Pennsylvania Physician Ebook Continuing Education

For example, contrary to a common perception that many women don’t leave abusive relationships, the majority do indeed leave or manage to make the violence end. 17 But leaving an abusive relationship is a process that may involve leaving and returning several times. Behavior change takes time and cycles of “relapse” and “remission” commonly seen in people trying to stop addictive behaviors such as smoking or drinking alcohol are also seen in people trying to escape abusive relationships. Patients need to move from a familiar unhealthy environment to a healthy unfamiliar one. Several studies have shown that formerly abused women are no more likely to go on to an abusive relationship than are other women in unhappy relationships. 17 Other studies have shown that survivors of IPV are best able to stay out of future abusive relationships and improve their health if economic and/or employment and/ or housing opportunities are available to enable financial independence. 18 It is important to remember that there is no “classic” type of victimized individual. Any person can be abused. Survivors come from all backgrounds, sexual orientations, genders, capabilities, education levels, and economic backgrounds. Universally, survivors desire lives free from abuse and are most likely to take steps toward this goal if provided with validation, support, opportunity, and health and economic security. The following statements reflect faulty beliefs or dysfunctional attitudes toward IPV, which are explained in the associated text. “She doesn’t look battered.” Often there are no obvious physical signs of abuse and/or the abuse may be psychological or emotional, rather than physical. Many elements that increase risk for lethality in IPV (i.e., threats of violence, jealousy) leave no signs. “He beats her but she keeps going back!” As noted above, the victim and perpetrator may live in the cycle of violence where, after the abusive event, the perpetrator feels guilty, apologies, brings flowers, and promises to never repeat the abuse. The victim hopes the perpetrator will embody their better sides moving forward. Other factors to consider are that the victim may be emotionally or financially dependent on the relationship, making it difficult to leave. Often victims have a family history of violence and so IPV relationships may be seen as normal. Lastly, women may internalize blame and responsibility. The message that IPV is the victim’s fault gets reinforced by repeated messages from the abuser and/or generalized societal, cultural, and media-transmitted messages that support social norms of submissiveness, inadequacy, or disempowerment. Women are often socialized to avoid conflict and promote harmony within the family at all costs. If they feel, for example, that the abuse prevents abuse of their children, then it may be perceived as not too high a price to pay for a peaceful household.

The Duluth Power and Control Wheel

In contrast, “situational couple violence,” is a more frequent type of IPV and this term describes relationships in which both partners (heterosexual as well as same-sex) use aggressive tactics characterized by less severe and less controlling tactics. Generally, these arise as a result of an argument in which one or both parties physically lash out. Situational couple violence is also less likely to involve sexual violence. 15 The Cycle of Violence Many times abuse occurs in a predictable pattern or cycle. When the perpetrator shows affection to the survivor between abusive episodes, it can make it difficult for the survivor to leave the relationship. The cycle can involve the following phases: • Abuse – the perpetrator abuses their partner, asserting their power and control. • Guilt – the perpetrator feels guilty and fears that the abuse may lead to getting caught and facing consequences. • Excuses – the perpetrator rationalizes their abusive actions by blaming the partner and avoiding responsibility. • “Normal” behavior or “Honeymoon Phase” – the perpetrator attempts to regain control and keep the partner in the relationship, either by showing affection or acting as if the abuse never happened.

• Fantasy and planning – the perpetrator starts to fantasize about abusing their partner again and plan the next episode of abuse. • Set-up – the perpetrator creates a situation where they can justify or blame their partner for the next abusive episode.

The IPV Cycle 16

Myths vs. Realities of IPV Frustration is common among professionals who work with IPV survivors, and this frustration can be rooted in fundamental misunderstandings about the way survivors of IPV behave.

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