Battered Woman Syndrome

Battered woman syndrome (BWS) is a term that was first used in the mid-1970s to describe the psychological effects that happened to women who were physically and sexually abused and psychologically maltreated by an intimate partner (Walker 1979). The definition of BWS, like those of most terms used in the field of domestic violence, often depends on what discipline or theory a person subscribes to. For example, a psychologist or other mental health professional might use the definition of a syndrome that appears in the current classification system, which is the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) (American Psychiatric Association [APA], 2000). A law enforcement officer or an attorney might use the legal definition of domestic violence that appears in the criminal statutes, which differ from country to country or even state to state. A shelter worker or domestic violence advocate might use the definition that appears in the domestic violence injunction statutes. A divorce lawyer might use the definition that appears in the family law statutes or in case law in that particular jurisdiction. A medical doctor might use the definition in her or his hospital protocols.

Outline

I. Introduction

II. What Is a Psychological Syndrome?

A. Diagnostic and Statistical Manual of Mental Disorders

B. Definitions of Battered Woman Syndrome

III. Cycle of Violence

A. Courtship Period

B. Phase One: Tension-Building Period

C. Phase Two: Acute Battering Incident

D. Phase Three: Loving Contrition

IV. Types of Abuse

A. Physical Abuse

B. Sexual Abuse

C. Psychological Abuse

D. Amnesty International’s Definition of Torture

V. Impact on the Children

VI. Intervention

VII. Public Health Model

Introduction

The beliefs of helpers and their philosophy about sex roles may also impact on the definition of what actions are serious enough to cause a psychological reaction. For example, a law enforcement officer might not pay attention to someone said to call a woman bad names, as this is not against the law, while a psychologist, who understands the harm that such behavior can cause, might give it more credence. Some battered women’s advocates do not want to label the psychological effects that are noted in these women with a formal diagnosis, usually for reasons that have some truth; labeling often causes stereotyped negative images (Dobash and Dobash 1998). This is especially true in the mental health field, where many people fear being labeled as ‘‘crazy.’’ Labeling can also cause misdiagnosis, so that the battered woman who demonstrates a psychological reaction after being abused cannot get appropriate assistance from professionals (Dutton et al. 2005). For example, a religious leader or emergency room nurse might not recognize a psychological reaction as coming from domestic violence, but for different reasons. The emergency room nurse who works with bleeding trauma victims who have broken bones and serious head injuries might have a different threshold for what constitutes serious harm, while the religious leader might blame the victim for not being a better wife. The psychologist or psychiatrist who is not trained in understanding the battered woman (or the child exposed to domestic violence) might misdiagnose a psychological reaction to domestic violence based only on the observable signs and symptoms and not the context in which the reaction occurred.

The inconsistency of definitions in the field of domestic violence has made it difficult to understand and treat women’s psychological effects that come from being battered in their own homes. In addition, battered women come from all walks of life, and some of them have other mental disorders in addition to the psychological effects from being battered. In some cases, these mental disorders worsen when living with intimate violence. For example, Dutton et al. (2005) suggest that BWS is not broad enough to diagnose and treat all the symptoms that battered women might demonstrate. This causes even further confusion in both the mental health and domestic violence fields. To complicate matters even more, many feminist researchers now call domestic violence ‘‘intimate partner violence.’’ Having one definition that everyone who works in the field recognizes and accepts would go a long way to getting battered women and other victims of intimate partner violence (i.e., men are victims too, albeit in less than 10 percent of known cases) better access to the interventions that they need.

What is a Psychological Syndrome?

The DSM-IV-TR (APA 2000) defines a syndrome as a collection of signs and symptoms that commonly appear in people who have a particular disorder. A sign is defined as something that is observable by the diagnostician whether or not reported by the individual. A symptom is defined as something that is reported by the person, whether or not it is observable by the diagnostician. In this case, BWS is a collection of signs and symptoms, some of which are observable by others and some of which are experienced and reported by the battered woman herself. Most of these signs and symptoms are similar to others in the category that lists the psychological effects from experiencing a trauma, especially a trauma that is believed to be able to cause someone to die or be seriously harmed. The DSM category used in this classification system is called acute stress disorder (ASD) if the psychological effects last less than one month, and posttraumatic stress disorder (PTSD) if they last more than one month. Some clinicians suggest that PTSD is not an appropriate diagnostic category to use for BWS, especially when women are still in the relationship and the violence has not stopped (Dutton et al. 2005). However, it is important to understand that past PTSD symptoms continue to have an impact on present and future abuse in that victims reexperience the trauma as if it were reoccurring, even when it is not. Therefore, cognitively and emotionally, anyone with PTSD can be expected to react in a similar manner whether or not the actual violence is in the past or is current or anticipated.

BWS, like battered child syndrome, rape trauma syndrome, and Vietnam War syndrome, has some differences from typical, onetime environmental trauma, such as may be experienced in an earthquake, a tidal wave, or even a terrorist attack (Walker 1994). Perhaps the major difference in the dynamics or context of the relationship comes from the repeated nature of violence in the family or during state-sponsored conflicts. Family violence has even further differences from the violence of state-sponsored conflicts such as civil wars because the ‘‘enemy’’ is also someone who is or was a loved one. In domestic violence, research has discovered a cycle of violence that is further described below.

Diagnostic and Statistical Manual of Mental Disorders

The criteria for a DSM diagnosis of PTSD include three thresholds that must be met and three categories of signs and symptoms. The first group of criteria comprise those symptoms that demonstrate high levels of arousal of the autonomic nervous system, which are often measured by parameters of anxiety, fearfulness, nervousness, jumpiness and hypervigilance to further trauma, frequent crying, sleep and eating disorders, and difficulty with concentration and attention. The second group of criteria are those symptoms that demonstrate a distancing from the trauma and emotional numbing, such as avoidance of people, places, and things that remind the person of the abuse whenever possible (including keeping the batterer calm); depression; denial; minimization; dissociation; and other ways of psychologically ‘‘running away,’’ as would be expected in a dangerous situation. Sometimes victims become counterphobic and face the danger head on, rather than succumb to the paralysis or depression seen in others. The third set of criteria includes those that keep victims reexperiencing the abuse in their minds, such as with flashbacks, intrusive memories, and dreams. This includes those who intentionally use alcohol and other substances to try to keep from experiencing the pain, as if the events were reoccurring.

Those who have experienced PTSD from domestic violence and have developed BWS also have difficulties in three other areas. These are in interpersonal relationships, due to isolation and problems with power and control issues, body image, and sexuality. It is believed that the isolation of the battered woman in the relationship and the numbing of emotions create difficulties in her interpersonal relationships even after the abuse has stopped. Loss of trust in and bitter feelings of betrayal by the person who once loved her enter into the difficulties she has in building new intimate relationships. Batterers abuse the power and control that couples normally share in intimate relationships, causing the woman to have difficulties knowing where the boundaries are between her own choices and those actions the man coerces her into doing. The battered woman shelter and other psychoeducational groups prove to be very useful in helping women reestablish trusting friendships and family connections.

Definitions of Battered Woman Syndrome

The psychological definition of BWS calls it a syndrome that includes the three criteria of the DSM diagnosis of PTSD (reexperiencing the event, avoidance and numbing of responsiveness, and hyperarousal) and the three additional effects that have been measured through the empirical study of hundreds of battered women (Walker 1984/ 2000). As described above, these additional effects disrupt interpersonal relationships caused by the batterer’s imposed isolation and abuse of power and control toward the woman, difficulties with body image and somatic concerns, and sexual and intimacy problems. New studies demonstrate that these symptoms constitute BWS in women in many different countries.

Cycle of Violence

Legal cases define BWS as PTSD and the addition of what has been described as the dynamics of battering relationships. The dynamics of the relationship usually include evidence of a cycle of violence and some description of the relationship between the parties. A three-phase cycle of violence that follows after the courtship, or ‘‘honeymoon period,’’ is identifiable in many but not all domestic violence relationships.

Courtship Period

It is well known that the courtship period in domestic violence relationships is characterized by extremely flattering and loving behavior by the batterer. Often, women say that the initial impression made by the batterer was not one that they liked, due to his sense of self-importance, entitlement, or even aggressive behavior toward others. However, he seeks them out, and his attention and loving behavior becomes attractive to them. Their descriptions include a lot of what is now being called ‘‘aggressive courtship’’ tactics, including frequent telephone calls, refusal to accept no for an answer, and increased inducements toward enjoyment and doing fun things. Frequently, the batterer has a sense for what buttons to push in a woman, being solicitously helpful in solving a difficult problem she has or being an ever so sympathetic listener to her stories. He may share intimate details about himself, particularly about earlier abuse or injustices he suffered, which may give the woman reason to believe that she can help him feel better about himself. These behaviors also begin to create a dependency for the woman on the batterer, and perhaps for some batterers, a dependency on the woman.

The women describe waiting for the man’s telephone calls, which may start out on a daily basis and escalate to five to ten a day. Initially this is part of the excitement of a new relationship, but eventually its purpose is to create intimacy and check on where she is and what she is doing. As he spends more time with the woman, she becomes more isolated from others. Eventually, he begins to regulate her contacts with her friends and family. In many relationships, battered women have more contact with the man’s friends or family than their own. Sometimes this is easier, as her family and friends may not like the man or how he treats her. Other times, the man may shower gifts on the woman’s family in an attempt to cause them to ignore his negative behavior. Once the man is sure he has ‘‘seduced’’ the woman, and the intimacy is set in place, the cycle of violence begins.

Phase One: Tension-Building Period

The first phase is a period of tension that builds. There are lots of small abuse incidents that often produce psychological harm. Each time an incident occurs, the woman may do something to stop it from going any further, and the tension starts to resolve, but the feeling of danger does not go away completely. There is an uneasy feeling in anticipation of the next incident, which pushes the tension level up further, until finally there is a period of inevitability, and the explosion occurs. In some relationships, the period of tension becomes associated with feelings of danger, so that any behavior that is reminiscent of earlier incidents can set off the anticipatory feelings in the woman. Sometimes the incidents are connected together—for example, if she violates rules he has established—while other times they occur with long intervals of time between them, so there may not be any perception of their connection. The most successful time to separate the couple and avoid the explosion is early during the tension-building period; once it approaches or reaches the period of inevitability, the explosion is difficult to stop.

Phase Two: Acute Battering Incident

The second phase—when the explosion occurs— is the shortest period and has the highest risk of physical or sexual harm. Some argue that the batterer is out of control during this period, while others believe that the batterer’s behavior is intentional. During this phase, the man uses physical abuse and threats of further harm or even death directed toward the woman or her family to force her to ‘‘listen to him.’’ Batterers often justify their abuse by insisting that they are teaching the woman important lessons that she needs to get along in life.

In some relationships, the second phase starts slowly, with pushing, shoving, shaking, hair pulling, and perhaps a slap or two, escalating to more serious assaults. In other cases, choking, threats of further harm, and being held captive at gunpoint may begin quickly, making it clear that this person has probably engaged in dangerously violent behavior previously.

The second phase may come rapidly after the first phase or it may punctuate long periods of tension-building types of incidents after some situational crisis. The introduction of a new baby, a crisis at work, having to move, or even children reaching a new developmental stage, such as entering their teens, can trigger a change in the cycle in these relationships.

Phase Three: Loving Contrition

The risk of danger is usually temporarily over during the third phase, which is the reinforcing period where loving behavior and contrition are demonstrated. For many women the reduction in tension and feelings of danger serves as reinforcing in itself. Some batterers apologize in nonverbal ways, such as with gifts, being less argumentative, exercising more self-control, or doing something they know will please the woman. Others may never say or do anything to convey their apologies. This third phase becomes reinforcing for the woman just because there is an absence or lowering of the tension and danger in the relationship, often bringing with it the positive memories of the courtship period.

Some women describe incidents that at first appear loving but turn out to be very aggressive and controlling despite their initial appearance. For example, one woman told of how her husband surprised her with a new Cadillac when she got out of the hospital. However, she later found out that he had not paid for it but rather left it for her to scrape together the money to make the monthly payments. In another example, a woman had been asking her partner to help her do some landscaping around the house. Instead of making it a joint project, her partner went out and bought a roomful of plants that she then had to spend several days planting or they would have withered and died. Some behavior starts out to be nice, but the batterer gets so grandiose that it inevitably becomes annoying and even dangerous for the woman. A typical example might be taking the woman on a surprise trip where the partner does not know where he is going, refusing to get directions, and ending up driving around lost for hours. Most battered women are so grateful to have some time without feeling as if they are ‘‘walking on eggshells’’ that they accept the good intentions of their partner and do not dwell on the negative aspects of these types of incidents.

As the relationship progresses, the third phase changes and becomes less reinforcing. Here women describe more perfunctory apologies or none at all. The tension may go down, but never to zero. Once the woman becomes aware that the man could have killed her or caused her to die during the acute battering incidents, she may never be sufficiently relaxed around him again, and the reinforcers of the relationship change significantly for her. This is the point at which she may begin to prepare to terminate the relationship.

Types of Abuse

Physical Abuse

Physical abuse described by battered women ranges from pushing and shoving, slapping, hitting, throwing her against walls, throwing objects in the room at her or on the floor, all the way to life-threatening incidents including stabbing and shooting her. Most studies use a checklist of possible violent acts and some estimate how frequently each occurs in the relationship. Some studies suggest that the violent behavior tends to increase over time (Walker 2000/1984) while others find that it may stay quite stable or even decrease on its own initiative (O’Leary 1993). Sonkin (2006) has developed a useful assessment tool for measurement.

It is often difficult to get an accurate picture of all the physically abusive incidents that have occurred in a domestic violence relationship because of the difference in how men and women report violent incidents. The perpetrator often will report only incidents in which he intentionally used physical violence. So, if he shoved his partner out of his way in an aggressive manner and she fell down and hurt herself, it may not count as a battering incident to the man. However, if a woman unintentionally kicks the man while she is sleeping, she usually will report that incident as domestic violence. This disparity in gender report causes some studies to overestimate the amount of aggressive behavior used by women and underestimate the amount used by men in domestic violence relationships.

In addition to differences in reporting because of intentionality, women minimize their reports of physical abuse toward themselves if they are not injured. Many incidents of what is sometimes called ‘‘low level’’ domestic violence go uncounted. Some have estimated that by the time an arrest is made, as many as thirty-five physically abusive incidents may have occurred. Some studies have simply counted aggressive acts without putting them into context, resulting in reports that women use as much violence toward men as men use toward women. However, when examining this issue more carefully, it is clear that one slap from a woman does not cause the same injury to a man as does one slap from him to her. Women are more likely to be the recipients of more injuries even when there is mutual violence in the relationship. It is the woman who is more often seen in the emergency room or doctors’ offices after a domestic violence incident, when they seek medical help. When the man does seek medical attention, it is more likely for very serious injury such as gunshot or knife wounds, often received as a result of their initiating the aggressive behavior, followed by the woman attempting to defend herself.

Interestingly, teenage girls appear to be using more aggressive behavior against other people than had previously been reported. The media has been portraying these girls as bad, mean, and violent without looking at the context during which these incidents have occurred. An examination of several hundred girls who had been arrested and placed in a detention center over a five-year period found that almost 85 percent had experienced or been exposed to domestic violence in their homes, causing them to develop PTSD as measured by several standardized tests. The higher their PTSD scores, the angrier they were, and the more they expressed their anger outwardly, resulting in aggressive behavior (Walker, Robinson, Dorsainville, Ipke, and Coker 2005). However, over half of them denied having been abused during the interviews. Studies like this support the early studies that violence begets more violence, at least when it occurs in families. While this trend of more aggressive behavior in adolescent girls has been noted internationally, statistics suggest that only a small percentage of them continue using aggressive behavior once they get out of their teenage years. It is thought that the biological changes and brain development that occur in the late teens and early twenties has some mediating effect on the girls’ aggressive behavior. Research is needed to determine whether these girls, like their predecessors, also have a higher risk of becoming battered women in their intimate relationships.

Sexual Abuse

Sexual abuse, which occurs in almost one-half of the domestic violence relationships studied, may come at any point in the cycle. Sometimes the woman initiates sex as a means to calm down the batterer during the tension-building period and is able to postpone the second phase for as long as possible. In some countries sexual abuse in a marital relationship, or marital rape, is neither legally prosecutable nor religiously defined because the act of marriage is considered an open consent for the couple to have sexual relations whenever it is desired, usually by the man. Nonetheless, there are new laws that forbid marital rape and give the woman the right to say no if she does not want to have sex at a particular time. These are usually used when the couple is separated and the man forcibly rapes the woman.

The man’s sexually aggressive behavior is commonly reported by the battered woman, usually beginning during the courtship period and often sporadically occurring during the relationship, frequently after an argument or battering incident. This behavior can range from embarrassing the woman in front of others with crude jokes or disclosures about their sex life to grabbing her breasts or buttocks in public and criticizing her dress at an important function. As the man’s jealousy over the woman’s possible attraction to other men is such a common theme in domestic violence relationships, anything that causes him to become jealous can be used to begin another acute battering incident. After a while, the women report, they do not want to attend events such as company parties or family receptions for fear that the man will become sexually jealous and an explosion will occur.

There are reports of some batterers demanding that their partners participate in unusual sex acts such as sex with objects, animals, and even third parties. It is not uncommon for the man to record these behaviors on video and then threaten to expose the woman by showing the pictures to others. Some men force their wives into prostitution and then control the money they earn. Other men have forced women to obtain other sex partners for the man’s own use. Women describe themselves as giving in to coercion to engage in these sexual practices in order to stop the men from escalating their violence. The women’s feelings of guilt and emotional distress afterward, especially if the act was recorded, are similar to those of rape victims.

Psychological Abuse

The most prevalent form of abuse that occurs in battering relationships is psychological in nature. It is often called the glue that holds together the pattern of violence in the relationship. There are many different ways to assess for psychological abuse, perhaps because most people feel that they have been taken advantage of, ignored, humiliated, embarrassed, or in some other way psychologically maltreated. Therefore, it is important to differentiate psychological abuse in intimate partner relationships from the psychological dynamics and effects of a dysfunctional but not abusive relationship. One of the most often confused areas is where one partner emotionally wounds the other by betrayal with another person. In most cases, this involves betrayal with another sexual partner. While this type of betrayal is not necessarily part of a battering relationship, the issue of jealousy is one that co-occurs frequently with domestic violence, with the batterer inappropriately jealous of the woman if she even looks at another man. The man may control what clothes the woman will wear, often wanting her to look sexy for him but not for anyone else. Acute battering incidents commonly follow attendance at a party when the man becomes angry with the woman for even talking to another man. The woman may also be jealous of the man’s behavior toward other women. Sometimes her jealousy is more justified than his is toward her. The most likely way for the batterer to let the woman go is when he has found another partner.

Amnesty International’s Definition of Torture

In assessing behaviors that constitute psychological abuse, it is possible to use the Amnesty International definition of torture regarding prisoners of war. Under this definition, aspects of psychological abuse include attempts to control someone’s mind, isolation, creating a dependency on the captor, hypnosis or brainwashing, debilitation by withholding food or interrupting sleep, humiliation and name-calling, forced drug administration, and threats of further harm to the captive or others, all offset by occasional indulgences. The pattern outlined in the Amnesty International list of behaviors is similar to the pattern seen in the cycle of abuse described above, with ‘‘occasional indulgences’’ serving the same role as the third phase, or period of loving contrition. Using a checklist of these behaviors, jealousy and overpossessiveness, financial control, and other power and control methods are seen on a daily basis in most domestic violence homes.

Impact on the Children

Perhaps one of the most difficult areas in which to intervene is in stopping the toll that the exposure to domestic violence takes on the children of a couple. Findings in psychological studies attest to the effects that interfere with children’s normal development by causing cognitive, emotional, and behavioral changes. Children as young as two years have been seen repeating their father’s attempts to control their mother’s behavior, and their increasing levels of anxiety have been measured while they were observing adults in angry verbal fights. Most battered women try to protect their children from exposure to their abusive fathers, but when questioned, the children acknowledge hearing the fights, even if they were in their bedrooms trying to sleep. Psychological tests indicate that these children may even develop PTSD themselves from this exposure.

Most battered women state that one of the reasons for staying in the relationship is to make sure the children have a father in the home. Others who have tried to terminate the relationship state that they returned because they were less able to protect their children from the mood swings of the typical abuser. Divorce courts are not able to protect the children and, in fact, may create or increase their PTSD by forcing shared parenting requirements on the abusive parent. Batterers must always be in control, or they will use whatever tactics are necessary to gain control, even if they are hurtful to the child.

Intervention

It has been difficult for mental health professionals to intervene in domestic violence relationships without the fear of making it more dangerous for those in the family or the community. A perusal of the local news will demonstrate the higher risk for homicide and suicide, especially when a separation has occurred.

Public Health Model

Given the high frequency of homes in the community where domestic violence occurs, some have suggested applying a public health model of prevention to try to stop the continued abuse. The three parts to the prevention model include primary, secondary, and tertiary levels of activities. In primary prevention, no one is singled out for services, but the entire community is eligible. For example, a movie or television program that talks about the dangers of domestic violence would serve a good educational function for the entire community. If there are, for example, teenage girls who may have been exposed to violence in their homes, then targeting them with a special presentation to teach them to avoid getting involved with an abuser might be another prevention strategy.

Secondary prevention targets those people who have already been exposed to an abuser. Psychotherapy or survivor therapy groups run by domestic violence shelters or rape crisis centers constitute secondary prevention strategies. The goal is to lessen the impact that exposure to domestic abuse has had on people, especially women, though men can also benefit. Secondary prevention strategies for the male abuser include anger management programs and offender-specific treatment groups. Usually secondary prevention strategies are offered on an outpatient basis and people use them as needed. However, it is typical for batterers to be court-ordered into treatment, while battered women who do not commit any offenses are not required to attend, although many do on a voluntary basis. Sometimes psychotropic medication, outpatient psychotherapy groups, or individual psychotherapy also may be used by a battered woman to help her to heal.

Tertiary-level treatment removes the individual from the community temporarily. Battered women are removed from the community when living in a battered women’s shelter or in a hospital. Batterers are removed from the community when they are placed in jail or prison. In many communities that have a pro-arrest policy, the batterer is arrested upon probable cause, denied bond at the time of arrest, and held until the next regularly scheduled hearing in front of a judge. This may be just overnight or it might last for several days, depending on the severity of the physical abuse, any prior arrests that the batterer might have, and the assessment of the current risk of dangerousness. If there has been a conviction, the tertiary intervention might be a prison sentence of one year or longer. Unfortunately, it is rare for there to be offender-specific treatment programs in jail or prison.

Also check the list of domestic violence research topics or all criminal justice research topics.

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