Correspondence
Domestic Violence
N Engl J Med 2000; 342:1450-1453May 11, 2000
- Article
To the Editor:
The article by Kyriacou et al. (Dec. 16 issue)1 on risk factors for injury to women from domestic violence reports on the characteristics of relationships and behavior that are associated with domestic violence. The partners of women at greatest risk were those who abused drugs or alcohol, were intermittently employed or unemployed, had less than a high-school education, and were former husbands, estranged husbands, or former boyfriends of the women. What is never stated, however, is that what carries the lowest risk of domestic violence for women is marriage.
Men are usually grouped into an undifferentiated, violent, threatening, irrational, predatory mass. However, all men do not fit this profile, as well-formulated, objective studies have shown in the past. Data from the Centers for Disease Control and Prevention in 1998 reveal that married women have one third as high a risk of injury from domestic violence as women who are separated, divorced, or cohabiting with a partner or who have never been married (odds ratio, 0.32; 95 percent confidence interval, 0.24 to 0.43; P<0.001; chi-square = 47.2).2 Stated another way, among women in relationships that are less stable than marriage, the risk is three times as high.
Unfortunately, the accompanying editorial by Minow3 attempts to blur these distinctions. The real risk of domestic violence does not depend on whether a man — any man — is present but, rather, on whether there is instability in the relationship. There will be more progress when distinctions between good guys and bad guys — between good behavior and bad behavior — return to the discussion. The polarization that otherwise results does no one any good.
3 ReferencesRichard W. Zalar, Jr., M.D.
Torrance Memorial Medical Center, Torrance, CA 905051
Kyriacou DN ,Anglin D ,Taliaferro E , et al. Risk factors for injury to women from domestic violence. N Engl J Med 1999;341:1892-1898
Full Text | Web of Science | Medline2
Lifetime and annual incidence of intimate partner violence and resulting injuries -- Georgia, 1995. MMWR Morb Mortal Wkly Rep 1998;47:849-853
Medline3
Minow M . Violence against women -- a challenge to the Supreme Court. N Engl J Med 1999;341:1927-1929
Full Text | Web of Science | Medline
To the Editor:
I spent more than half my career practicing psychology in community mental health centers. My work mostly involved therapy for violence in families and included a treatment program for batterers. For these reasons, I was interested in the article addressing risk factors for violence among men. I was disappointed, however, to read that there had been no direct contact with the men in the study by Kyriacou et al. If there had been, different risk factors would have emerged.
In my experience, an almost universal risk factor for violence among men is a history of family violence. All the men I treated had been physically or psychologically abused as children and adolescents. Some had been sexually abused. Participation in competitive sports in high school was almost universal. Most had military experience, and most were hunters. Furthermore, all were raised in a culture in which violent behavior by men was condoned as “masculine.” Fighting and aggression by boys were seen as normal.
Although alcohol and drug use and unemployment and underemployment were identified as factors in the study by Kyriacou et al., these were factors in only about half of my clients. I believe research on men would find the following risk factors: a family history of violence, with or without alcohol and drug abuse; “socialization toward violence” (i.e., participation in highly competitive and violent sports); risk-taking behavior in adolescence as a demonstration of manliness; weapons training, either through hunting or military training; a highly developed drive for success, defined by financial achievement; and difficulty with emotional expression or even the ability to identify one's emotions accurately. All these factors lead me to conclude that we need to address the larger cultural issues of the training of men to be violent if we are ever going to eliminate violence within the family.
Robert B. Harris, Ph.D.
Antelope Valley College, Lancaster, CA 93536Author/Editor Response
The authors reply:
To the Editor: Dr. Zalar states that “men are usually grouped into an undifferentiated, violent, threatening, irrational, predatory mass” and argues that not all men fit this profile. We did not attempt to portray men as such. Our objective was not to assign blame for domestic violence but to identify the most important risk factors associated with this type of intentional injury. Since most of these risk factors were characteristic of the women's male partners, it is not unreasonable to focus attention and interventions on this group.
Zalar also claims that we did not focus on marriage as a factor that decreases the risk of domestic violence. In fact, we did study the marital status of the male and female partners. We also investigated cohabitation status and the duration of the relationship. We found that marital status, duration of the relationship, and cohabitation status were not risk factors. We did find, however, that having a former male partner placed women at much greater risk for injury through domestic violence, especially if they were still living with the male partner.
We strongly disagree with Zalar's view that domestic violence is a result of instability in the relationship. This concept implies that such instability causes the male partner to lose his job, use drugs, drink alcohol excessively, and be poorly educated. This is obviously not likely. It is also not likely that these factors are the definitive causes of domestic violence; probably they only act to increase the risk. There are several antecedent factors that contribute to domestic violence, but the main cause is an underlying pathology, not instability, in the intimate relationship. This pathology is defined as the abnormal need for the male partner to have control over the female partner.1-3
We appreciate Dr. Harris's perspective from his clinical psychological practice. There is no doubt that other male characteristics may also be important risk factors for domestic violence. Our study focused on risk factors for acute injury to women from domestic violence. Thus, we based our study in a clinical setting where victims of acute injury could readily be identified (i.e., emergency departments). From this perspective, it would have been impossible to obtain information directly from the male partner, because victims rarely come to the emergency department with the perpetrators. Our study, therefore, was limited to the characteristics of the male partner that we could evaluate. We were encouraged, however, by the fact that spousal and next-of-kin surrogates have been found to be accurate sources of information in case–control studies.4,5
5 ReferencesDemetrios N. Kyriacou, M.D., Ph.D.
Northwestern University Medical School, Chicago, IL 60611-2914Deirdre Anglin, M.D., M.P.H.
University of Southern California School of Medicine, Los Angeles, CA 900331
Dutton DG ,Strachan CE . Motivational needs for power and spouse-specific assertiveness in assaultive and nonassaultive men. Violence Vict 1987;2:145-156
Medline2
Coleman DH ,Straus MA . Marital power, conflict, and violence in a nationally representative sample of American couples. Violence Vict 1986;1:141-157
Medline3
Ellis D . Male abuse of a married or cohabiting female partner: the application of sociological theory to research findings. Violence Vict 1989;4:235-255
Medline4
Lerchen ML ,Samet JM . An assessment of the validity of questionnaire responses provided by a surviving spouse. Am J Epidemiol 1986;123:481-489
Web of Science | Medline5
McLaughlin JK ,Mandel JS ,Mehl ES ,Blot WJ . Comparison of next-of-kin with self-respondents regarding questions on cigarette, coffee, and alcohol consumption. Epidemiology 1990;1:408-412
CrossRef | Medline
Author/Editor Response
I welcome Dr. Zalar's emphasis on the distinctions between good guys and bad guys — and better yet, between good behavior and bad behavior. A reduced risk of domestic violence among married women, however, does not mean that there is no risk at all. Even allowing for the problems with self-reported data, other studies suggest that there is at least one incident of domestic violence in at least half of all marriages.1-3 In addition, to note that the risk increases with marital instability or separation hardly indicates that marriage is a protective state.
Unfortunately, even many ongoing marriages include periods of separation and instability when violence can occur. It is not marriage but the avoidance of men in any relationship that offers the lowest risk of domestic violence for women. Fundamentally, from a policy perspective, lower risks of injury from domestic violence for married women do not demonstrate that marriage provides sufficient protection; nor should the fact that a couple is married counteract the legal protections — federal as well as state and local — that my editorial addressed.
3 ReferencesMartha Minow, J.D.
Harvard Law School, Cambridge, MA 021381
Feld SL ,Straus MA . Escalation and desistance of wife assault in marriage. Criminology 1989;27:141-141
CrossRef | Web of Science2
Langley R, Levy RC. Wife beating: the silent crisis. New York: Dutton, 1977.
3
Walker LE. The battered woman. New York: Harper & Row, 1979.
- Citing Articles (1)
Citing Articles
1
Poco Kernsmith, Sarah W. Craun. (2008) Predictors of Weapon Use in Domestic Violence Incidents Reported to Law Enforcement. Journal of Family Violence 23:7, 589-596
CrossRef
