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28 NARCHI Bulletin
Violence Against Women: Psychological Issues and
Interventions
Vibha Sharma
Associate Professor, Department of Clinical Psychology, Institute of Human Behaviour & Allied Sciences (IHBAS), Delhi
Introduction
All kinds of violence against women (VAW), especially
sexual violence, have serious and multiple e ects
on their mental health. Psychologically, it radically
changes the image that the victim has of herself, her
relations with her immediate social circle and beyond.
It changes the way in which the victim sees the past,
present and future and it has a lasting negative impact
on her perception of herself, of events and of others. At
the community level, it stigmatizes the victim, stripping
her of any social status or intrinsic value as a person and
thereby modi es relationships within the community
with an overall deleterious e ect. This article discusses
the consequences of violence on the mental health of
these women and the available interventions.
Violence and Mental Health:
A two way relation
Besides physical injuries and illnesses, violence against
women may leave deep scars on their psyche. Woman
who experience a physical or sexual assault may feel
many emotions - fear, confusion, anger and even
numbness. She may feel guilt or shame over being
assaulted. Many women also report having mental
health problems after violence. To cope with the
e ects of the violence, some women start misusing
alcohol or drugs or engage in risky behavior such as
having unprotected sex. Sexual violence can also a ect
her perception of her own body leading to unhealthy
eating patterns or eating disorders. Some women try
to minimize the abuse or hide it by covering bruises
and making excuses for the abuser. However, support
and assurance for protection from assault or abuse
can help prevent long-term mental health e ects and
other health problems.
Violence against women has been seen as one of the
major factors linked with mental health problems in
Indian women. Such violence creates a vicious cycle in
a woman’s life. It may act as a causative factor, resulting
in the onset of a mental health problem/illness or
Intellectual disability. The type of violence and the
degree of its severity plays an important role in the
development of a particular type of mental health
problem.
On the other hand, women su ering from mental
illness or intellectual disability are very often subjected
to violence and neglect as commonly seen in Indian
society. Married or single, they are easy prey for family
members and society, may be because these mentally
ill women cannot take proper care of themselves nor
are they able to ful ll their expected duties. Violence
is generally reported when force is applied to restrain
them from causing harm to themselves or others. It may
even happen when long and exhausting care giving
takes a huge toll on the care givers. Even the near ones
themselves are either involved in perpetrating violence
or keep silent when others do it.
Violence and mental illness, therefore, have a two way
relationship.
Psychological Impact of Violence on
Women: Immediate and Longterm
All kinds of violence, be it physical violence, verbal
abuse, social humiliation, emotional or psychological
trauma have a tremendous impact on the mental
health of women. The many psychological issues that
can arise are:
• Low self-esteem, emotional distress
• Self-blame, mistrust
• Feeling of lack of control over self and environment
• Nightmares, death wishes
• Crying spells, Poor self-care
• Lack of interest in surroundings, etc.
These mental health problems, sometimes, may
convert into serious mental health illnesses like:
• Anxiety (Chronic Anxiety issues)/Depression (Chronic
Depression in some cases)
• Post-Traumatic Stress, Panic attacks
• Dissociative and Conversion reactions/disorders
• Chronic pains and aches, Headaches
• Sleep problems
29MAMC, Issue 1, February 2021
• Repeated injuries
• Self-neglect, self- harm behaviour, Suicide attempts
• Drug and Alcohol Dependence
• Sexual dysfunction
Besides these, the a ected women may also face the
following adverse outcomes
• Malnutrition
• Strained family relations
• Poor care or neglect of children
• Death
Impact of Childhood Sexual abuse
Impact of childhood sexual abuse is very serious.
Sexual violence, particularly during childhood, can
lead to increased smoking, alcohol and drug abuse and
risky sexual behavior in later life. It is also associated
with being a perpetrator of violence in adulthood
(for males) or being vulnerable as a victim of violence
during adulthood (for females).
Interventions and Strategies to Reduce
Mental Health Consequences of VAW
In order to reduce the mental health consequences
of VAW, a proactive approach needs to be followed
at the governmental and non-governmental level
along with maximum community participation. These
interventions can be Preventive or Curative.
Preventive Interventions
The aim to create an environment which is free from
violence and includes:
• Training of mental health professionals, practitioners
and social workers to identify children and women
living in violent homes so that they can be helped
and assisted.
• The creation of Crisis centres, Hotline services,
Counselling centres for intake of VAW cases and
providing referral services.
• Provision of medical services for women in-need,
availability of legal consultation before taking legal
action against the o enders, creation of short stay
homes for women who are unable to stay in the
violence a ected home.
• Creating awareness through educational campaigns
and mass media, of resources available and setting
public norms of what is and is not acceptable.
Socialization of boys and girls since childhood
and throughout adolescence on values of gender
equality and non-violence at home, in schools and in
their communities. Promoting communication and
relationship skills within couples and communities
• Providing vocational skills training, job
reservations and easily available loans for starting
entrepreneurship programmes as rehabilitative
measures, to ensure that she is able to earn for herself
and her children.
• Establishing women helplines to provide immediate
relief and services to women in distress and in need
of care and protection.
• Policy recommendations: Based on a review
of studies and discussions, the World Health
Organization suggested some policy interventions
to help in stopping mental health consequences of
violence against women.
• Recognizing VAW as a serious public mental health
issue and a global emergency requiring universal
access to emergency and basic services, including
psychological support.
• Integrating Violence against women and Gender
studies into medical and nursing education
curricula and training.
• Implementing domestic violence protocols such
as intimate partner violence assessment and
interventions in treatment for depression and
substance abuse.
• Ensuring medical examination of sexual assault
victims by female physicians.
• Developing coalitions for public mental health
research and advocacy for policy reforms and
an appropriate allocation of resources. Relevant
questions on VAW should also be integrated into
national mental health surveys.
• Training of mental health care providers. Mental
health professionals, practitioners and social
workers may be the safest, and sometimes the only
contact for women victims su ering from mental
illness as a consequence of VAW. With training,
mental health social workers can recognize, discuss,
and provide support for women experiencing
violence. Although, reform in the mental health
sector alone cannot resolve the problem, it would
go a long way towards bringing a change related
to attitudes, beliefs and social responses to a
considerable degree.
30 NARCHI Bulletin
Curative Interventions include
• Providing support services to the women victims
such as Legal services and Counselling services to
help her regain her lost self-esteem.
• Shelter homes, Rehabilitative services and
Mainstreaming e orts
• Providing medical and psychological care.
Psychological Interventions
While considering psychological interventions for
women victims of violence, it must be recognized that
women experiencing violence often have little or no
control over their perpetrator’s behavior. Furthermore,
there may be limited insight into and labeling of the
abuse. This is particularly relevant among women with
poor self-esteem and social isolation, both of which are
commonly associated with abusive relationships and
contribute to the di cult process of decision making
about accessing help and/or escaping the violence. In
this complicated setting, the psychologist can play a
major role, whose interventions have the potential to
change beliefs and behaviours. These include:
• Formal Cognitive Behavioural Therapy (CBT): Trauma-
focused CBT (TF-CBT) and CBT-based techniques
• Third wave CBTs eg. Acceptance and Commitment
Therapy, Mindfulness etc.
• Behaviour Therapies eg. Eye Movement
Desensitization Reprocessing (EMDR) and Relaxation
techniques, many of which are based upon Cognitive
Behavioural Processes
• Integrative therapies including Motivational
Interviewing
• Humanistic therapies e.g Supportive and Non
Directive therapies
• Other psychologically oriented interventions e.g. Art
Therapy, Meditation, Narrative therapy
• Brief psychodynamic therapies
Cognitive Behavioural Processes, which form part
of the therapies listed, are further sub classi ed into
following three major classes:
• Cognitive re-structuring, which focuses on internal
underlying beliefs and thoughts with the aim to
challenge maladaptive thought patterns
• Coping skills therapy which focuses on identi cation
and alteration of cognitions and behaviours that may
increase the impact of negative external events. This
type of therapy is primarily used for problems that
are external to the person, focusing on reducing the
consequences of negative external events.
• Problem-solving therapies which combine
cognitive restructuring and coping skills therapy
to change internal thought patterns and optimise
responses to external negative events.
How the Interventions Work
It is important to understand how CBT-based
interventions, Integrative therapies, Humanistic
therapies and other psychologically oriented
interventions might impact on a woman experiencing
violence.
Cognitive Behavioural Interventions (e.g. formal
CBT, CBT based techniques, TF-CBT, third wave,
behavioural) are based on the preposition that
behaviours are often cognitively mediated. Mental
health and social problems may be in uenced by
underlying cognitions and resulting behaviours.
Because cognitive activity may be monitored and
altered, behaviours may be changed through cognitive
changes. Therefore, addressing certain thinking
patterns and beliefs may result in positive changes in
symptoms, problems and behaviours that may reduce
some of the negative consequences of exposure to
violence. It is important to recognize that women
experiencing violence often make signi cant e orts to
minimize harm and certain behaviours and cognitions
(such as safety planning) have been associated
with harm reduction. These positive cognitions and
behaviours provide a good example of important
potential targets for psychological interventions. Third
wave CBTs e.g. Acceptance and Commitment Therapy
and Mindfulness CBT act on changing the function of
psychological events and the individual’s relationship
to them through acceptance and committed action.
Eye Movement Desensitization and Reprocessing
(EMDR) is thought to work for patients who have
been traumatised by the fact that eye movements can
reduce the intensity of disturbing thoughts, under
certain conditions.
Psychosocial Readiness Model describes the process
of change for victims of partner abuse. It encompasses
external as well as internal factors: awareness that the
partner’s behaviour is abusive and perceived support
from others and self.
Humanistic therapies: Supportive and Non Directive
therapy may be helpful for women exposed to IPV. For
women who have decided that the abuse must end,
bu t whose intentions are not translated into action
31MAMC, Issue 1, February 2021
due to perceived external barriers, then supportive
interventions and problem‐solving techniques may
be helpful. Problem‐solving techniques help patients
to e ciently identify problem areas, and generate and
implement solutions.
Other psychologically oriented interventions e.g.
art therapy, music therapy, meditation, narrative
therapy may be helpful for women who have left the
relationship, to assist them in managing ongoing
trauma symptoms.
Pharmacotherapy
Dysregulation of the Hypothalamic- Pituitary-
Adrenal (HPA) axis is the fundamental cause of the
structural and functional abnormalities contributing
to symptoms of Post-Traumatic Stress Disorder (PTSD)
in survivors of sexual assault. Pharmacotherapies
are available to treat PTSD but are often inadequate
or unwanted. There are four main goals for treating
PTSD with medications. These include a reduction of
the core symptoms such as anxiety and ashbacks,
an improvement in stress resilience, an improvement
in the quality of life, and a reduction in disability and
comorbidity. Selective Serotonin Reuptake Inhibitors
(SSRIs) such as Fluvoxamine, Benzodiazepine inhibitors
such as Flumazenil and Monoamine oxidase inhibitors
are the common drugs used successfully to treat
symptoms of anxiety, depression and ashbacks.
Conclusion
Psychological interventions and counselling should
be an integral part of management plan when dealing
with problems of violence in women. Interventions at
various levels aiming at both individual women and
women as a large section of the society are essential.
These should be implemented at primary care delivery
as well as on legal and judicial fronts. The primary
health care providers must be aware of the major
psycho social and cultural issues like domestic violence
and related physical and mental health problems
a ecting women. They should routinely enquire
about common factors and common physical and
mental health problems while dealing with women
and should provide the most appropriate intervention
and support. They should provide education to the
community on issues related to women. Women
are increasingly joining the workforce, and there is
great potential to intervene at this level too. Besides
this, for prevention, it is essential to recognise how
the sociocultural, economic, legal, infrastructural,
and environmental factors that are responsible for
violence against women are con gured in the given
community setting and a ect women’s mental health
signi cantly. Hence, awareness, education, training,
and interventions targeting the social and physical
environment are crucial for addressing violence against
women and women’s mental health.
Suggested Readings
1. Kumar A, Nizamie SH, Srivastava NK. Violence against
Women and Mental Health. Mental Health & Prevention
2013; (1):4–10. http://doi.org/10.1016/j.mhp.2013.06.002
2. Malhotra S, Shah R. Women and Mental Health in India:
An overview. Indian J Psychiatry 2015;57(Suppl 2): 205–
11
3. Tan M,O’Doherty L,Gilchrist G,Taft A,Feder G,Muñoz JT
et al. Psychological therapies for women who experience
intimate partner violence. Cochrane Database Syst Rev.
2018; (5):CD01301.
4. Russo NF & Tartaro J. Women and Mental Health. Chapter
in Psychology of women: A handbook of issues and
theories (2008). Editors: Denmark FL, Paludi MA-2nd ed.
Praeger Publishers, USA
5. Putting women rst: Ethical and safety recommendations
for research on domestic violence against women (2001)
Geneva: Department of Gender and Women’s Health.
World Health Organization
6. Guidelines for psychological practice with girls and women
(2006) Washington, DC: Am Psychol.2007;62(9):949-79.
