Exploring the relationship between PTSD and domestic violence.
Jason Brien.
Domestic violence (DV) involves violence, sexual, emotional, physical and verbal abuse/ aggression and/or any other forms of degradation of one individual against another which, necessarily, occurs within the sanctity of an intimate relationship (Showden, 2011). Males and females can be either the abused or the abuser (Wendt & Zannettino, 2014). Ultimately, perpetrators of domestic violence seek to control and isolate their intimate partners by effectively rendering the partner compliant, dependent and isolated from friends, family and other external resources (Rees & Pease, 2007).
The psychological impact of having experienced single or multiple incidences of DV is significant and can easily launch the victim into an acute crisis state (Davis, 2008: Mechanic, Weaver & Resick, 2008). In the moments of abuse, and the immediate aftermath, the sufferer/survivor may experience intense fear, depression, anxiety, helplessness, powerlessness, deep concern for safety of self and others (children) and may feel guilt and blame for having ‘caused’ the abuse (Mourad et al., 2008). It is also common for the abused to experience physical injuries stemming directly from the abuse, difficulty relaxing and/or sleeping, hypervigilance and/or racing thoughts (Mourad et al., 2008). Coupled with the insidious and malevolent reality warping (gaslighting) that the perpetrator inflicts upon the significant other, the partner being abused can completely lose sight and hope of ever being able to avoid or escape the abuse and the abuser (Rees & Pease, 2007). The abused partners increasing lack of self-efficacy and gradual distortion’s in their beliefs and thoughts systems can significantly alter the way they in which they view themselves and the world in which they interact (Dutton, 1993).
The degree, severity and tolerance of domestic violence is primarily culturally dependent (Lockhart & Danis, 2010). For example, the mistreatment and abuse of women in some Muslim oriented countries is considered the norm and therefore no cause for concern (Afrouz, Beth & Taket, 2018). In these countries, the domestic violence abuse can be expanded to include instances of female voter repression, stalking, prior male consent to travel abroad and the compulsory wearing of the burqa in public (Afrouz, Beth & Taket, 2018). Despite a less lenient attitude towards DV in Australia, there has been a reported 72,000 women, 34,000 children, and 9,000 men that have utilised homeless services as a direct result of domestic violence (AIHW, 2018). The most common form of punishment the Australian legal system dishes out to perpetrators of domestic violence is a good behaviour bond (NSW Government, 2010). For DV perpetrators that are charged with common assault (the most common charge and the less serious form of assault) only 7.2% will receive a prison sentence of, on average, 4.6 months (NSW Government, 2010). In contrast, DV perpetrators charged with recklessly causing grievous bodily harm (the most serious form of assault) will receive on average just over a 1-year prison sentence (NSW Government, 2010).
If the DV is ongoing, and/or left untreated, it is easy for the victim to develop Post-Traumatic Stress Disorder (Sullivan, 2018; Trevillion et al., 2012). In fact, a multitude of research exists confirming the link between ongoing domestic violence and the subsequent development of PTSD (Kennedy, Bybee & Greeson, 2014; Kunst, Winkel & Bogaerts, 2010; Scott & Babcock, 2010; Johansen et al., 2007). Furthermore, a DV sufferer/survivor that has developed PTSD will experience intense flashbacks, thoughts, feelings, emotions and memories associated with the perpetrator and the different forms of the abuse that was inflicted upon them (Kvavilashvili, 2014). Additionally, DV induced PTSD sufferers will experience depression, difficulty sleeping, nightmares, hyper-vigilance, anhedonia, anxiety, avoidance of trauma triggers, social/familial/occupational withdrawal and difficulties managing anger, sadness and other related emotions (Kuijpers et al., 2012; Bisson, 2007).
As such, multiple counselling treatment approaches exist which can assist a client who has experienced domestic violence to recover from the associated trauma (Roddy, 2013). With domestic violence in particular, the perpetrator, through physical or non-physical abuse, seeks to control and blame the victim thus distorting and modifying the victim’s beliefs and perceptions of reality (Kelly and Johnston, 2008). It can be challenging for a sufferer or survivor of DV to recognise how their beliefs, thoughts and behaviours have changed in relation to their abuse as the modification process inflicted by the perpetrator is quite malevolent and insidious (Dutton, 1993).
Therefore, cognitive behavioural therapy (CBT) can be useful in the treatment of the symptoms experienced by sufferers and survivors of DV (Iverson et al., 2011). CBT focuses on the current and past moment(s)/problems/concerns and seeks to understand the clients affective, cognitive and behavioural predispositions (Scott, 2011). CBT can help the client understand and recognise how their exposure to domestic violence has had an impact upon their thought processes, beliefs and behaviours and, furthermore, highlight how their abuse may have led them to feelings of unworthiness, guilt, helplessness and episodes of depression, anxiety and low self-esteem/confidence (Webb, 1992). Additionally, CBT can help the client to learn and incorporate healthy coping mechanisms/strategies into their life (Kubany et al., 2004). CBT has also been proven to be an effective treatment option for those self-medicating the symptoms of their PTSD with alcohol and/or drugs (Johnson, Zlotnick & Perez, 2011). Therefore, given that CBT is efficacious in alcohol and substance use disorders and PTSD treatments, then concurrent issues can be addressed simultaneously (Stover, Meadows & Kaufman, 2009).
Positive psychology is holistic by nature as it seeks to view the person as a whole, identify strengths and weaknesses, address positive encounters and experiences and highlights support networks that are available for the clients use (Hackney & Cormier, 2005). Positive psychology seeks to focus on the positives that are available in life rather than focus on the negatives or focusing on limiting clinical labels (Snyder & Lopez, 2005). The aim is to increase positive, meaningful, and happy relationships and experiences which ultimately help the client to foster growth and healing (Snyder & Lopez, 2005). Using positive psychology principles on clients who have endured DV or PTSD can help shift the clients focus from what they don’t have, or what they can’t do (which are introjections derived from the DV perpetrator) to what they can do and the resources that are actually available to them and identify strengths that they possess which can be utilised for recovery (Hackney & Cormier, 2005). This, in turn, can help empower victims and survivors of DV and can potentially reduce their susceptibility to further violence (Song, 2012). A positive, life-affirming approach can help clients to rediscover the resources and support networks from which they have been increasingly isolated from and significantly improve life satisfaction (Song, 2012).
References
Afrouz, R., Beth, R. C., & Taket, A. (2018). Seeking help in domestic violence among Muslim women in Muslim-majority and non-Muslim-majority countries: A literature review. Trauma, Violence and Abuse, https://doi.org/10.1177/1524838018781102
Bisson, J. I. (2007). Post-traumatic stress disorder. Occupational Medicine, 57(6); 399-403Davis, R. L. (2008). Domestic violence: intervention, prevention, policies, and solutions. Retrieved from https://ebookcentral.proquest.com
Dutton, M. A. (1993). Understanding women 's responses to domestic violence: A redefinition of battered woman syndrome. Hofstra Law Review,
Hackley, H., & Cormier, S. (2005). The professional counsellor: A process guide to helping (5th ed.). Boston, MA: Pearson Education.
Johansen, V., Wahl, A., Eilertsen, D., Weisaeth, L., Johansen, V. A., Wahl, A. K., & Eilertsen, D. E. (2007). Prevalence and predictors of post-traumatic stress disorder (PTSD) in physically injured victims of non-domestic violence. A longitudinal study. Social Psychiatry & Psychiatric Epidemiology, 42(7), 583–593
Johnson, D. M., Zlotnick, C., & Perez, S. (2011). Cognitive behavioural treatment of PTSD in residents of battered women’s shelters: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 79(4), 542–551.
Kelley, J. B., & Johnston, M. P. (2008). Differentiation among types of intimate partner violence: Research update and implications for interventions. Family Court Review, 46(3); 476-499.
Kennedy, A. C., Bybee, D., & Greeson, M. R. (2014). Examining cumulative victimization, community violence exposure, and stigma as contributors to PTSD symptoms among high-risk young women. American Journal of Orthopsychiatry, 84(3), 284–294.
Kubany, E. S., Hill, E. E., Owens, J. A., Iannce-Spencer, C., McCaig, M. A., Tremayne, K. J., & Williams, P. L. (2004). Cognitive trauma therapy for battered women with PTSD (CTT-BW). Journal of Consulting and Clinical Psychology, 72(1), 3–18.
Kuijpers, K. F., van der Knaap, L. M., & Winkel, F. W. (2012). PTSD symptoms as risk factors for intimate partner violence re victimization and the mediating role of victims’ violent behavior. Journal of Traumatic Stress, 25(2), 179–186.
Kunst, M. J. J., Winkel, F. W., & Bogaerts, S. (2010). Post-traumatic growth moderates the association between violent re victimization and persisting PTSD symptoms in victims of interpersonal violence: A six-month follow-up study. Journal of Social and Clinical Psychology, 29(5), 527-545.
Kvavilashvili, L. (2014). Solving the mystery of intrusive flashbacks in post-traumatic stress disorder: Comment on Brewin (2014). Psychological Bulletin, 140(1), 98–104.
Lockhart, L., & Danis, F. (Eds.). (2010). Domestic violence: intersectionality and culturally competent practice. Retrieved from https://ebookcentral.proquest.com
Mechanic, M. B., Weaver, T. L., & Resick, P. A. (2008). Mental health consequences of intimate partner abuse: A multidimensional assessment of four different forms of abuse. Violence Against Women, 14(6); 634-654.
Mourad, M., Levendosky, A., Bogat, G., & Eye, A. (2008). Family psychopathology and perceived stress of both domestic violence and negative life events as predictors of women’s mental health symptoms. Journal of Family Violence, 23(8), 661–670.NSW Government (2010). Sentencing of domestic violence offenders. Retrieved fromhttps://www.bocsar.nsw.gov.au/Pages/bocsar_media_releases/2010/bocsar_mr_bb48.aspx
Rees, S., & Pease, B. (2007). Domestic violence in refugee families in Australia. Journal Of Immigration and Refugee Studies, 5(2); 1-19.
Roddy, J. K. (2013). Client perspectives: The therapeutic challenge of domestic violence counselling – a pilot study. Counselling & Psychotherapy Research, 13(1), 53–60
Scott, S., & Babcock, J. C. (2010). Attachment as a moderator between intimate partner violence and PTSD symptoms. Journal of Family Violence, 25(1), 1-9.
Showden, C. R. (2011). Choices women make: agency in domestic violence, assisted reproduction, and sex work. Retrieved from https://ebookcentral.proquest.com
Snyder, C. R., & Lopez, S. J. (Eds.). (2005). Handbook of positive psychology. Retrieved from https://ebookcentral.proquest.com
Song, LY. (2012). Service utilization, perceived changes of self, and life satisfaction among women who experienced intimate partner abuse: The mediation effect of empowerment. Journal of Interpersonal Violence, 27(6).
Stover, C. S., Meadows, A. L., & Kaufman, J. (2009). Interventions for intimate partner violence: Review and implications for evidence-based practice. Professional Psychology: Research and Practice, 40(3), 223–233.
Sullivan, C. M. (2018). Understanding how domestic violence support services promote survivor well-being: A conceptual model. Journal of Family Violence, 33(2); 123-131
Trevillion, K., Oram, S., Feder, G., & Howard, L. M. (2012). Experiences of domestic violence and mental disorders: A systematic review and meta-analysis. PLoS ONE, 7(12).
Webb, W. (1992). Treatment issues and Cognitive Behavior techniques with battered women.Journal of Family Violence, 7(3); 205-217
Wendt, S., & Zannettino, L. (2014). Domestic violence in diverse contexts: a re-examination of gender. Retrieved from https://ebookcentral.proquest.com