The Intimate Partner Abuse

One area of study that has attracted the attention of many researchers is behavior, thoughts and feelings/motions of individuals, and the way the environment in which individuals live affects these aspects. The environment could refer to other individuals or media that are in the individual’s vicinity. A social psychologist merges the concepts in psychology and sociology to study the effects of the social environment on the behavior and emotions of an individual. The fact that a given change in behavior and emotion of an individual has followed an exposure to a given environment may not necessarily imply a causal relationship. The behavior, emotions, and feeling could have been caused by other factors that are not known in the theoretical contexts. This is the main reason behind different researches in the field of social psychology. The factors that affect an individual’s behavior and emotions may be extreme to the extent of posing health problems to the victims. A more reliable relationship needs to be developed for use in other areas like in psychotherapy.

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A rapidly increasing problem in the society is domestic violence and other misunderstandings observed among individuals in a relationship or those who had a relationship earlier. These are manifested in different ways. In many situations, one partner in the relationship attempts to exercise power and control over the behavior and emotions of the other partner. There are cases of sexual abuse, physical assault, or psychological torture witnessed in the society among individuals in the present or past relationship. There are cases of rape being reported among spouses or ex-spouses. Cases of domestic violence are a common scenario in the societies. Serious situations may result into a physical disability or death of the victims the assault. One partner in a relationship may subject the other to some psychological torture that is unbearable. The victim may be forced to act in a manner that is contrary to his or her principles. One partner may be forcefully isolated from the family members, or he/she may be forced to part with some important property unwillingly. All these actions are termed as intimate partner abuse. The abuse often has adverse effects on the victims. The relationship referred to here could a homosexual or heterosexual relationship. However, females are more vulnerable to the adverse effects of such abuse in a relationship. In many instances, the injuries sustained by females following an intimate partner abuse like physical assault or sexual abuse exceed the injuries suffered by men. In this regard, the study of the effects of intimate partner abuse is always associated with an examination of the violation of the rights of women. A significant proportion of women who seek primary care in the US of have reported violence in their relationships (Coker et al, 2000a, p.553)

Various researches have shown that intimate partner abuse has adverse effects on the health of the victims. The psychological problems like stress and depression following an oppression or assault by a partner could be a cause to some of the health problems observed in patients. These health problems resulting from sexual abuse or any other form of intimate partner abuse are believed to be rampant among females. The effects are more pronounced on pregnant females due to threat to the mother and fetus’s life (Campbell, 2002, p.1333). Nevertheless, the solution of this problem does not only rely on the establishment of the descriptive correlation between abuse and the associated health problem. A proper understanding of the cause and effect relationship between the abuse and health problems is necessary to help develop an effective psychotherapy or any other form of therapy for a patient. On the other hand, the understanding of the societal factors that contribute to such intimate partner abuse practices is essential in the prevention of future abuse and other negative behaviors and emotions. The abuse could be the effect of alcohol and drug abuse. The abuser could also be reacting to an assault or abuse he/she had suffered from the partner. The other factor that could lead to abuse by partner is forced relationship or marriage. The research is intended not only to establish the genuine cause-effect relationship between abuse and health problems, but also to examine the social factors that are associated with such abuse. One of the difficulties in conducting the research is that many cases of abuse in a relationship are not often disclosed. The abused partner in a given relationship is often reluctant to provide information to different party like a researcher, whom they often view as non-partisan and should not be involved. It requires a lot of expertise to convince the victims to be interviewed to understand the importance and implication of the research. A different approach like obtaining the information through healthcare providers could be used. The research will involve collection of data pertaining to patients in some community hospitals through the nurses. However, the reliability of such information will be lower as more parties are involved in the collection of data. The healthcare providers might not have the have enough time or potential to carry out the interview to obtain the required information from the clients.

Problem statement

Like many researches in the field of psychology, this research will be conducted to study the association and establish the relationship between intimate partner abuse like psychological harassment, physical assault, and sexual abuse and the cases of health problems reported among females. With the kind of relationship that is to be identified, the research is also intended to illuminate on the factors that could have led to such deeds by the abuser. Previous researchers have pointed out factors like level of education and financial constraints to be related to such incidences. However, more factors are present that may lead to such behaviors among spouses. Establishing the relationship between these variables and providing medical services to the victims of the abuse do not provide a proper solution to the social problems created. The proper management of these actions consists in the identification of these fundamental factors contributing to such actions in the society.

Literature review

Intimate partner abuse (IPA) is a situation whereby one partner in a relationship exercises power and control over the behavior of the other partner. This is often carried out through psychological intimidation, physical abuse, or through sexual abuse (Intimate Partner Abuse and Relationship Violence Working Group, n.d, p.3). The victims of partner abuse often feel depressed, isolated, impatient, fearful, and lack ability to concentrate on a given task. They have difficulties in getting sound sleep. IPA is common in a substantial proportion of relationships in the US (Rodriguez et al, 2001, para.1; Bauer et al, 2000, para.7). Sexual abuse has been found to be a common practice intimate partner abuse. Researches have shown that a significant proportion of cases of rape are encountered in a relationship. The cases of intimate partner abuse are not only common among partners in a heterosexual relationship. It has been observed that such cases are also common among gays, lesbians, and other homosexuals (Intimate Partner Abuse and Relationship Violence Working Group, n.d, p.3). Either of the partner in the relationship could be the abuser. In either case, abuse against women partners are often much higher than the abuse against men (Intimate Partner Abuse and Relationship Violence Working Group, n.d, p.3). The women are also more likely to suffer the consequences of violence in a heterosexual relationship than their male counterparts are. Perhaps, this could be attributed to the masculine nature of the men. As such, the effects of different forms of intimate partner abuse are felt more in females than in males.

A part from physical assault and sexual abuse, intimate partner abuse could also take other forms. The abuser could restrict the other partner’s access to facilities like television or computer that is family-owned. He or she may be denied access to information such as the bank statement of the spouse or the worth of a given family business. The abuse could also involve isolating one from his or her family members and other friends, and restricting one’s movement unnecessarily. All these actions usually affect females more than males. Researches have shown that the experiences that women get from abuse by their male partners have effects on the health of the women. In study to examine the prevalence an intimate partner abuse among patients who reported for an emergency treatment, Dearwater et al (1998) observed that a significant number of the female patients who came from emergency treatment had past traumatic experiences (p.433). Out of the 3455 female patients who took part in the research and provided all the information needed, it was observed that nearly half of them reported cases of abuse by intimate partner (Dearwater et al, 1998, p.433). There were those who suffered acute trauma following recent abuse, there were those who reported cases of physical or sexual abuse for the past one year, and there were those who reported ever suffering an abuse in their lifetimes. Similar results were obtained in other researches (Coker et al, 2000b, p.454).

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The females who suffer intimate partner abuse have a mixture of psychosocial and medical conditions. Even though the exact causal mechanism may not be explained, it has been observed that chronic health problems, gynecological problems and disorders in the central nervous systems are some effects of intimate partner abuse on females (Campbell, 2002, p.1332; Campbell et al, 2002, p. 1157). Such women also have a high likelihood of reporting cases of some form of disability (Svavarsdottir & Orlygsdottir, 2009, p.1453). A research was conducted by Dr Amy E. Bonomi and others from Ohio State University to examine the different psychosocial and medical problems associated with intimate partner abuse. The research gave a comparison in the behaviors and medical conditions between women who reported past abuse by their partners and those who had no past abuse. According to the report by Brauser (2009), the research indicated that medical conditions including ‘chest pain, menstrual disorders, depression, urinary tract infections, and lower back pain’ were common in females with past abuse (para.1). The information on these medical conditions was obtained from the health records of the patients and the interview conducted through telephone. The diagnosis that had been given to the patients was an effective method of identifying whom to include in the survey. Increased substance abuse, stress and depression, and increased family issues were also common among this category as compared to the control group (Brauser, 2009, para.1). Further analysis showed that the abused women also had higher risks of having sexually transmitted diseases than the others who had no past abuse (Brauser, 2009, para.11). The investigators noted that the collection of such data in another survey might be difficult as the females abused by their partners may be reluctant to speak it out to some investigator. As such, it is suggested that medical practitioners should keep records of such previous studies and administer questions relating to abuse if these conditions are observed (Brauser, 2009, para.14).

Several other literatures are available that indicate a relationship between the medical and psychosocial conditions and intimate partner abuse. The researches have been reported to have certain weaknesses that need to be reinforced in the future. Some of the researches have conflicting reports, like in reporting race and ethnicity as a factor associated with IPA (Bauer et al, 2000, para.8). They did not present a precise definition of intimate partner abuse and the actions involved. There were also differences among the screening tools used by the investigators and a long period of research (Dearwater, 1998, p.433). These researches do not probe further to seek information on the causes of the violence and other forms of abuse experienced in a relationship. Little is also addressed concerning the future behaviors of the victims. Some of the researches (in the US) also relied on the information from hospitals yet the latter have been reported to be less sensitive to such conditions in patients (Rodriguez et al, 2001, para.1). It is necessary that the future researches should go ‘beyond descriptive studies towards analytical epidemiological studies in the natural history of IPA and the health care use patterns of abused women’ (Dearwater, 1998, p.438). Rather than relying on clinical reports to help victims of intimate partner abuse, an understanding of the causes of the abuse can be used by counselors to prevent such abuse or their reoccurrence. Medical practitioners will also find it easy to manage victims with such experiences.

Hypotheses of the study

The research to be conducted will have a number of hypotheses (proposed statements) about intimate partner abuse. Like many researches that have been conducted, one of the hypotheses of the study will be that there is a (positive) relationship between intimate partner abuse and health problems among females. Various health disorders are believed to follow past traumatic experiences like rape or physical domestic violence. Another hypothesis of this study is that cases of intimate partner abuse are common among individuals in a forced relationship. It is believed that the females who suffer the different forms of abuse by their spouses are in a forced relationship. The forced relationship could result from peer influence, attraction to the material wealth the other partner has, or as way of obtaining favor in some services provided by the partner. The latter occurs where one individual has some (illicit) control over the quality and outcome of the services offered to the other as is the case between students and their dons in colleges. A forced relationship is often characterized by high level of dependency of one partner on the other. This dependence becomes the basis for abuse since the dependant has little power.

The third hypothesis of the study is that level of physical violence or the frequency of sexual abuse between partners in a relationship will depend on the individuals’ exposure to violent scenes aired in the television programs. Lastly, it is believed that intimate partner abuse is likely to contribute to drug and substance abuse by the victims.

Methods

Participants

Most of the researches that have been conducted in the US on intimate partner abuses are in the in the urban regions. This does not provide the exact characteristic of the whole population since there are differences between the urban life and rural life. For instance, the cases of violence are common in the urban centers as opposed to rural areas. The social life in these regions are quite different and do have an implication on the nature of relationship between partners. As such, the survey will be conducted in health centers in the urban, suburban, and rural regions. The whole survey will be conducted in Pennsylvania State. Five community hospitals in each of the three categories of region have been identified for the survey. Arrangements have been made with the management of these hospitals to help conduct the survey over the intended period.

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The participants in the survey will be females who have presented themselves for medical services at the centers. The survey is intended to include about 3000 participants. The fifteen different hospitals will be expected to interview an average of 200 patients. The survey will involve thorough screening of the patients for abuse and related factors. With the experience from other researches, it has been recommended that the exercise be conducted for seven consecutive days. The short-term seasonality will be eliminated by obtaining the data throughout the week.

There are situations under which a female patient with signs of intimate partner abuse might be exempted from the interview. Firstly, only females between the ages of 18 and 65 will be included in the survey. Secondly, a patient who has had a serious physical or sexual abuse, and is in a critical condition that needs immediate medical action will not be interviewed. Similarly, a patient who appears to be traumatized and is confused will not be included in the survey. The interview requires one to give information concerning his or her private life like in marriage. The presence of a family member is an obvious barrier to obtaining effective information. Thus, a patient who is accompanied by a family member will also not be considered. A language barrier might also lead to one’s exemption from the survey.

Materials

For this survey, the normal Patient Satisfaction and Safety Survey (PSSS) tool used by hospitals will be used. This is a form of questionnaire used by hospitals to record the patients’ attitudes towards their services. It seeks for demographic information of the patient like age, race, education, relationship status, and income (Dearwater, 1998, p.434). It also contains questions that seek to identify if the patients has current or previous experiences of sexual or physical abuse by their partners. There are other questions as to how long the patients have stayed in a marriage or relation, and if they divorced within the last one year. These questions mainly require a Yes/No answer. Most important to this research is a set of three other questions that are incorporated into the PSSS tool.

Unlike the other questions, two of these questions do not require a Yes/No response. Instead, the responses are presented in a Likert scale with five different points indicating the degree of the response in relation to the questions. The first of these questions seek to identify the patient’s attitudes towards their spouses/ boyfriends or ex-spouses. This will be used to identify if the woman was forced into a relationship. The question shall read; “What is your attitude towards your husband/ boyfriend (or ex-husband/ ex-boyfriend)?” The responses will be 1) Definitely love him 2) Somehow love him 3) Neither love nor hate him 4) Somehow hate him 5) Definitely hate him. In conjunction with the previous responses relating to the relationship, the response here will indicate if the female had genuine love for the male partner or she was forced by certain circumstances. It will also indicate the level of social stress that the female is experiencing in the relationship.

The second of the questions seeks to identify if violent and pornographic films could be the cause of the abuse by the male partners. It reads; “Is your husband/boyfriend a fan of the late night pornographic and violent television programs?” This simply requires a Yes/No response.

The last question will seek to identify the patient’s attitude towards drug abuse as a tool to overcome stress and depression. In particular, the patients will be required to respond to the claim that “Cigarette smoking and taking alcohol provides remedy to stress and depression.” Again, the responses will be 1) Strongly agree, 2) somehow agree, 3) neither agree nor disagree, 4) Somehow disagree, 5) Strongly disagree. The type of response provided her will indicate the likelihood that the patient will engage in drug abuse following the traumatic experience..

In the analysis, SPSS 17.0 will be used. The main dependent variable will be measured in terms of the prevalence of IPA in a given relationship. A measure of correlation of the dependent variable and the independent variables like exposure to violent scenes, social stress in the marriage, or the medical conditions will be observed through regression models.

Procedures

Previous researches have involved telephone follow-up on victims who were diagnosed with psychosocial and medical conditions that were indications of past trauma. The telephone interviews were unreliable due to non-response and the level of mistrust by the interviewee. This research to be conducted is based on the previous findings. Reports from previous researchers show some of the medical conditions that are associated with IPA. The patients will be subjected to the normal medical check up. Information from patients with unrelated medical conditions is not relevant here. The patients that appear to have the indicative symptoms will be handed over to another nurse who will conduct the interview. This will not raise suspicion and inconvenience the patients in any way. If anything, different medical conditions need different medical attention.

The encounter of the second nurse and the patient might not need a formal introduction in the normal interview. However, an element of rapport has to be developed before administering the questions. The nurse will examine if the patient is eligible to be subjected to the interview. The patient has to be convinced that the health center is in the process of improving the quality of its services to the clients. He/she will be convinced that the information to be collected will only be used by the hospital for medical purposes, and that it will not be leaked to another individual or agency. The process will be carried out for one week. In case the targeted number is not covered by the end of the seventh day, the survey period may be extended until such time when the target number is hit. On the other hand, in case the target number is hit before the end of the period, the exercise will continue to the end of the period. This will provide a measure of variation of the cases among different regions. There shall be a daily communication between the researcher and the health centers concerning the statistics of the day.

Discussion

Implications

Just like the previous researches, this research is intended to provide further evidence on the relationship between physical/sexual abuse among partners in a relationship and the health problems that may be observed in one of the partners, with much emphasis on the female partners as victims. The success of the research will provide more evidence to this claim. The research is likely to show that cases of IPA are common among female partners who do not have love for their male partners. Different circumstances could have forced the woman into the relationship. Another research finding that will be important is that intimate partner abuse like physical and sexual abuse are common among males who have affection for violent programs and pornographic movies aired on television or on any other media. Most importantly, the research will indicate a positive relationship between the cases of intimate partner abuse and future drug abuse by the victims. The result of the research will indicate that victims of severe IPA are more likely to turn to drugs as a way of relieving stress and depression compared to those with little or no IPA experience.

Applications

The results that will be obtained have applications in the practice of clinical psychology and other situations that need psychological intervention. The therapeutic services to victims with traumatic experience require that one understands the fundamental principles that will be shown by these results. The quality of medical care that will be provided to a patient will be improved if the practitioner is able to identify that the patient suffers relationship violence.

The intervention by medical practitioners and psychologists to victims of IPA are not only intended to provide medication and therapy to the victims. It is intended to prevent future abuse and improve on the behavior of the victims. With the knowledge that many victims of such abuse are likely to become drug addicts, the psychotherapists will be able to develop an effective therapy to the victims.

The results of the research will also be of use to counselors of females (and males) below the age of 18. The counselors can apply the evidences that will be revealed on the consequences of succumbing to forced marriages or relationship. The future adults will be educated on how to make proper decision concerning relationship based on the finding of the research.

Directions for future research

It is important to recognize the fact that the research will only include females who have reported to the local hospitals for treatment. The care providers are to administer the research questions to the female clients who appear to have had some form of abuse prior to the admission. However, it has been stated that there are women who will not seek medical services following such assaults and continue to suffer silently in their troubled relationship. Besides, others who have had sexual abuse may not be willing to share the experience with anybody lest their partners suffer the consequences of the legal procedures. Different methods of screening having been proposed for use at different levels in the health sector (Svavarsdottir, 2010, p.224). However, the differential approach might still pose problems calling for a standard approach. More still, there are an increasing number of intimate partner abuse cases on males. The situation has been neglected by many researchers and yet it is one of the social problems in the contemporary society. Some researchers have indicated that better management of IPA cases can be achieved if the doctors can consult with both the couples (Taft, Broom, and Legge, 2004, para.1). Future researchers should apply other differential techniques to seek information on abuse for individuals not in the healthcare centers. Members in other social institutions like schools, colleges, or churches could be surveyed to obtain such information. The purpose of the research should be stated clearly to the participants in the survey. It should be stated clearly that the research is conducted to mitigate future cases of abuse and not to subject the abuser to the legal procedures. The researches should also focus on the plight of men in the society in relation to the intimate partner abuse and relationship violence. Besides, the research to be carried out and the other previous researches have focused on heterosexual relationship. This ignores the fact that there are a significant proportion of homosexuals in the contemporary society. These individuals are also subject to intimate partner abuse by the partners. The management of IPA as a social problem should also include these groups of individuals.

References

Bauer, H. et al. (2000). Prevalence and Determinants of Intimate Partner Abuse among Public Hospital Primary Care Patients. Society of General Internal Medicine, 15(11); 811–817.

Brauser, D. (2009). Intimate Partner Abuse Can lead to Wide Range of Health Problems. Medscape Medical News.

Campbell, J. (2002). Health consequences of intimate partner violence. THE LANCET, 359; 1331-1336. Web.

Campbell, J. et al. (2002). Intimate Partner Violence and Physical Health Consequences. Arch Intern Med, 162:1157-1163. Web.

Coker, A. et al. (2000a). Frequency and Correlates of Intimate Partner Violence by Type: Physical, Sexual, and Psychological Battering. American Journal of Public Health 90(4); 553-559. 

Coker, A. et al. (2000b). Physical Health Consequences of Physical and Psychological Intimate Partner Violence. Arch Farm Med, 9; 451-457. Web.

Dearwater, D. et al. (1998). Prevalence of Intimate Partner Abuse in Community Hospitals JAMA, 280(5); 433-436. Web.

Intimate Partner Abuse and Relationship Violence Working Group. (N.d). Intimate Partner Abuse and Relationship Violence. Web.

Rodriguez, M. (2001). The Factors Associated with Disclosure of Intimate Partner Abuse to Clinicians. A Journal of family practice, 50(4). Web.

Svavarsdottir, E. (2010). Detecting intimate partner abuse within clinical settings: self-report or an interview. Scand J Caring Sci; 24; 224–232. Web.

Svavarsdottir, E. and Orlygsdottir, B. (2009). Intimate partner abuse factors associated with women’s health: a general population study. Journal of Advanced Nursing, Vol. 65, No. 7, pp.1452-1462. Web.

Taft, A., Broom, D. and Legge, D. (2004). General practitioner management of intimate partner abuse and the whole family: qualitative study. BMJ, 328(7440).

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