199577

The author(s) shown below used Federal funds provided by the

U.S. Department of Justice and prepared the following final

report:
Document Title: Violence Against Women: Synthesis of

Research for Practitioners
Author(s): Bonnie E. Carlson ; Alissa Pollitz Worden ;

Michelle van Ryn ; Ronet Bachman
Document No.: 199577
Date Received: September 2003
Award Number: 98-WT-VX-K001
This report has not been published by the U.S. Department of

Justice. To provide better customer service, NCJRS has made
this Federally-funded grant final report available electronically in
addition to traditional paper copies.
Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect
the official position or policies of the U.S.
Department of Justice.
Violence Against Women:
Synthesis of Research for Practitioners
By Bonnie E. Carlson, Alissa Pollitz Worden, Michelle van Ryn, and Ronet Bachman
December 2000
NCJ 199577
This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of
view expressed are those of the author(s) and do not necessarily reflect the
official position or policies of the U.S. Department of Justice.
Bonnie E. Carlson, Ph.D., CSW, is with the School of Social Welfare and Alissa Pollitz Worden,
Ph.D., is with the School of Criminal Justice at the University at Albany, State University of
New York; Michelle van Ryn, Ph.D., MPH, is with the School of Public Health at the University
of Minnesota; and Ronet Bachman is with the Department of Sociology and Criminal Justice at
the University of Delaware.
Findings and conclusions of the research reported here are those of the authors and do not reflect
the official position of the U.S. Department of Justice.
The project directors were Alissa Pollitz Worden, Ph.D., and Bonnie E. Carlson, Ph.D., CSW,
both of whom are at the University at Albany, State University of New York. Dr. Worden is with
the School of Criminal Justice; Dr. Carlson is with the School of Social Welfare. The research
was supported by the National Institute of Justice (NIJ) under grant number 98–WT–VX–K011
with funds provided under the Violence Against Women Act.
The National Institute of Justice is the research, development, and evaluation agency of the U.S.
Department of Justice and is solely dedicated to researching crime control and justice issues. NIJ
provides objective, independent, evidence-based knowledge and tools to enhance the administration of
justice and public safety.
The National Institute of Justice is a component of the Office of Justice Programs, which
also includes the Bureau of Justice Assistance, the Bureau of Justice Statistics, the Office
of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime.

This report has not been published by the Department. Opinions or points of
Violence Against Women: Synthesis of Research for Practitioners
Since the 1970s, society began to define violence against women as a distinct phenomenon rather
than a means of grouping offenses by particular victim characteristics. This redefinition has been
accompanied by a proliferation of research on the causes and nature of violence against women;
the consequences for victims; and the roles of criminal justice, social service, and public health
practitioners in preventing, intervening in, and ameliorating the effects of women’s
victimization.1
The purposes of this project are to provide practitioners with information on key findings from
scientific research on violence against women, identify knowledge gaps that may be inadvertently
filled by unsubstantiated assumptions or beliefs, and increase practitioners’ awareness of, access
to, and ability to use information across the boundaries of professional domains. The task of
communicating research findings to practitioners is challenging on several counts.
Responding to violence against women is the responsibility of many agents in criminal

justice, social services, and public health, and these practitioners occupy independent niches
in the public and private sectors.
These groups tend to think about women’s victimization in terms defined by their own
professional values, training, and paradigms.
The fragmentation of service sectors that is reproduced in programmatic responses and in

published evaluations of programs and services (Chalk and King, 1998) limits many practitio-
ners’ and researchers’ understanding of how their practices interact with those of others. This
agency-specific and program-specific thinking obscures more constructive recognition of
common strategies and goals that might lead to more coordinated and effective responses.
The channels through which social science findings are disseminated are not readily accessi-
ble to most practitioners.
Many practitioners take pride in the progress that has been made in reforming laws and
practices and are optimistic about the effectiveness of those reforms. Research findings that
challenge their assumptions, and results that document the limitations of interventions, are
occasionally misinterpreted as indictments of their hard-won efforts, rather than practical
information that could be incorporated into ongoing innovations.
This report reviews research issues and questions that are common to the work of all audiences
for this project.2 The first section reviews definitions of different forms of violence against
women and summarizes what researchers know about their incidence and prevalence. The next
section briefly documents the emergence of violence against women as a social, legal, and public
health issue. The next section presents a summary of research on risk and contributing factors; it
is followed by a review of the consequences associated with violence against women.

This report has not been published by the Department. Opinions or points of 1
Defining Violence Against Women

For the purposes of this project, violence against women is defined as any physical, emotional,
sexual, or psychological abuse or violence committed against women by intimate partners or
acquaintances, including current or former spouses, cohabiting partners, boyfriends, or dates.
Although this definition is broader than ones adopted by many practitioners and narrower than
others, it captures the scope of women’s victimization at its most fundamental level. Regardless
of how it is socially or legally defined, women’s experiences of violent victimization are
dominated by victimization by people they know (Browne and Williams, 1993; Lentzner and
DeBerry, 1980; Mercy and Saltzman, 1989; Tjaden and Thoennes, 1998a). Moreover, although
the law distinguishes between sexual assault, domestic violence, and stalking, research shows
that these types of victimization often occur simultaneously or sequentially (Browne, 1987;
Caputi, 1989; Eby et al., 1995; Frieze, 1983; Shields and Hanneke, 1983; Zillman, 1984).3
Researchers and practitioners have yet to develop a complete consensus on what constitutes
violence against women, but many include the following:
Acts carried out with the actual or perceived intention of causing physical pain or injury to
another person (Gelles and Harrop, 1989).
Acts that are, or potentially are, physically and emotionally harmful (O’Leary and Browne,
1992).
Physical, visual, verbal, or sexual acts that are experienced as threatening, invasive, assaul-
tive, hurtful or degrading, or controlling (American Psychological Association, as cited in
Koss et al., 1994). Legally and historically, these behaviors have been distinguished as
physical violence, sexual assault, and, most recently, stalking.
Physical violence includes fatal and nonfatal physical assault. Consistent with the definitions
most commonly used by researchers, physical violence is defined herein as any act of physical
aggression intended to harm one’s partner. These acts include pushing, grabbing, and shoving;
kicking, biting, and hitting (with fists or objects); beating and choking; and threatening or using a
knife or gun.4
Legal definitions of rape and sexual assault differ from State to State, although their common
element is the lack of victim consent to sexual acts. Many States have ceased to use the term
“rape” in their criminal codes, substituting more general definitions of sexual assault and abuse.
In general, State laws distinguish between aggravated sexual assault (forcing a victim to engage
in a sexual act through actual or threatened death, serious bodily injury, or kidnapping) and
sexual abuse (which involves less serious threats and engaging in sexual acts with a person who
cannot give consent; see, for example, 18 U.S.C. § 2241–2245). For the purposes of this project,
sexual assault includes rape as conventionally defined (forced or coerced vaginal, anal, or oral
penetration), as well as other forced or coerced sexual acts that do not involve penetration.

Emotional or psychological abuse includes any act intended to denigrate, isolate, or dominate a
partner. Emotional abuse is intended to control victims by limiting resources and social contacts;
creating actual and emotional dependence; and reducing victims’ sense of self-worth, compe-
tence, and value. Emotional maltreatment can include verbal abuse, such as insults, criticism,
ridicule, name calling, discounting, and discrediting; isolation of the victim; control of social and
family contacts; denial of access to finances or transportation; demonstration of extreme jealousy
and possessiveness; the monitoring of behavior; accusations of infidelity; threats of harm to the
victim’s family, children, or friends; threats of abandonment or infidelity; and damage to or
destruction of personal property (Davis and Swan, 1999; Follingstad et al., 1990; Marshall,
1999). Health care, mental health, and legal researchers have not reached full agreement on a
definition of emotional abuse, and less is known about this form of abuse than others (O’Leary,
1999).5
Stalking has been defined by the National Institute of Justice as “a course of conduct directed at a
specific person that involves repeated visual or physical proximity, nonconsensual communica-
tion, or verbal, written implied threats, or a combination thereof, that would cause a reasonable
person fear” (Tjaden and Thoennes, 1998b, p. 2). Examples include behavior such as following
the victim, conducting surveillance, threatening the victim or victim’s family, harassing the
victim through phone calls or letters, appearing at the victim’s home or place of business, or
breaking into the victim’s home. Although high-profile cases of celebrity stalking have attracted
media and public interest, the majority of stalking victims are ordinary people who are pursued or
threatened by someone with whom they have had a relationship. Almost 80 percent of stalking
cases involve women stalked by persons they know (Tjaden and Thoennes, 1998b). In recogni-
tion of this problem, 48 States and the District of Columbia passed antistalking statutes between
1990 and 1994.
The Emergence of Violence Against Women as a Social

Problem
Since the 1970s, largely through the efforts of victim advocates, the public and policymakers
have become more informed about violence against women. Society has assumed greater
responsibility for preventing and ameliorating the effects of violence against women, and it has
evolved into a social, community, criminal justice, and public health issue.
The Emergence of Violence Against Women as a Social and Legal Issue

Given the current level of public concern and policy reform surrounding domestic violence,
sexual assault, and stalking, it would be easy to overlook the fact that much of what is called
violence against women today was classified in the domain of private, interpersonal relationships
a few decades ago. Historically, limitations on women’s activities, legal protections, and political
rights were justified in terms of women’s presumed delicacy and emotionalism. Men’s presumed
role as leader and decisionmaker in both public and private life was another important factor
(Dobash and Dobash, 1979; Pleck, 1987).

These assumptions about gender and gender roles underlie legal constructions of violence against
women in the form of legislative statutes and common law (Hart, 1991). In the case of sexual
assault, the common law addressing rape departed from standard criminal codes in several ways
(Estrich, 1987). Early English definitions and subsequent American interpretations of the crime
of rape established special circumstances for proving intent, justified by explicit assumptions.
Truly forced or coercive sexual intercourse is extremely rare.

Women are socially motivated to lie about consensual encounters.
Men are often unable to distinguish consensual from nonconsensual sex.
Because the burden of proof in criminal law falls on the prosecution, the effect of such laws is to
minimize the probability of conviction when there is any doubt as to the defendant’s state of
mind about the victim’s willingness to have sex, or any doubt about the victim’s propensity to
misrepresent the incident.6
The bias in rape law has had two important effects: It is associated with very low reporting and
prosecution rates for sexual assault, and it has created two social categories of rape. The first
category includes what one author has termed “real rapes” (Estrich, 1987): allegations of stranger
assaults by blameless and helpless victims who suffer severe injuries or die as a result of the
attack. The second, and much larger, category includes “simple rapes”: assaults committed by
acquaintances or friends that typically involve force or coercion but not necessarily weapons or
severe injuries and are hence open to the special challenges in rape code.
Domestic violence has a somewhat different legal history, although it is rooted in similar
assumptions about relationships between women and men. Although history shows sporadic
efforts to criminalize wife-beating (Pleck, 1987), such laws were seldom called into use and
many States did not have them. As a result, judges were rarely confronted with assault charges
involving spouses, but when they were asked to rule on cases of criminal wife-beating, they often
explicitly condoned the behavior as a form of family discipline and male responsibility
(Bonsignore et al., 1989; Allison and Wrightsman, 1993). Women’s claims were also rebuffed in
civil court, where common law rulings declared that if beatings did not cause lasting injury, they
were insufficient to constitute the “extreme cruelty” that justified divorce.
Throughout most of history, rape was a difficult accusation to sustain in criminal court because
the standards of factual proof were set so high. Assault on a wife was an almost impossible
criminal allegation to sustain because physical assault on a wife was not against the law and was
at most seen as a matter of civil law. Not surprisingly, rape of one’s wife was a legal impossibil-
ity: Rape statutes specifically excluded husbands from the charge under almost all circumstances
because marriage was assumed to constitute a standing consent to sex, and a husband’s physical
retribution for a wife’s disobedience was accepted (Denno, 1994; Ryan, 1996).
Although these laws may be viewed as relics of the past, some of their core elements remain
intact in many States and prosecutors and judges recognize that the beliefs that underlie them are
still held by many people, including potential jurors. Research suggests that many people,

including some practitioners, are still reluctant to label violent incidents between partners as
crimes (Ellis, 1984; Schmidt and Steury, 1989), even when they strongly disapprove of the
behavior (Johnson and Sigler, 1995; Klein et al., 1997; Stalans, 1996). Research also suggests
that, regardless of their own attitudes, prosecutors consider this reluctance when deciding
whether, and how, to process these cases in court (Schmidt and Steury, 1989; Spohn and Spears,
1996).
The Redefinition of Violence Against Women as a Community Responsibility

The women’s movement of the 1960s gave birth to the rape crisis and battered women’s
movements of the 1970s. Advocacy efforts to ameliorate the effects of violence against women
began as two parallel tracks: One focused on sexually victimized women and the other focused
on physically assaulted women. Awareness of stalking and its definition as a community
responsibility did not emerge until the early 1990s.
Initially, even sexual assault victim advocates assumed that rape and sexual assault were largely
committed by strangers. In contrast, battered women’s advocates and the public presumed that
domestic violence was largely perpetrated in the context of marriage. Over time, sexual assault
victim advocates and researchers learned that most sexual assaults were committed by family
members, intimate partners, or acquaintances. It also became clear that married men were not the
only group that used physical force on their female partners; women in cohabiting and dating
relationships beginning as early as adolescence were found to be at equal or higher risk for
physical or emotional abuse by their male partners.
The National Organization for Women (NOW) played an active role in the formation of the first
task forces on woman abuse, and by the middle 1970s, the first shelters had been formed in
Boston, Ann Arbor, San Francisco, and Minneapolis (Okun, 1986). At the same time, NOW was
instrumental in some communities in the development of rape crisis centers (Koss and Harvey,
1987). Although not coordinated or integrated, the rape crisis and battered women’s movements
had several important similarities. Both efforts were social change movements that emerged in
the early 1970s. Both were strongly grounded in a feminist awareness and analysis of the
problem. (This fundamentally social analysis perceived violence against women as inevitable
given the position of women in society and the treatment of women historically.) Both move-
ments believed that the solution was not to change individual women but to change the society
that socialized men to believe they were entitled to control and dominate women. Both move-
ments embraced the twin goals of providing support and assistance to victims and community
education aimed at preventing violence against women. As social movements, both challenged
traditional, male-oriented organizational structures and were committed to forming new
organizational structures, such as collectives, that were not patriarchal and were less hierarchi-
cally organized (Harvey, 1985; Koss and Harvey, 1987). Both began with few resources and were
financed primarily by volunteer contributions. Over time, both movements increased and
diversified their funding structures, professionalized their staffs, and in some cases became more
conventional and less alternative organizations (Harvey, 1985; Koss and Harvey, 1987; Roberts,
1981, 1998).

Reframing Violence Against Women as a Criminal Justice Issue

Advocates from the rape crisis and domestic violence movements who believed the causes of
violence against women could be found in a culture that tolerated male violence found ample
evidence for that view in laws and legal practices that effectively decriminalized most instances
of violence against women. When advocates lobbied for changes in the law and criminal justice
practice, they frequently encountered resistance and skepticism. Although reforms in the areas of
sexual assault, domestic violence, and stalking have followed different paths, they share a
common objective from a sociolegal perspective: removing the burden of proof or prevention
from victims and potential victims, thereby chipping away at the exceptions to legal codes that
have made these gender-based crimes historically distinct. In the area of domestic violence,
reform efforts have also been directed toward placing greater responsibility on the legal system
for protecting women from revictimization, largely through greater use and enforcement of
protection orders (Worden, 2000a).
Legal changes in the area of sexual assault include elimination of the utmost resistance test,
elimination or modification of the corroboration requirement, repeal of the marital exemption,
redefinition of the crime from rape to gender-neutral sexual assault, and, in some States, adoption
of rape shield laws that bar some forms of defense interrogatories regarding victims’ past sexual
experiences (Berger, Searles, and Neuman, 1988). These laws were passed by States in various
forms and combinations with the intention of alleviating victims’ fears of reporting and charging
and improving the ability of prosecutors to secure convictions and sentences. The laws were an
attempt to reset the balance between defendants’ and victims’ rights to more closely approximate
other criminal adjudications. Research in six States that adopted different packages of reforms
during the early 1980s indicates that few changes in these outcomes followed the legal changes,
but it concluded that in the most progressive jurisdictions, prosecutors, judges, and defense
lawyers had already adopted more victim-sensitive practices (Bachman, 1998; Bachman and
Paternoster, 1993; Horney and Spohn, 1991).
Other innovations in the area of sexual assault law are aimed at offenders and include mandatory
sentencing and sex offender registries. The aim of such policies is to incapacitate offenders,
denying them access to victims and rendering them less likely to recidivate. Despite the political
popularity of such innovations, there has been little research on their effectiveness in reducing
violent incidents.
Reforms have also occurred in the area of domestic violence. Domestic violence is now
criminalized in all States in the sense that exemptions from assault statutes for wives are no
longer entertained by appellate court judges, and many States have created code categories for
offenses involving family members. The more important target of reform, however, has been
enforcement and prosecution practices. Police departments that historically adopted a hands-off
approach to domestic incidents or that subscribed to the crisis intervention approach widely
promoted in the 1960s (Bard and Zacker, 1971) were encouraged by advocates to arrest offend-
ers. The real impetus for most pro-arrest policies adopted in the 1980s was the threat of civil
liability for failing to protect victims, especially victims of repeat violence who were well-known
to the police. Some jurisdictions and States have taken an even stronger stand, mandating arrest

in certain circumstances, although the effectiveness of such policies remains a topic of debate
(Bachman, 2000; Hirschel and Dawson, 2000; Worden, 2000a).
Just as arrest policies were expected to take the onus off victims, prosecution reforms were
intended to clarify victims’ roles as victims and witnesses, not disputants, in court. No-drop
policies, evidence-based prosecution, and routine issuance of temporary protection orders were
aimed at minimizing the need for victims’ active participation to secure conviction and improve
their own safety (Lerman, 1981; Mickish and Schoen, 1988), but whether they achieved those
aims is still in question (Ford, 1991; Ford and Regoli, 1993). Research has addressed only some
of these reforms (Ford and Breall, 2000; Worden, 2000a). Sentencing innovations, especially
court-mandated counseling, reflect a rehabilitative but controversial approach to offenders
(Saunders and Hamill, 2003).
Stalking laws have a distinct legal history. Rape law reforms were adopted to correct the special
imbalance between defendants and victims that was historically built into the law, and domestic
violence reforms targeted local practices that continued informally to decriminalize spouse
assault. Stalking laws, however, were designed to give law enforcement more tools with which to
apprehend and prosecute offenders whose behavior in any particular incident was unlikely to rise
to the level of a crime (Tjaden and Thoennes, 1998b). Originally conceived as a way to appre-
hend stalkers whose victims did not know them, stalking laws criminalized patterns of behavior
that produced fear in victims. However, it appears likely that these laws will be most often
deployed in acquaintance stalking situations.
In summary, the reconstruction of violence against women as a criminal justice issue proceeded
along different paths for different forms of violence. However, all criminal justice reforms share
a common element: They acknowledge greater responsibility and jurisdiction for criminal justice
agents in intervening in and, to a lesser extent, preventing, violence, largely through revoking
traditional protections and entitlements afforded to men who are violent.
Violence Against Women as a Public Health Issue

Violence began to be addressed as a public health and medical care issue in the early 1980s
(Waller, 1994). In 1985, Surgeon General C. Everett Koop formed the Workshop on Violence
and Public Health to focus professionals on the nature and consequences of violence. The three
factors that have contributed to the inclusion of violence against women as a public health
problem were increased knowledge on the prevalence and effects of partner violence, the efforts
of advocacy groups (Hagen and Postmus, 2000), and growing awareness of the impact of
violence against women on health care utilization. As a result, the Public Health Service’s
priority-setting document Healthy People 2000 includes six objectives directly related to
violence against women.
The application of a traditional public health perspective to the problem of violence against
women involves identifying its prevalence, pattern variations within a population, and risk
factors; developing causal models; and developing and testing preventive intervention strategies
at the individual, social, and physical environment levels (see Chalk and King [1998] for further

discussion, as well as Moracco, Runyan, and Dulli, 2003). This research approach is based on
public health’s considerable success in studying and responding to infectious and chronic
disease. However, the usefulness of this approach in understanding and intervening in intimate
partner violence has not been proven. The focus on community health promotion has led to the
development of largely school-based interventions aimed at preventing partner violence by
targeting potential abusers and victims (Foshee et al., 1996; see also Cascardi and Avery-Leaf,
2000).
In the medical care arena, the focus on violence against women is generally limited to screening,
identifying, referring, and treating victims of partner violence (Campbell and Boyd, 2000). This
reflects the medical care system’s historic focus on the diagnosis and treatment of individual
patients rather than on the larger social problems and forces that create the problems (Randall
1990). Thus, there has been a proliferation of interventions aimed at improving screening and
referral with limited evaluation of and unclear effect on violence against women.
Prevalence of Intimate Partner Violence

Estimates of the prevalence of partner violence vary, in part because researchers use different
definitions and data collection strategies and victims report crimes at low rates. Practitioners’
estimates of the frequency of victimization vary, depending on whether they work with general or
at-risk populations, rely on victim reports or official incident data, and focus on recent incidents
or lifetime abuse experiences.
Prevalence of partner violence in national samples. In 1985, the National Family Violence
Survey estimated rates of intimate partner violence among married and cohabiting adults. The
survey, which measured violence using the Conflict Tactics Scale, found that 11.6 percent of
women reported having been physically assaulted by their partners during the preceding year
(Straus and Gelles, 1986). The National Crime Victimization Survey, conducted in 1993,
estimated that 9.3 out of 1,000 women were victims of partner violence during that year and an
additional 12.9 out of 1,000 experienced violence at the hands of friends and acquaintances.
Furthermore, this study suggests that 29 percent of victimizations involving single offenders
were perpetrated by intimates, 9 percent were perpetrated by other relatives, 40 percent were
perpetrated by someone known to the victims but not an intimate or relative, and only 24 percent
were perpetrated by strangers (Bachman and Saltzman, 1995). The National Violence Against
Women Survey, conducted during 1995 and 1996, examined violence against women rates
among adult American women (Tjaden and Thoennes, 2000) and found, consistent with the
National Crime Victimization Survey, that 1.3 percent of women had experienced violence by an
intimate partner in the previous year. This study also found that 22 percent of women reported
physical assaults by an intimate partner at some time in their lives.
Data on sexual assault parallel reports on physical assault. The National Violence Against
Women Survey concluded that 25 percent of women experienced sexual or physical assault from
an intimate partner at some point in their lives7 and 77 percent of all sexual assaults on adult
women were perpetrated by a current or former intimate partner (Tjaden and Thoennes, 1998a).

Similarly, the National Crime Victimization Survey reported that 80 percent of the 500,000
sexual assaults experienced by women annually are perpetrated by someone known to the victim.
Stalking is the least investigated form of violence against women. The National Violence Against
Women Survey, the only community study that assesses the magnitude of stalking, reports that
approximately 8.1 percent of women are stalked at some time in their lives (Tjaden and
Thoennes, 2000). As with other forms of intimate partner violence, stalking is most commonly
perpetrated by current or former partners. About 68 percent of the stalking cases reported to the
National Violence Against Women Survey lasted a year or less, but 10 percent lasted 5 years or
more.
Prevalence of partner violence in crime reporting systems. Experts agree that despite their
accessibility, the two major sources of crime information compiled by the Federal Bureau of
Investigation—the Uniform Crime Reports and the National Incident-Based Reporting System—
significantly underestimate the prevalence of partner violence. These systems rely on voluntary
reports of crimes by local police departments, which include fewer than 50 percent of actual
crime victimizations (Reiss and Roth, 1993) and an even lower percentage of partner violence
incidents. A recent study concluded that only 20 percent of rapes, 25 percent of physical assaults,
and 50 percent of stalking incidents are reported to local authorities, and police do not formally
record all incidents reported (Tjaden and Thoennes, 2000). Furthermore, because these records
typically do not include complete information on the victim/offender relationship, these statistics
are particularly unreliable for cases of sexual assault (Fisher and Cullen, 2000).
Prevalence of partner violence in patient populations (clinical samples). Studies based on

clinical samples8 report that between 5 percent and 35 percent of women presenting complaints
in health care settings have been victims of partner violence (Glander et al., 1998; Hamberger,
Saunders, and Hovey, 1992; Hayden, Barton, and Hayden, 1997; McCauley et al., 1995; Quillian,
1996; Randall, 1990). These rates exceed those of community samples because victims are more
likely than nonvictims to suffer from an array of physical and mental health issues and are thus
more likely to seek health care (Bergman and Brismar, 1991; Felitti, 1991; Koss, Woodruff, and
Koss, 1991; Sorenson and Siegel, 1992). About 25 percent of women who are identified as
victims of intimate partner violence in clinical samples had been severely abused (Abbott et al.,
1995; McCauley et al., 1995).
In summary, estimates of the prevalence of violence vary depending on the types of questions
asked of the victims and the nature of the samples studied, but at a minimum, 1 percent of
women experience violence at the hands of a partner during a year and 25 percent are victimized
during their adult lifetime. Women are at higher risk of assault from someone known to them
than from strangers (Crowell and Burgess, 1996; Gilbert, 1995). In general, official data reported
to government agencies about violence against women is of limited value in estimating the
prevalence of the problem because most victims do not make such reports.

Research on Risk and Contributing Factors

Separate areas of research have investigated the risk factors for partner violence, sexual assault,
emotional abuse, and stalking. Little is known about risk factors for stalking or emotional abuse.
Because there is so much overlap among the risk factors for sexual and physical assault by
intimate partners, they are discussed together. There is a strong consensus that there is no single
risk factor for violence against women. Rather, researchers have learned that a number of factors
may increase the likelihood that a woman will be victimized.
Because there are numerous risk factors, an ecological framework has been adopted for organiz-
ing the different factors that are nested within one another. Some explanations for violence look
to sociocultural risk factors—characteristics of society that promote social tolerance of violence.
In contrast, social structural risk factors include social and economic factors that increase the
probability of involvement in violence. Family risk factors include relationship characteristics
that are related to violence. The risk markers that have been most studied are those that pertain to
individuals—both perpetrators and victims.
Sociocultural Risk Factors

Historically, sociocultural risk factors establish a broad context that has made many forms of
violence against women socially acceptable. Sexism in American society and sex-role stereotyp-
ing contribute to both physical and sexual victimization of women. A recent review of research
attributes social acceptance of violence to “historically male dominated social structure and
socialization practices teaching men and women different gender-specific roles” (Kantor and
Jasinski, 1998, p. 13). Research comparing rates of marital violence across States has concluded
that rates are highest “in those [American] states where structural inequality in economic,
educational, political, and legal institutions is greatest,” thus supporting patriarchy as a contribut-
ing factor (Yllo and Straus, 1990, p. 397). Research on cultural explanations for rape rates across
States has reached the same conclusions (Baron and Straus, 1989).
The impact of cultural values has also been examined at the individual level, but findings have
been inconclusive. Some studies find that men who sexually assault women are more likely than
other men to see sexual violence as acceptable (Burkhart and Stanton, 1988), although other
researchers have not consistently reached this conclusion (Neff, Holamon, and Schluter, 1995;
Sugarman and Frankel, 1996). Sugarman and Frankel (1996) concluded that assaultive men had
more positive attitudes toward violence than nonviolent men, but violent behavior was not
associated with the trait of masculinity. In addition, they found that abused women hold more
traditional gender role orientations than nonabused women, which may account in part for the
difficulty some women experience in extricating themselves from abusive relationships. Thus,
research is inconsistent regarding whether traditional sex roles are a risk factor for violence
against women (O’Leary and Cascardi, 1998).
Race and ethnicity have been widely researched as possible risk factors for violence against
women, but the results have been inconclusive.9 Some studies show that black women experience
higher rates of physical violence than white women (Neff, Holamon, and Schluter, 1995;

Sorenson, Upchurch, and Shen, 1996). Other research reports higher rates for whites than for
Hispanic women (Neff, Holamon, and Schluter, 1995; Sorenson and Telles, 1991) or no racial or
ethnic differences (Bachman and Saltzman, 1995; Tjaden and Thoennes, 1998a). Many of these
studies have not considered the effects of socioeconomic status, which is correlated with race and
ethnicity, so they may overestimate the effect of race on violent victimization. For example,
when Straus and Smith (1990) controlled for age, income, and urban residence, the apparently
higher rate of spouse abuse for Hispanic families disappeared.
The research on sexual assault indicates that
Except for college students, sexual assault is slightly more prevalent among African-
American women compared to White women. . . . The prevalence rate of sexual assault
among non-Hispanic Whites has been reported to be 2.5 times higher than that of
Hispanics. . . . [P]revalence varies by acculturation [based on the work of Sorenson and
Siegel, 1992]. (Koss, 1993, p. 215)
Among college students, the highest rates of sexual victimization were reported by Native
American women, followed by white, black, and Latino women (Koss, Gidycz, and Wisniewski,
1987). Tjaden and Thoennes (1998a) also found the highest rates of rape among Native Amer-
ican women and the lowest among Hispanic women. As is the case with domestic violence,
however, most research on race and sexual assault has not controlled for the effects of socioeco-
nomic factors, such as income, that may help to explain ethnic differences in sexual assault rates.
The findings on race or ethnic differences in stalking from the National Violence Against
Women Survey indicate the highest rates for American Indian women and the lowest rates for
Asians, with no differences between Hispanic and non-Hispanic women (Tjaden and Thoennes,
1998b).
Social Structural Risk Factors

Two kinds of social structural risk factors have been investigated: economic status and commu-
nity factors. Domestic violence occurs in households of all income levels, but researchers agree
that low income is a risk factor for partner violence (Bachman and Saltzman, 1995; Greenfeld et
al., 1998; Plichta, 1996). It is not only severe poverty and its associated stressors that increase the
risk for partner violence. Higher income correlates with lower reported intimate violence rates.
For example, in a large national sample, Sorenson, Upchurch, and Shen (1996) found that
families with incomes below $40,000 were at higher risk. Several studies have also found
unemployment of the male partner to be a risk factor (Straus and Gelles, 1986). Low income has
also been found to predict the continuation of violence over time (Aldarondo and Sugarman,
1996), with higher income a predictor of cessation (Aldarondo and Kantor, 1997).
Economic status may increase the risk of violence in two ways. First, insufficient income can
affect the perpetrator. Second, researchers have documented that poverty or economic depend-
ency on the abuser can also be a barrier to the victim’s ability to terminate an abusive relation-

ship (Horton and Johnson, 1993; Strube and Barbour, 1983; Sullivan et al., 1994; Woffordt,
Mihalic, and Menard, 1994).10
The most compelling finding regarding community-level risk factors is that rates of intimate
partner violence are highest in urban areas (Greenfeld et al., 1998; Plichta, 1996; Sorenson,
Upchurch, and Shen, 1996). Little has been written about how urban life may increase the risk
for violence, but associations between urban residence and poverty may account for the relation-
ship. This finding has significant implications for prevention and intervention efforts.
A second community-level risk factor relates to the availability and quality of prevention and
intervention services. A lack of services increases the risk that a victim will stay in an abusive
relationship or be unable to address the consequences of physical or sexual abuse. In the past, the
lack of services was a major barrier that prevented women from addressing the consequences of
violence against women, and abused women were often “frustrated in their efforts to obtain help
from traditional institutions such as the criminal justice, legal, and mental health systems”
(Mitchell and Hodson, 1983, p. 633). Since the 1970s, services, especially domestic violence
programs and rape crisis centers, have grown dramatically (Chalk and King, 1998); however,
victims were often dissatisfied with the help they received from community agencies through the
middle 1980s (Gondolf and Fisher, 1988). Although not well researched, many community
services for partner violence and sexual assault were reported to be culturally insensitive and “in
large part inappropriate and inadequate” (Heron et al., 1997). Thus, they were underused by
certain racial and ethnic groups (Neville and Pugh, 1997). The stigma associated with violent
victimization also interfered with women’s willingness to access those services, especially in the
case of rape. Few women utilized rape crisis centers, although those who did reported satisfac-
tion with the services they received.
Family Risk Factors

Risk factors pertaining to the family or couple unit have not been well researched, although
mental health professionals assume such factors play a contributing role in partner violence.
There is a consensus that relationship status is a risk factor. Among intimates, separated and
cohabiting couples are at a higher risk for partner violence than are married or dating couples
(Bachman and Saltzman, 1995; Capaldi and Crosby, 1997; Plichta, 1996), even when important
risk factors such as age and education are taken into account (Stets and Straus, 1989). Rates of
violence by cohabiting men in this study were almost triple those of married males (Yllo and
Straus, 1981).
Although it is often assumed that factors such as poor problem-solving and communication skills
and unilateral power and decisionmaking are significant risks for partner violence, there is little
research comparing violent and nonviolent couples on these dimensions. Based on data from the
1975 National Family Violence Survey, Kalmuss (1979) concluded that highly dependent wives
were significantly more likely to experience marital violence because “wives who are highly
dependent on marriage are less able to discourage, avoid, or put an end to abuse” than wives in
more egalitarian relationships (p. 379). Victim substance abuse and serious mental health

problems can increase dependency and interfere with a woman’s ability to prevent violence or
leave an abusive relationship once it has developed (Hilbert, Kolia, and VanLeeuwen, 1997).
Research also suggests that conflict is an important risk factor for partner violence. An early
study showed that both male and female dominance were associated with marital conflict, which
was in turn predictive of violence unless the wife believed that the husband should be dominant
(Coleman and Straus, 1990).
Individual Risk Factors—Perpetrators

Individual risk factors affecting perpetrators have been studied extensively. Age is among the
best documented individual risk factors for physical and sexual violence for both victims and
perpetrators, with younger age being at greater risk (Bachman and Saltzman, 1995; Koss, Gidycz,
and Wisniewski, 1987; Pan, Neidig, and O’Leary, 1994; Plichta, 1996; Sorenson et al., 1987;
Tjaden and Thoennes, 1998a). Substance abuse, especially alcohol use and abuse, has also been
found to be associated with both partner violence (Aldarondo and Kantor, 1997; Kantor and
Jasinski, 1998; Leonard and Senchak, 1996; Pan, Neidig, and O’Leary, 1994; Woffordt, Mihalic,
and Menard, 1994) and sexual assault (Ullman, Karabatsos, and Koss, 1999). Between 33 and 66
percent of sexual assaults are reported to be alcohol related (Ullman, Karabatsos, and Koss,
1999).
Numerous perpetrator personality characteristics or traits have been studied as antecedents of

physical or sexual abuse, although findings have been inconclusive. It is clear that there is no
single male personality type that is prone to sexual or physical violence. Kantor and Jasinski’s
(1998) review of research concluded that the following are personality risk markers for male
partner abuse:
Emotional dependence and insecurity.

Low self-esteem, empathy, and impulse control.
Poor communication and social skills.
Aggressive, narcissistic, and antisocial personality types.
Anxiety and depression.
Some research has attempted to identify different types of batterers (Holtzworth-Munroe and
Stuart, 1994). These studies have concluded that there may be several different types of abusive
men. At least two types—one that is violent only toward intimates and another that more
generally is violent toward others—may require different types of interventions. Because
emotional or psychological abuse typically precedes and accompanies physical abuse (O’Leary,
Malone, and Tyree, 1994), emotional abuse should also be considered a risk factor.
A history of violence in the family of origin has been extensively researched, with most research-
ers concluding that exposure to violence between parents and being the recipient of violent
punishment are risk factors for violence toward intimates as an adult (Aldarondo and Kantor,
1997; Barnett and Fagan, 1993; Leonard and Senchak, 1996), but not all studies have supported
this conclusion (MacEwen and Barling, 1988; Riggs and O’Leary, 1996).

Although stress is assumed to be a risk factor for violence against women, there is limited
research support for this assertion. One study found that men who were violent toward intimate
partners reported more stressors (Barnett and Fagan, 1993), but another found that work and
marital stressors were not predictive of partner violence (Pan, Neidig, and O’Leary, 1994). The
relationship between stress and intimate partner violence is complex and may be affected by
other important factors, such as social isolation, the husband’s belief that he should be dominant
or his approval of violence, and his exposure to violence as a child (Straus, 1990).
Individual Risk Factors—Victims

It is difficult to study risk factors for victimization because most studies do not identify victims
until after abuse has occurred. Consequently, what appears to be a risk factor might actually be a
consequence of victimization. This is especially true for social isolation and substance abuse.
There is strong research support for the assertion that earlier victimization, especially childhood
physical and sexual abuse, and witnessing violence between parents increases the risk of sexual
assault and partner violence in adulthood (Collins, 1998; Gidycz and Koss, 1991; Maker,
Kemmelmeier, and Peterson, 1998; Miller and Downs, 1993; Weaver et al., 1997).
Substance abuse has also been studied as a risk factor for victimization, especially sexual assault.
Several studies have documented the association between alcohol or drug abuse and physical
(Hilbert, Kolia, and VanLeeuwen, 1997; Plichta, 1996) and sexual victimization (Collins, 1998;
Miller and Downs, 1993; Teets, 1997). Kilpatrick and colleagues (1997) attempted to disentangle
substance abuse as a cause or effect of violent victimization in a 2-year longitudinal study that
concluded that substance abuse, especially drug use, is both a predictor and an effect of violent
victimization, affecting young women and minority women in particular. Abuse of alcohol or
drugs, which may have origins in childhood victimization and the ongoing distress it causes,
appears to be associated with the kind of lifestyle and male relationships that increase women’s
risks for victimization and makes it more difficult for women to terminate abusive relationships
(Hilbert, Kolia, and VanLeeuwen, 1997; Kilpatrick et al., 1997; Weaver et al., 1997).
Social isolation of abused women has been documented by researchers. Although it can be a
consequence of abuse, it may also serve as a risk factor. It is plausible that women with greater
social support are less likely to be physically or sexually assaulted, and thus social support may
be protective. The research of Nielsen, Endo, and Ellington (1992, p. 381) suggests that social
isolation both precedes and follows partner violence. Research suggests that abusive men often
attempt to control their partners by cutting them off from meaningful social contact. In addition,
isolated women and families may be less closely monitored by others, allowing abuse to occur
more easily (Nielsen, Endo, and Ellington, 1992). Although social isolation has not been widely
studied as a risk factor for sexual assault, Zweig, Barber, and Eccles (1997) found that it was one
predictor of sexual coercion in young adults.
Risk Factors for Stalking

Little is known about the risk factors for stalking. One study concluded that batterers who also
stalk their victims are different from nonstalking abusive men. They are more likely to have

stalked previous victims and have a history of assault, alcohol abuse, and noncohabitation
(Burgess et al., 1997). Women surveyed in the National Violence Against Women Survey
perceived motivations to be the stalker’s desire to control the victim, continue the relationship, or
instill fear (Tjaden and Thoennes, 1998b). A history of physical or sexual assault by an intimate
partner can also be considered a risk factor for stalking (Tjaden and Thoennes, 1998b).
Conclusions
Neither physical nor sexual assault are caused by one factor. Usually several factors, often
interconnected, interact with one another to increase risk. The following risk factors for violence
against women have the strongest research support:
Low income.
Urban residence.
Relationship status (unmarried or separated).
Relationship conflict.
Emotional abuse.
Young age.
Substance abuse.
Childhood abuse.
Although little is known about risk factors for stalking, a history of domestic violence, sexual
assault, stalking behavior, and alcohol abuse can be considered risk factors.
Consequences of Violence Against Women

Because consequences of partner abuse are discussed in detail in the reviews for nurses,
physicians, and service providers, only a brief summary is provided here. Violence against
women has significant consequences in terms of injury, physical complaints and symptoms, and
mental illness. Physical violence has been demonstrated to have a direct effect on trauma-related
injuries, numerous health conditions, and stress-related psychological outcomes and is implicated
as a risk factor for a range of physical and emotional disorders.
Injuries
Because the majority of violence against women cases consists of less severe forms, most women
who are the recipients of these acts are not physically injured and do not require medical
intervention (Stets and Straus, 1990). The National Violence Against Women Survey found that
36 percent of rape victims and 42 percent of physical assault victims reported injuries and
between 28 and 31 percent of them received medical care. The most common injuries are
scratches, bruises, and welts (about 72 percent of rape victims and 76 percent of physical assault
victims who are injured); lacerations and knife wounds (9 to 15 percent); and broken bones and
dislocated joints (6 to 11 percent). Perpetrator substance abuse is a significant predictor of injury
(Tjaden and Thoennes, 2000). However, injuries do not appear to be the most common health-
related aftereffect of violence against women.

Physical Complaints and Symptoms

Abused women have generally poorer health and more symptoms than nonabused women
(Attala, 1994; McCauley et al., 1995). Among the symptoms commonly associated with physical
violence11 are gastrointestinal disorders, chronic pain, fatigue or low energy, dizziness, loss of
appetite and eating disorders, and gynecologic and urologic disorders. Alcohol and drug abuse
and other risky health behaviors are also aftereffects of physical violence.12 Both abused pregnant
women and their fetuses are at risk for a number of negative outcomes, including miscarriage,
preterm labor, and neonatal death (Webster, Chadler, and Battistutta, 1996). In addition, violence
against women may influence pregnancy outcomes through its effect on health behaviors, such as
smoking and substance abuse (Martin et al., 1996).
Like victims of physical abuse, victims of sexual assault have higher rates of both medically
explained and unexplained symptoms compared with nonvictims (Kimerling and Calhoun, 1994;
Golding, Cooper, and George, 1997). In general, victims of sexual assault are at higher risk for
all the symptoms and health outcomes associated with physical violence. Gynecological
symptoms may be even more prevalent among victims of sexual abuse, including increased risk
of sexually transmitted disease infections (e.g., Murphy, 1990), pregnancy (e.g., Koss, Woodruff,
and Koss, 1990), and sexual problems and dysfunction (Campbell, 1989; Eby et al., 1995).
Women assaulted by someone known to them are more likely to have sexual problems than those
assaulted by strangers (Becker et al., 1984). Although many sexual assault survivors recover
within 6 months, at least 20 percent (Resick, 1993) and as many as 70 percent have reported
long-term problems (Burgess and Holmstrom, 1974).
Mental Health Effects

Physical abuse has consistently been found to be associated with several adverse mental health
outcomes, such as depression (Campbell, Sullivan, and Davidson, 1995; Plichta, 1996; Stets and
Straus, 1990), suicide and suicide attempts (Gelles and Straus, 1990), posttraumatic stress
disorder (PTSD) (Astin, Lawrence, and Foy, 1993; Saunders, 1994), other forms of anxiety
(Follingstad et al., 1991; McCauley et al., 1998), and alcohol and drug abuse and dependency
(Kilpatrick et al., 1997; Miller and Downs, 1993; Plichta, 1996).
The negative mental health effects of sexual assault and rape have been extensively documented
and substantially overlap with the effects of physical violence. Short-term emotional reactions to
sexual assault include “shock, intense fear, numbness, confusion, extreme helplessness, and/or
disbelief, in addition to self-blame” (Goodman, Koss, and Russo, 1993, p. 82). Mental health
effects associated with sexual assault include fear, PTSD, anxiety disorders (including phobias
and obsessive-compulsive disorder), depression, suicide attempts, sexual dysfunction, reduced
self-esteem, relationship problems, and substance abuse (Collins, 1998; Goodman, Koss, and
Russo, 1993; Kilpatrick, Edmunds, and Seymour, 1992; Resick, 1993; Teets, 1997; Zweig,
Barber, and Eccles, 1997). One research review found that symptoms begin to subside for most
victims after 3 months, but little spontaneous recovery occurs after 1 year. Thus, a subset of
victims experience problems such as fear, anxiety, PTSD, depression, suicide attempts, sexual
difficulties, and substance abuse on a chronic level (Resick, 1993).

Although it has not been thoroughly researched, emotional abuse also appears to be associated
with compromised psychological well-being. Both overt and subtle psychological abuse have
been found to influence a range of mental health and well-being outcomes, even when the effects
of physical and sexual abuse are considered (Marshall, 1999). Psychological abuse is regarded by
many women and researchers as more distressing and harmful than physical abuse (Follingstad et
al., 1990; Marshall, 1994). Emotional abuse is associated with lower self-esteem (Aguilar and
Nightingale, 1994; O’Leary and Jouriles, 1994; Orava, McLeod, and Sharpe, 1996), depression
(Rollstein and Kern, 1998), somatic problems (such as headaches), and posttraumatic effects
(Arias and Pape, 1999; Loring, 1994).
Results from the National Violence Against Women Survey suggest that victims of stalking
experience considerable distress, and stalking typically activates a protective or help-seeking
response. Almost 33 percent of self-reported stalking victims sought counseling, 25 percent lost
time from work, 22 percent took extra precautions, 18 percent sought help from friends or family
members, and 17 percent acquired a gun (Tjaden and Thoennes, 1998b).
The more severe, frequent, and long-lasting the abuse is, the more likely it is that the victim will
experience symptoms and the more severe those symptoms are likely to be (Follingstad et al.,
1991; McCauley et al., 1998; Stets and Straus, 1990). The harmful effects of abuse may linger
significantly beyond the end of the abuse. For example, a rape that occurred 10 or more years ago
can be associated with current overall health status (Leserman et al., 1997). In addition, a history
of childhood physical and sexual abuse, common in women abused as adults (McCauley et al.,
1997), exacerbates the effects of current physical violence (Plichta, 1996; Weaver and Clum,
1996) and has especially deleterious effects on adult victims of sexual assault (Becker et al.,
1984).
Economic Impact
Partner abuse has a significant economic impact on victims and families, as well as on society as
a whole. This is due in part to its impact on the health care, mental health, and criminal justice
systems. Data from the National Crime Victimization Survey between 1992 and 1996 indicate
that costs to women who are victims of nonfatal partner violence can be conservatively estimated
to be $150 million per year. These costs included medical expenses (40 percent), property losses
(44 percent), and lost pay. In addition to victim impact, partner violence creates an enormous
burden on and cost to the health care system (Bachman and Saltzman, 1995).
Conclusions
Since the 1970s, violence against women has been redefined as a social and legal problem, so
communities, criminal justice agencies, and public health organizations have been encouraged to
take greater responsibility for intervening in and preventing its occurrence. Contemporary
discussions about how to respond to violence most effectively are characterized by differences of
opinion on the gravity and urgency of the problem as well as what to do and how to do it. Across
diverse fields, practitioners disagree about the causes of violence, the goals of interventions, and
the potential for effecting positive change. Even people in the same professions hold different

views about effective practices and strategies. Because emerging strategies for intervention and
prevention call for collaboration across these groups, there is a compelling need to understand
and respect these differences in perspective and to recognize that effective solutions will require
transcending these differences and reaching common understandings.
In part, these different points of view stem from the fact that most practitioners encounter
violence against women as only a part of their work. Often, the protocols, practices, and
assumptions built into their work are of limited applicability to situations involving violence
against women. This begins with the issue of defining, recognizing, and counting victimizations.
Whereas health workers may define violence victims as patients who seek attention for injuries,
police define them as a subset of 911 calls. Victim advocates attend to shelter residents and
women who seek services, educators concern themselves with teens who prefer not to discuss it,
and mental health professionals work with clients in distress. Probation officers are most likely to
encounter victims as partners of men they are supervising on other criminal charges. Most
practitioners generalize from their own experiences, which are often based on different subsets of
the victim and offender populations.
Furthermore, practitioners often must choose between adapting their responses to violence
against women to their agencies’ general structure and devising new strategies that may
challenge the assumptions built into those structures. For example, an adversarial criminal
process that assumes victims will be proactive, cooperative, and retributive (and therefore make
good witnesses for the prosecution) may have to be modified to accommodate the ambivalence
experienced by many female victims who are in close relationships with offenders. Criminal
justice practitioners’ frustration with reluctant victims is matched by advocates’ frustration with
an unwieldy, often hostile criminal process.
Practitioners also differ over priorities, especially when resources are scarce. Resources invested
in batterer treatment may be seen by some as resources lost to victim services or prevention.
These differences of opinion reflect not only competition for resources, but also more basic
disagreement about what causes violence and what might be effective in reducing, ending, or
preventing it. For example, policies aimed at deterring violence through arrest or punishment
may not look promising to practitioners who attribute violence to mental health problems or
deeply entrenched socialization patterns.
As practitioners and policymakers experiment with collaborative responses to violence against

women, they face the dual challenges of coming to terms with these differences in perspective
and increasing their knowledge about the causes, consequences, and effectiveness of interven-
tions. Practitioners and policymakers seem to agree that coordinating efforts across agency lines
will prove more effective than traditional responses to violence, but researchers have only begun
the challenging task of evaluating the impacts of these coordination efforts (Chalk and King,
1998; see also Worden, 2000b). Increasingly, practitioners will be obliged to learn what does and
does not work, not only in their own domains, but also in those of others with whom they share
responsibility for victims and offenders. Their knowledge is often based more on their own
experiences than on an understanding of the broader picture that research can provide. It is

obvious that there are potential benefits to acquiring more knowledge about other fields—for
instance, victim advocates’ opinions of batterers’ programs would ideally be influenced by
information on what kinds of programs have been found effective and ineffective and with what
populations; accessing research-based knowledge is time-consuming, however. Furthermore,
most reports of research are not written with practitioners in mind. This project represents an
attempt to remedy that deficiency toward the dual objectives of increasing practitioners’
understandings of each others’ work and contributing to a more informed dialogue about
responding to violence against women.
Notes
1. The focus of this report is on violent victimization of women. Much research has documented
that women are also sometimes violent toward their male or female partners (e.g., Straus and
Gelles, 1986). There is debate over the prevalence, reasons for, and effects of women’s intimate
violence. However, researchers are generally agreed that female victims of violence are more
likely than male victims to be injured and harmed in other ways (Tjaden and Thoennes, 2000).
2. Studies reviewed here were U.S. empirical research studies published through 1999, obtained
via CD–ROM searches of Criminal Justice Abstracts, Medline, PsycINFO, and Sociofile
databases as well as other research of which participating authors were aware.
3. Sexual harassment is not included here, despite its overlap with emotional abuse in particular,
and despite its deleterious impact on women, because it typically occurs outside of intimate and
romantic relationships (U.S. Equal Opportunity Commission, 1997).
4. These acts are included in the Conflict Tactics Scales inventory of physical aggression acts
(Straus et al., 1996). “Severe” physical violence includes acts very likely to cause physical injury,
such as hitting, beating, choking, or using a knife or gun.
5. For example, the Psychological Maltreatment of Women Inventory differentiates

psychological abuse into two categories, dominance/isolation and emotional/verbal abuse
(Tolman, 1999, 1989), and the revised Conflict Tactics Scales (Straus et al., 1996) includes
measures that reflect a definition of abuse that involves both overt emotional abuse and intent on
the part of the abuser. In contrast, Marshall (1999) argues for the importance of recognizing more
subtle emotional abuse, irrespective of the abuser’s intent to harm, which can also affect well-
being.
6. As a result, the law of rape, unlike most criminal law, historically has required that the
prosecution prove that victims did not consent, and in fact resisted to the point of being seriously
injured or incapacitated (known to lawyers as the “utmost resistance” test). Corroboration, either
from physical evidence of the act (e.g., semen, injuries), or less likely, a witness, was a required
element for conviction. Victims’ sexual biographies were fair game for defense attorneys, in that
women who had been unchaste once were perceived as likely to be willing parties. However,
even women with no sexual experience were suspect, since presumably a virgin might be both

desperate and duplicitous enough to preserve her social reputation by lying about a sexual
encounter prior to marriage.
7. Rates of sexual assault may be even higher in some population groups; for example, based on
a large national sample of female college students, Koss, Gidycz, and Wisniewski (1987) found
that more than half had been sexually victimized, most commonly experiencing unwanted sexual
contact.
8. Clinical populations are groups of people who present for services at an organization such as
an agency or hospital and are not randomly selected from the community.
9. Only research based on large, representative community samples is discussed here.
10. Low income also is associated with higher sexual assault rates (Koss, Gidycz, and
Wisniewski, 1987).
11. For reviews, see Bodden-Heidrich et al. (1999); Drossman et al. (1990); Drossman et al.
(1995); Eby et al. (1995); Hendricks-Matthews (1993); Hourani et al. (1999); McCauley et al.
(1995); and Rapkin et al. (1990).
12. Although clearly significantly associated, the causal direction between intimate partner
violence and substance abuse among victims has not yet been clearly established. However, there
are indications that intimate partner violence victims, like other people, self-medicate as a means
of coping with the stress and pain caused by abuse (Martin et al., 1996; Stark et al., 1981).
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The author(s) shown below used Federal funds provided by the

U.S. Department of Justice and prepared the following final

Document Title: Violence Against Women: Synthesis of

Author(s): Bonnie E. Carlson ; Alissa Pollitz Worden ;

Document No.: 199577

Date Received: September 2003

Award Number: 98-WT-VX-K001

This report has not been published by the U.S. Department of

Opinions or points of view expressed are those

This document is a research report submitted to the U.S. Department of Justice.

This document is a research report submitted to the U.S. Department of Justice.

 Responding to violence against women is the responsibility of many agents in criminal

 The fragmentation of service sectors that is reproduced in programmatic responses and in

This document is a research report submitted to the U.S. Department of Justice.

Defining Violence Against Women

This document is a research report submitted to the U.S. Department of Justice.

The Emergence of Violence Against Women as a Social

The Emergence of Violence Against Women as a Social and Legal Issue

This document is a research report submitted to the U.S. Department of Justice.

 Truly forced or coercive sexual intercourse is extremely rare.

This document is a research report submitted to the U.S. Department of Justice.

The Redefinition of Violence Against Women as a Community Responsibility

This document is a research report submitted to the U.S. Department of Justice.

Reframing Violence Against Women as a Criminal Justice Issue

This document is a research report submitted to the U.S. Department of Justice.

Violence Against Women as a Public Health Issue

This document is a research report submitted to the U.S. Department of Justice.

Prevalence of Intimate Partner Violence

This document is a research report submitted to the U.S. Department of Justice.

Prevalence of partner violence in patient populations (clinical samples). Studies based on

This document is a research report submitted to the U.S. Department of Justice.

Research on Risk and Contributing Factors

Sociocultural Risk Factors

This document is a research report submitted to the U.S. Department of Justice.

The research on sexual assault indicates that

Social Structural Risk Factors

This document is a research report submitted to the U.S. Department of Justice.

Family Risk Factors

This document is a research report submitted to the U.S. Department of Justice.

Individual Risk Factors—Perpetrators

Numerous perpetrator personality characteristics or traits have been studied as antecedents of

 Emotional dependence and insecurity.

This document is a research report submitted to the U.S. Department of Justice.

Individual Risk Factors—Victims

Risk Factors for Stalking

This document is a research report submitted to the U.S. Department of Justice.

Consequences of Violence Against Women

This document is a research report submitted to the U.S. Department of Justice.

Physical Complaints and Symptoms

Mental Health Effects

This document is a research report submitted to the U.S. Department of Justice.

This document is a research report submitted to the U.S. Department of Justice.

As practitioners and policymakers experiment with collaborative responses to violence against

This document is a research report submitted to the U.S. Department of Justice.

5. For example, the Psychological Maltreatment of Women Inventory differentiates

This document is a research report submitted to the U.S. Department of Justice.

9. Only research based on large, representative community samples is discussed here.

This document is a research report submitted to the U.S. Department of Justice.

This document is a research report submitted to the U.S. Department of Justice.

This document is a research report submitted to the U.S. Department of Justice.

Responding to violence against women is the responsibility of many agents in criminal

The fragmentation of service sectors that is reproduced in programmatic responses and in

Truly forced or coercive sexual intercourse is extremely rare.

Emotional dependence and insecurity.