory,
cognitive and social learning theory, and social
the review and then abstracted using a common
template. Key points of this research review are
listed at the beginning of this article, and impli-
cations for practice, policy, and research are
listed at its conclusion.
REVIEW OF RESEARCH
Rates of Child Abuse and
Exposure to DV
In 2005, approximately 3.3 million referrals
for alleged maltreatment were made to child
protective service agencies (U.S. Department of
Health and Human Services, 2007). From these,
an estimated 899,000 children in the United
States were officially documented as having
been maltreated. Children from birth to age 3
have the highest rate of victimization, and
slightly more than half of all victims are girls
(50.7%). Data from 2004 indicate a similar
number of documented cases (906,000). In both
years, physical child abuse was second to
neglect in overall prevalence. By most accounts,
these figures represent just a fraction of all abuse
and neglect cases in a given year, with numer-
ous acts of child maltreatment going unreported
to protective service agencies (U.S. Department
of Health and Human Services, 2006).
Data on the prevalence of children’s expo-
sure to DV are also alarming, although there is
considerable variation in reported estimates.
According to the first National Family Violence
Survey, conducted in 1975, approximately 3
million children witnessed spousal abuse each
year in the United States, including minor to
more serious acts of aggression in which
injuries and weapon use are involved (Carlson,
1984; Straus, Gelles, & Steinmetz, 1980).
Retrospective reports from adult respondents
of the second National Family Violence Survey,
conducted in 1985, showed an incident rate
closer to 10 million children (Straus, 1992).
Prevalence estimates from several retrospective
studies of students and adults in the general
population are also available (Dong et al., 2004;
Silvern et al., 1995). For example, Dong et al.’s
(2004) investigation of adverse childhood
events for 8,600 adult members of the Kaiser
Health Plan found that 24% (n = 2,081) of those
sampled recalled having been exposed to DV
before age 18. DV exposure in that study
involved individuals’ recollections of their
fathers (or stepfathers) having abused (e.g.,
pushed, grabbed, slapped, hit, or threatened)
their mothers (or stepmothers). As with rates of
exposure, what constitutes and/or defines DV
also differs from one study to another, although
common criteria include a child’s visual or
auditory witnessing of violence; his or her wit-
nessing of consequences such as injuries,
household damage, and police involvement; or
the child’s being otherwise aware of violence in
the home (Guterman, 2004; Holden, 1998).
Co-Occurrence of Child Abuse
and DV Exposure
It is known that child abuse and DV often co-
occur; that is, in families in which one form of
violence is present, there is an increased risk for
the other (Appel & Holden, 1998; Fantuzzo,
Boruch, Beriama, Atkins, & Marcus, 1997;
McCloskey, Figueredo, & Koss, 1995; Moffitt &
Caspi, 2003; Straus, 1990). Findings from Felitti
et al.’s (1998) retrospective study of adult health
maintenance organization participants showed
that individuals who retrospectively reported
having been exposed to one form of violence
(e.g., physical abuse or DV) often were exposed
to multiple other adversities. Dong et al.’s
(2004) analyses of these data found that the like-
lihood was significantly higher of an individ-
ual’s having experienced some form of child
maltreatment when there was DV in the home.
In that study, the prevalence of physical child
abuse was 57.5% for adults who reported ear-
lier DV exposure and 21.7% for those who
reported no prior exposure.
In their often cited review of studies involv-
ing battered women, Appel and Holden (1998)
found a median rate of co-occurrence between
child abuse and DV of 41%, although in some
studies included in the review, rates of overlap
were even higher. Correlations between child
and spouse abuse were moderate to strong (r =
.28 to .56). Renner and Slack’s (2006) recent
examination of retrospective data on childhood
physical abuse and exposure to intimate part-
ner violence for a sample of welfare families
86 TRAUMA, VIOLENCE, & ABUSE / April 2008
showed a correlation of .52, within the range
suggested by Appel and Holden’s earlier
review. The findings of other literature reviews
and primary research studies are generally con-
sistent, with some variation here as well in rates
of overlap and the strength of associations
among the measured constructs (Edleson, 2001;
Gewirtz & Edleson, 2007; Osofsky, 1999; Tajima,
2000). For example, in their study of a birth
cohort from Dunedin, New Zealand, Moffitt
and Caspi (2003) found that the risk for abuse
among children in homes in which parents
physically fought was 3 to 9 times higher than
for other children in the study. Osofsky (1999)
reported an increased risk for abuse and neglect
even greater: 15 times the national average in
homes in which DV occurred. In general, esti-
mated rates of co-occurrence for DV and child
abuse within community samples are lower
than for targeted, high-risk samples (e.g.,
samples from shelters and child welfare set-
tings), but they are substantial nonetheless
(Appel & Holden, 1998).
Factors Associated With Child Abuse
and Exposure to DV
Although evidence of the co-occurrence of
child abuse and DV exposure is compelling, it
appears that these are among the numerous
other risk factors encountered by some families
(Fantuzzo et al., 1997; Margolin & Gordis,
2000). Fantuzzo et al.’s (1997) multisite study of
misdemeanor DV cases found that in house-
holds in which DV was present, poverty,
parental unemployment, and substance abuse
also were more common. Similarly, Dong et al.
(2004) found that among those who reported
one or more forms of child maltreatment
and/or prior DV exposure, the prevalences of
prior substance use, mental illness, and crime
in the family also were higher. Elsewhere,
Hartley (2002) found that the co-occurrence of
DV and physical child abuse was related to
fathers’ use of drugs, alcohol, and arrest for
criminal offenses involving something other
than DV. Tajima (2004) also found overlap in
DV exposure, child abuse, and substance use
within the family; other factors related to the
co-occurrence of abuse and DV in that study
included lower education, poor health, and
depression in the family.
Poverty (including low socioeconomic status
[SES]) has perhaps been most well documented
as a correlate of overlapping forms of violence
(Gewirtz & Edleson, 2007; Herrenkohl,
Herrenkohl, Egolf, & Wu, 1991; Lee, Kotch, &
Cox, 2004), although there is evidence as well of
an association between family violence and
related context factors, such as neighborhood
disadvantage (e.g., low income, crime, disorga-
nization) and violence outside the home
(Margolin & Gordis, 2000).
In our work on the Lehigh Longitudinal
Study, a prospective study of abusive and com-
parison families, we have examined the inter-
section of abuse and children’s exposure to DV,
as well as the overlap of these and other co-
occurring risk factors for children. Participants
of the study were assessed over a 15-year period
and recruited originally from child welfare
abuse and protective service programs, as well
as Head Start, day care programs, and nursery
programs (n = 457, 54.3% male). In the first two
assessments, completed when children were of
preschool and elementary school ages, parent
caregivers were asked (on a scale ranging from
1 = none of the time to 4 = all of the time) about the
presence of 39 stressors within and outside the
household, such as an insufficient income,
parental unemployment, physical and mental
illness in the family, alcohol and drug use in the
family, parental criminality, overcrowding in the
home, breakup of the family, child behavior
problems, a lack of social support, a lack of com-
munity resources, housing problems or recent
or frequent family moves, conflicts with neigh-
bors, and community crime and violence.
Variables were combined using a principal com-
ponents analysis, which yielded three compos-
ite measures: Family conflict included marital
problems, marital conflict, parent alcohol use or
abuse, and other negative aspects of family life,
such as unemployment and an insufficient
income (items of this measure do not address
child abuse or DV per se). A second factor, per-
sonal problems reported by parents, was
defined by parents’ unfulfilled ambitions, lack
of privacy, loneliness, and other related difficul-
ties. A third factor, external constraints, was
Herrenkohl et al. / ABUSE AND DOMESTIC VIOLENCE 87
defined mainly by characteristics of the house-
hold in relation to the surrounding community
(e.g., crime in the neighborhood, a lack of
home conveniences, physical remoteness)
(Herrenkohl & Herrenkohl, 2007).
In this study, we examined associations
among these three composite variables and five
indicators of child maltreatment or victimiza-
tion, including physical child abuse and DV
exposure (the study also included sexual abuse
and neglect). The results showed modest to
strong correlations among the variables. For
example, physical child abuse was positively
correlated with a child’s having been exposed
to DV (r = .16, p < .01). The correlations of phys-
ical child abuse and each of the above compos-
ite “stressor” variables were also significant
(with family conflict, r = .18, p < .01; with per-
sonal problems, r = .16, p < .01; and with exter-
nal constraints, r = .12, p < .05). Similar results
were shown for DV exposure (with family con-
flict, r = .25, p < .001; with personal problems,
r = .14, p < .01; and with external constraints,
r = .14, p < .01). The correlation of all indicators
of child maltreatment and stressors combined
as latent constructs was strong and statistically
significant (r = .71, p < .001).
Margolin and Gordis’s (2003) study of a
small community sample of families also pro-
vided evidence of a link between family vio-
lence and other risks. The researchers examined
a stress moderation effect in which child abuse
potential among caregivers (for those perpe-
trating or being victimized by violence)
increased linearly with financial and parenting
stress. The data showed that husband-to-wife
aggression was associated with the likelihood
of child abuse in the presence of high, but not
low, stress. Wife-to-husband abuse was linked
only to mothers’ potential for child abuse in the
presence of elevated stress within the family.
In sum, there is relatively strong evidence of
an overlap of childhood abuse and DV expo-
sure, as well as an association between these
and other risks within and outside the home. By
taking a more comprehensive approach that
examines family violence in context, it is possi-
ble to develop a more complete picture of the
vulnerability of families and hardship faced by
many children (Daro, Edleson, & Pinderhughes,
2004). Although limited to relatively few stud-
ies, results suggest that children in violent
homes encounter additional adversities that
place them at risk for a variety of problems later
in life. These include low SES, neighborhood
disadvantage, and parents’ harmful use of
drugs and alcohol (Fantuzzo et al., 1997).
Examining how these risk factors operate in
combination is an important first step toward
developing interventions and policy-level
change efforts to improve the lives of disadvan-
taged children and families (Daro et al., 2004;
Guterman, 2004). Equally important is learning
about resilience and protective factors that
buffer against the effects of risk exposure
(Masten, 1994, 2001). We turn to both topics
next, addressing first what studies show with
regard to the many short- and longer term con-
sequences of direct and indirect exposure to
Consequences of Child Abuse
and Children’s Exposure to DV
Although prospective longitudinal studies on
the consequences of child abuse and children’s
exposure to DV are rare, the findings of several
studies suggest a range of adverse social and
emotional consequences for those who have been
abused and/or exposed to DV (Gewirtz &
Edleson, 2007). For child abuse, the evidence is
particularly strong: Young victims of physical
abuse routinely experience feelings of isolation,
shame, fear, and guilt following the disclosure
of one or more forms of abuse (Osgood &
Chambers, 2000; Widom, 2000). Symptoms of
post-traumatic stress disorder (PTSD), anxiety,
and depression also are found more often than
the norm in abuse victims during and after abuse
has been disclosed (McLeer, Callaghan, Henry, &
Wallen, 1994; McLeer et al., 1998). In adolescence,
those who were abused as children are more
likely than are others to drop out of school before
completion (Widom, 2000), become pregnant at a
young age (Herrenkohl, Herrenkohl, Egolf, &
Russo, 1998), suffer from depression (Fergusson,
Horwood, & Lynskey, 1996; Widom, 2000; Wolfe,
1999; Wolfe, Scott, Wekerle, & Pittman, 2001),
attempt suicide (Fergusson et al., 1996), and
engage in delinquency, violence, and substance
88TRAUMA, VIOLENCE, & ABUSE / April 2008
use (Fergusson et al., 1996; Fergusson & Lynskey,
1997; Hawkins et al., 1998; Herrenkohl, Egolf, &
Herrenkohl, 1997; McCabe, Lucchini, Hough,
Yeh, & Hazen, 2005; Smith & Thornberry, 1995;
Widom, 2000; Wolfe, 1999).
Childhood exposure to DV appears to produce
many of the same developmental consequences,
although these are generally less well docu-
mented. For example, children exposed to DV
have higher than average rates of cognitive,
psychological, and emotional impairments
(Fantuzzo et al., 1997). Long-term developmental
problems, such as low self-esteem, depression,
anxiety, physical aggression, and school failure,
also appear more common among children in
homes with DV (Edleson, 1999; Fantuzzo et al.,
1997; Graham-Bermann, 1998; Hughes, 1988;
Lichter & McCloskey, 2004; Litrownik, Newton,
Hunter, English, & Everson, 2003; McCloskey et
al., 1995; McCloskey & Lichter, 2003; Moffitt &
Caspi, 2003; Sudermann & Jaffe, 1997).
There is some evidence of even longer term,
adulthood consequences, although here, stud-
ies are limited primarily to physical and sexual
abuse. For example, as adults, child abuse
victims face increased risks for depression
(Beitchman et al., 1992; Felitti et al., 1998;
Styron & Janoff Bulman, 1997; Widom, 2000;
Wiederman, Sansone, & Sansone, 1999), eating
disorders and other health problems (Beitchman
et al., 1992; Felitti et al., 1998; Hulme, 2000; Kang,
Magura, Laudet, & Whitney, 1999), drug use and
alcoholism (Felitti et al., 1998; Widom, 2000;
Widom, Ireland, & Glynn, 1995), and criminality
(Kang et al., 1999; Widom, 2000). In addition,
there is evidence that individuals who were vic-
tims of abuse are less securely attached to their
romantic partners, have poorer conflict resolu-
tion skills, and become vulnerable to further
victimization and perpetration of violence
(Cunningham, 2003; Ehrensaft et al., 2003;
Herrenkohl, Herrenkohl, & Toedter, 1983;
Hotaling & Sugarman, 1986; Styron & Janoff
Bulman, 1997; Widom, 2000). Unfortunately,
there have been few parallel, independent inves-
tigations of adult outcomes of DV exposure. The
need for additional prospective studies of both
abuse and DV effects is clear, especially those
that extend into the adult years (Gewirtz &
Unique effects of child abuse relative to DV expo-
sure. Because DV exposure and childhood abuse
have been researched mainly as independent
risk factors (Litrownik et al., 2003; McCloskey et
al., 1995; National Research Council, 1993, 1998),
knowledge is limited as to whether they each
exert unique effects on outcomes and, if so,
whether their effects are comparable in strength.
Edleson (1999) noted that a common problem in
DV research is a tendency to draw conclusions
about the effects on children of having wit-
nessed DV when those effects may be more
directly attributable to their having been
abused. Poorly estimated and inaccurate results
are, of course, also possible if child abuse is
studied apart from co-occurring DV exposure.
In that there is considerable overlap in these
and other risk factors and environmental stres-
sors (e.g., problems within the family, poverty,
community factors), an even more comprehen-
sive approach to the study of variables—risks
and outcomes—is warranted (Buka, Stichick,
Birdthistle, & Earls, 2001; Margolin & Gordis,
Just a few studies have investigated child
abuse and DV exposure combined. One example
is McCabe et al.’s (2005) investigation of the link
between earlier abuse, DV exposure, and con-
duct disorder (CD) among adolescents served by
public service agencies. Data on lifetime abuse
(and neglect) and adolescents’ exposure to DV
were collected approximately 2 years before the
assessment of adolescent CD. The results
showed an effect on CD of maltreatment after
controlling for DV exposure and prior conduct
problems. Exposure to violence in the commu-
nity also was independently predictive of later
CD, yet DV exposure by itself was not predic-
tive. Maughan and Cicchetti (2002) also found
that co-occurring child abuse accounted for the
effect of DV exposure when considering later
conduct problems among youth.
In the Lehigh Longitudinal Study, we have
begun to explore the unique consequences of
children’s co-occurring abuse and exposure to
DV. For example, in a previously mentioned
analysis of the data, we examined the unique
and combined effects of these on later internal-
izing and externalizing behaviors measured in
adolescence (Herrenkohl & Herrenkohl, 2007).
Herrenkohl et al. / ABUSE AND DOMESTIC VIOLENCE89
Although DV exposure predicted later youth
outcomes as an indicator of general child mal-
treatment, only physical and sexual abuse were
found to have specific effects above and
beyond that general construct. However, in
another analysis of the data set, Tajima,
Herrenkohl, Huang, and Whitney (2004) found
independent effects of children’s retrospec-
tively reported exposure to DV for outcomes
that included adolescent depression, teenage
pregnancy, running away from home, high
school dropout, and criminal victimization.
Analyses in that study controlled for co-occur-
ring physical child abuse but did not examine
its specific effects.
Several other studies provide relevant find-
ings. For example, Herrera and McCloskey
(2001) found that childhood exposure to DV was
actually more important as a predictor of youth
delinquency (offending) than earlier child abuse.
Similarly, Cunningham (2003) showed that
whether an individual was directly abused as a
teenager (physically punished, hit, or slapped)
mattered less to an individual’s risk for later per-
petration of abuse than did the experience of
having witnessed violence in the home, alone or
in combination with abusive punishment.
In sum, evidence on the unique effects of DV
exposure and child abuse is mixed, although it
appears from several studies that certain out-
comes may be more strongly linked to one or
the other risk factor. One possibility is that con-
duct problems among adolescents, which often
include some form of recurrent aggression, are
more strongly linked to direct (physical) abuse
than to DV exposure. If this holds true, implica-
tions for prevention and intervention would be
worth considering. One possibility is that
programs could be tailored to the needs of
children on the basis of which form of violence
they encountered or whether they were exposed
to both child abuse and DV. For example, those
serving physically abused children might
emphasize training in social problem solving
and conflict resolution skills over other
approaches, given the strong link between
this form of intervention and reduced risk
for conduct problems in youth (Institute of
Medicine, 1994). Yet because of the high rate of
co-occurrence in abuse and DV exposure, the
feasibility of a more targeted or tailored inter-
vention approach is unclear.
Perhaps in cases in which findings across
studies are inconsistent, differences in sample
composition (e.g., targeted vs. community
samples), operational definitions of key vari-
ables, and other method effects (e.g., the use of
cross-sectional vs. longitudinal data) are at
play. In any event, further comparative analy-
ses are needed to establish the degree of over-
lap and relative strength of each as a risk factor
for later outcomes. Analyses using prospective
longitudinal data are, of course, better than
cross-sectional studies for establishing the tem-
poral ordering of variables under study. Yet
cross-sectional studies can also be of use, espe-
cially when focusing on within-time measures
of co-occurring forms of violence and the sur-
rounding context (Guterman, 2004).
Compounding effects of child abuse and a child’s
exposure to DV. Aquestion related to the topic of
independent prediction is one of compounding
effects: Is the effect of child abuse and DV expo-
sure worse in combination? On this question,
there is some evidence that children who are
exposed to DV and childhood abuse fare worse
in later life than those who experience only one
form of violence (Hughes, Parkinson, & Vargo,
1989; McCloskey et al., 1995; Wolfe, Crooks, Lee,
McIntyre-Smith, & Jaffe, 2003); this has been
termed a “double whammy” effect (Hughes
et al., 1989). In one study of children residing in
a battered women’s shelter, Hughes et al. (1989)
found that children who had witnessed violence
and had been physically abused had higher
internalizing and externalizing symptom scores
than those who had only witnessed violence.
McClosky et al. (1995) arrived at a similar con-
clusion. Felitti et al.’s (1998) cross-sectional study
of adults found that the number of serious health
risk indicators for individuals increased linearly
with their number of childhood exposures to
violence (including DV and direct abuse).
Edwards, Holden, Felitti, and Anda (2003)
described a dose-response relation between
the number of types of maltreatment and
mental health scores. In another cross-sectional
study by Graham-Bermann and Seng (2005),
analyses showed that childhood exposure to
90 TRAUMA, VIOLENCE, & ABUSE / April 2008
abuse and DV predicted child health prob-
lems above and beyond several demographic
variables, including a child’s sex, SES, and
maternal substance use.
Furthermore, Cunningham’s (2003) analysis
of data from the 1985 National Family Violence
Survey showed a compounding effect on later
risk for perpetrating abuse of an individual’s
having been physically punished and having
witnessed interparental violence. Heyman and
Slep’s (2002) analysis of these data examined
the effect of an individual’s childhood expo-
sure to family violence (direct abuse and expo-
sure to interparental violence) and his or her
current use of violence as an adult partner and
caregiver to children. For fathers and mothers
both, there was an association between having
experienced violence as children and their later
abuse of their own children. However, only for
women was there a further elevation in risk for
current abuse due to their having been exposed
to multiple versus a single form of violence.
Similar findings were shown with current part-
ner violence as an outcome. Finally, Appleyard,
Egeland, van Dulman, and Sroufe (2005) deter-
mined that children with increasing numbers
of risk factors, including abuse and exposure to
DV, exhibited more externalizing problems
than children with fewer risks overall.
The extent to which exposure to violence out-
side the home further elevates a child’s risk for
psychosocial problems beyond that associated
with violence exposure within the home is
unclear from existing research, although there is
evidence of an increasing level of risk when
children exposed to violence in the community
simultaneously encounter problems in the home
(e.g., instability, lack of safety; Gorman-Smith &
Tolan, 1998). Evidence from several studies sug-
gests that parenting behaviors can mediate the
effects of community violence exposure so that
child outcomes depend in part on the degree to
which children experience warmth and consis-
tent prosocial discipline (Margolin & Gordis,
2000). Evidence here would suggest that positive
parenting lessens the risk for adverse outcomes
for children exposed to community violence;
conceivably, then, poor and/or abusive practices
would further elevate that risk (Gorman-Smith &
Tolan, 1998; Margolin & Gordis, 2000). Indicative
also of a potential compounding effect of com-
munity violence exposure are findings from
studies that show a linear increase in the likeli-
hood and/or frequency of negative youth out-
comes with additional risk exposures (Hawkins
et al., 1998; Herrenkohl et al., 2000; Sameroff,
Bartko, Baldwin, Baldwin, & Seifer, 1998;
Sameroff, Gutman, & Peck, 2003).
Gender differences. An important and still
emerging area of research focuses on gender dif-
ferences in child outcomes of family violence,
which Widom (1998) identified as an area
largely overlooked in the family violence litera-
ture. Some have hypothesized that the conse-
quences of direct abuse for girls and boys are
expressed in different ways. For example, some
research shows that boys are more prone to
develop externalizing behaviors such as aggres-
sion, impulsivity, and defiance in response to
abuse, whereas girls are at risk for internalizing
problems, including depression, low self-confi-
dence, and social withdrawal (Widom, 1998).
However, not all findings support this pattern.
For example, several studies have failed to
detect gender differences in behaviors such as
aggression in youth previously exposed to vio-
lence (McCloskey & Lichter, 2003). Some
research suggests that boys are more sensitive
than girls to the effects of family violence,
although other research contradicts this conclu-
sion (Yates, Dodds, Sroufe, & Egeland, 2003).
Relatively few studies have examined gender
differences in the long-term outcomes of vio-
lence exposure in children. In their study of
young adults from the Dunedin Longitudinal
Study, Magdol, Moffitt, Caspi, and Silva (1998)
found that harsh discipline at ages 7 to 9
(smacking or hitting a child, hitting a child with
something, trying to frighten a child, threaten-
ing to smack or deprive a child) predicted later
partner violence perpetration and victimization
for women (at age 21). For men, however, harsh
discipline was not associated with these out-
comes, which appears inconsistent with the
internalizing–externalizing hypothesis refer-
enced above. Elsewhere, Widom (2000) found
that abuse was predictive of later alcohol prob-
lems for women but not men. Widom (1998)
found that men with histories of abuse were at
Herrenkohl et al. / ABUSE AND DOMESTIC VIOLENCE91
risk for antisocial personality disorder in adult-
hood, whereas women were not.
Heyman and Slep’s (2002) study is among
the few that have systematically investigated
gender differences in childhood exposure to
DV (interparental conflict) in particular. In that
study, women appeared more susceptible to
the effects of multiple and differing forms of
prior violence. For men, but not women, cur-
rent violence perpetration was uniquely associ-
ated with their having witnessed violence
perpetrated by their fathers toward their
mothers. For women who were not exposed to
father-to-mother abuse as children, increased
exposure to mother-to-father abuse elevated
the likelihood of their own use of violence with
their children. Although few in number, these
studies do raise the possibility that long-term
outcomes of family violence (direct abuse and
exposure to DV) differ to some degree by child
gender. However, given the inconsistencies in
measures and findings, further investigation is
Protective Factors and Resilience From
Abuse and Exposure to Violence
The final sections of this review focus on
resilience, protective factors, and processes
leading from early risk exposure to later out-
comes. Resilience refers to an end-point identi-
fication of a child’s having overcome early risk
exposure (i.e., achieved positive outcomes or
avoided negative outcomes). Protective factors
are those qualities of the individual, experi-
ences, and aspects of a child’s social environ-
ment that increase the likelihood of resilience
on the part of those exposed to earlier risks. Yet
despite long-standing interest in the topics of
resilience and protection (Gewirtz & Edleson,
2007; Kaufman & Zigler, 1989; Luthar, Cicchetti,
& Becker, 2000; Masten, Best, & Garmezy, 1990;
Rutter, 2001; Trickett, Kurtz, & Pizzigati, 2004;
Werner & Smith, 1992; Wolin & Wolin, 1993),
only a handful of well-designed studies are
Among those studies reviewed, the follow-
ing are factors that appear to protect against
the long-term effects of child abuse: high intel-
ligence on the part of a child, internal locus of
control, positive self-image or self-esteem, and
a determination to be different from one’s abu-
sive parents (Bolger & Patterson, 2001; Cicchetti,
Toth, & Rogosch, 2000; Herrenkohl, Herrenkohl,
& Egolf, 1994; Trickett et al., 2004). Evidence also
suggests that a positive relationship with a car-
ing, nonabusive adult can reduce the likelihood
for some of these negative outcomes (Lynskey &
Fergusson, 1997; Masten et al., 1990; Trickett
et al., 2004; Widom, 2001). Furthermore, Toth,
Cicchetti, and Kim (2002) found that maltreated
children who maintained higher positive per-
ceptions of their abusive mothers had fewer
internalizing and externalizing behavior prob-
lems than maltreated children with less positive
perceptions of their mothers.
In the Lehigh study, we have identified sev-
eral factors that distinguish resilient from non-
resilient adolescents raised in families in which
abuse and neglect had been present in earlier
assessments (Herrenkohl et al., 1994). For
example resilient youth were found to be of
average or above average intelligence; to have
had at least one stable caretaker present; and to
have been the victims of sporadic, but not
chronic, abusive discipline at the hands of oth-
erwise supportive parents or surrogate care-
givers. In a more recent analysis of the data,
Herrenkohl, Tajima, Whitney, and Huang
(2005) found that among abused children, hav-
ing a strong commitment to school, having
parents and peers who disapprove of antisocial
behavior, and being involved in a religious
community lowered rates of lifetime violence,
delinquency, and status offenses. As hypothe-
sized, exposure to an increasing number of
protective factors for each outcome resulted in
a stronger diminution in risk.
There have been few investigations of
resilience in children exposed only to DV or to
DV in combination with abuse (Gewirtz &
Edleson, 2007; Hughes, Graham-Bermann, &
Gruber, 2001). One relevant study by Tajima,
Herrenkohl, and Moylan (2007) found that the
association between exposure to DV and certain
adverse youth outcomes was moderated by par-
enting characteristics and adolescent peer sup-
port. For example, among youth whose mothers
were highly accepting and responsive (e.g.,
respect for child’s feelings, acceptance of the
92 TRAUMA, VIOLENCE, & ABUSE / April 2008
child for who he or she is) the relationship
between exposure to DV and risk for dropping
out of high school was reduced significantly.
Measures of adolescent peer support (i.e., peer
trust, communication, and alienation from
peers) consistently moderated the relationship
between DV exposure and later depression.
Developmental studies and mechanisms related to
the transmission of violence. Review of current
research suggests that risks and outcomes of
family violence are rarely integrated into a
developmental model, although theory may
inform hypotheses that are tested. More often,
studies of risks and outcomes unfold as empiri-
cal investigations leading to further model test-
ing and theory development. In many instances,
theory testing is not possible given a study’s
cross-sectional design and/or other limiting fea-
tures. However, the tendency to examine vari-
ables apart from theory has slowed progress
toward developing evidence-based prevention
and intervention programs because the mecha-
nisms that link risks to outcomes are unclear;
thus, targets of risk reduction are known, but
leverage points (shown in tests of mediation
and or moderation of risk factors) beyond initial
risk exposure are not.
There are a relative few studies from which to
draw implications for further theory testing and
practice. For example, Dodge, Bates, and Pettit
(1990) and Dodge and Pettit (2003) studied the
relation between child maltreatment and cogni-
tive and social processes linked to later use of
aggression and violence. They found that youth
who had been abused had a tendency to overat-
tribute hostile intentions to others and were
more likely to judge the use of their own aggres-
sion more positively. Egeland, Yates, Appleyard,
and van Dulmen (2002) found that “emotional
alienation” (the level of avoidance of the pri-
mary caregiver, a lack of trust, and low seeking
of support and guidance) was a strong mediator
of earlier abuse on later externalizing behaviors
in youth. Elsewhere, Pears and Capaldi (2001)
tested several hypotheses about potential medi-
ators of parents’ history of abuse. Although
parental psychopathology and inconsistent dis-
cipline of children were shown to predict recur-
rence of abuse in the next generation, these
variables did not fully explain the relationship
between prior and later abuse.
Studies of attachment in young children have
shown that those raised in stressful home envi-
ronments appear less able to bond to their adult
caregivers and others in the home, thereby
making them susceptible to ongoing relationship
problems (Gewirtz & Edleson, 2007). One
hypothesis is that early failed attempts at rela-
tionships increase an individual’s risk for a range
of psychosocial problems, including externaliz-
ing behaviors (including violence), recurrent
depression, and low self-esteem. In addition, cog-
nitive and social learning theory (Akers, 1985;
Bandura, 1977) has been used to explain the link
between violence exposure and later recurrence
of violence; here, violence is considered a learned
behavior, acquired through modeling and rein-
forcement of the same behavior by others (Moffitt
& Caspi, 2003; Singer et al., 1999). Skill deficits
linked to impulse control and poor emotion regu-
lation also appear to contribute to ongoing diffi-
culties in various roles and life domains (Moore
& Pepler, 1998). Finally, some research has begun
to identify neuropsychological and cognitive
impairments as mediators and moderators of
earlier childhood risks (De Bellis, 2001; De Bellis,
Keshavan, Spencer, & Hall, 2000; Dodge &
Pettit, 2003). For example De Bellis et al. (2000)
studied the effects of PTSD on neurobiological
characteristics of the brain following child
maltreatment. They compared small samples of
maltreated and nonmaltreated children, matched
on age, sex, race, pubertal development, and
SES. The results suggested that children with
PTSD following maltreatment experienced
decreased neuronal connections, which in turn
contributed to observed psychosocial and cog-
Still other hypotheses emerge from inte-
grated, social developmental perspectives. The
social development model (SDM; Catalano &
Hawkins, 1996) is one that has guided some of
our earlier work on child abuse and DV expo-
sure effects. The SDM is a theory of human
development that specifies both prosocial and
antisocial pathways linking childhood risks to
later outcomes. The theory suggests that poor
outcomes in children result from socialization
in which individuals learn, and then are reinforced
Herrenkohl et al. / ABUSE AND DOMESTIC VIOLENCE 93
94 TRAUMA, VIOLENCE, & ABUSE / April 2008
for, antisocial behavior over time. The theory
posits that when provided opportunities for
involvement within a socialization unit, when
actively involved in the socialization of that
unit, and when consistently rewarded for one’s
participation, a child will become bonded to the
unit itself and to the individuals within the
unit. Behavior will be prosocial or antisocial
depending on the beliefs and behaviors of those
to whom the individual becomes most strongly
bonded; strong bonds to prosocial others will
lessen the risk for negative outcomes, whereas
weak bonds to prosocial others will elevate the
risk. Similarly, strong bonds of attachment to
antisocial others, such as delinquent peers, will
increase the likelihood of antisocial behavior
through further modeling and reinforcement of
violence and other problem behaviors.
Consistent then with the SDM, a child from a
violent home would likely encounter fewer
opportunities for prosocial interactions in the
family—because of a high level of stress in the
family and/or a lack of emotional availability
of one or both caregivers (Holden, Stein,
Ritchie, Harris, & Jouriles, 1998)—weakening
parent–child (family) bonds. Alack of opportu-
nities for positive interactions, and exposure to
ongoing hostility among family members, may
lead a child to seek refuge outside the home,
turning to peers and others for emotional and
instrumental support and guidance. Were the
child to become bonded to peers who engaged
in antisocial behavior, he or she would encounter
further modeling and reinforcement of negative
behavior, increasing the likelihood of problems
for the child. A child who is disconnected from
his or her family might also become depressed
or withdrawn and socially isolated. Alternatively,
a child could become bonded to a caregiver
who directly models the use of violence, in
which case the relationship would have a direct
influence on the use of violence and other prob-
lems for the child. In either scenario, one would
expect the family environment to impair a
child’s ability to acquire skills necessary to form
and maintain positive relationships, solve inter-
personal conflicts, succeed academically, and
develop a sense of personal mastery and con-
trol (Rutter, 2002).
There is relatively strong evidence that the
direct abuse of children and their exposure to
DV occur together and that both increase the
likelihood of a full range of psychosocial prob-
lems for youth and young adults. The combined
effects of these and other risk factors appear to
be greater than the effect of one risk exposure
apart from the others, although research is less
clear as to how much greater or for which out-
comes a combination of risks is most detrimental.
The outcomes of several studies suggest that
family violence is likely to occur with other
risks, including parental substance use and
unemployment, financial stress on the family,
and co-occurring violence and other adverse
conditions in the surrounding community. Risks
from simultaneous exposure to community vio-
lence are an important consideration, especially
for children in areas (neighborhoods) in which
violence occurs with the greatest frequency,
such as in low-income, urban settings. Further
study of the overlap in family violence and envi-
ronmental influences is needed to more fully
understand the range and interaction of experi-
ences that produce the many adverse outcomes
documented in the literature. Well-designed
longitudinal studies of overlapping risks are
particularly well suited to this task, because
they allow direct tests and examination of the
temporal sequencing of events that characterize
a developmental chain leading to a particular
outcome. Yet more common to date are cross-
sectional and retrospective designs.
Despite the variety and number of risk factors
that many victims encounter, studies suggest that
oftentimes many children are resilient to the dele-
terious effects of violence exposure. Resilience is
likely the outcome of a child’s both having quali-
ties that are inherently protective (e.g., intelligence
and positive coping skills) and having access to
resources and networks of support that promote
and help maintain a process of healing and psy-
chological wellness (Rutter, 2001, 2002). Biological
and genetic factors may also play a role, although
research on genetic influences is relatively new
(Gewirtz & Edleson, 2007). Whether resilience
in child victims of violence exposure can be
Herrenkohl et al. / ABUSE AND DOMESTIC VIOLENCE95
promoted through planned interventions
requires further investigation, although data do
show that the prevention of adolescent problems
is possible when programs attend systematically
and comprehensively to risk and protective fac-
tors across domains of influence, including the
family and surrounding community (Institute of
• Understanding how child abuse, DV exposure, and
other factors relate to one another is an important first
step in setting the context for intervention and policy-
level change efforts to improve the lives of disadvan-
taged children and families.
• The prevention of adolescent problems is possible when
programs attend systematically (and comprehensively)
to risk and protective factors across domains of influ-
ence, including the family and surrounding community.
• More research is needed to understand the degree of
overlap and relative risk for child abuse, DV exposure,
and related factors in predicting later outcomes.
• Further study of the overlap in family violence and
environmental influences is warranted.
• Additional prospective, longitudinal studies are
needed to capture developmental changes as they
emerge in victimized children over time.
• Systematic investigations into gender differences in
long-term outcomes related to child abuse and DV are
• Researchers should consider using theoretical or con-
ceptual models to guide their research.
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