Theories of Intimate Partner Violence: From Blaming the Victim to Acting Against Injustice Intersectionality as an Analytic Framework

Abstract

Intimate partner violence (IPV) has garnered increasing public and academic attention in the past several decades. Theories about the causes, prevention, and intervention for IPV have developed in complexity. This article provides an overview of the historical roots of IPV, as well as a description and critique of historical and contemporary theories of IPV causes and women's responses to IPV. This is followed by a discussion of the most current theoretical developments and application of critical theories to the problem of IPV. The article concludes with theoretically based implications for nursing practice and research with women who are experiencing IPV.

Full text

ANS200096 August 4, 2011 17:47
Advances in Nursing Science
Vol. 34, No. 3, pp. E29–E51
Copyright c
2011 Wolters Kluwer Health |Lippincott Williams & Wilkins
Theories of Intimate Partner
Violence: From Blaming the
Victim to Acting Against Injustice
Intersectionality as an Analytic
Framework
Ursula A. Kelly, PhD, MSN, ANP-BC, PMHNP-BC
Intimate partner violence (IPV) has garnered increasing public and academic attention in the
past several decades. Theories about the causes, prevention, and intervention for IPV have
developed in complexity. This article provides an overview of the historical roots of IPV, as
well as a description and critique of historical and contemporary theories of IPV causes and
women’s responses to IPV. This is followed by a discussion of the most current theoretical
developments and application of critical theories to the problem of IPV. The article concludes
with theoretically based implications for nursing practice and research with women who are
experiencing IPV. Key words: critical theory,domestic violence,feminist intersectionality,
intersectionality,intimate partner violence,nursing,nursing theory,social action,social
justice,theory development,violence against women
IN THE 40 YEARS or so since abuse and vi-
olence in intimate relationships came into
the public eye, scholarship and lay discourse
about this problem have increased dramati-
cally. Intimate partner violence (IPV), previ-
ously considered a private matter between
Author Affiliation: Atlanta VA Medical Center,
Atlanta, Georgia; Emory University Nell Hodgson
Woodruff School of Nursing, Atlanta, Georgia.
This paper is a revision of a previously published book
chapter; copyright permission obtained.
Kelly UA, Gonzalez-Guarda RM, Taylor JY. Theories of
intimate partner violence. In: Humphreys J, Campbell
JC, eds. Family Violence and Nursing Practice. 2nd ed.
New York, NY: Springer Publishing Co; 2011:51-89.
The author has disclosed that she has no significant
relationships with, or financial interest in, any com-
mercial companies pertaining to this article.
Correspondence: Ursula A. Kelly, PhD, MSN, ANP-BC,
PMHNP-BC, Emory University, Nell Hodgson Woodruff
School of Nursing 1520 Clifton Rd. NE, Atlanta, GA
30322 (ukelly@emory.edu).
DOI: 10.1097/ANS.0b013e3182272388
2 adults, became recognized as a complex
sociocultural problem and public health epi-
demic. Social activists and scholars in many
disciplines continue to develop new and in-
creasingly complex understandings of the
causes of IPV and women’s responses to be-
ing abused by an intimate partner. This arti-
cle first provides an overview of the histori-
cal roots and scope of IPV. This is followed
by a description and critique of historical
and contemporary theories of IPV causes and
women’sresponsestoIPV,aswellasadis-
cussion of the most current theoretical devel-
opments and applications of critical theories
to the problem of IPV. The article concludes
with theoretically-based implications for prac-
tice and research with women who are being
abused by an intimate partner.
The current state of theoretical and clini-
cal knowledge about IPV includes an under-
standing of the inextricable link between IPV
and other forms of violence against women
(VAW). Contemporary theories of IPV apply
to multiple forms of VAW; most women who
experience IPV experience other forms of
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
E29

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E30 ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2011
gender-based violence in their lifetime. There-
fore, this article incorporates information and
analyses of the causes of VAW beyond IPV.
IPV DEFINITION AND SCOPE
Intimate partner violence encompasses a
variety of behaviors within adult intimate
relationships. The Centers for Disease Con-
trol and Prevention definition of IPV can be
summarized as follows: threats or intentional
use of physical violence, sexual violence, or
both with the potential to cause injury, dis-
ability or death; or psychological/emotional
abuse, coercive tactics, or both when there
has been prior physical violence, sexual vi-
olence, or both perpetrated by a current or
former spouse or nonmarital partner, for ex-
ample, dating, boyfriend, or girlfriend.1The
World Health Organization’s (WHO) defini-
tion of IPV does not necessitate the presence
of physical or sexual violence in addition to
psychological violence: “As well as acts of
physical aggression such as hitting or kick-
ing, violence by intimate partners includes
forced intercourse and other forms of sexual
coercion, psychological abuse such as intim-
idation and humiliation, and controlling be-
haviors such as isolating a person from family
and friends or restricting access to informa-
tion and assistance.”2(p24)
Most reported IPV prevalence rates include
physical and sexual violence only.3,4 How-
ever, more recently, IPV researchers have
included psychological abuse as they rec-
ognize its pervasive nature, severity, and
harmful effects.5In the United States, most
population-based estimates of lifetime physi-
cal and sexual IPV prevalence among women
range from 1.9% to 70%, typically between
25% and 35%.6Among women worldwide,
prevalence rates range from 15% to 71%, with
most results between 30% and 60%.3Rates of
past year IPV against women range from 1.8%
to 14% in population-based studies and up
to 44% in health care settings, although most
reports of prevalence in health care settings
are between 10% and 23%.5Data from 2001
to 2005 gathered in the National Violence
Against Women Survey include nonfatal IPV
prevalence rates of 21.5% and 3.6%, among
women and men, respectively.4In this same
study, intimate partner rape was reported by
7.2% of women versus 0.8% of men. Approx-
imately two-thirds of nonfatal IPV assaults oc-
curred at home for both women and men.4
Similar to research reports of the preva-
lence of IPV in heterosexual relationships, re-
ports of IPV in lesbian and gay male relation-
ships have a wide range, from less than 10%
to more than 50%. Overall, available data sug-
gest that the rates of IPV among heterosexual
and same-sex couples are roughly equal, but
that the prevalence of IPV among male same-
sex couples is significantly higher than among
female same-sex couples.7
The United States has the highest level of
intimate partner homicide of any industrial-
ized country.2From 2001 to 2005, intimate
partners committed 30.1% of homicides of
women and 5.3% of homicides of men.4The
percentage of IPV-related femicide is even
higher (40%–50%) when ex-boyfriends are in-
cluded among perpetrators.8
HISTORICAL ROOTS OF IPV AND VAW
Intimate partner violence and other forms
of VAW have existed as acceptable social
norms and behaviors for centuries; they con-
tinue to be condoned and even legally sanc-
tioned in many societies. A fundamental as-
pect of current cultural support for abusing
women is embedded in the historical and con-
temporary context of the many forms of VAW
that operate to maintain the patriarchal struc-
ture of most societies. bell hooks described
the relationship between patriarchy and VAW
when she observed that domestic violence is:
inextricably linked to all acts of violence in this
society that occur between the powerful and the
powerless, the dominant and the dominated. While
male supremacy encourages the use of abusive
force to maintain male domination of women, it
is the Western philosophical notion of hierarchical
rule and coercive authority that is the root cause of
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ANS200096 August 4, 2011 17:47
Theories of Intimate Partner Violence E31
violence against women, of adult violence against
children, of all violence between those who domi-
nate and those who are dominated.9(p118)
This analysis of power dynamics allows us
to better see the foundations upon which op-
pression is grounded. Isolated acts of female
intimate partner abuse do not keep our soci-
ety sexist, but when the acts are multiplied
and coupled with the frightening incidence
of rape, homicide of women, and genital mu-
tilation and joined with the historical prece-
dents of suttee, witch-burning, foot-binding,
mutilating surgery, and female infanticide, the
power of patriarchy can be seen as ultimately
based upon violence.
The Bible provides the earliest written
prescription for the physical punishment of
wives. Deuteronomy 22:13-2110 lists a law
condemning brides to death by stoning if un-
able to prove virginity.11 By medieval times,
the widespread nature of wife-beating had
been documented in several ways. In Spanish
law, a woman who committed adultery could
be killed with impunity. In France, female sex-
ual infidelity was punishable by beating, as
was disobedience. Italian men punished un-
faithful women with severe flogging and ex-
ile for 3 years.12 The close of the Middle Ages
saw the rise of the nuclear family along with
the development of modern states and the be-
ginning of capitalism, all of which eroded the
position of women and strengthened the au-
thority of men. The basic unit of production
moved outside of the family, and for the first
time wages were paid for work on a regular
basis. Domestic work performed by women
received no wages and therefore became
devalued.
The “witch-hunts” in Western Europe from
the 1500s to the 1700s represent 1 of the
best documented forms of systematic VAW.
Though the actual number of women mur-
dered can never be known, authoritative esti-
mates range from 200 000 to 9 million, of-
ten by hanging or burning, as punishment
for their perceived healing abilities, which
were assumed to have been acquired through
“consorting with Satan.”13 Feminist analysis
of this practice is that the main crime of the
women involved was a lack of submission to
the stereotyped role of the subservient me-
dieval woman.
During the same time period as the witch
burnings in Europe, the practice of suttee,
or inclusion of the widow and concubines
in the man’s funeral pyre, was being carried
out in India. Cultural beliefs held the widow
to blame for the man’s death, if not during
her present life, then in her past ones. During
the Reformation, the common saying of the
times was, “Women, like walnut trees, should
be beaten every day.”11(p14) Throughout the
17th, 18th, and 19th centuries in the Western
world, there was little objection to a husband
using force as long as it did not exceed certain
limits.
Western medicine in the late 19th century
used the surgical procedures of clitoridec-
tomy, oophorectomy, and hysterectomy to
“cure” masturbation, insanity, deviation from
the “proper” female role, heightened sexual
appetites, and rebellion against husband or fa-
ther. Control of reproductive rights, and the
development and use of particularly risky and
permanent methods of contraception, for ex-
ample, Norplant and antifertility “vaccines,”
have come into question as part of an ongoing
pattern of discrimination against women, es-
pecially poor women and women of color.14
Violence against women in the United
States began with its founding on the equal
rights of white men, not of women (and not
of persons of color). The English law that up-
held the husband’s right to employ moderate
chastisement in response to improper wifely
behavior was used as a model for American
law. In 1824, the state of Mississippi legalized
wife-beating, and in 1886, a proposed law for
punishment of husbands who beat their wives
was defeated in Pennsylvania. North Carolina
passed the first law against wife-beating, but
the court pronounced that it did not intend to
hear cases unless there was permanent dam-
age or danger to life.11 It was legal for men to
rape their wives in every state in the United
States until the early 1970s. Laws preserving
the legality of marital rape were common in
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ANS200096 August 4, 2011 17:47
E32 ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2011
the United States until the late 1980s and early
1990s. While there has been a clear cultural
shift in the United States in the past 2 decades
away from viewing domestic violence as ac-
ceptable and as a private matter, IPV contin-
ues to be an epidemic worldwide.2
CONTEMPORARY FORMS OF VAW
IPV: who does what to whom and how
Intimate partner violence occurs in all
kinds of intimate relationships: heterosex-
ual and same-sex relationships, committed
and dating/casual relationships of adults and
adolescents, and current and terminated
relationships. Most commonly, men are the
perpetrators and women are the victims,
though women can be perpetrators and IPV
can be bilateral, meaning both partners are
violent. The use of severe violence and con-
trol, called “intimate terrorism,” is more often
perpetrated by men with more severe injuries
inflicted on women than vice versa.15,16 Low-
level violence between intimate partners is
often more bilateral and less often includes
forced sex and controlling behaviors.
The kind of IPV that is seen in domestic
violence shelters, the criminal justice system,
among women with mental health problems
related to IPV, and in emergency departments
is primarily directed toward women, is severe
and is characterized by coercive control. In
addition, in nonemergency health care set-
tings, for example, clinics, in-patient units,
community settings, and schools, many pa-
tients are experiencing less visible but not
necessarily less severe IPV, that is, psycho-
logical and emotional abuse, and less severe
injuries for which they may not have sought
formal assistance.
Battering has been defined as a pattern of
deliberate and repeated physical aggression,
sexual assault, or both inflicted on a woman
within a context of coercive control by a man
with whom she has or has had an intimate
relationship. Although it is true that in some
small proportion of cases a woman may be
the primary perpetrator of battering against a
male partner, the preponderance of evidence
suggests that the incidence is very low.4
The concept of coercive control refers to
the variety of strategies used by the abusive
partner to keep the woman fearful of future
harm to herself and her children, and, in
fact, even doubtful of her own reality. Ex-
amples of controlling strategies include emo-
tional and verbal abuse, restriction of her con-
tact with others (social isolation), controlling
her personal and household finances (eco-
nomic abuse), and using coercive, intimidat-
ing, and threatening behaviors. These con-
trolling behaviors are depicted in the “Power
and Control Wheel” developed by the Du-
luth, Minnesota, Domestic Abuse Interven-
tion Project, which is widely used as part of
a curriculum for intervention with batterers
and victims of IPV and in public and pro-
fessional education literature (http://www
.theduluthmodel.org/wheelgallery.php).
Research on the dynamics of IPV in same-
sex couples is minimal. However, several
researchers have challenged a reliance on
heterosexually gendered theoretical and em-
pirical analyses of IPV power dynamics in
research with same-sex couples, particularly
lesbian couples, arguing instead for analyses
that consider the power dynamics of inter-
secting identities (race, socioeconomic status,
age, disability, and sexual orientation) and mi-
nority stress.17, 18
Violence against women takes
many forms
Female infanticide, homicide of women,
and genital mutilation are 3 forms of violence
directed at females that are rooted in history
and continue today. They are found in their
most blatant forms in societies that rigidly
adhere to male dominance. Because of the
higher life expectancy of females, the pro-
portion of women in the population should
be higher than men; however, world pop-
ulation statistics show that the male popu-
lation exceeds that of females. The world-
wide male/female ratio is 102/100, with 105
male births for every 100 female births.19 This
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ANS200096 August 4, 2011 17:47
Theories of Intimate Partner Violence E33
imbalance is highest in Arab and Islamic coun-
tries and India, with the United Arab Emi-
rates having the highest male/female ratio of
205/100.19
India and Arabic and Islamic nations also
practice “honor killings,” murder committed
by male family members against female family
members who are perceived to have brought
dishonor upon the family, either through
“dishonorable acts,” including divorce, pre-
marital sex, or herself being the victim of a
sexual assault or rape, or even because of
rumor of impropriety. While data on honor
killings are difficult to obtain, it is estimated
that worldwide 5000 women are killed each
year for “honor.” For example, in 2008 in
Afghanistan alone, there were 96 cases of so-
called honor killings.20
Female genital mutilation, also called “cut-
ting” and abbreviated as “FGM” or “FGM/C”
is defined by the WHO as all procedures in-
volving partial or total removal of the exter-
nal female genitalia or other injury to the fe-
male genital organs for nonmedical reasons; it
is considered a human rights violation.21 Fe-
male genital mutilation/cutting is widespread
in much of East, West, and Central Africa, in
parts of the Middle East, and in certain im-
migrant communities in North America and
Europe. The serious health consequences are
both immediate and long-term. Between 100
and 140 million girls and women in the world
have undergone FGM/C, and 3 million girls
in Africa are considered at risk for FGM/C
annually.21 Female genital mutilation/cutting
is deeply entrenched in inequitable social and
political structures. In areas where FGM/C
is widely practiced, it is supported by both
men and women, reflecting the extreme so-
cial pressure to conform or risk ostracism and
other social disadvantages.21 International po-
litical and grassroots efforts, in addition to the
work of the WHO and other nongovernmen-
tal organizations over the past few decades,
are gradually increasing support for the aboli-
tion of FGM/C.
Rape is a well-known form of VAW and
takes many forms: sexual abuse of children,
gang rape, forced intercourse with wives, sex-
ual torture of female prisoners, intercourse
with therapists, forced sexual initiation, bride
capture and group rape as a puberty rite, sex-
ual assault during military service by fellow
soldiers, as well as sexual assault on a female
by an unknown male. In the United States,
more than half of the women who are raped
are younger than 18 years; more than two-
thirds of female rape victims are raped by
someone they know.4Rape is a crime of vi-
olence, not sex, and has long been used as
systematic weapon of war. Recent systematic
uses of rape as a war strategy and a form of
genocide occurred in the former Yugoslavia
(mainly in Bosnia and Kosovo) and in civil
wars in Rwanda, Liberia, and Uganda. The
United Nations estimated that a quarter of a
million women were raped as part of the 1994
Rwandan genocide.22
Sex trafficking of women and children has
existed for centuries, but has garnered pub-
lic attention only recently. Sex trafficking, or
human trafficking for the purposes of sexual
exploitation, occurs internationally, as well as
into and within the United States, primarily
from Southeast Asia, the former Soviet Union
and Latin America. Like other forms of sexual
VAW, the physical and mental health conse-
quences of sex trafficking are profound and
long-lasting.
THEORETICAL FRAMEWORKS
Scholarly attention to IPV has increased
exponentially in the past 3 decades as pub-
lic and private funds have been allocated
for research, education, treatment services,
and prevention programs. Many theories have
been offered to explain the social struc-
tures, cultural traditions, and personal be-
haviors that create and perpetuate abuse
and violence. Feminist critiques remind us
that focusing exclusively on individual and
couple dynamics fails to explain why so
many women are abused by their intimate
partners. Additional important critiques of
existing theoretical frameworks have come
from those who point out their questionable
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E34 ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2011
relevancy to persons of racial and eth-
nic minority groups and those exposed to
other systems of oppression, such as het-
erosexism, classism, ageism, ableism, and
religion/spirituality-based oppression.23- 25
Only recently have researchers and pol-
icy makers begun to explore the adequacy
of theories of IPV when applied to persons
of color, and even less so to persons with
disabilities. Ethnicity shapes the experience
and interpretation of IPV in myriad ways, in-
cluding culturally-based family structures and
subordinate roles for women. Women with
disabilities’ experiences of IPV are uniquely
colored by their impaired mobility, depen-
dence on others for personal care, and
physical and social isolation.25 The poverty
experienced by persons of racial and ethnic
minorities and persons with disabilities in the
United States clearly complicates women’s
experiences, particularly in terms of un-
equal access to health and social resources
and financial independence.24 Recent efforts
to integrate research findings and theoreti-
cal explanations from many disciplines hold
promise in our search for theories that help
us explain, predict, ameliorate, and ultimately
prevent IPV.
THEORIES OF THE CAUSES OF IPV
Historical theories
Theories of causation attempt to explain
and predict the motivations, circumstances,
and other factors that characterize individuals
who perpetrate and are victims of abuse and
violence within intimate relationships. His-
torically, frameworks for understanding the
causes of IPV fall into one of several cate-
gories: (a) theories of psychopathology (eg,
mental illness, substance abuse) of perpetra-
tors and typologies of batterers, (b) theories of
psychopathology of victims, (c) biological the-
ories of aggressive and violent behavior, (d)
family systems theories, and (e) social learning
theories. A summary and critique of these the-
oretical approaches to IPV causation is pro-
vided in Table 1.
None of these theories fully explain why
an individual perpetrates IPV. For example,
although social learning theory proposes that
aggression toward an intimate partner is a
learned behavior that can be transmitted from
generation to generation, not all children ex-
posed to aggressive parents become perpetra-
tors. Integration of scholarship from various
disciplines led to more comprehensive and
contemporary explanations for IPV, such as
theories that describe gender-based inequities
based on systems of oppression and power,
and sociocultural models that draw from var-
ious traditional theories.
Contemporary theories
Early feminist theories
Second wave feminist theories of the
causes of IPV, that is, those generated in
the 1960s and 1970s, emphasize the need
for power and control on the part of bat-
terers and the societal arrangements of patri-
archy and tolerance (not support for) of VAW
that support individual abusers in consider-
ing this behavior as acceptable.12, 26 Histori-
cal and contemporary records of VAW associ-
ated with cultural norms of male ownership
of women and lack of equal power relation-
ships within families provide evidence that
continues to support these feminist theories.
Patriarchy, or male dominance, is established
and maintained through male socialization to
societal and cultural ideals of masculinity, that
is, power and authority over women. The con-
cept of machismo or compulsive masculinity
can be found in psychological, sociological,
and anthropological literature, and more re-
cently in feminist scholarship and studies of
masculinities,27 all of which have influenced
current thinking about gendered roles and
gender-based violence.
In the past 2 decades, feminist scholars
have developed theories that explain the ways
in which power and oppression act in the
lives of women along multiple social iden-
tities, for example, gender, race, class, age,
disability, and sexuality. This “third wave” of
feminist scholarship calls for social action to
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ANS200096 August 4, 2011 17:47
Theories of Intimate Partner Violence E35
Table 1. Historical Theories of the Causes of IPV
Level of Focus Explanations for IPV Critique
Individual psy-
chopathol-
ogy
Perpetrator Abusive behavior results
from mood disorders
(depression, anxiety),
personality disorders
(borderline, antisocial)
These disorders can
involve aggression but
they do not cause IPV
nor explain how
perpetrators’
aggression is typically
targeted toward
intimate partners.
Psychoneurological effects
of brain injury and
posttraumatic stress
disorder
Victim Abuse is deliberately
provoked by women to
meet their need for
suffering (female
masochism) or to benefit
indirectly by being
abused (secondary gain).
Blames the victim for IPV
related to her
pathology or ulterior
motives.
Evolution Perpetrator genetic
or inherited
predisposition
Extreme jealousy and
violent male behavior
date back to
evolutionary forces to
reproduce and pass
along genes for survival
of the species.
Themajorityofmendo
not exhibit violent
behavior toward their
intimate partners.
IPV causes significant
morbidity and
mortality.
Alcohol and
drug use
Perpetrator use Serve as risk factors for IPV
occurrence, more severe
IPV, perpetrator
reassault after
intervention, and
intimate partner
femicide
Alcohol/drug use may
potentiate abusive
behaviors among
perpetrators but do not
cause the abuse.
Leads to biochemical
disinhibition whereby a
person’s usual voluntary
behavior constraints are
temporarily removed,
resulting in aggression
Partners are not always
intoxicated or impaired
when abusive or
abusive when they are
intoxicated or
impaired.
Social norms Socially unacceptable
behaviors, for example,
IPV, are rationalized by
intoxication and are
therefore tolerated.
(continues)
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ANS200096 August 4, 2011 17:47
E36 ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2011
Table 1. Historical Theories of the Causes of IPV (Continued)
Level of Focus Explanations for IPV Critique
Family systems
and family
stress
theories
Family members and
their interactions
Family functioning, such as
role expectations,
communication
patterns, and power
status of family members
are affected by the
response and feedback
of family members.
Minimizes the
responsibility of the
perpetrator and
exaggerates the
responsibility of the
victim.
Family violence is the
result of behaviors of
both perpetrator and
victim; usually, all
involved family
members are culpable.
Social learning
theory
Perpetrator
individual learning
Abusive behaviors are
learned by children
during childhood;
children observe and
imitate the behaviors
adults model for them.
Not all children who are
exposedtoabuse
during childhood
become abusive as
adults; not all
perpetrators were
abused as children.
As children grow, these
behaviors are reinforced
by society; for example,
boys are taught to use
aggression to cope with
negative feelings.
Does not incorporate
other risk or protective
factors for IPV
perpetration.
Abbreviation: IPV, intimate partner violence.
address the social injustices and inequities
that power imbalances create and sustain.
These theories are presented and applied to
IPV later in this article.
Social cultural models
A multifactorial model of IPV, which com-
bines elements of family systems theory, so-
cial learning theory, social structures, and
cultural factors, was first developed by Mur-
ray Straus and his colleagues.28 This social
cultural model places family violence in the
context of a high level of violence in our cul-
ture, the sexist organization of our society
and family systems, and cultural norms le-
gitimizing violence against family members.
According to this model, family interactions
inherently lead to violent behaviors, particu-
larly due to the manifestation of these soci-
etal influences at the level of family structure,
norms of parental behavior and childrearing,
and individual interactions.28 A summary and
critique of these theories can be found in
Table 2.
THEORIES OF WOMEN’S RESPONSES
TO IPV
Historical theories
As IPV became publicly acknowledged, a
common question in public and professional
discourse was “Why does she stay?” Histori-
cally, this question about women’s responses
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ANS200096 August 4, 2011 17:47
Theories of Intimate Partner Violence E37
Table 2. Contemporary Theories of the Causes of IPV
Level of Focus Explanations for IPV Critique
Feminist theory:
gender-based
inequities
Social systems of
power and
oppression
Patriarchal societies, which
support male domination
and authority in family,
social, and cultural systems,
foster violence against
women, particularly IPV,
and threaten women’s
rights.
All systems of power
and oppression are
not based on gender,
for example, racism,
classism, ableism.
Socialization for
masculinity
Social influence
on boys/men
Boys are socialized for the
male role from an early age.
The ideal male is
authoritative, has sexual
prowess, is invulnerable,
competitive, tough, brave,
self-sufficient, and never
discloses emotion.
Processes of male
socialization vary
within families and
cultures.
Themajorityofmendo
not perpetrate IPV.
Positive male role
attributes include
protecting and
providing for the
family.
Social cultural
model
Family member
relationships
within a
broader
societal context
Multifactorial model of IPV:
combines elements of
family systems theory,
social learning theory,
social structures, and
cultural factors (norms).
Does not fully account
for the influence of
the broader social
context.
Family interactions within a
social context of a highly
violent culture, a sexist
society and family systems,
and cultural norms
legitimizing violence
against family members.
The family is inherently at
high risk for violence by
virtue of the quantity and
emotional intensity of
interaction; the broad
range of activities over
which conflict can occur;
the involuntary nature of
family membership; the
impingement of family
members on each other’s
personal space, time, and
lifestyles; and the
assumption of family
members that they have
the right to try to change
each other’s behavior.
Places significant
responsibility for IPV
on family dynamics;
somewhat victim
blaming.
Abbreviation: IPV, intimate partner violence.
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ANS200096 August 4, 2011 17:47
E38 ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2011
to IPV has been addressed primarily from
a psychopathological perspective, similar to
historical theories of the causes of IPV. For the
most part, these theories about women’s re-
sponses take a victim-blaming stance through
attributions of psychopathology.
Low self-esteem, various mental health
problems, including symptoms of depression,
posttraumatic stress disorder, and alcohol and
drug abuse are strongly associated with IPV
in women.29 While these have often been
presumed to be risk factors for IPV, a pre-
ponderance of evidence indicates that these
problems are sequelae of the trauma of IPV
rather than precursors to it. Mental health
sequelae of IPV, particularly posttraumatic
stress disorder, can lead to deficits in women’s
social functioning, which may impair their
coping and problem solving abilities. The
development of effective interventions to
address symptoms of mental illness or
psychological distress in women who have
experienced IPV is an active area of research
in nursing.
The theory of learned helplessness was ap-
plied in the late 1980s to battered women;
as a result, abused women were considered
deficient in motivational, cognitive and emo-
tional skills. Women exposed to repeated
abuse were seen as depressed, apathetic and
without skills to leave the abusive relation-
ship. The application of the theory of learned
helplessness theory to IPV victims has been
refuted by multiple nursing studies, which de-
scribe the proactive and skillful responses of
women to IPV.
Contemporary theories
The past 3 decades of research have pro-
vided a robust description of the complexity
and resourcefulness of women’s coping be-
haviors and strategies in responding to IPV,
either in attempts to end the abuse in their re-
lationship or to break free and remain out of
the abusive relationship. Contemporary un-
derstandings of women’s responses to IPV
are mainly derived from sociological and sys-
tems theories. The question of “Why does she
stay?” no longer dominates discourse about
IPV. Given the current state of knowledge rel-
ativetoIPV,thequestions“Whydosomany
men assault their partners?” and “What is get-
ting in the way of women’s safety and free-
dom from abuse?” are more salient and fruitful
areas of inquiry.
Most research on women’s responses to
IPV has relied on samples of women who
have sought some type of formal assistance,
for example, health care, social services, and
legal services. As a result, our knowledge of
women who quickly break free from abusers
without complications is very limited. There-
fore, our current knowledge pertains to the
responses of women who endure abuse over
a longer period of time and whose abuse be-
comes public by virtue of their help-seeking
behaviors and involvement with official agen-
cies, rather than women who extricate them-
selves from relationships at the onset of abuse,
or soon after, without seeking help outside of
their own network. Research with the latter
population from community-based samples is
needed.
Contemporary theories about women’s re-
sponses to IPV include resiliency and survivor
models, both strengths-based approaches,
and social support. Together, these theories
provide a rich understanding of the processes
involved in women’s responses to IPV. Ro-
bust research has been reported about the
emotional processes of being in, leaving,
and recovering from abusive relationships,
and more recently, adaptive responses and
strategies used in these processes.30, 31 These
historical and contemporary theories are
presented and critiqued in Table 3. This schol-
arship has lead to a reformulation of the char-
acteristics of women experiencing IPV and
their responses to it (see Table 4).
Critical theories
Critical theory, also known as critical so-
cial theory (CST), originates from philoso-
phy and has several meanings and applica-
tions across philosophy, the social sciences,
nursing science, and other health sciences.
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ANS200096 August 4, 2011 17:47
Theories of Intimate Partner Violence E39
Table 3. Historical and Contemporary Theories of Women’s Responses to IPV
Historical Theories
Level of Focus Explanation Critique
Individual
psychological
pathology
Risk factors for
being abused
Low self-esteem and
mental health
problems, for
example,
depression, anxiety,
posttraumatic stress
disorder, personality
disorders, and
substance abuse
problems
Research does not
support low
self-esteem or mental
health problems as
being risk factors for
IPV. Rather, the low
self-esteem, mental
health problems, and
substance abuse seen
in abused women are
very likely the result of
the violence rather
than a precursor.
Responses to IPV;
remaining in the
abusive
relationship
Learned helplessness:
repeated abuse
leaves the victim
unable to get out of
the abusive
relationship because
of her depression,
apathy, and poor
problem solving.
Women’s responses to
abuse are not passive.
Coping with the abuse
is an active process that
involves creativity,
problem solving, and
strategizing.
Traumatic bonding:
abused women
develop strong
emotional bonds to
their abusers; similar
to “Stockholm
syndrome.”
Typically, love precedes
the abuse. The
emotional bond may
remain despite the
abuse. Women want
the abuse to end, not
necessarily the
relationship.
Low self-esteem and
mental health
problems (as earlier)
Likely the result of IPV
rather than the cause of
remaining in the
relationship.
Contemporary Theories
Level of Focus Explanation Challenges
Resiliency Victim’s/survivor’s
individual
strengths
Women’s responses to
IPV are active
processes, requiring
creativity and inner
strength. Resiliency
is defined as positive
coping, adaptation,
and persistence.
Identifying and assisting
women who are
abused but who do not
seek services requires
effective screening and
community outreach,
both of which are
difficult to implement
universally.
(continues)
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ANS200096 August 4, 2011 17:47
E40 ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2011
Table 3. Historical and Contemporary Theories of Women’s Responses to IPV (Continued)
Contemporary Theories
Level of Focus Explanation Critique
Women use various
strategies to protect
themselves and their
children, seeking
safety in whatever
ways they can.
On-going IPV can
erode women’s
sense of inner
strength and
resiliency. Their
self-efficacy can be
negatively impacted
by the abuse, making
moving toward
change very difficult.
Assisting women who are
abused to recognize
and tap into their inner
strengths can be
difficult.
Survivor model Victim/survivor of
IPV
Women’s responses to
IPV vary over time as
they adapt to
individual
circumstances and
pragmatic concerns
using multiple
strategies.
Social agencies and health
care settings are not
adequately prepared to
address the pragmatic
needs of women
subjected to IPV.
Social support Interpersonal and
community
Social support, both
perceived and
tangible, can
increase a woman’s
ability to leave and
remain out of an
abusive relationship.
Accessing resources to
provide abused women
with tangible support is
difficult, particularly
women who are
marginalized or in
socially oppressed
groups.
Tangible social support
is a protective factor
for IPV-related
mental health
problems, including
depression and
posttraumatic stress
disorder.
Abbreviation: IPV, intimate partner violence.
Generally described, critical theory encom-
passes a spectrum of theories which take a
critical view of society and the human sci-
ences. Critical social theory scholarship in
multiple disciplines continues to unfold as
CST is applied by scholars to social, politi-
cal, scientific, and health related phenomena.
Feminist scholars in nursing and the social sci-
ences have used CST to describe and expose
the complexity of life experiences within
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ANS200096 August 4, 2011 17:47
Theories of Intimate Partner Violence E41
Table 4. Reformulations of Women’s Responses to Intimate Partner Violence
Historical Contemporary
Personal attributes Weak Strong
Helpless Resilient
Victim Survivor
Definition of response Decision to stay or leave Ongoing process of seeking
safety for self and children
Mental and emotional reaction Psychologically dysfunctional Complex of internal and
external factors
Coping style Passive Active
Static Adaptive
intersecting oppressions that include (but are
not limited to) race, class, gender, disability,
sexuality, ethnicity, nationality, and religion
(see eg Collins, 2000; Cramer & Plummer,
2009; and Samuels-Dennis et al, 2010).25, 32, 33
The application of CST to IPV addresses
the complexity, chronicity, and seeming in-
tractability of IPV. Critical social theory ap-
plies to the phenomenon of IPV as a whole,
as its various dimensions, for example, the
causes, effects and potential remedies, are in-
tertwined and interrelated.
One of the organizing principles of CST
is that individuals and groups have different
political, social, and historic contexts charac-
terized by injustice. Although people seek to
alter their social and economic situations, of-
ten they are constrained by multiple forms
of social, cultural, and political domination. A
second principle is that social critique of the
status quo is essential so that constraining con-
ditions can be exposed. In addition, critical
social theorists advocate for empowerment,
liberation, and emancipation from alienation
and domination. Collins succinctly summa-
rized the goal of CST, “What makes critical
social theory ‘critical’ is its commitment to
justice, for one’s own group and/or for that
of other groups.” 32(298)
Ecological frameworks
An ecological framework is used by the
WHO to describe violence as a global pub-
lic health problem.34 This framework inte-
grates research findings and theories from
several disciplines, including feminist theory,
into an explanatory framework of the ori-
gins of gender-based IPV. Within the ecolog-
ical framework, IPV is understood as a mul-
tifaceted phenomenon that is the result of a
dynamic interplay among individual, relation-
ship, community, and societal factors that in-
fluence an individual’s risk to perpetrate or
become a victim of violence (see Figure 1).
At the individual level, the person who per-
petrates or is a victim of abuse and violence
possesses a set of biological and personality
traits and a personal history that shape his
or her behaviors and interactions with other
individuals, for example, with intimate part-
ners and with the broader community and
society. Individual-level factors that are as-
sociated with IPV perpetration include: (1)
demographic factors such as age, education
and income, (2) witnessing domestic violence
as a child, (3) experiencing physical or sex-
ual abuse as a child, and (4) substance use.
A personal history of multiple interpersonal
traumas, for example, IPV, child abuse, and
rape, is associated with posttraumatic stress
disorder and other negative health outcomes
for victims; therefore, cumulative trauma is
an individual factor influencing women’s re-
sponses to IPV. Disability is widely described
as an individual’s restricted ability to perform
a range of social, work-related, or cognitive
or physical activities. Considered in this way,
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ANS200096 August 4, 2011 17:47
E42 ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2011
Figure 1. The ecological model of interpersonal violence.
it is an individual level factor that increases a
woman’s risk for IPV as well as an influencing
factor on women’s responses to IPV.
The second level of influence includes
close relationships with partners, family mem-
bers and peers that can influence the risk of
the individual to perpetrate or become a vic-
tim of violence. Several aspects of the rela-
tionship level, especially in terms of family
structure and functioning, have been identi-
fied as risk factors for the development of
IPV. These include: (1) male economic and
decision-making authority in the family, (2)
male control of wealth and resources in the
family, and (3) marital conflict, especially in
relationships with asymmetrical power struc-
tures.
The third level of factors is the commu-
nity and includes settings such as neighbor-
hoods, schools, and workplaces. Research
has demonstrated that communities with
high levels of social disorganization, for ex-
ample residential mobility, high population
densities and lack of cohesion among resi-
dents, are associated with higher levels of
violence.35 Community poverty, unemploy-
ment, and alcohol outlets have also been iden-
tified as risk factors for the perpetration of vi-
olence, victimization by violence, or both.36
According to social disorganization theory,
poverty at the community level may under-
lie much stress and conflict within intimate
couples, such that the influence of commu-
nity poverty is manifested at the relationship
level.
The fourth and last level of factors is the
societal level. This includes broad societal
factors that create a climate that encour-
ages or discourages violence at the com-
munity, relationship and individual levels,
including the rules, norms, and social ex-
pectations that govern personal behavior and
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ANS200096 August 4, 2011 17:47
Theories of Intimate Partner Violence E43
social inequities between groups, for exam-
ple, patriarchal systems, oppression, poverty,
sexism, and health disparities. For example,
sources of support and formal assistance may
not be readily available to socially marginal-
ized women, thus making them vulnerable
to IPV and impacting their responses to
the violence. This ecological approach to
understanding violence integrates research
findings from various disciplines into a com-
prehensive framework that improves our un-
derstanding of the context, causes, and im-
pact of IPV in the lives of women, as well as
the environment in which they are respond-
ing to it. The implications of the ecological
model for IPV intervention are that strategies
must be developed that target multiple lev-
els, that is, individual, family, community, and
societal.
Feminist theory & feminist
intersectionality
Feminist theory of gender-based oppres-
sion has evolved to account for additional
factors and complexities that intersect with
gender to place women and other vulnera-
ble groups at a disadvantage in establishing
equitable power relationships with their part-
ners and in society. Much of this scholar-
ship came from social scientists, domestic
violence advocates, and minority women who
have conceptualized VAW as much more than
just a gender issue. Black Feminist Theory
emerged in response to the predominately
white women’s feminist movement and pre-
dominately male black civil rights movement,
neither of which completely represented the
experience of both being Black and a woman.
In Black Feminist Theory, the interaction be-
tween gender, race, and class are conceptual-
ized as being part of an overarching structure
of domination.32
Similarly, Chicanas and Latinas felt that
their concerns were not being adequately rep-
resented by either the Chicano movement
or the women’s movement. Chicana Femi-
nist Theory describes the dynamics between
race/ethnicity, social class, linguistics, and na-
tionalism. Chicana feminists also focused on
approaches they felt were unique to their
culture, such as the need to challenge tradi-
tional and exaggerated gender-roles that were
present in Latino households, while still pre-
serving strong family structures and the im-
portant role of women in the home.37 Native
American and other indigenous feminists find
that postcolonial frameworks that emphasize
the role of historical trauma, as well as the
many different tribal traditions in male-female
relationships, are important in understanding
the often high rates of IPV among aboriginal
peoples worldwide.38
Feminist scholars and activists have ex-
panded the application of intersectionality
theory to other socially constructed identi-
ties and social locations that marginalize peo-
ple, beyond race, class and gender, for exam-
ple, disability. Social justice models applied to
women with disabilities distinguish between
the biological state of impairment and the so-
cial construct of disability that is reflective of
sociocultural and environmental restrictions,
rather than individual limitations. Nixon39 ar-
gued that women with disabilities who are
being abused or who are vulnerable to being
abused may be silenced or made invisible by
intersecting aspects of oppression based on
social identity, for example, disablism, sex-
ism, ageism, and structural oppression by or-
ganizations, social movements and society in
general.
Feminist intersectionality is built upon
the assumptions that every social group has
unique qualities; that individuals are posi-
tioned within social structures that influence
power relationships; and that there are inter-
actions between different social identities, for
example, race, gender, and class, that have
multiplicative negative effects on health and
well-being. Feminist intersectionality is a body
of knowledge that is driven by the pursuit of
social justice and seeks to explain the pro-
cesses by which individuals and groups in
various oppressed social positions, such as
gender, race, ethnicity, class, age, sexual ori-
entation, disability status, and religion, result
in inequitable access to resources, which in
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ANS200096 August 4, 2011 17:47
E44 ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2011
turn results in societal inequities and social
injustice.23, 32, 40 Health disparities, which are
gaps in access to and quality of health care in
disaffected racial, ethnic, and socioeconomic
groups, are 1 example of a social inequity.
Feminist theorists in nursing and other so-
cial sciences have recommended the use of
feminist intersectionality as a means of not
only obtaining a more comprehensive under-
standing of the multiplicative effects of social
inequalities experienced by vulnerable and
marginalized groups, but also of conducting
research and developing interventions that
address health disparities.41
Intersectionality operates at 2 levels: (1)
as a tool for analyzing structural oppression,
and (2) as a framework for understanding the
ways in which individual’s intersectional iden-
tities contour their lives.42 Though these lev-
els can be considered separately, they are in-
tertwined and interrelated. The application of
intersectionality to IPV involves: (1) examin-
ing the ways in which structural inequities
enable and foster IPV, and (2) examining the
influence of disadvantaged social identities on
women’s responses to IPV, which are inher-
ently related to the responses of helping pro-
fessionals and social agencies to women ex-
periencing IPV (see Table 5).25, 43- 48
The first analysis addresses the question,
“what is it about our society that makes
IPV such a prevalent, persistent, and in-
tractable problem?” The second analysis pro-
vides multiple lenses through which to con-
sider women’s responses to IPV; simply put,
context is everything. For example, what does
considering disability (or any other disadvan-
taged social identity) as a vector of analy-
sis add to our understanding of IPV and a
woman’s response to it? What do we learn
when we consider that this same woman is
an immigrant? And that she is unemployed?
And most important of all, what are the in-
dividual, organizational, social, and political
remedies available to nurses who are work-
ing with survivors of IPV and other forms of
VAW?
The influence of social systems, such as
children’s protective services, the police,
court systems, and health care systems and
providers, on abused women’s responses
have been well-described in the literature,
often as oppressive and intrusive, even af-
ter women become free from the abuser.43
These formal systems can be barriers to help-
seeking for abused women, particularly those
with multiple subordinate group identities.44
Women’s responses to IPV are inherently con-
nected, and at times reliant, on the influence
of these oppressive systems on their lives. For
example, mothers’ overt or public responses
to the violence may depend on their percep-
tions of or experiences with children’s pro-
tective services. They might not disclose the
abuse to anyone for fear of having their chil-
dren removed from their custody,45 or they
may be penalized for the abuser’s behavior
because of their (the women’s) “failure to
protect”.46 Ineffective responses by police or
court systems will prompt women to respond
differently than if they had received the legal
assistance they were seeking, perhaps staying
in the relationship and managing the violence
as best they can. Women with disabilities may
find that existing community resources are
not accessible to them or that legal and health
care systems and providers are incognizant
and ill-equipped to address their particular
needs. Understanding the complex and often
oppressive contexts of women’s responses
to IPV is essential to understanding the com-
plexity of their active and adaptive responses
to it.
Consider, for example, a woman who is be-
ing abused who is an immigrant with limited
English proficiency and a grade school edu-
cation, who is in the United States with her
husband and 3 children without her own fam-
ily, and is unemployed. She will have a limited
spectrum of possible responses to IPV relative
to a white woman who is a US citizen, has a
high level of education, is employed, and has
a network of friends and family nearby. At the
same time, if the white woman is in severe
danger from the abuser, does not have ac-
cess to household finances, and believes that
she would lose custody of her children and
her social network if she disclosed the abuse
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ANS200096 August 4, 2011 17:47
Theories of Intimate Partner Violence E45
Table 5. Intersectionality and IPV: Structural Inequalities, Social Identities, and Promoting Health
Level of Focus Explanation Critique Challenges
Nurses’ Actions for
Promoting Health
Structural
inequalities
Context of individuals’
lives: social,
economic, cultural,
political, health care
access, historical
Women who are poor,
from a minority
ethnic group, or are
immigrants, face
compounded
barriers to leaving
the abuser and to
recovering from the
abuse due to the
socially unjust
contexts in which
they live.
Abused women face
many external
barriers to leaving or
escaping an abusive
intimate partner and
to getting help from
officials, including
health care
providers.
Official helping
agencies can
perpetuate the
abuse, treat abused
women in
demeaning and
punitive ways, and
become controlling
and “intrusive,” even
after a woman has
left the
relationship.43
These theories do not
take into account
the ways in which
women’s inner
emotional and
psychological states
also contribute to
their responses to
intimate partner
violence.
Identifying points of
immediate
intervention is
difficult when
considering unjust
systems at the
societal level. Social
action is a long-term
intervention;
effective short-term
and immediate
interventions need
to be developed.
Changing the responses
of helping agencies
universally to make
it “safe” for women
to seek services is
challenging. As
nurses, we cannot
guarantee that there
will not be negative
ramifications from
seeking services
from formal systems,
for example, loss of
custody of
children.46
Advocacy for the
individual:
Providing information
on financial, legal,
health care options
Facilitating access to
community
resources, for
example, shelters,
government
assistance programs,
subsidized daycare
Partner with IPV
survivorsasthey
cope and make
adaptive choices
about how they cope
and respond to IPV
Community advocacy:
Partner with
community and
government
agencies to support
IPV survivors and
their families
without harmful
intrusion or control
Raise awareness among
helping agencies of
the social “locations”
IPV survivors inhabit
and develop
innovative programs
to address their
specific needs
(continues)
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ANS200096 August 4, 2011 17:47
E46 ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2011
Table 5. Intersectionality and IPV: Structural Inequalities, Social Identities, and Promoting Health (Continued)
Level of Focus Explanation Critique Challenges
Nurses’ Actions for
Promoting Health
Social identities Identities based on
location in disadvan-
taged/oppressed
social group(s)
Individual and
intersecting
identities influence
women’s responses
to IPV, for example,
“Strong Black
Woman,”49
“mother,”45
“Latina.”44
Raising women’s
critical awareness of
the impact of IPV,
their intersectional
location, and their
personal strength
and resilience
Individual and
intersecting
identities influence
social systems’
responses to abused
women, for
example, “bad
mother,” “welfare
queen.”50
Abbreviation: IPV, intimate partner violence.
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ANS200096 August 4, 2011 17:47
Theories of Intimate Partner Violence E47
to anyone, she too will have a limited spec-
trum of responses available to her. If she is
disabled, her dependence on her abuser could
be a barrier to her seeking safety. Both women
will also have their unique internal emotional
and psychological responses to the abuse and
violence.
An illustration of the relationship between
various oppressive social systems and the op-
pressive and controlling behaviors and tactics
enlisted by perpetrators of IPV was developed
by Chavis and Hill,23 in their adaptation of
the Duluth Power and Control Wheel (see
Figure 2). In the original Power and Control
Wheel, battering is characterized by a pattern
of abusive behaviors and tactics that are used
to control and dominate an intimate partner,
for example intimidation, using coercion and
threats, emotional and economic abuse, and
using children. Chavis and Hill added 7 dis-
tinct rings on the wheel surrounding these
tactics to represent multiple forms of oppres-
sion that are connected with each other and
with specific dynamics and behaviors in IPV.
Nursing interventions with women who are
being abused need to be developed in full
recognition of this “multifaceted plight” in
which they have been placed.47(533)
CLINICAL IMPLICATIONS
The application of the intersectionality
framework to the problem of IPV provides
a nuanced yet complex understanding of the
multifaceted positions of inequity and injus-
tice in which women who experience IPV
are placed by oppressive social structures,
IPV perpetrators, social agencies/professional
helpers, and health care providers, includ-
ing nurses. However, knowledge alone serves
no purpose; in fact, given the opportuni-
ties for action that nurses have, inaction can
be considered perpetuation of injustice, at
individual, community and societal levels. In
this light, it imperative that we answer the
question posed earlier, “What are the in-
dividual, organizational, social and political
remedies available to nurses who are work-
ing with survivors of IPV and other forms of
VAW?”
In a recent systematic review of inter-
ventions initiated by health care profession-
als aimed at women who experienced IPV,
Sadowski51 reported that advocacy, career
counseling coupled with critical conscious-
ness awareness, peer support groups, safety
planning, and cognitive psychotherapies are
likely to be beneficial. All of these inter-
ventions can be used by nurses with indi-
vidual and groups of women. Advocacy for
the individual can take the form of infor-
mation sharing, facilitating access to com-
munity resources, mobilizing her own in-
ternal and external resources, assisting in
goal setting and making choices, validating
her feelings and providing emotional support
(see Table 5).
Nurses can use the nonjudgmental, non-
confrontational, and non-adversarial strate-
gies of motivational interviewing to facilitate
IPV survivors’ critical awareness of the im-
pact of the intersections of disadvantage in
their lives and of their strength, resilience,
and adaptive coping skills in the face of living
with IPV. This process requires that the nurse
reflect on her/his personal and professional
social location of power relative to survivors
of IPV and guard against enacting the control-
ling dynamics often found in health care set-
tings. Nurses can take action by addressing
language and behaviors among co-workers
that blame the victim and perpetuate nega-
tive stereotypes. In partnership with patients
and clients, nurses can navigate a route out
of the congested intersection in which these
women have been living. As an example,
rather than asking, “Why don’t you leave?”
a nurse might ask a patient who is experienc-
ing IPV, “How have you kept yourself (and
her children if applicable) safe?” “How is the
abuse affecting you and your health?” “How
are your children being affected?” “What is
getting in the way of you being safe, healthy,
and accomplishing what you want in life?”
At the same time, the nurse would provide
positive feedback on the woman’s strength,
resilience, and coping abilities to survive and
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

ANS200096 August 4, 2011 17:47
E48 ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2011
Figure 2. The multicultural Power and Control Wheel.
endure, whether she is in or out of the violent
relationship.
Nurses can work within their organization
to develop systems that recognize and re-
spond to the needs of IPV survivors seeking
health care, specifically targeting barriers to
their safety, health, and healing. For example,
an interdisciplinary IPV response team (eg,
nurses, social workers, emergency depart-
ment and primary care providers) can be de-
veloped, with procedures in place to respond
to time sensitive situations and crises, as well
as to provide on-going advocacy and support.
Partnering with community agencies and re-
sources can expand this team to include legal
advocates, shelters, daycare providers, edu-
cational institutions, and governmental pro-
grams, such as Medicaid and financial entitle-
ment programs (see Table 5 for a list of sug-
gested nursing actions and interventions). Fi-
nally, nurses can take political action through
professional organizations, in their personal
lives, or both to address social inequities
and barriers to IPV survivors’ safety, health,
and healing. This can include financial sup-
port for nonprofit organizations, lobbying for
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

ANS200096 August 4, 2011 17:47
Theories of Intimate Partner Violence E49
legislative change and funding for programs
that address social inequities, and being ac-
tive in professional nursing organizations to
address health disparities.
Within an intersectionality framework,
nurse scholars are called to attend to the in-
herent power dynamics and ethics in con-
ducting research with survivors of IPV.41
The community-based participatory research
approach is philosophically, conceptually,
and practically aligned with an intersec-
tional approach to advocacy and research.
Community-based participatory research is
a collaborative model in which researchers
and community members partner to con-
duct research in areas of concern to the
community and for the benefit of the
community. Community-based participatory
research intentionally addresses multilevel
power relations and necessitates researcher
reflexivity, active engagement, and social
action.
CONCLUSION
This review of the historical roots of IPV
and VAW and presentation and critique of the
historical, contemporary, and evolving theo-
retical understandings of the causes of IPV
and women’s responses to violence illustrate
the entrenched nature of the problem. Theo-
retical development related to IPV in the past
several decades has coincided with and hope-
fully prompted some of the social and cultural
shifts that have occurred relative to VAW,
with widespread public acknowledgement of
the problem, commitment of resources for
intervention and research, and recognition
among health sciences disciplines that IPV is
a public health epidemic that requires pre-
vention and intervention. However, despite
this growing momentum among health and
social scientists and clinicians, few effective
interventions have been developed to pre-
vent IPV, respond appropriately to survivors
of IPV, and to mitigate its harmful effects on
women. This is likely due to an overly simplis-
tic rather than multidimensional understand-
ing and approach to the problem.
Critical social theories have shifted causal
attributions from purely internal, dysfunc-
tional psychological processes to multidimen-
sional frameworks, in which women being
subjected to IPV are seen in the context of
their families, communities and broader so-
ciety. Critical analyses of the influences and
interactive effects of oppressive social struc-
tures, for example, the political climate, the
economy, social services and health care sys-
tems, and culture now appear in IPV-related
nursing and social sciences literature.
Intersectionality is a body of knowledge
that holds the most promise for providing a
theoretical basis on which to base IPV multi-
dimensional research and effective clinical in-
terventions. The intersectionality framework
is a call to action. Just as this framework
guides analyses at the levels of social struc-
tural oppression and individual’s intersec-
tional identities, so must nursing clinical in-
terventions, education, and research address
IPV at individual and societal levels. Even
though intersectional analyses of IPV por-
tray IPV as entrenched and intractable, nurses
have many opportunities to develop short-
term interventions and to take action toward
long-term change for individuals, communi-
ties, and society. Intimate partner violence is
both an epidemic public health problem and
a critical social justice issue—its resolution
mandates nursing intervention, scholarship,
and social action that address both of these
dimensions.
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