|Year : 2014 | Volume
| Issue : 2 | Page : 105-113
Psychosocial characteristic of female victims of domestic violence
Khaled Abd El Moez1, Mona Elsyed1, Ismail Yousef2, Amany Waheed Eldeen3, Wafa Ellithy2
1 Lecturer of Psychiatry, Suez Canal University, Ismailia, Egypt
2 Professor of Psychiatry, Suez Canal University, Ismailia, Egypt
3 Professor of Community Medicine, Suez Canal University, Ismailia, Egypt
|Date of Submission||01-Mar-2014|
|Date of Acceptance||01-Apr-2014|
|Date of Web Publication||11-Jun-2014|
Khaled Abd El Moez
Lecturer of Psychiatry, Suez Canal University, Ismailia
Source of Support: None, Conflict of Interest: None
Domestic violence against women is prevalent in every country, cutting across boundaries of culture, class, education, income, ethnicity, and age. Domestic violence against women results in far-reaching physically and psychological consequences. Although the impact of physical abuse may be more visible, psychological scarring is harder to define and report. Women who remained in violent relationships were considered to have morbid characteristics, which included the need to be hurt and punished.
This work was carried out to determine the psychosocial characteristics of women exposed to domestic violence.
Materials and methods
The current study is a cross-sectional controlled study. In this study, psychological characteristics, using the Minnesota multiphasic personality inventory scale (MMPI) personality inventory scale, of 44 women (who presented to the Emergency Unit of Suez Canal University Hospital) complaining of physical abuse of domestic origin were evaluated after taking their consent, and were compared with 22 women with no history of domestic violence.
The psychological assessment to 44 female victims of domestic violence according to the MMPI personality inventory scale showed a significant difference between the study and the control group in depressive traits, psychopath traits, and psychotic traits.
Our finding suggested that the study group showed more depressive, psychotic, and psychopathic manifestations than the control group and more studies need to identify whether this results were related to abuse or character logical traits in those women.
Keywords: domestic violence, psychological traits, social characteristics
|How to cite this article:|
Abd El Moez K, Elsyed M, Yousef I, Eldeen AW, Ellithy W. Psychosocial characteristic of female victims of domestic violence. Egypt J Psychiatr 2014;35:105-13
|How to cite this URL:|
Abd El Moez K, Elsyed M, Yousef I, Eldeen AW, Ellithy W. Psychosocial characteristic of female victims of domestic violence. Egypt J Psychiatr [serial online] 2014 [cited 2017 Aug 23];35:105-13. Available from: http://new.ejpsy.eg.net/text.asp?2014/35/2/105/134197
| Introduction|| |
Violence against women in the domestic sphere is usually perpetrated by men who are, or who have been, in positions of trust and intimacy and power such as husbands, fathers, fathers-in-law, stepfathers, brothers, uncles, sons, or other relatives. Domestic violence is, in most cases, violence perpetrated by men against women. Women can also be violent, but accounts for a small percentage of domestic violence (United Nation Children Fund (UNICEF), 2000).
Domestic violence against women is often a cycle of abuse that manifests itself in many forms through their lives. Even at the very beginning of her life, a girl may be the target of sex-selective abortion or female infanticide in a culture where a preference for sons is prevalent. During childhood, violence against girls may include enforced malnutrition, lack of access to medical care and education, incest, female genital mutilation, early marriage, and forced prostitution. Some go on to suffer throughout their adult lives, abused, raped, and even murdered by intimate partners. Other crimes of violence against women include forced pregnancy, abortion or sterilization, and harmful traditional practices such as killings in the name of honor. Elderly women may also experience abuse (World Health Organization (WHO), 2004).
A review of studies from 35 countries indicated that between 10 and 52% of women reported being physically abused by an intimate partner at some point in their lives, and between 10 and 30% reported that they had experienced sexual violence by an intimate partner. Between 10 and 27% of women and girls reported having been sexually abused, either as children or as adults (WHO, 2007).
Culture ideologies - both in industrialized and in developing countries - provide 'legitimacy' for violence against women under certain circumstances. Religious and historical traditions in the past have sanctioned the chastizing and beating of wives. The physical punishment of wives has been particularly sanctioned under the notion of entitlement and ownership of women. The concept of ownership, in turn, legitimizes control over women's sexuality. Women's sexuality is also tied to the concept of family honor in many societies. Traditional norms in these societies allow the killing of 'errant' daughters, sisters, and wives suspected of defiling the honor of the family by indulging in forbidden sex, or marrying and divorcing without the consent of the family (UNICEF, 2000).
The prevailing belief has always been that only women who "liked it and deserved it" were beaten. In a study of battered wives as recently as twenty years ago, it was suggested that beatings are solicited by women who suffer from negative personality characteristics, including masochism. "Good wives" were taught that the way to avoid assaults. She must examine their behavior and attempt to modify it to please men: to be less provocative, less aggressive, and less frigid. There was no suggestion that provocation might occur from other than masochistic ones, that aggressiveness might be an attempt to avoid further assault, and that frigidity might be a very natural result of subjection to severe physical and psychological pain (Bogard, 1988).
The burden of guilt for battering has fallen on women and the violent behavior of men has been perpetuated. The myth of the masochistic woman is a favorite of all who try to understand the battered woman. No matter how sympathetic people may be, they frequently come to the conclusion that the reason an abused woman remains in such a relationship is because she is masochistic. Masochism in a woman is defined as experiencing pleasure, often sexual pleasure, by being beaten by the man she loves. Because this has been such a prevailing stereotype, many abused women begin to question whether they are indeed masochistic (Bogard, 1988).
This myth is related to the masochism myth in that it places the blame for the battering on a woman's negative personality characteristics. The survival behaviors of abused women have often earned them the misdiagnosis of 'being crazy'. Unusual actions which may help them to survive in the battering relationship have been taken out of context by closure their problems from medical and mental health workers. Several of the women were reported being hospitalized for schizophrenia, paranoia, and severe depression (Walker, 1995).
The theory of learned helplessness in passive women quickly becomes entwined with the commonly asked question of why does she stay? The result was a picture of masochistic and passive women who are to blame completely for their situation (Bogard, 1988).
Criticisms have suggested that learned helplessness cannot explain why so many women have been able to get away from their violent partners. The concept of learned helplessness also portrays women as passive rather than as active individuals seeking help. The theory of learned helplessness also ignores the multiple dimensions involved in the process of escape, including, for example, the potential for greater violence if attempts to escape unsuccessful or violence against other family members especially her children, she may be emotional in love, hope to change and fear to be alone, culture stigma, and /or has no residence.(Gondolf, 1988).
In contrast to the learned helplessness model, Gondolf (1988) has developed a model suggesting that women are active survivors who try to escape violent relationships, but are often limited by the unavailability of resources. In other words, women respond to abuse by attempting to seek help that does not exist rather than taking the blame as a victim; this model places blame on the social structure (Gondolf, 1988).
| Aim|| |
This work was carried out to determine the psychosocial characteristics of women exposed to domestic violence.
| Materials and methods|| |
This is an analytic cross-sectional study that was carried out to study the psychosocial characteristics of women exposed to domestic violence.
All female participants ranging in age from 16 to 60 years, able to write and read, and presented to the Emergency Unit of Suez Canal University Hospital because of physical abuse of domestic origin were included in this study after obtaining their consent.
Selection of the control group
The control group was selected from among women who were matched to the abused group for age, educational level, marital status, occupation, and income, and had apparently no history of domestic violence.
Patients and control women were eligible for the study on exclusion of certain medical problems (epilepsy, stroke, hypertension, diabetes mellitus, and chronic liver cirrhosis), head injuries, and history of psychotic disorder. Also, illiterate patients were excluded because they would not be able to perform the psychological test.
The sample size included all female patients who fulfilled the inclusion criteria, presented during the period of the study (from April to December 2006), and agreed to participate in this study.
In the study, psychological traits were evaluated using the MMPI personality inventory scale for 44 women who had experienced domestic violence and were compared with 22 women with no history of domestic violence.
| Results|| |
[Table 1] shows statistically nonsignificant differences between the abused group and the control group in age, residence, education, marital status, occupation, family size, and income. The mean age of the women was 30.9 ± 9.2 and 35.5 ± 4.1 years in the abused group and the control group, respectively.
Sporadic abuse was the most frequent (54%) [Table 2].
The most common causes of abuse were financial (22.7%), followed by forced intercourse (15.9%) [Table 2]; 75% of women had not notified the authorities, whereas 25% of abused victims had physical sequels and 95% had psychological sequel [Table 2].
There was a statistically significant difference between the abused group and the control group in depressive traits, psychopath, paranoid, psychoasthenia, and psychotic traits (P < 0.00) [Table 3].
There was a nonstatistically significant difference between the abused group and the control group in hysterical, manic, and avoidant traits, and hypochondriasis (P > 0.05) [Table 3].
| Discussion|| |
Frequency of abuse
The present study shows that all abused women reported repetition of abuse. More than half of them were abused sporadically, a quarter were abused daily, and a fifth were abused weekly. These results were in agreement with another study carried out on a sample of 100 females between 14 and 65 years of age from Manshiet Nasser, which indicated that all the women reported repetition of abuse, whereas 30% of the women questioned admitted to being subjected to domestic violence on a daily basis, 34% on a weekly basis, 15% on a monthly basis, and 21% occasionally (Committee on the Elimination of Discrimination against Women, 2001).
Causes of abusing
The present study shows that the commonest causes for abusing were financial causes (22.7%) following by forcing wives to sexual intercourse (15.9%) then marital argument (11%), disobedience (11%), forced to married against her will (9.1%) then jealousy (6%). Other included kids hitting (4.5%), drug abused of husbands (4.5%) and presence other women (4.5%) lastly insist to divorce (2.3%).
These results were different than Manshiet Nasser's study where the main reason for domestic violence (75%) of these women, was sexual (women are beaten, raped or abused for refusing to have sex with their husbands) followed by financial causes (65%) then visiting family without husband permission (32%), housework (25%), religion (8%), jealousy (6%) and disobedience (5%) (Committee on the Elimination of Discrimination against Women, 2001).
The difference between two studies may due to difference in time as in our study financial causes was the first cause then refuse sexual relationship while the reverse is true in other study as more financial difficulties present nowadays in most Egyptian families to obtain basic life needs comparing with their financial difficulty since 7 years ago.
These results different from that of Tayseer et al; (2003) who studied domestic violence against women among rural families in Suez Governorate which revealed the commonest causes of violence against women was disobedience followed by outside home problems, refusing female intercourse, and finally the presence of addict husbands. This difference between studies may be because of differences in the setting as the sample in the Tayseer study included rural families; thus, the most common reason for abuse was disobedience, and community norms allow punishment of women who do not obey their husbands.
Types of abuse
The present study shows that there was more than one type of abuse. Physical and verbal abuse was the most common (52%), followed by physical, verbal, and sexual abuse (22.7%), physical and sexual abuse (11.4%), physical and verbal abuse, and control over wives' money (6.8%), and all forms of abuse (6.8%). These results are supported by Heise et al. (1999), who found that physical violence in intimate relationships is almost always accompanied by psychological abuse and, in one-third to half of the cases, by sexual abuse.
The UNICEF (2000) also reported that physical violence is usually accompanied by psychological abuse and in many cases by sexual assault.
A WHO (2004) multicountry study showed that in the majority of the countries studied, there was a considerable overlap between physical and sexual violence by intimate partners.
Notification of authorities
In the present study, of 44 abused women, 75% did not notify authorities, whereas 25% notified authorities.
The percentage of women who did not notify authorities is less than that in the Manshiet Nasser study, which reported that 87% did not notify authorities and only 13% went to the police (although all of them subsequently withdrew the charges) not really wanting to cause any harm to abusers (Committee on the Elimination of Discrimination against Women, 2001).
This result in consistent with a WHO (2004) multicountry study that found that between 55 and 95% of women who had been physically abused by their partners had never sought help from formal services or from individuals in a position of authority (e.g. village leaders). Women were more likely to have sought help or left home if they had experienced severe physical violence.
Despite cultural differences, the percentage of women who did not notify authorities in the present study is not very different from that reported by Scottish Executive (2003), where nearly 60% of intimate partner violence was not reported. This can be explained by the WHO (2004), which reported that domestic violence is considered a family matter and women sometimes view a certain amount of physical abuse as justified under certain conditions. Cultural, ethnic, or religious backgrounds may influence a woman's response to abuse and her awareness of viable options.
Reasons for not notifying authorities
The current work highlights the main causes for not reporting abuse to the authorities. Women did not report violent incidents to the authority, which represents a major problem in the community. The most common cause of un-notification authorities benefit of kids (fear from take them or abuse them) (33.4%) then family's fame (18.2%), wish to continues in marital relation (18.2%) then fear from assailants (more abuse) (15.1%) and keep for assailant (in love) (15.1%). Another study carried out on a sample of 100 women from Manshiet Nasser showed that (87%) of the women did not report violence to the police because of embarrassment (65%), for the children's sake (32%), fear for their husbands, or fear of their husbands (19%) (Committee on the Elimination of Discrimination against Women, 2001).
This was similar to the Gondolf's (1988) study, which reported that fear of more abuse, emotional causes (being in love, hope to change, and fear of being alone), cultural stigma, fear for children (will take children, better with both the parents), and economic reasons (no place to stay and lack of economic resources) were the most common causes for not reporting to authorities and continuation in a violence relationship.
The widespread acceptability of circumstances where wife beating is justified highlights the extent to which, in many countries, women appear to make distinctions in terms of the circumstances under which wife beating may or may not be 'acceptable'. In all countries, considerably more women accept wife-beating in the case of actual or suspected female infidelity, or for 'disobeying' a husband or a partner. Qualitative research suggests that individuals make complex judgments about the acceptability of violence by considering who does what to whom, and for what reason (Heise and Garcia-Moreno, 2002).
Responses of victims other than notification of authorities
In the present study, the common responses of abused women were temporarily leaving their homes (22.7%), followed by notifying relatives (20.5%), angry inside home (18.2%), and crying (13.6%). These results differed from the Manshiet Nasser study, which showed that most of the abused women suffered in silence (53%) and attempted suicide (9%), and only 6% of these women demanded a divorce. The other common responses to violence were calling their neighbors, attempting to leave their homes at least once, and seeking help from family members (either their own or their spouse's) (Committee on the Elimination of Discrimination against Women, 2001).
The WHO (2004) multicountry study found that women who had been physically abused by their partner were under circumstances ranging from not completing the housework adequately, refusal to have sex, disobeying her husband, or being unfaithful. The study also showed that between 19 and 51% of them ever left home for at least one night. The study also found that when women who had not sought help from any of the services mentioned were asked why this was the case, the most common responses were either that the women considered the violence normal or not serious or because they feared the consequences, either for their own safety, or that they would lose their children, or that they would bring shame to their families. In Ethiopia province, 53% of these women reported that fear kept them from seeking help. Other reasons included beliefs about the inadequacy of the likely response, in particular, that they would not be believed or that it would not help (WHO, 2004).
Rubenstein (1999) reported that abused women tend to remain in abusive relationships for a number of reasons: women tend to be the peacekeepers in relationships (the ones responsible for making the marriage work), adverse economic consequences, it is more dangerous to leave than to stay, prior threats by batterer to abscond with children, lost self-esteem and lack psychological adaptation to separate from batterer.
Psychological traits of studied groups according to MMPI
A comparison between the mean scores of the abused group and the mean scores of the control group showed an increase in scores in scale 2 (depression), which is similar to the result of Campbell (2002), who found that intimate partner violence is associated with high rates of depression. Coid et al. (2003) also supported this finding; they reported a statistical association between domestic violence and depression.
These results also in agreement with Golding (1999), who found that the association between domestic violence and depression reflects a causal link. Campbell (1997) also reported that abused women were found to have more depressive symptoms than other women.
A comparison between the mean scores of the abused group and the mean scores of the control group showed an increase in the scores of scale 6 (paranoid), scale 8 (schizophrenia), and scale 4 (psychopath), consistent with the Patrici's (1997) study, which found a statistically significant difference between the mean scores of abused women and the mean scores of control women in the control group for paranoia, schizophrenia, and psychopathic traits.
Davidson (1991) also found a significant difference between the abused group and the control group in their study in terms of paranoia, schizophrenia, and psychopathic traits.
There was an increase in scores on scale 6 (paranoia). Paranoia is a disturbed thought process characterized by excessive anxiety or fear, often to the point of irrationality and delusion. Paranoid thinking typically includes persecutory beliefs of a perceived threat (Wikipedia, 2006).
From this point of view, the fearfulness and suspicion of others might be viewed as a logical outcome of abuse by one with whom an individual had an intimate relationship. Intimate relationships are supposed to be based on trust and abuse in an intimate relationship would destroy that trust (Erickson, 2004).
There was increase in the scores on scale 8 (schizophrenia). This can be explained by understanding what scale 8 measures. It measures confusion in thought processes and feelings of being overwhelmed. It is not necessary to be schizophrenic to receive an elevated score on scale 8. Abuse by an intimate partner could certainly cause confusion in thought processes and feelings of being overwhelmed (Erickson, 2004).
Increases in scores on scale 4 (psychopath) are more difficult to interpret. As the text on MMPI indicates, scale 4 was developed to measure the personality characteristics of an amoral and asocial subgroup with psychopathic personality disorders. If the evaluator does not examine more deeply the possible reasons for an elevation on scale 4, he/she might infer that the individual has serious character logical traits such as impulsiveness, poor interpersonal judgment, and reduced sense of responsibility and morals. They tend to sacrifice long-term goals for short-term desires. Social relations are typically shallow and strong loyalties are rarely developed (Morrell and Rubin, 2001).
Dukworth and Anderson (1995) viewed fighting as a cardinal feature of increase scores on scale 4. They suggested that the individual may be in conflict with his or her parents, friends, spouse, society, or school and that it is essential to examine the context in which the individual is being assessed. Another important issue in terms of an increase in the scores on scales 4, 6, and 8 is whether this elevation character logical or reactive.
Abused women, however, on the basis of the results of the MMPI, appear to have various psychopathologies, including but not limited to paranoia, histrionic personality, psychopathic traits, and even schizophrenia. The evaluator may conclude that the women's apparent psychopathology is a personality disorder and therefore character logical (a 'trait'). Personality disorders are viewed by many psychologists as highly treatment resistant and therefore curable (Rosewater, 1988).
Lundy and Jay (2002) shows that an 'alternative conceptualization' is that a woman's psychological presentation is a reaction to the abuse she has suffered (a reactive 'state'). If the increase in scores on MMPI of abused women is reactive, one would expect that their MMPIs before abuse would be relatively 'normal', their MMPIs during the abusive relationship would be increased, and that their MMPIs would decrease after the abuse ended. In addition, it might be expected that the severity of the abuse suffered by the woman or the length of time she was abused might correlate with increases in the scores of MMPI.
As yet, no such longitudinal study has been reported. Therefore, we do not know with any degree of certainty whether abused women, before they suffered abuse, were 'normal' or showed certain psychological problems (and, if so, what the problems are). However, research on MMPI scores of abused women strongly suggests that they are usually 'normal' before abuse (Erickson, 2004).
An important study in this field compared the MMPI scores of 12 currently abused women, 12 formerly abused women, and 12 never abused women. It was found that the increases in MMPI on scales 2, 4, and 8 were lower for formerly abused women (similar to the control group) than for currently abused women. It was found that the scores decreased when the women were no longer being abused, indicating that the increase in scores on MMPI clinical scale 2, 4, 6, and 8 could be considered a reaction to the abusive relationship than as character logical (Dolores, 1986).
Rosewater (1988) also administered the MMPI to three groups. Group one included 50 women in a currently abusive relationship, group two included 29 women from an intervention program, and group three included 27 women who had never been abused as a control group. They found an increase in scores on scales 4, 6, and 8 for group one. The formerly abused women had lower increases in the scores than the currently abused women. In other words, the formerly abused women appeared to be recovering from the effects of abuse. Rosewater pointed to the MMPI scores of a battered women might lead to a mental health evaluator to misdiagnosis the women as severely mentally ill even psychotic or psychopath while they were actually suffering from the effect of abuse, their elevation of scale 4 consider as angry, their elevation of scale 6 consider fear and their elevation of scale 8 measure confusion. Rosewater believed the condition of abused women could be most accurately described as post-traumatic stress disorder (PTSD).
What used to be called 'battered woman syndrome' is now more often known as PTSD (Erickson, 2004).
Some experts suggest, however, that the effects of interpersonal violence (rape and abuse of children and intimate partners) are perhaps broader than the diagnostic criteria of PTSD and lead to a more serious form of PTSD than traumas that are not interpersonal in nature. This more serious form of PTSD is sometimes called 'complex' PTSD or disorder of extreme stress not otherwise specified (DESNOS) (Luxenberg, 2001).
A crucial factor in terms of PTSD is that it is now understood that any previously healthy individual exposed to a trauma can develop PTSD (DSM-IV-R).
Another important study compared abused women diagnosed with PTSD with abused women who did not fulfill the criteria for PTSD. The study found that, first, many of the non-PTSD participants reported symptoms indicative of PTSD, but were not diagnosed with PTSD because they failed to fulfill all the criteria for PTSD. Second, the non-PTSD participants had scores on MMPI elevation that were above the cut-off point on scales 4 and 6. They also had increased scores on scales 7 and 8 that approached the cut-off point. The MMPI scores of the PTSD participants were higher than those of the non-PTSD participants. Although there was no statistically significant difference between the PTSD group and the non-PTSD group, it is noteworthy that 10% of the participants in the PTSD group reported 'extreme and permanent injuries', whereas only 3% of participants in the non-PTSD group reported such injuries. This study lends support to the reactive state theory. By definition, PTSD is a sequel (post) of trauma. The fact that such an overwhelming percentage of abused women are diagnosed with PTSD indicates that they have suffered severe trauma. The trauma that they reported is domestic violence. Also, the PTSD group exposed to more severe trauma showed higher increases in the scores on MMPI scales (Morrell and Rubin, 2004).
Clinical interpretation of a profile of a survivor of domestic violence should recognize that, on average, they will have significant levels of emotional turmoil, major difficulties in trusting others, suspiciousness, and paranoia. This level of stress is not unreasonable because many survivors of domestic violence live with their perpetrators everyday or at least have contact with them periodically. This continuing interaction with the perpetrators leads to constant emotional turmoil, fear, paranoia, and distrust (Lundy and Jay, 2002).
Although the current study attempted to identify the characteristics of women exposed to domestic violence, we aimed to determine whether increased MMPI scores of abused women on clinical scales represent character logical traits or a reactive 'state'. Research to date seems to lend more support to the reactive state theory. When groups are tested while domestic violence is ongoing or has just ended, abused women typically show increases in scores of MMPI/MMPI-2 on several clinical scales. However, MMPI/MMPI-2 tends to normalize after the abuse ends and with time. In addition, the severity of abuse appears to be correlated with the increased scores of MMPI/MMPI-2, suggesting that the increase is caused by the abuse.
More studies should be carried out in community samples to determine whether residence, education, occupation, family size, and family income may be risk factors in domestic violence against women.
More studies should be carried out using MMPI psychological assessments comparing women in an abusive relationship and after recovery from the abusive relationship to determine whether the increase in depressive traits, psychopathic traits, and psychotic traits (paranoid and schizophrenic) is a reaction to the abusive situation or character logical traits of abused women.
More studies should be carried out to assess the other aspect of abuse, that is, personality traits of perpetrators.
Resources and training programs should be provided for physicians in primary care, emergency, and psychiatric clinics including policies and protocols on domestic violence, and clinical guides on effective assessment, intervention, documentation, and referral.
Marital counseling clinics and psychotherapy programs should be set up for abused women.
This problem should also be tackled through health education programs including targeting of religious men, and through mass media and human right organizations to increase awareness of the problems of domestic violence and its impact on the family and society.
| Acknowledgements|| |
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]