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Intimate partner violence - effects on mental health and its treatment by authorities

Violence is a phenomenon that has always been present in human behaviour. Violence plays out in different forms in our every day lives, and it can range from more insidious forms, like psychological violence (Basile et al., 2011) to more evident forms like physical violence. Regardless of its form, violence is observable around us; whether it is strangers on the street having an altercation, a boss screaming at an employee or married neighbours fighting, it often happens in relation with other people. Violence in one particular type of relationship has been of interest for researchers throughout time, and that is romantic intimate relationships.


The type of violence present in intimate relationships is called in the specialized literature intimate partner violence (IPV) and it includes physical violence, sexual violence and psychological violence (Basile et al., 2011). Another relevant definition of IPV is made by distinguishing between: coercive control/intimate terrorism (i.e. using nonviolent strategies that aim at maintaining dominance over a partner), situational couple violence (i.e., violence that arises because of an intense argument, without the intent of controlling the other), violent resistance (i.e., violence without control used by a victim of IPV as a response to the abuse) and mutual violent resistance (i.e., both partners are violent and controlling) (Johnson, 2008). By these definitions, one can already see that violence in intimate partnerships may go beyond the more evident physical aspects and could potentially appear in more subtle ways.



But how does this violence affect the people involved?


People who experience IPV may have many negative health outcomes, such as being at a higher risk for chronic pain, sleep difficulties, posttraumatic stress disorder and depressive symptoms (Cheung et al., 2020 ). Lagdon, Armour and Stringer (2014) also highlight in their systematic review that IPV has been extensively researched in relation to mental health: It is concluded that IPV is related to depression, anxiety, somatization, psychological distress and PTSD symptoms. Coker et al. (2002) also conclude that IPV is strongly related to both physical and mental health consequences in men and women. They have also found that men and women who are victims of IPV have poorer physical health. These finding further highlight the important impact that IPV has on not just physical health, but also on the mental health of victims regardless of gender (Figure 2).

Additionally, similar types of outcomes can be observed even in the more insidious forms of IPV. When looking at the different types of IPV outlined by Johnson (2008), coercive control tends to be more frequent than situational couple violence amongst couples that experience IPV, while also having some of the worst psychological consequences during and after the relationship (e.g., depression, posttraumatic stress disorder, low self-esteem) ( Crossman & Hardesty, 2018).



All this information begs the question: how is this dealt with within our society? 


Firstly, giving that people who engage in violence often also end up getting involved in the legal system, one should look at how is IPV treated in court. To look at this, one may first look at a concept called high-conflict divorce (HCD). Even though conflict is an inevitable part of separation and even couples that have had harmonious separations go through phases of hostility and exhibit negative behaviours towards their ex-partner (Saini, 2012), some couples experience higher levels of conflict than most couples going through separation (Ornstein & Rickne, 2013). Some authors argue that HCDs are the small percentage of cases (i.e., 10%; Joyce, 2016) that take up the most time and resources in family court proceedings (Smyth & Moloney, 2019; Ordway et al., 2020). Other authors seek to differentiate HCD from common separation (Ordway et al., 2020; Saini, 2012) through different characteristics like prolonged and repetitive litigation that involve custody battles and allegations of abuse, severe anger, hostility and distrust (Shumaker & Kelsey, 2020; Polak & Saini, 2019; Saini, 2012; van Lawick & Visser, 2015; Levite & Cohen, 2012). 


Joyce (2016) highlights that an important aspect of HCD is that ex-partners often have a history of intimate partner violence (IPV), HCD therefore often involving allegations of partner abuse. The prevalence of violence may even increase during the separation process and continues (sometimes in different ways) post-separation (Anderson et al., 2010). A part of the HCDs continue to be chronically conflictual post-separation (Ornstein & Rickne, 2013). For example, between 10 and 20% of separated couples still experience significant conflict, and out of them, 4-5% are still in conflict up to five years after separation (Treloar, 2019).


Interestingly, IPV has been observed to continue after the divorce especially in couples that have a history of controlling behaviours during the relationship perpetuated by men (Ornstein & Rickne, 2013). Therefore, negative psychological outcomes might also be seen after separation. In addition, the IPV tactics used post separation either stay the same or change as to accommodate the new goals of the perpetrator. For example, some of these goals could relate to the settlements of the divorce, which can include custody arrangements for divorcing couples with children. A victim of IPV might tell the court that their partner has been violent towards them and ask for full custody of the children in order to protect them. The perpetrator could then claim that they are a victim of parental alienation (i.e., a phenomenon that describes a child allying themselves with a preferred parent and rejecting the other one without a legitimate justification; Lorandos et al., 2013).


In cases like the example above, courts in the United States, for example, give weight to the parental alienation claims, often putting aside the IPV accusations and failing to at least investigate them (Meier & Dickson, 2017). This could have negative consequences for the children, who might end up living with an abusive parent, but also on the other parent, who could end up in a situation where the IPV is continuously perpetuated after separation. Therefore, it is evident that the family court and all other institutions that parents who are divorcing come in contact with, play a significant role in decision making regarding people’s post-separation lives. People going through a high-conflict divorce rely heavily on these institutions to help them settle the divorce as in the Netherlands, for example, it is required by the law that they decide on custody and parenting arrangements. Unfortunately, the legal and social welfare institutions are not always helpful (Smith & Freyd, 2014). They sometimes make it harder for a victim of IPV to seek justice and bounce back from the previous relationship.


But how is the impact of institutions on couple separation studied in research?


In order to be able to study how institutions may negatively intervene in this process, two relevant concepts have been introduced in the literature: institutional betrayal (Smith & Freyd, 2014) and legal harassment (Clemente et al., 2019). Institutional betrayal (IB) refers to actions and inactions performed by an institution that amplify the impact of traumatic experiences (Smith & Freyd, 2014). Dockler and Mueller (2017) define IB as the failure of an institution to appropriately prevent trauma or support victims. Examples of institutional betrayal behaviours are: mishandling a case, failing to respond to allegations, and covering up or denying the experience reported (Reffi et al., 2021). Bedera (2021) also presents six actions that represent IB: “refusal to take proactive steps in preventing or addressing victimization, responding inadequately to claims of trauma, minimizing the severity of a victim’s experience, making it difficult to report traumatic experiences, punishing victims in some way for coming forward and creating an environment in which similar traumatic events seem more likely” (p. 268).


IB has negative stress-related consequences (Wright, Smith & Freyd, 2016), such as experiencing higher levels of posttraumatic symptoms (Smith & Freyd, 2013). Pinciotti and Orcutt (2021) present some risk factors for experiencing IB: they have found that sexual orientation is a significant predictor of IB, in the sense that heterosexual people were more likely than people who identify as LGB to report experiencing IB. They have also found that age at the time of the assault is important in the sense that victims who were older at the time were more likely to report that they experienced IB. Smith and Freyd’s (2017) findings legitimize the concept and show it has its own negative effects, distinct from interpersonal betrayal. They show that IB relates to poor health and dissociation.


Legal harassment (LH) refers to taking legal action against either the accuser or the accused in order to continue to abuse and harass them (Vollans, 2010). LH may be perpetuated by judges, prosecutors and lawyers of the opposing party and it usually relates to legal fights concerning custody arrangements (Clemente et al., 2019). This phenomenon has been significantly correlated with symptoms of psycho-somatization, posttraumatic stress and burnout (Clemente et al., 2019). LH has been significantly less studied than IB, given that the construct was only recently introduced in the scientific literature.



For a person going through a high-conflict divorce, the experience of IB and/or LH (Figure 3 for examples) from the authorities (e.g., family court, police, child welfare services) that are supposed to protect victims and bring justice, could indeed lead to a worsening of psychological wellbeing. The literature on negative experiences with institutions shows how this can exacerbate trauma related to abuse (Smith & Freyd, 2013). Moreover, it shows that the way that institutions handle your case and allow certain abusive behaviours to be repeated matters as much, if not more than the original trauma (such as IPV during the relationship) that the victim suffered. Research on secondary victimization and revictimization also shows the impact of unjust treatment after psychological trauma: for example, women end up experiencing a strong distrust in the family justice system and report not viewing it as a viable option to protect themselves and their children, and they report that the mother-child relationship is affected (Laing, 2017; Rivera et al., 2012). This ties into the research that shows the importance of the response of the community that the victim is part of, as well as how important it is to be believed and supported in the process of dealing with trauma (Flannery, 1990).


Bibliographical References

Anderson, S. R., Anderson, S. A., Palmer, K. L., Mutchler, M. S., & Baker, L. K. (2010). Defining high conflict. The American Journal of Family Therapy, 39(1), 11–27. https://doi.org/10.1080/01926187.2010.530194


Basile, K. C., Black, M. C., Breiding, M. J., Chen, J., Merrick, M. T., Smith, S. G., Stevens, M. R. & Walters, M. L. (2011). National Intimate Partner and Sexual Violence Survey: 2010 summary report. National Center for Injury Prevention and Control (U.S.). Division of Violence Prevention.


Bedera, N. (2021). Beyond trigger warnings: A survivor-centered approach to teaching on sexual violence and avoiding institutional betrayal. Teaching Sociology, 49(3), 267–277. https://doi.org/10.1177/0092055X211022471


Cheung, D. S. T., Tiwari, A., Chan, K. L., Fong, D. Y. T., Chau, P. H., Yuen, F. K. H., & Tolman, R. M. (2020). Validation of the Psychological Maltreatment of Women Inventory for Chinese women. Journal of Interpersonal Violence, 35(21-22), 4614-4639. https://doi.org/10.1177/0886260517715602 


Clemente, M., Padilla-Racero, D., Espinosa, P., Reig-Botella, A., & Gandoy-Crego, M. (2019). Institutional violence against users of the family law courts and the Legal Harassment Scale. Frontiers in Psychology, 10, 1. https://doi.org/10.3389/fpsyg.2019.00001


Coker, A. L., Davis, K. E., Arias, I., Desai, S., Sanderson, M., Brandt, H. M., & Smith, P. H. (2002). Physical and mental health effects of intimate partner violence for men and women. American Journal of Preventive Medicine, 23(4), 260–268. https://doi.org/10.1016/S0749-3797(02)00514-7


Crossman, K. A. & Hardesty, J. L. (2018). Placing coercive control at the center: What are the processes of coercive control and what makes control coercive? Psychology of Violence, 8(2), 196-206. http://dx.doi.org/10.1037/vio0000094 


Dockler, L., & Mueller, J. (2017). Introduction to the Special Issue on Institutional and Betrayal Trauma. Journal of Aggression, Maltreatment & Trauma, 26(1), 1–2. https://doi.org/10.1080/10926771.2016.1263707


Flannery, R. B. (1990). Social support and psychological trauma: A methodological review. Journal of Traumatic Stress, 3(4), 593–611. doi:10.1002/jts.2490030409


Johnson, M. P. (2008). A typology of domestic violence. Northeastern University Press


Joyce, A. N. (2016). High-conflict divorce: A form of child neglect. Family Court Review, 54(4), 642–656. https://doi.org/10.1111/fcre.12249 


Lagdon, S., Armour, C. & Stringer, M. (2014) Adult experience of mental health outcomes as a result of intimate partner violence victimisation: a systematic review. European Journal of Psychotraumatology, 5(1), 24794, https://doi.org/10.3402/ejpt.v5.24794 


Laing, L. (2017). Secondary victimization: Domestic violence survivors navigating the Family Law System. Violence Against Women, 23(11), 1314–1335. https://doi.org/10.1177/1077801216659942


Levite, Z., & Cohen, O. (2012). The tango of loving hate: Couple dynamics in high-conflict divorce. Clinical Social Work Journal, 40(1), 46–55. https://doi.org/10.1007/s10615-011-0334-5


Lorandos, D., Bernet, W., & Sauber, S. R. (Eds.). (2013). Parental alienation: The handbook for mental health and legal professionals. Charles C Thomas.


Meier, J. S., & Dickson, S. (2017). Mapping gender: Shedding empirical light on family courts’ treatment of cases involving abuse and alienation. Law and Inequality, 35, 311.


Ordway, A. M., Moore, R. O., Casasnovas, A. F., & Asplund, N. R. (2020). Understanding vicarious trauma, burnout, and compassion fatigue in high-conflict divorce. The Family Journal, 28(2), 187–193. https://doi.org/10.1177/1066480720904028


Ornstein, P., & Rickne, J. (2013). When does intimate partner violence continue after separation? Violence Against Women, 19(5), 617–633. https://doi.org/10.1177/1077801213490560


Pinciotti, C. M., & Orcutt, H. K. (2021). Institutional Betrayal: Who Is Most Vulnerable? Journal of Interpersonal Violence, 36(11–12), 5036–5054. https://doi.org/10.1177/0886260518802850


Polak, S., & Saini, M. (2019). The complexity of families involved in high-conflict disputes: A postseparation ecological transactional framework. Journal of Divorce & Remarriage, 60(2), 117–140. https://doi.org/10.1080/10502556.2018.1488114


Reffi, A. N., Pinciotti, C. M., & Orcutt, H. K. (2021). Psychometric properties of the Institutional Betrayal Questionnaire, version 2: Evidence for a two-factor model. Journal of Interpersonal Violence, 36(11–12), 5659–5684. https://doi.org/10.1177/0886260518805771


Rivera, E. A., Sullivan, C. M., & Zeoli, A. M. (2012). Secondary victimization of abused mothers by family court mediators. Feminist Criminology, 7(3), 234–252. https://doi.org/10.1177/1557085111430827


Saini, M. (2012). Reconceptualizing high-conflict divorce as a maladaptive adult attachment response. Families in Society: The Journal of Contemporary Social Services, 93(3), 173–180. https://doi.org/10.1606/1044-3894.4218


Shumaker, D., & Kelsey, C. (2020). The existential impact of high-conflict divorce on children. Person-Centered & Experiential Psychotherapies, 19(1), 22–37. https://doi.org/10.1080/14779757.2020.1717985


Smith, C. P., & Freyd, J. J. (2013). Dangerous safe havens: Institutional betrayal exacerbates sexual trauma. Journal of Traumatic Stress, 26, 119-124. https://doi.org/10.1002/jts.21778 


Smith, C. P., & Freyd, J. J. (2014). Institutional betrayal. American Psychologist, 69(6), 575–587. https://doi.org/10.1037/a0037564


Smith, C. P., & Freyd, J. J. (2017). Insult, then injury: Interpersonal and institutional betrayal linked to health and dissociation. Journal of Aggression, Maltreatment & Trauma, 26(10), 1117–1131. https://doi.org/10.1080/10926771.2017.1322654


Smyth, B. M., & Moloney, L. J. (2019). Post-separation parenting disputes and the many faces of high conflict: Theory and research. Australian and New Zealand Journal of Family Therapy, 40, 74-84. doi: 10.1002/anzf.1346


Treloar, R. (2019). Parents making meaning of high-conflict divorce. Australian and New Zealand Journal of Family Therapy, 40, 85-97. doi: 10.1002/anzf.1347


van Lawick, J., & Visser, M. (2015). No kids in the middle: Dialogical and creative work with parents and children in the context of high conflict divorces. Australian and New Zealand Journal of Family Therapy, 36(1), 33–50. https://doi.org/10.1002/anzf.1091


Vollans, A. (2010). Court-Related abuse and harassment: Leaving an abuser can be harder than staying. YWCA.


Wright, N. M., Smith, C. P., & Freyd, J. J. (2016). Experience of a lifetime: Study abroad, trauma, and institutional betrayal. Journal of Aggression, Maltreatment & Trauma, 26(1), 50–68. https://doi.org/10.1080/10926771.2016.1170088 



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