_________________________________________________________________ Domestic and Sexual Violence
complex humanitarian settings have experienced sexual vio- lence, but this is likely an underestimation [119]. Refugees may also experience torture and sexual violence prior to being displaced. Among male survivors, sexual torture is substantially under-reported, and estimates indicate that 5% to 15% of male survivors were sexually abused by threats of castration or rape, being raped or forced to perform sex in view of others, or receiving electric shock or mutilation to the genitals [120; 121]. Fewer women than men are tortured in aggregate, but around 50% of female torture survivors report sexual torture, typically by rape and sometimes in front of family members [122; 123; 124]. Studies also show that sexual violence victim- ization is more likely while in transit to a host country [125]. Sexual and gender minority migrants may feel they need to conceal their identities for fear of sexual harassment and pos- sible violence [125]. Immigrants tend to underuse health services, especially undocumented immigrants, who typically lack health insur- ance and may avoid seeking medical attention out of fear of being deported. Immigration status and the inability to understand domestic violence within given cultural norms are major barriers to help-seeking among recent immigrants [126]. They may also face language barriers, exacerbating an inability to seek help and lack of trust in health and social services. When migrants do seek help, access to interpreters may be limited [127]. The Violence Against Women Act puts some protections in place for noncitizen women, including the ability to self-petition for citizenship (instead of requiring a citizen sponsor) and immigration relief to victims of sexual/ other violence or human trafficking [128]. Access to bilingual and culturally appropriate services is also a major concern. PEOPLE OF COLOR In the United States, intimate partner violence disproportion- ately affects women of color [129]. Black and multiracial non- Hispanic women have significantly higher lifetime prevalence of rape, physical violence, or stalking by an intimate partner [130]. Black, American Indian or Alaska Native, and multi- racial non-Hispanic men have a significantly higher lifetime prevalence of rape, physical violence, or stalking compared with White non-Hispanic men. These findings may be a reflection of the many stressors that racial and ethnic minority communities continue to experience. For example, a number of social determinants of mental and physical health, such as low income and limited access to education, community resources, and services, likely play important roles. These factors and medical mistrust, historical racism and trauma, perceived discrimination, and immigration status may affect help seeking and the assessment of victims [129; 131]. Level of acculturation should also be taken into account. Some studies have found there is a relationship between acculturation and interpersonal intimate violence. It is possible that as racial and ethnic minority women are exposed to Western norms, they are less likely to adhere to traditional gender roles. As they challenge these cultural norms, they are at increased risk of abuse [132].
When race and ethnicity are considered, it is important to remember that there is great diversity within these groups. Certain factors may be generally applicable, but there may be unique contributions by ethnic sub-group [133].
PERPETRATORS OF DOMESTIC/SEXUAL VIOLENCE Abuser characteristics have been studied far less frequently than victim characteristics. Some studies suggest a correlation between the occurrence of abuse and the consumption of alco- hol. A man who abuses alcohol is also likely to abuse his mate, although the abuser may not necessarily be inebriated at the time the abuse is inflicted [134]. Domestic violence assessment questionnaires should include questions that explore social drinking habits of both victims and their mates. Other studies demonstrate that abusive mates are generally possessive and jealous. Another characteristic related to the abuser’s dependency and jealousy is extreme suspiciousness. This characteristic may be so extreme as to border on paranoia [135]. Domestic violence victims frequently report that abusers are extremely controlling of the everyday activities of the fam- ily. This domination is generally all encompassing and often includes maintaining complete control of finances and activi- ties of the victim (e.g., work, school, social interactions) [135]. In addition, abusers often suffer from low self-esteem and their sense of self and identity is directly connected to their partner [135]. Borderline personality disorder, characterized by impulsivity, fluctuation of emotions, and instability in sense of identity and interpersonal relationships, has been identified as a risk factor for perpetrating domestic violence [136]. Extreme dependence is common in both abusers and those being abused. Due to low self-esteem and self-worth, emotional dependence often occurs in both partners, but even more so in the abuser. Emotional dependence in the victim stems from both physical and psychological abuse, which results in a nega- tive self-image and lack of self-worth. Financial dependence is also very common, as the abuser often withholds or controls financial resources to maintain power over the victim [137]. In some cases, a perpetrator and victim will seek help together (joint or couples counseling) to resolve issues in their rela- tionship. Some domestic-violence-focused joint counseling approaches have been described [138]. However, many orga- nizations, including the National Domestic Violence Hotline, the Department of Justice, the American Bar Association, and Futures Without Violence, recommend against joint counsel- ing for violent couples due to the risk of additional harm to and isolation of the victim [139; 140]. A better option for abusive partners is battering intervention and prevention programs.
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MDCT2026
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