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Same-Sex Domestic Violence: Prevalence, Unique Aspects, and Clinical Implications

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Abstract Domestic violence (DV) is a significant public health issue. Prevalence rates for same-sex DV (SSDV) vary due to methodological issues related to recruitment and definitions of sexual orientation, but are currently considered to be similar to slightly greater than other-sex (OSDV) rates. Research has identified differences between SSDV and OSDV, including internalized and externalized stressors associated with being a sexual minority that interact with DV to create or exacerbate vulnerabilities, higher risk for complex trauma experiences, and difficulties accessing services. This review provides a critical review of the literature, focusing upon empirical findings regarding SSDV.
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Same-Sex Domestic Violence:
Prevalence, Unique Aspects, and Clinical
Implications
Colleen Stiles-Shieldsa & Richard A. Carrollb
a Department of Preventive Medicine and Center for Behavioral
Intervention Technologies, Northwestern University Feinberg School
of Medicine, Chicago, Illinois, USA
b Department of Psychiatry and Behavioral Sciences, Northwestern
University Feinberg School of Medicine, Chicago, Illinois, USA
Accepted author version posted online: 04 Sep 2014.Published
online: 10 Oct 2014.
To cite this article: Colleen Stiles-Shields & Richard A. Carroll (2014): Same-Sex Domestic Violence:
Prevalence, Unique Aspects, and Clinical Implications, Journal of Sex & Marital Therapy, DOI:
10.1080/0092623X.2014.958792
To link to this article: http://dx.doi.org/10.1080/0092623X.2014.958792
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JOURNAL OF SEX & MARITAL THERAPY, 0(0), 1–13, 2014
Copyright C
Taylor & Francis Group, LLC
ISSN: 0092-623X print / 1521-0715 online
DOI: 10.1080/0092623X.2014.958792
Same-Sex Domestic Violence: Prevalence, Unique Aspects,
and Clinical Implications
Colleen Stiles-Shields
Department of Preventive Medicine and Center for Behavioral Intervention Technologies,
Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Richard A. Carroll
Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School
of Medicine, Chicago, Illinois, USA
Domestic violence is a significant public health issue. Prevalence rates for same-sex domestic violence
vary because of methodological issues related to recruitment and definitions of sexual orientation.
However, such prevalence rates are currently considered to be similar to slightly greater than other-
sex prevalence rates. Research has identified differences between same-sex domestic violence and
other-sex domestic violence, including internalized and externalized stressors associated with being a
sexual minority that interact with domestic violence to create or exacerbate vulnerabilities, higher risk
for complex trauma experiences, and difficulties accessing services. This review provides a critical
review of the literature, focusing upon empirical findings regarding same-sex domestic violence.
Domestic violence is an international public health issue that affects millions of individuals
annually (Tjaden & Thoennes, 2000a). Domestic violence, also referred to as intimate partner
violence, refers to physical, sexual, or psychological harm occurring between current or former
intimate partners. The Centers for Disease Control and Prevention identify four main types of
domestic violence: (a) physical violence, the intentional use of physical force with the potential
of harm; (b) sexual violence, the intentional use of physical means to force a person to engage in
a sexual act against his or her will; (c) threats of physical or sexual violence; and (d) emotional
or psychological violence, including stalking (Saltzman, Fanslow, McMahon, & Shelley, 2002).
While domestic violence has been ubiquitous throughout history, empirical research involving
domestic violence began only in the 1970s in response to the emergence of the women’s movement
(Tjaden & Thoennes, 2000b). The primary focus of research has been female subjects reporting
abuse from a male partner, hereafter referred to as other-sex domestic violence (OSDV). This
initial focus of research is historically cited as a primary explanation for the dearth of data
regarding same-sex domestic violence (SSDV; Murray & Mobley, 2009). The movement was
Address correspondence to Colleen Stiles-Shields, Department of Preventive Medicine and Center for Behavioral
Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10-115C,
Chicago, IL 60611, USA. E-mail: colleenss@u.northwestern.edu
Downloaded by [University of Chicago Library] at 06:55 15 October 2014
2STILES-SHIELDS AND CARROLL
originally referred to as the “battered women’s movement” and has perpetuated beliefs that
violence committed by men against their female partners is more serious than domestic violence
in same-sex pairings (Poorman, Seelau, & Seelau, 2003). Research involving SSDV began in 1978
and expanded in the late 1980s; however, a number of methodological issues have contributed to
a shortage of data (L. K. Burke & Follingstad, 1999).
Past reviews of literature involving SSDV include (a) a focus on the effect of domestic violence
on men, with an inclusion of SSDV (Randle & Graham, 2011); (b) counselor’s attitudes toward
SSDV (Banks & Fedewa, 2012); (c) the social context of SSDV (Murray et al., 2007); and
(d) reviews of empirical studies involving SSDV (L. K. Burke & Follingstad, 1999; Murray &
Mobley, 2009). To our knowledge, there is not a complete and current review of the unique
population needs and clinical implications of SSDV. In this review, the prevalence and predictors
of violence in same-sex dyads will be explored, followed by differences between OSDV and
SSDV as well as differences in lesbian and gay SSDV, barriers to service access, and clinical
implications of SSDV.
A systematic literature search was conducted to examine the current body of evidence related
to SSDV. The MEDLINE/PubMed and PsycINFO abstract databases were searched from January
1, 1998, to March 1, 2014. For both database searches, six main search components (same-sex
domestic violence, same-sex interpersonal violence, review of literature, gay, lesbian, clinical
interventions) were created by combining subject headings with the “AND” or “OR” operators.
Relevance was determined by screening titles and abstracts, and reference lists of relevant articles
were screened for further potentially relevant studies.
PREVALENCE OF SAME-SEX DOMESTIC VIOLENCE
A major limitation of the research literature is that prevalence rates of domestic violence are
generally reported without defining the sexual orientation of the sample and are therefore assumed
to be OSDV rates (L. K. Burke & Follingstad, 1999; Murray & Mobley, 2009). The National
Institute of Justice and the Centers for Disease Control and Prevention report that from a sample
of 16,000 men and women, 25% of the women had been raped or physically assaulted by an
intimate partner, and 7.6% of men reported the same experiences. From their estimates, about 1.5
million women and 834,732 men are annually raped and/or physically assaulted by an intimate
partner in the United States. In addition, approximately 503,485 women and 185,496 men are
stalked by intimate partner annually in the United States (Tjaden & Thoennes, 2000a). Given
these statistics, it is estimated that one in four heterosexual women will experience OSDV in her
lifetime (Tjaden & Thoennes, 2000a).
Past Prevalence Rates
Prevalence rates of SSDV demonstrate great variability and have been described as lower, equal,
or higher than OSDV rates (Blosnich & Bossarte, 2009; Carvalho, Lewis, Derglega, Winstead,
& Viggiano, 2011; Goldberg & Meyer, 2012; Halpern, Young, Waller, Martin, & Kupper, 2004;
Messinger, 2011; Murray & Mobley, 2009; Rothman, Exner, & Baughman, 2011; Stephenson,
Khoropur & Sullivan, 2010; Tjaden & Thoennes, 2000a, 2000b). L. K. Burke and Follingstad
(1999) reviewed 19 studies for the prevalence of physical violence in same-sex relationships and
found that prevalence rates for SSDV were higher than OSDV rates. Their review also indicated
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SAME-SEX DOMESTIC VIOLENCE 3
that lesbians and gay men are equally likely to abuse their partners as their heterosexual male
counterparts and that risks markers and correlates of SSDV are similar to OSDV (L. K. Burke
& Follingstad, 1999). Murray and colleagues (2009) found that SSDV occurs in one quarter to
one half of same-sex relationships, equaling OSDV rates. Their review indicated that 22–46%
of lesbians and 22% gay men have experienced physical abuse; 52% of a mixed sample (gay
men and lesbians) experienced sexual manipulation; 7–55% of lesbians have experienced sexual
abuse; and nearly one third of lesbians and gay men experienced psychological or emotional
abuse (Murray et al., 2007). Both reviews argue that methodological issues may affect reported
prevalence, such that SSDV may be more pervasive than indicated by the rates.
Current Prevalence Rates
Table 1 displays studies that have evaluated the prevalence rates of SSDV in the time since the
publication of past reviews (L. K. Burke & Follingstad, 1999; Murray & Mobley, 2009). As
evidenced by the presented studies of SSDV, variance in sampling methods and inconsistent
definitions of sexual orientation, relationship status, and domestic violence continue to appear in
the current literature. These methodological issues make it unclear if the presented rates are truly
representative of the current prevalence of SSDV.
Logistic regressions performed as part of a secondary data analysis of the National Vio-
lence Against Women Survey (N=14,182), indicate that SSDV rates are twice that of OSDV
(Messinger, 2011). Using nonprobability sampling, lesbian, gay, and bisexual (LGB) individuals
in this sample were at increased risk for all types of SSDV. Bivariate analyses indicated that
bisexual respondents were more likely to be victimized than heterosexual or gay counterparts. In
addition, gay men were at greater risk of experiencing all types of SSDV—with the exception of
sexual domestic violence—than were their lesbian counterparts (Messinger, 2011). Differences
in the prevalence of sexual SSDV by gender are supported by a survey of 5,602 men who have sex
with men (MSM), which indicated that 4% experienced coerced sex; a rate lower than previously
reported for this population (Stephenson et al., 2010). However, a surveyed sample of 7,998 (173
victims of SSDV) indicated no differences in type of physical or sexual victimization for men
experiencing SSDV and OSDV (Blosnich & Bossarte, 2009). Inconsistencies in prevalence rates
for SSDV, as well as the types of domestic violence experienced by group, are evident in the cur-
rent literature. Taken together, the recent empirical evidence since the publication of past reviews
indicates that SSDV affects one quarter to nearly three quarters of LGB individuals (Blosnich
& Bossarte, 2009; Carvalho, Lewis, Derlega, Winstead, & Viggiano, 2011; Messinger, 2011;
Stephenson et al., 2010). These prevalence rates are similar to slightly greater than OSDV rates.
PREDICTORS OF SAME-SEX DOMESTIC VIOLENCE
While much of the literature regarding predictors of violence is related to OSDV, a few charac-
teristics and behaviors have been identified as predictors of SSDV. Substance and alcohol abuse
have been identified as risk factors for all types of domestic violence (Riggs, Caulfield, & Street,
2000). Alcohol and substance abuse are a salient factor in SSDV, given that LGB individuals have
been found to abuse these at higher rates than heterosexuals (Bradford, Ryan, & Rothblum, 1994),
particularly when experiencing discrimination for sexual minority status (Bimbi, Palmadessa, &
Parsons, 2008; McCabe, Bostwick, Hughes, West, & Boyd, 2010; McCabe, West, Hughes, &
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TABLE 1
Summary of Recent Studies on Same-Sex Domestic Violence Prevalence Rates
Sex Definition of sexual
Study Sample size Age (% female) Race (%) orientation Definition of violence Prevalence findings
Blosnich &
Bossarte
(2009)
Total: 7998
SSDV: 173
OSDV: 7825
NR NR NR “Same-sex couples were
identified by matching
the respondent’s sex
with the identified sex
of the perpetrator”
“ . . . Victimization included
lifetime verbal abuse, physical
violence, and unwanted sexual
intercourse”
SSDV male victims more
likely to experience verbal
abuse than OSDV male
victims; same types of DV
reported for SSDV and
OSDV female victims
Stephenson
et al.
(2010)
Total: 5,602 18–24: 68.07%
25–29: 20.84%
30–35: 11.09%
0% White: 64.67%
Hispanic: 37.47%
African American: 14.86%
“Reported at least one
male sex partner in the
last 12 months”
“In the last 12 months has any
partner been physically violent
to you? This includes pushing,
holding you down, hitting you
with his fist, kicking,
attempting to strangle,
attacking with a knife, gun, or
other weapon?” and “In the
last 12 month has any partner
ever forced you to have sex
when you were unwilling?”
(Yes/No)
11.8% reported physical
violence from a current
partner; 4% reported
experiencing coerced sex;
7% reported perpetrating
physical violence
Messinger
(2011)
Total: 16,000
SS: 144
OS: 14,038
45.14 ±15.16 51.17% White: 85.43%
Hispanic: 1.38%
African American: 7.70%
Asian: 1.43
Multiple races: 2.09%
Native American/Native
Alaskan: 0.98%
“The variable is coded 1,
heterosexual, if the
respondent only has an
opposite-sex
relationship history,
anditiscoded0,GLB,
if the respondent had at
least one same-sex
relationship, thus a
merging of
behaviorally ‘gay’ and
‘bisexual’ respondents”
Verbal: “verbal tactics that hurt,
humiliate, or isolate one’s
partner”
Controlling: “attempts to control
a partner’s thoughts and
actions”
Physical: “physical attacks or
threats of physical attacks
against one’s partner”
Sexual: “when one completes or
attempts to complete oral, anal,
or vaginal penetration through
force of threat of force”
Regardless of sex, SSDV is
twice as prevalent than
OSDV; bisexual
respondents more likely to
be victimized than
heterosexual or gay
counterparts; gay men at
greater risk of experiencing
all types of SSDV, except
sexual DV, than lesbians
Carvahlo
et al.
(2011)
SSDV: 102
OSDV: 38
Both: 36
NR 45.09% White: 79% “Gay men and lesbians
who were recruited to
participate in a study on
‘gay men’s and
lesbians’ beliefs,
attitudes, and opinions
about oneself and
others”
“Have you ever been a victim of
domestic violence?” and
“Have you ever been a
perpetrator of domestic
violence?” (yes/no)
One fourth of participants
reported being victims of
SSDV; just under 10%
reported perpetrating
SSDV; no difference in the
proportion of gay men and
lesbians who reported
SSDV
Note. SSDV =same-sex domestic violence; OSDV =other sex domestic violence; SS =same sex; OS =other sex; NR =not reported or means not reported for
entire sample.
4
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SAME-SEX DOMESTIC VIOLENCE 5
Boyd, 2013). Research related to substance and alcohol abuse and SSDV suggests that substance
and alcohol abuse may serve as: (1) precipitating factors for violence (Fortunata & Kohn, 2003);
(2) coping mechanisms following violence (Klitzman, Greenberg, Pollack, & Dolezal, 2002); or
(3) a factor not directly related to violence, as the violence occurs with or without the presence
of substance or alcohol abuse (Cruz & Peralta, 2001; Murray et al., 2007). Further research is
needed to better understand the role of substance and alcohol abuse in SSDV.
Psychological factors have also been identified as predictors of violence in a relationship (Riggs
et al., 2000). Insecure attachment styles have been frequently cited as a risk factor for the perpetra-
tion of SSDV, such that one partner may be more vulnerable to utilizing violence in a relationship
when perceiving a lack of power and control following threats to the relationship (Dutton, 1998;
Klinger, 1995; Lockhart, White, Causby, & Isaac, 1994; McKenry, Serovich, Mason, & Mosack,
2006; Renzetti, 1992). Depression, anxiety, and post-traumatic stress disorder (PTSD) have been
identified as increasing risk for perpetration and victimization of SSDV (Ferraro & Johnson,
1983; McKenry et al., 2006; Tech & Lindquist, 1984; Trevillion, Oram, Feder, & Howard, 2012).
The predictive power of PTSD, specifically, may interact with past exposure to violence. Family-
of-origin violence has been cited as occurring at equal or greater frequency for victims and perpe-
trators of SSDV, compared with OSDV peers (Craft & Serovich, 2005; Farley, 1996; Fortunata &
Kohn, 2003; Murray et al., 2007). In summary, the presence of insecure attachment, depression,
anxiety, PTSD, and exposure to familial violence all appear to increase the risk for SSDV.
Individuals with HIV-positive status have been suggested to be at increased risk for SSDV
involvement, and victims of SSDV are at an increased risk for HIV infection (T. W. Burke &
Owen, 2006; Craft & Serovich, 2005; Heintz & Melendez, 2006; Murray et al., 2007; Siemieniuk,
Krentz, Gish, & Gill, 2010). Further research regarding the relations among SSDV, sexual risk
behaviors, and HIV-status has been conducted, with a primary focus on convenience samples of
men who have sex with men (MSM). Young MSM account for nearly 70% of all new HIV/AIDS
diagnoses among all American adolescents and young adults (Centers for Disease Control and
Prevention, 2010). SSDV has emerged as a predictor of increased risk for HIV infection in
MSM literature because of its connection to engaging in risky sexual behaviors. Two studies
found that history of sexual or physical violence victimization perpetrated by a family-of-origin
and/or partner increased the risk of sexual risk behaviors for young MSM (Braitstein et al., 2006;
Koblin et al., 2006). SSDV has also been included as one of many co-occurring epidemics of
psychosocial health problems for young MSM that magnify risk for HIV (Mustanski et al., 2007).
More recently, 122 young MSM were assessed at three time points over 18 months to explore
the effects of relationship and partner characteristics on the frequency of unprotected sex. Across
casual and serious relationships, feeling physically or verbally pressured to have sex and being the
recipient of physical violence and aggression were significantly associated with higher rates of
unprotected sex (Mustanski et al., 2011). A relation among HIV status, sexual risk behaviors, and
SSDV appears to exist, yet requires more research, particularly with more representative samples.
DIFFERENCES BETWEEN OTHER-SEX AND SAME-SEX DOMESTIC
VIOLENCE
While many similarities exist in the experience of victims and survivors of OSDV and SSDV,
research on SSDV indicates that its victims, as part of a marginalized sexual minority, are sub-
jected to unique stressors (Meyer, 2003). These stressors are experienced in the context of the
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6STILES-SHIELDS AND CARROLL
minority stress model, which includes internalized stressors, such as perceived discrimination and
internalized homonegativity; and externalized stressors, such as: experiences of violence, harass-
ment, and discrimination. These stressors interact with domestic violence to create or exacerbate
vulnerabilities for those experiencing SSDV not necessarily matched by their OSDV counterparts.
Sexual minority status may also exacerbate the feelings of isolation and helplessness frequently
experienced by victims of domestic violence. SSDV has been referred to as the “double closet”
as a victim seeking aid would have to disclose not only the experience of domestic violence but
also his or her sexual orientation (Kaschak, 2001; McClennen, 2005). Those who have concealed
or are questioning their sexual orientation may have trouble reaching out to friends and family for
support or alternative housing, as doing so would likely entail disclosure of a relationship with a
same-sex partner (Allen & Leventhal, 1999). Others may not want to disclose the relationship as
they are still questioning their sexuality or identify their sexual orientation as part of a spectrum,
rather than through the dichotomy of gay or heterosexual. In addition, a partner may threaten to
reveal the sexual orientation of the victim to a family member, employer, or others to prevent the
victim from reporting the abuse or seeking aid (Carvalho et al., 2011). Concealment of sexual
identity may be related to internalized homonegativity for both perpetrators and victims of SSDV.
Perpetrators may project their negative self-concept through violent acts towards their gay or
lesbian partners. In a sample of 581 LGB individuals, expectations of experiencing prejudice
and/or discrimination were significantly related to SSDV perpetration (Carvalho et al., 2011).
Conversely, internalized homonegativity affects victims such that they may view their sexual
orientation as a reason to “deserve” the abuse. In a sample of 272 lesbians and bisexual women,
bivariate analyses indicated that both SSDV perpetration and victimization were associated with
the minority stress variables of internalized homophobia and discrimination. In addition, path
analysis indicated that self-reported relationship quality fully mediated the relation between
minority stress and recent SSDV (Balsam & Szymanski, 2005).
Sexual minority status may also make those involved in SSDV more likely to experience com-
plex trauma. Complex trauma, the experience of multiple and cumulative forms of interpersonal
violence (Cortois, 2004), affects how a person experiences and interacts with his or her environ-
ment and also has important treatment implications (Pearlman & Courtois, 2005). As previously
noted, family-of-origin violence have been cited as occurring at equal or greater frequency for vic-
tims and perpetrators of SSDV, compared with OSDV peers (Craft & Serovich, 2005; Farley, 1996;
Fortunata & Kohn, 2003; Murray et al., 2007). Bullying and other forms of violence from peers,
particularly in school settings, have also been noted in the literature as a frequent early trauma
experience for LGB youth (Mishna, Newman, Daley, & Solomon, 2009). Insidious trauma, het-
erosexist experiences ranging from hate crime victimization to general discrimination, including
not having the right to marry in some states, has also been implicated in the formation of complex
trauma for victims of SSDV (Szymanski & Balsam, 2010). In working with clients that have ex-
perienced SSDV, it is likely that other traumatic experiences may influence the experience of the
current violence and should therefore be fully assessed and incorporated into the treatment plan.
DIFFERENCES BETWEEN LESBIAN AND GAY DOMESTIC VIOLENCE
Much as there are similarities in the experiences of OSDV and SSDV victims, similarities also
exist between lesbian and gay victims. However, the literature does highlight some key differences
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SAME-SEX DOMESTIC VIOLENCE 7
in experience for these two populations. More SSDV research has involved lesbians (female same-
sex domestic violence) than gay men (male same-sex domestic violence). It has been postulated
that lesbian victims more closely align to the underlying feminist paradigm that propelled the
domestic violence movement, that is, patriarchy and sexism are root causes of violence towards
women in relationships (Murray & Mobley, 2009). In this framework, men experiencing SSDV
have had a greater difficulty overcoming the heterosexual paradigm that has defined the history of
the domestic violence movement. A man is expected to be able to defend himself against another
man, otherwise he is considered “weak” and less masculine (Murray et al., 2007).
Bidirectionality of violence in male SSDV is frequently cited in qualitative interviews with
participants, who may identify as having a history of being both a victim and perpetrator
(Bartholomew, Regan, Oram, & White, 2008; Stanley, Bartholomew, Taylor, Oram, & Landolt,
2006). Similar to OSDV, correlates of bidirectional SSDV were income, education, and attach-
ment style in a sample of 186 men; however correlates of bidirectional abuse unique to male SSDV
were HIV status and public outness, such that those with an HIV-positive status or those that were
out to less people were more likely to experience bidirectional abuse (Bartholomew et al., 2008).
The dual identity as perpetrator and victim in bidirectionality of violence may reflect the violation
of stereotypical gender norms assumed by the heterosexual paradigm involved in domestic vio-
lence: if a man cannot defend himself against another man, he is weak; if he fights back, he is no
longer a victim but may be viewed as a perpetrator (Murray et al., 2007). Another common theme
of the male SSDV literature is the reported experience of multiple forms of abuse (e.g., emotional,
physical; Bartholomew, Regan, White, & Oram, 2008; Houston & McKirnan, 2007). As much of
the male SSDV data has been gathered through surveys and health-related questionnaires, a need
for more qualitative research regarding the psychological effects of male SSDV is also frequently
highlighted in this literature. (Hester & Donovan, 2009; Randle & Graham, 2011).
In the female SSDV literature, a common theme is the contributory effect of lesbian fusion on
violence. Waldner-Haugrud, Gratch, and Magruder (1997) defined lesbian fusion as “the tendency
for lesbian couples to withdraw from the community, and become socially isolated and fused
within the relationship unit” (p.180). Higher likelihood of physical aggression has been associated
with participants reporting higher levels of fusion to the relationship in combination with a partner
being identified as controlling (Miller, Greene, Causby, White, & Lockhart, 2001). Other common
themes for female SSDV include unique challenges of mothers seeking assistance from female
SSDV (Hardesty, Oswald, Khaw, & Fonseca, 2011) and the violation of gender norms. Counter
to the violation of stereotypical gender norms assigned to victims of male SSDV, perpetrators of
female SSDV are considered to be unnatural and violate the stereotype of women being passive,
caretaking, and nurturing (Hassouneh & Glass, 2008).
OBSTACLES IN ACCESSING SERVICES
Seeking shelter is difficult for SSDV victims as they tend serve individuals by gender. In a same-
sex dyad, both victim and perpetrator could be given access to shelter services at the same time.
Therefore, a victim of SSDV would not be provided the guarantee of safe haven without being
pursued by his or her abusive partner. In addition, as most shelters were created with the intent of
serving female OSDV victims, shelters serving male victims are very limited (Merrill & Wolfe,
2000).
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8STILES-SHIELDS AND CARROLL
In addition to the significant barriers also reported by OSDV victims in accessing services
and seeking action through the legal system, victims of SSDV report exacerbated discrimination
and limits to their legal rights (Elliot, 1996; Kingsnorth & Macintosh, 2006; Potoczniak, Mourot,
Crosbie-Burnett, & Potoczniak, 2003; Seelau, Seelau, & Poorman, 2003). Several states omit
SSDV language in their domestic violence statutes and some deny the right to apply for a
protective order against a same-sex partner (T. W. Burke, Jordan, & Owen, 2002; Murray et al.,
2007; Potoczniak et al., 2003). Despite the United States Supreme Court deeming sodomy laws
unconstitutional in 2003, many states continued to enforce them beyond this ruling (Murray
et al., 2007). Male victims of SSDV in such states have had a history of having to admit to
criminal behavior prior to receiving assistance or legal protection. In addition, the nature of the
relationship in same-sex partnerships is often minimized, misinterpreted, or negated by the legal
system, typically upon the first encounter with law enforcement personnel. Training on issues
specific to SSDV is often not as readily available for law enforcement as it is for OSDV (Tesch,
Bekerian, English, & Harrington, 2010). Victims of SSDV also report a reluctance to initiate
reporting violence to police due to a precedent of oppression from law enforcement and the legal
system (Murray et al., 2007).
Another complication that occurs for individuals seeking services for SSDV is the concept
of mutual battering. Mutual battering is defined as a situation in which both partners contribute
equally to violence in an intimate relationship (Peterman & Dixon, 2003). It has been established
in the literature that there are subsets of lesbians and gay men involved in SSDV that identify as
victims that fight back with the intent of hurt (Carvalho et al., 2011; Marrujo & Kreger, 1996).
While this occurrence within OSDV is typically viewed as a female victim defending herself from
an abusive, more physically powerful male partner, within SSDV it is often mislabeled as mutual
battering rather than a form of self-defense (Peterman & Dixon, 2003). Within such a view, it
is difficult for law enforcement to clearly identify a victim and perpetrator. For this reason, law
enforcement is sometimes hesitant to intervene during an SSDV call.
CLINICAL IMPLICATIONS
Outcomes related to clinical interventions for SSDV are sparse in the literature. Despite this
gap in the literature, clinical guidelines adapted from OSDV therapeutic interventions have been
proposed for working with clients affected by SSDV (Murray et al., 2007). While initial data
suggest that graduate coursework directly related to work with LGB clients improves clinical
competency and self-efficacy in issues related to this population, such courses are not required in
order to practice as a clinician (Bidell, 2012). Even if LGB affirmative practice is not a required
aspect of clinical training, clinicians who provide individual or couples therapy have an ethical
obligation to become informed about OSDV, SSDV, and appropriate screening and treatment
options (American Psychological Association, 2010). The limited research that has investigated
the therapeutic experience of clients that are LGB and report domestic violence to clinicians has
indicated deficits in clinical practice for SSDV. Qualitative data indicate that clinicians misunder-
stand control tactics used by SSDV partners, make the victim feel responsible for the abuse, or
minimize the violence reported (Bornstein, Fawcett, Sullivan, Senturia, & Shiu-Thornton, 2006).
In response to this gap in the literature, Ard and Makadon (2011) developed suggested
steps to address SSDV with LGB patients seeking medical care. These steps cover clinical,
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SAME-SEX DOMESTIC VIOLENCE 9
institutional/community, educational, and research domains that require changes to address
SSDV (Ard & Makadon, 2011). These steps include using LGB affirmative assessments for a
general population (e.g., “Inquire about sexual behavior and desire in a non-judgmental manner
during the clinical history-taking of all patients; do not assume heterosexuality”) and initiatives
to increase systemic attention to the needs of individuals affected by SSDV (e.g., “advocate
for the full inclusion of LGB individuals in institutional and community [domestic violence]
services, such as hospital abuse programs and community shelters”; Ard & Makadon, 2011,
p. 631). Such efforts can be adapted for clinicians, particularly those in the mental health
field, through altering the steps to reflect the ongoing frequency with which clinicians work
with patients and the psychoeducation regarding emotional needs that are not covered in the
steps suggested for medical professionals. These additions include maintaining current referrals
for support and service resources, establishing an understanding of the unique stressors and
relational dynamics of being involved in SSDV, using assessment and treatment materials that
use LGB-affirmative language, and competency in providing psychoeducation regarding the
experience of SSDV. Clinicians have the opportunity and responsibility to develop, evaluate,
and disseminate LGB-affirmative assessments, interventions, and measures of prevention for
SSDV.
CONCLUSION
This review provided a critical overview of the literature regarding SSDV. Current prevalence
rates of SSDV are considered similar to slightly higher than OSDV rates, with the exception
of a secondary data analysis indicating SSDV rates as double that of OSDV (Messinger, 2011).
Research has identified unique needs of LGB individuals affected by SSDV, including internalized
and externalized stressors associated with being a sexual minority that interact with domestic
violence to create or exacerbate vulnerabilities, higher risk for complex trauma experiences, and
difficulties accessing services.
Despite calls for changes in how SSDV prevalence rates are studied (L. K. Burke & Follingstad,
1999; Messinger, 2011; Murray & Mobley, 2009), many methodological issues remain. The
limited research that has investigated SSDV has primarily focused upon lesbians, frequently to
the exclusion of individuals identifying as bisexual, as well as gay men (Balsam, Rothblum, &
Beauchaine, 2005; Randle & Graham, 2011). Difficulties in recruiting representative samples
are also frequently observed. Stigma associated with both sexual minority status and domestic
violence has been highlighted as a possible barrier to reporting violence (T. W. Burke et al.,
2002). Many researchers work with convenience samples recruited through LGB publications,
organizations, and events, which may yield a skewed sample of individuals who more open about
their sexuality (Murray, Mobley, Buford, & Seaman-DeJohn, 2007). In addition, a consistent
definition of SSDV is not evident in the literature, which complicates comparisons of findings
across studies (Murray et al., 2007). Perpetrator and victim roles are either not assigned or are
considered mutually exclusive. Without understanding respondents’ roles in the SSDV reported,
it is possible that overall rates are affected. Different from OSDV, if prevalence data are collected
from women or men only, a respondent’s partner may also have been sampled. Such an instance
would incorrectly inflate the sampled prevalence rate. Also, prevalence of SSDV is often conflated
with family-of-origin abuse and/or assaults from peers related to stigma. A focus on child abuse,
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10 STILES-SHIELDS AND CARROLL
HIV/AIDS, and hate crimes in the literature has also dominated LGB studies, to the exclusion of
SSDV (Murray & Mobley, 2009; Stephenson, Khosropour, & Sullivan, 2010).
The lack of representative data is problematic, as the results provide an incomplete view of
the serious consequences of SSDV to policymakers, law enforcement, the LGB community, and
clinicians (Murray et al., 2007). For example, unclear prevalence rates directly affect policies
and the services allotted to the LGB community (Dixon & Graham-Kevan, 2011). Consequences
of SSDV also extend to other matters of public health, such as HIV risk (Braitstein et al., 2006;
Koblin et al., 2006; Mustanski, Garofalo, Herrick, & Donenberg, 2007). Young men who report
experiencing physical aggression or violence in a relationship are also significantly more likely
to report engaging in unprotected/risky sex (Mustanski, Newcomb, & Clerkin, 2011).
Future research is necessary to better understand the prevalence, psychological experience,
and clinical outcomes of SSDV. In addition, reliable and validated assessments, as well as
empirically supported treatments tailored to the unique needs of the LGB community, must be
developed, evaluated, and disseminated. Given the limitations presented in the literature, future
research can improve methodologically in multiple ways. Recruitment and intervention methods
must be tailored to the unique needs of the LGB population; how researchers meet these needs
should be explicitly and consistently defined. To obtain representative samples, SSDV researchers
may benefit from collaborating with OSDV researchers for their recruitment strategies as well
as utilizing quota sampling strategies so recruited samples reflect LGB census profiles. SSDV
research would also be improved with clear, consistent definitions of SSDV as well as the types
of abuse measured, and assessment strategies that control for the potential influence of social
desirability on respondent answers.
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