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Post-Traumatic Stress Disorder (PTSD) in Victims of Domestic Violence: A Review of the Research

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Abstract

The objectives of this research were to analyze data from literature based on studies of battered women to determine (a) the correlation of domestic violence and post-traumatic stress disorder (PTSD), (b) the best treatment strategies for PTSD, and (c) the evidence of PTSD treatment effectiveness with battered women. Findings were (a) symptoms of battered women are consistent with PTSD symptoms; (b) certain populations are at higher risk of developing PTSD symptoms; (c) intensity, duration, and perception of the battering experience is a significant factor in the severity of the PTSD symptoms; (d) demographic variables influence PTSD severity; (e) standardized PTSD assessment is needed by professionals working with women experiencing domestic violence; (f) there is a need for greater public health involvement for prevention, identification, and medical treatment of domestic violence and PTSD; and (g) certain treatment strategies are recommended for PTSD but lack rigorous testing of their efficacy.
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... One study demonstrated a clear association between the intensity of PTSD symptoms and the extent, severity, and type of DV (Jones et al., 2001). Moreover, PTSD and depressive disorders are found to be highly comorbid among DV survivors (Cascardi et al., 1999;Lipsky et al., 2001;Nixon et al., 2004;Stein & Kennedy, 2001). ...
... Increasing awareness that a primary outcome for DV survivors is PTSD has developed over the years (Golding, 1999;Hughes & Jones, 2000;Jones et al., 2001). The American women's movement in the mid-1970s generated a wealth of research on sexual assault and rape which contributed significantly to the conceptualisation of the PTSD construct (Herman, 1997). ...
... There is also a dose-response relationship between experiences of DV and PTSD, which suggests that chronic abuse could lead to devastating cumulative effects on the mental health of survivors (Jones et al., 2001). Theories of DV have emphasised the traumatic context as crucial to understanding the deleterious effects of abuse, as opposed to discrete, isolated incidents of abuse (Kaysen et al., 2003). ...
Article
The current understanding of domestic violence is largely nomothetic by design and does not adequately address the treatment and rehabilitation needs of survivors. This thesis aimed to gain a qualitative understanding of the culture-specific experiences of domestic violence in south Indian female survivors, with a focus on the treatment of posttraumatic stress disorder (PTSD), and comorbid psychopathology. An interpretative phenomenological analysis was undertaken with five south Indian women to investigate the in-depth, lived experiences of domestic violence and its mental health sequelae. Responses to, and appraisals of abuse were found to be heavily influenced by pre-abuse identity, interpersonal childhood experiences, societal perceptions of, and stigmatising attitudes towards survivors. These factors impact the experience of disclosure and help-seeking among survivors, with a clear preference for informal sources of support such as family and social care organisations. Further, the findings shed light on the experience of resisting and counteracting the abuse in this context, as well as the complex, non-linear and iterative process of leaving abusive relationships. This was found to be rooted in the sociocultural framework of Indian society, patriarchal ideologies of gender roles, and the systemic and structural disempowerment of women, perpetuating the perpetration and experience of abuse and violence. The treatment protocol examined in this thesis is Narrative Exposure Therapy (NET), which is a short-form psychotherapeutic technique originally developed for survivors of war and organised violence in low-resource contexts. The comprehensive and up-to-date meta-analysis of its current evidence base along with a quality appraisal of the trials included was conducted. The findings revealed low- to medium-quality evidence of NET efficacy for the alleviation of PTSD. High heterogeneity estimates and low powered trials significantly impact the interpretation of the pooled intervention effect estimates. This review also revealed an overreliance on randomised controlled trial findings and a paucity of idiographic research investigating change mechanisms through NET. In the final study, an inductive and deductive thematic analysis was undertaken to investigate the change mechanisms through NET for survivors of domestic violence. NET was administered to seven south Indian women and was well tolerated by the sample. Paired sample t-tests revealed a statistically significant improvement in PTSD and somatic symptoms at post-test. The raw testimony data was qualitative analysed, and a theoretically-informed framework of recovery was developed through thematic analysis to elucidate the specific processes that contribute to change and underlie improvement on symptom scores. There was evidence for several proposed mechanisms based on seminal PTSD theories, as well as some data-driven mechanisms such as positive memories and a focus on future aspirations that contributed to recovery in this sample. There are no published accounts of NET’s use or efficacy in India, and practice implications include culture-specific and stressor-specific applications of NET using the template from the recovery framework. These findings complement the limited RCT evidence of NET from an idiographic perspective. Importantly, the need to consider and explore culture- and context-specific change mechanisms is demonstrated through the framework, which found additional processes contributing to recovery in this sample. Recommendations for the adaptation of individual-focused, empirically supported treatments such as NET that are culturally sensitive and consider the complex socio-ecological milieu of the Indian context are discussed.
... Determining how to create a space that emphasizes both a sense of safety among program participants and freedom of expression at times may require prioritizing the needs of one group or individual over another. For example, women who have experienced domestic violence may feel unsafe in spaces where others are communicating in a loud manner, and individuals who experience specific mental health challenges may find it difficult to feel comfortable in a setting where there is excessive stimulation or many people (Brown et al., 2015;Jones et al., 2001). Additionally, developing and upholding boundaries that feel comfortable among program participants, and between participants and staff, can be complicated both because notions of ideal boundaries will vary from person to person, and the salience of boundaries can reinforce existing power dynamics (Coughlan et al., 2020). ...
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Contemporary United States society is marked by exacerbated economic inequity and deep sociopolitical polarization, which increases a sense of precarity among marginalized communities. There is growing need to develop and foster practices that promote care and justice for marginalized communities. Organizational settings designed with the intent of supporting marginalized communities may possess unique knowledge related to actualizing care and promoting justice. Through analysis of ethnographic field notes and qualitative interviews conducted with 22 participants at the organization, this study examines organizational policies and practices of everyday decision‐making at a drop‐in center for women and gender non‐conforming people in Washington State, USA. Findings document how policies and practices at the center promote care and justice for diverse marginalized groups. Implications for promoting equitable values in social settings more broadly are discussed.
... In addition to the injurious impacts of IPV, IPV is associated with many adverse outcomes such as mortality, disability, poor sexual, reproductive, and gastrointestinal health, chronic pain, poorer health behaviors, mental health conditions, and substance abuse [3][4][5][6][7][8][9]. IPV itself and the aforementioned consequences can be highly stressful and emotionally distressing for survivors [2,10], as evident by many studies finding IPV to be associated with increased levels of stress or distress [11][12][13][14][15][16][17][18]. Even in circumstances where the survivor has left the relationship, stress can continue or become worse via intimidation from the abuser or emotional and financial stressors related to single parenting or court proceedings, impacting many facets of life [19]. ...
Article
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PurposeWhile the association between intimate partner violence (IPV) and stress is well documented, the directionality of this relationship is unclear. We use an adjusted longitudinal study design to better understand if stressful life events in the home precipitate or exacerbate intimate partner violence (IPV) and if experiences of IPV, in turn, increase levels of perceived stress.Methods Longitudinal data were collected among married women in rural Pakistan at 12 and 24 months postpartum (N = 815). Adjusted Poisson and linear regression models were used to examine stressful life events, past year IPV and severity (number and frequency of violent acts), and perceived stress (Cohen Perceived Stress Scale).ResultsAt 12 months postpartum, the prevalence of past year physical, psychological, and sexual IPV was 8.5%, 25.7%, and 25.1%, respectively, with 42.6% experiencing any IPV. After adjustment, stressful life events were associated with a subsequent increased likelihood of all IPV types and increased severity of all but physical IPV. Any past year IPV (versus none) and greater IPV severity were associated with 3.43 (95% CI 2.33–4.52) and 2.57 (95% CI 1.87–3.27) point subsequent increases in perceived stress. Physical, psychological, and sexual IPV and their respective severities were all independently associated with increased perceived stress.Conclusions Among postpartum women in Pakistan, stressful life events increase the likelihood of IPV and, in turn, experiences of IPV increase stress levels. Support to families undergoing stressful circumstances may be critical to reducing women’s IPV exposure and resulting elevated stress.
... Current responses to IPV focus on crisis support, with less attention given to longer-term support. Many IPV victims experience PTSD, often accompanied by depression, suicidal behaviours, and substance abuse [62]. Women with long-term trauma have complex needs that require services that can provide multidisciplinary integrated responses, such as developmental-relational, cognitive-behavioural, skill-building, and strengths-based approaches [63]. ...
Preprint
Background Almost one-half of women aged 45 years or over have been victims of intimate partner violence (IPV) during their lifetime, and this proportion is likely to increase as the population ages. Women impacted by IPV related to gambling face unique challenges, yet there is a paucity of research into older women’s past experiences of gambling-related IPV. This paper explores past experiences of older women who are victim-survivors of male partner violence linked to gambling. Exploring the generational differences (cohort effects) and wider contextual differences (period effects) in which gambling-related IPV occurred offers valuable insights for services who support women impacted by this issue, and into the role of gender inequality and gambling in IPV. Methods Qualitative interviews were undertaken with 72 women as part of a larger study exploring the nature of the relationship between problem gambling and IPV. The current study analysed a subset of 22 interviews with women aged 50 years or over. We analysed the data within a gender-sensitive socio-ecological framework using an adaptive grounded theory approach. Women’s experiences are analysed in terms of cohort and period effects on their past experiences of IPV. Results Cohort effects on the women’s experiences of IPV included gendered attitudes, traditional views of marriage, silence surrounding IPV, reticence to disclose the abuse, and little understanding of problem gambling. Period effects included a lack of services for IPV and gambling, gendered service responses, and a failure of some service and institutional responses to prioritise the safety of victims. Three main areas of influence on the women’s experiences were apparent - gender inequality, tolerant attitudes towards and limited understanding of IPV, and the role of gambling in IPV. These influences reflect prevailing attitudes, systems and societal norms at the time of their victimisation. Conclusion The findings point to the critical importance of reducing gender inequality to reduce male partner violence towards women. Women impacted by gambling-related IPV, including the legacy of past abuse, need effective service responses. Service providers must recognise the many forms and patterns of abuse and understand the historical and contextual factors that underlie and exacerbate it.
... In another study, it was stated that female victims of violence did not receive social support from their family and immediate surroundings as they were ashamed of their experiences and blamed themselves for violence and did not share the events they experienced 47,48 . In addition, given the explanations remarking that women exposed to violence need to be informed about social support sources to get rid of the effects of violence and to get better and that strong social support sources are directly proportional to the strength of women 49 , it was thought that women need to be encouraged to share in order to get rid of the effects of the traumatic events and to get social support. ...
Article
BACKGROUND: The lack of studies proving the effect of Pilates exercises on mood of female victims of violence staying in women’s shelters is the reason to conduct this study. The aim of this study was to examine the effect of 8-week Pilates exercises on stress coping styles, cognitive distortions, and psychological endurance of female victims of violence staying in women’s shelters. METHODS: The purpose of the study was explained to the female victims of violence staying in women’s shelters. The Cognitive Distortions Scale, the Stress Coping Styles Scale and the Psychological Endurance Scale were administered as pretests to 22 women voluntarily participating in the study. 1.5-hour Pilates exercises were performed two days a week in a gym. The study started with 22 women and ended with the administration of the post-tests to 15 women remaining at the end of 8 weeks due to separations from women’s shelters. RESULTS: Pilates exercises were found to be significantly effective in terms of the preoccupation with danger, hopelessness, self-blame, and sense of self sub-scales of the psychological endurance and cognitive distortions scales and in terms of the submissive approach, optimistic approach and helpless approach sub-scales of the stress coping styles scale. CONCLUSIONS: It was seen that application of Pilates exercises enabled female victims of violence to cope with stress, eliminated cognitive distortions, which are the basis of many psychological problems, and increased psychological endurance. It is suggested that Pilates exercises should be applied in Women’s shelters to cope with stress and to increase psychological endurance.
... [18][19][20][21][22] Witnessing parental physical violence at home has long term adverse consequences on the physiological health of children, apart from this earlier literature asserts that verbal or emotional abuse has also some detrimental effects to increase the likeliness of depressive disorder among adolescents and adults. [23][24][25][26] However, there has been a lot of work on the association between risk factors and depressive disorder among adolescents, younger and older adult boys & girls all over India but a dearth of work has been identified specifically for the underdeveloped or backward region. Various indicators linked with region's backwardness for example poor income to resource access, poor water supply, unavailability of sanitation, housing, unemployment condition, unhealthy food and its cumulatively effect on parental mental & physical health and as a result parental factor play the key determinant role for children's mental or emotional health. ...
... [18][19][20][21][22] Witnessing parental physical violence at home has long term adverse consequences on the physiological health of children, apart from this earlier literature asserts that verbal or emotional abuse has also some detrimental effects to increase the likeliness of depressive disorder among adolescents and adults. [23][24][25][26] However, there has been a lot of work on the association between risk factors and depressive disorder among adolescents, younger and older adult boys & girls all over India but a dearth of work has been identified specifically for the underdeveloped or backward region. Various indicators linked with region's backwardness for example poor income to resource access, poor water supply, unavailability of sanitation, housing, unemployment condition, unhealthy food and its cumulatively effect on parental mental & physical health and as a result parental factor play the key determinant role for children's mental or emotional health. ...
Article
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Introduction Worldwide depression is one of the most common chronic disorder as well as mental health problems in adolescent and young adult boys & girls. In Bihar, as per the report published by population council of India namely “Understanding the lives of adolescents and young adults (UDAYA) in Bihar, India”, pointed out that more than 90% boys & girls displayed symptoms of mildly depressive disorders and nearly 15% boys and girls reported their symptom of moderate to severe depressive disorders. Objectives This current study identified the risk factors of moderate to severe depressive disorders among adolescents and young adults from Bihar, a most underdeveloped state of India. This study also to identify is there any relationship between depressive disorders and educational outcome as well as suicidal outcome of adolescents and young adults in Bihar. Methodology adopted Descriptive statistics, Logistic regression and Chi-square test were adopted to complete this study. Results The likelihood of moderate to severe depressive disorder is higher among to those adolescents or young adults who were physically punished [AOR: 1.59; P < 0.05; 95% CI: 1.48–1.71] by their parent, had no permission to disclose their opinion to the other elder member of that family [AOR: 1.41; P < 0.05; 95% CI: 1.12–1.57] and to those whose parents neglect their child to hear personal things [AOR: 1.18; P < 0.05; 95% CI: 0.96–1.31] if they want to share, studied at private school and whose mother had no educational attainment or very less.
... Therefore, more research is needed on individual differences in symptom severity and especially, symptom development in association with women's shelters residency. Women in shelters are a particular vulnerable and important group, as previous research have demonstrated greater IPV severity (Saunders, 1994) and higher risk of PTSD (Jones et al., 2001), compared with IPV exposed women in the general community. Furthermore, the ICD-11 will come into effect in 2022 and introduce the new Complex-PTSD diagnosis (C-PTSD). ...
Article
Background: To protect women from Intimate partner violence (IPV), women's shelters should not only provide emergency safety from IPV exposure, but also prolonged support that empowers women to build a life free from violence. The present study aims to investigate individual symptom development in association with residency at a women's shelter. Method: Data were collected at four different timepoints, that is, enrolment (T1, N = 150), 3-months residency (T2, = 110), 6-months residency (T3, N = 68) and after relocation (T4, N = 63). Women were included from four Danish women's shelters. The International Trauma Questionnaire (ITQ) was applied to test for post-traumatic stress disorder (PTSD) and Complex-PTSD (C-PTSD) at all timepoints. A paired sample t-test was used to test the mean symptom development, and a Latent Class Growth Analysis (LCGA) was applied to test for different classes of PTSD-trajectories. Logistic regression was applied to predict class membership from shelter-related variables and symptom severity, that is, length of residency, psychological counselling, revictimization and key symptoms of C-PTSD. Results: The prevalence of PTSD (31%) and C-PTSD (37.9%) was high at enrolment. Although t-tests suggested a significant decline in symptoms at follow-up, the LCGA revealed different classes of symptom development. The two-class model was found to be the best representation of data with low-symptom- and high-symptom profiles, respectively. Overall, the largest decline in symptoms occurred within the first 3 months of residency. Revictimization was high and was further found to predict class membership. However, when included in a multiple regression only symptom severity predicted the high-symptoms profile class. Discussion: Psychological treatment focussing on PTSD and C-PTSD is important for the women's future well-being and safety. Reports on revictimization was alarmingly high, which emphasises a continuing need to protect women from psychological violence within the shelters. These findings should be replicated in larger samples before we can draw any conclusion.
Article
Previous research has not assessed the association between intimate partner violence (IPV) and disordered eating (DE), nor the potential indirect effect through posttraumatic stress disorder (PTSD) symptoms, among residents of IPV shelters. Among 212 IPV survivors, this study examined these and the differential associations by PTSD symptom cluster and types of DE. In the current sample, 67.9% met criteria for probable PTSD, 20.3% met criteria for a probable eating disorder, and 18.4% had probable comorbid diagnoses. Consistent with escape theory, there was an indirect effect of IPV on DE through PTSD symptoms. Additionally, there was an indirect effect of IPV on weight/shape concerns and binge symptoms through PTSD symptoms. Although there was a significant total effect of IPV on compensatory behaviors, there was no indirect effect through PTSD symptoms. When PTSD symptom clusters were examined concurrently, the only indirect effect of IPV on weight/shape concerns was via the PTSD symptom cluster of negative alterations in cognition and mood. Although there was an indirect effect of IPV on binge symptoms via PTSD symptoms overall, no specific PTSD symptom cluster drove this association. Implications highlight the need for attention to DE within this population. Consistent with escape theory, survivors' DE might serve to distract from psychological distress.
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Eighty four abused women seeking therapy with their husbands were accepted into a group treatment program for spouse abuse. In the current study, we evaluated the treatment outcome of those women (n = 27) diagnosed with Posttraumatic Stress Disorder (PTSD). PTSD diagnosis, itself, did not differentiate those women who dropped out of treatment. Results indicated, however, that across all women, avoidance symptomatology significantly differentiated treatment completers from dropouts. Although women with PTSD began treatment in worse condition (lower marital satisfaction, higher depressive symptomatology, greater fear of spouse), post-assessment revealed they achieved positive treatment gains parallel to those of women without PTSD. Women with PTSD improved on each outcome variable measured, including a reduction in fear of spouse. Women with PTSD also did not differentially drop out of either treatment condition (men's/women's versus conjoint groups) which lends support to the appropriateness of conjoint treatment for spouse abuse.
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This study investigated the type, severity, and frequency of Posttraumatic Stress Disorder (PTSD) symptoms experienced by battered women prior to killing male partners. Eighteen women were assessed for frequency and severity of lifetime PTSD symptoms and type of abuse endured. Correlations were performed between clusters of PTSD symptoms and composites of violent experiences. It was found that before killing male partners, these battered women suffered moderate to high levels of PTSD symptom frequency and severity, except for an inability to recall important aspects of the trauma. Significant canonical correlations were found between the frequency and severity of PTSD symptoms and the severity of types of abuses inflicted.
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Fifteen women who had sought refuge from domestic violence were studied with a view to listing information about the nature of the violence experienced, the coping strategies and the psychological and social consequences of such violence. Compared with non-abused women the subjects were found to have lower self-esteem, higher rates of depression, generalized anxiety and fearfulness, increased stress-related symptoms, irritability and suicidal ideation. The level of psychosocial and behavioural disturbance in the women who had been battered was not present in a comparison group of non-abused women.