This unit focuses on increasing your knowledge about the types, forms, and tactics of domestic and sexual violence (DV/SV). It also describes the immediate and long-term consequences on survivors’ physical, behavioral, social, and economic health. Given that this training is targeted to healthcare providers, we highlight several particularly dangerous situations that are often overlooked and misdiagnosed: non-fatal strangulation, traumatic brain injury, and violence during pregnancy. Finally, we end with a section on the experiences of children who are exposed to DV/SV and its impact on them.
At the end of this unit, you should be able to do the following:
Describe the forms and tactics of DV/SV
Describe the different typologies or patterns of domestic violence
Understand health impacts associated with the experience of domestic and sexual violence
Identify common physiological symptoms and emotional impacts of experiencing domestic violence and sexual violence
Identify and have an understanding of the immediate and long-term effects of domestic violence and sexual violence on survivors, including children who witness such abuse
Understand that SV/DV is a healthcare issue
Decades of research and advocacy have led to the understanding that domestic violence consists of distinct types, or patterns, of abusive behaviors. Arguably, the most common typology comes from Michael Johnson, which he has expanded over time with several colleagues.1,2 Herein, we describe these typologies, with the recognition that the first two are the most prevalent and widely studied. Understanding these typologies is critical because they can guide the interventions you use with survivors and people who use abusive behaviors.
Coercive Controlling Violence: Refers to violence that is used to "undermine their partner's willingness or ability to fight for freedom from control”.1 The first part of coercive controlling violence is the actual violence, followed by the idea that the "perpetrator must make it clear that he or she is willing and able to impose punishment."1 It is essential to remember the following aspects about coercive controlling violence: it is motivated by a desire to gain power and control over one’s partner; partners can be coercive and controlling without using physical violence;3 and the actual coercive and controlling behaviors that a partner use are often unique to each relationship because it requires exploiting and manipulating a survivor’s particular vulnerabilities.4
Situational Couple Violence: Refers to when violence is “situationally provoked, as the tensions or emotions of a particular encounter lead someone to react with violence."1 Situational couple violence stems from poor communication skills between partners and a mutual inability to appropriately manage feelings, such as frustration. It is not motivated by a desire to exert power or control.
Violent Resistance: Used by survivors who resist “coercing controlling violence” with their own violence. This type of violence “arises in reaction to that attempt to exert general control."1 "For some, this is an instinctive reaction to being attacked."1 Essentially, violent resistance is motivated by the need to protect oneself from a partner’s coercive controlling violence.
Table 1a: Forms of Domestic and Sexual Violence
In this table, we define the main forms of domestic violence, including sexual violence, and offer examples of potential corresponding tactics. It is important to have a solid understanding of the varied forms of violence in order to understand patterns, and assess victimization and perpetration risk. Please note that these types reflect general categories and are neither mutually exclusive nor exhaustive.
References for Table 1a
Breiding MJ, Basile KC, Smith SG, Black MC, Mahendra RR. Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 2.0. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Published 2008.
Adams AE, Sullivan CM, Bybee D, Greeson MR. Development of the Scale of Economic Abuse. Violence Against Women. 2008;14(5):563-588.
Voth Schrag RJ, Edmond T. School Sabotage as a Form of Intimate Partner Violence: Provider Perspectives. Affilia. 2017;32(2):171-187.
Woulfe JM, Goodman LA. Identity Abuse as a Tactic of Violence in LGBTQ Communities: Initial Validation of the Identity Abuse Measure. [Published online ahead of print 2018]. Journal of Interpersonal Violence. 2018.
Grace KT, Anderson JC. Reproductive Coercion: A Systematic Review. Trauma Violence Abuse. 2018;19(4):371-390.
NNEDV. Assessing for technology abuse and privacy concerns. Retrieved here. Published 2014.
Dimond JP, Fiesler C, Bruckman AS. Domestic Violence and Information Communication Technologies. Interacting with Computers. 2011;23:413-421.
NNEDV. Evidence collection series: Spoofing calls and messages. Retrieved here. Published 2014.
Given the many forms and tactics of DV/SV, the potential effects are numerous and multifaceted, as well as immediate and long-term. Moreover, the relationship is often not straightforward. For example, although physical forms of violence obviously can lead to physical effects (e.g., punching leads to concussion), physical violence can also contribute to impaired mental health (e.g., strangulation leads to hypervigilance and depression). Similarly, psychological aggression can impair mental health (e.g., insults leads to low self-esteem) and economic health (e.g., depression leads to reduced work productivity leads to loss of employment). Studies have also shown that psychological aggression can affect physical health as profoundly as physical violence.5,6 Essentially, the impact of any one form of violence can cross multiple domains of health and wellbeing. In the section below, we outline some of the most commonly documented effects. The list is in no way exhaustive, but certainly underscores how critically important it is for healthcare providers to view DV/SV as a healthcare issue. In Unit 2, we talk about the ways in which these effects can differ according to aspects of social location (e.g., race, age).
Effects on Physical Health
Domestic and sexual violence victimization can lead to injuries such as abrasions, contusions, lacerations, concussions, and fractured/broken bones.7 There are also well-documented associations between victimization and chronic conditions such as asthma, bladder and kidney infections, cardiovascular disease, central nervous system disorders, circulatory conditions, chronic pain, gastrointestinal disorders, diabetes, joint disease, migraines and headaches, impaired hearing, impaired eyesight, sexually transmitted infections, and traumatic brain injury (TBI; see spotlight on TBI below).5,8-11
In situations of chronic health conditions, regardless of whether DV/SV was the cause of the condition (e.g., survivor contracts HIV from person who raped them), DV/SV very likely exacerbates the condition and further erodes the survivor’s health (e.g., the stress of DV contributes to more frequent migraines). The heightened risk for poor health is especially acute when the person being abusive is actively sabotaging a survivor’s efforts to access healthcare. These situations can lead to a cyclical relationship between DV and chronic health conditions; that is, DV causes or exacerbates the condition, thereby increasing survivors’ dependency on abusive partners and putting them at risk for continued abuse.12
It is essential to understand the myriad ways in which DV/SV affects health in order to avoid jumping right into treating an assumed (or even stated) problem instead of focusing on the underlying or actual problem. This awareness is particularly important in cases where it is hard to imagine how the condition and DV/SV could possibly be related.
Effects on Behavioral Health
In this training, behavioral health includes mental health and substance use.
Mental Health
A robust body of literature documents the profound negative effects of DV/SV on survivors’ mental health. Survivors of both DV and SV are at heightened risk for PTSD, depression, anxiety, suicidality, eating disorders, and chronic mental illness.5,9,13-15
Survivors of rape and severe forms of DV, such as strangulation, often experience flashbacks and feelings of hypervigilance not only immediately after the incident but also months (possibly years) after.15,16 These mental health conditions are associated with disrupted sleep and insomnia, both of which affect physical and mental health in their own right.14 These relationships are different from – but can be compounded by – situations in which abusive partners intentionally prevent survivors from sleeping.14
Generally speaking, the extent to which DV/SV affects mental health depends upon severity and duration of the violence as well as co-occurrence with other forms of interpersonal violence (e.g., childhood violence, hate crimes) and traumatic experiences (e.g., homelessness, foster care system involvement).15 In addition, social support is an important buffer that mitigates the impact of DV/SV on survivors’ mental health.17,18 As we will discuss in Unit 3, ongoing work with survivors should include helping them to build and/or rebuild healthy relationships with friends, family, and other people in their networks.19,20
Substance Use Disorders
The use of substances, such as alcohol, cigarettes, marijuana and other drugs (illicit and prescription), are strongly associated with experiencing DV/SV victimization. However, as with physical and mental health, the relationship is complex, particularly in terms of directionality. On one hand, substance use can increase someone’s risk of being victimized,21,22 and on the hand, the use of substances is a common coping strategy among people who are experiencing or have experienced DV/SV.23,24 In terms of practice, however, determining directionality is not really what is important. It is far more important to be non-judgmental about survivors’ substance use and work with them to build up positive coping strategies that can replace negative ones (e.g., substance use).
Effects on Social, Economic, and Educational Health
In addition to physical and behavioral health, DV/SV also can have negative consequences for other important life domains. First, DV/SV can erode survivors’ social health (i.e., level of social support and social connectedness). In some cases, particularly with DV, abusive partners use a variety of strategies to sabotage survivors’ relationships (e.g., restricting contact, ruining relationships by lying about friends and family to the survivor or vice versa).19 In other cases, survivors might withdraw from people in their network due to fear, shame, self-protection, or to protect others.19,20 Finally, people in survivors’ networks might be the one to withdraw in order to protect themselves physically and mentally.25
Second, DV/SV can have devastating effects on economic health. As described in Table 1a above, abusive partners often actively sabotage survivors’ ability to work, access their own finances, build credit, and control their professional reputations.26,27 In cases of DV and SV, the physical, psychological, and emotional toll of victimization can hinder survivors’ ability to work and advance in their careers, and safety concerns can limit where it is safe for them to work.27,28
Finally, the challenges and concerns regarding employment are very similar to the ways in which DV/SV can impair educational performance and attainment. Research has shown that abusive partners sabotage educational involvement (e.g., interfering with homework, class attendance, and financial aid; belittling educational goals and abilities)29, and that people who experience DV/SV are more likely than their non-victimized peers to have poor academic performance, including by way of the impact that such victimization has on their mental health.30,31
It is critical that providers understand the impact of DV/SV on social, economic, and educational health. These domains are closely interrelated with physical and behavioral health, and many survivors have to (or want to) prioritize them over physical and behavioral health. For example, a survivor might go to great lengths to maintain employment or social ties, even though to do so comes at the expense of physical health and even safety.32 These situations can render treatment plans null and void if providers do not ask survivors what they are prioritizing and what they will lose by not prioritizing those things.
Strangulation is a particularly prevalent and dangerous form of DV/SV that can be fatal, but is not always fatal.33,34 Nonfatal strangulation can lead to a range of adverse physical and mental health conditions35 (see Patch et al., 2018 for a detailed review), and is a primary risk factor for eventual intimate partner homicide.36 Because the majority of survivors are strangled repeatedly, these effects are exacerbated with each strangulation incident.37 As we will describe, it can be difficult to detect when someone has survived a strangulation attempt (i.e., nonfatal strangulation), which can lead to improper medical care. Thus, education about this issue is essential.
What is strangulation?
Strangulation, which is often called “choking” in the common vernacular, has been defined as “external compression of a person’s neck and/or upper torso in a manner that inhibits that person’s airway or the flow of blood into or out of the head”.38
It takes approximately 4.5 lbs of pressure to close the jugular veins and 10-11 lbs of pressure to close the carotid arteries.39 Pressure to the jugular veins and/or carotid arteries can lead to unconsciousness and cerebral hypomexia within seconds; pressure lasting more than 4-5 minutes can cause brain death.39
Strangulation falls into one of three types: manual (most common), ligature, and choke hold.39
Why is strangulation difficult to detect?
The physical injuries caused by nonfatal strangulation often are invisible to the naked eye40, thereby requiring the use of strategies such as alternative light sources.41 Detection is particularly difficult with women who have darker complexions because darker pigment obscures bruising.42,43
Neurological and cardiovascular problems often emerge days after the incident, making it challenging for survivors and professionals to connect the cause with the symptoms.35,39
Because the loss of oxygen to the brain causes confusion, difficulties remembering what happened, and slurred speech (aphasia), victims may be mistakenly identified as mentally unstable or under the influence of drugs/alcohol.44
Very few survivors seek medical help or report the incident to the police. This is partly because strangulation is a powerful weapon of abuse and control that can hinder survivors’ disclosure and help-seeking, and survivors often are unaware of the negative effects of strangulation.16,35,45
Important information for practice:
It is important to ask behaviorally specific questions instead of using only the terms “choking” and “strangling” because some survivors have their own unique definitions of those terms.16 An example question you might ask is: “Has anyone recently applied pressure to your neck or throat with their hands, arm, or some kind of object?”
Accurate medical documentation is essential because it can serve as helpful evidence in court cases. (See Faugno and colleagues39 for information on documentation.)
Non-fatal strangulation is a felony offense in MA and in many other states. See here.
Although much of the research focuses on male-on-female strangulation, be aware that this tactic also occurs in same-sex relationships.46 Of all couple configurations, female-on-male strangulation is least common.34,46
Spotlight on Traumatic Brain Injury
Traumatic brain injury (TBI) is an especially prevalent, yet often overlooked, condition among survivors of domestic and sexual violence. Estimates indicate that between 30-88% of DV survivors sustain multiple, repetitive incidents of TBI11, with variations due largely to how TBI is defined. According to Valera,47 “To put IPV-related TBI in the context of other subpopulations sustaining high rates of TBIs such as athletes or Iraq and Afghanistan military personnel, the number of abused women sustaining TBIs by their partners can be estimated to far exceed the number of TBIs sustained in such athletes or military personnel combined” (p. 736). Despite the prevalence of TBI, a recent study found that fewer than one quarter of DV survivors (21%) seek medical attention for DV related head injuries.48
What is TBI?
“An alteration in brain function, or other evidence of brain pathology, caused by an external force”.49 TBI can be caused by a closed or non-penetrating injury of the head, meaning that there was no direct contact with the brain, or it can be caused by an open or penetrating injury of the head, meaning the injury penetrates the skull creating direct contact with the brain.50
What are the causes of TBI in the context of DV/SV?
Blunt trauma to the head, face or neck51
Rapid acceleration and deceleration of the head and neck (e.g. violent shaking)51
Rotation of the head52
Non-fatal strangulation can also cause an acquired brain injury51 (see spotlight on strangulation)
What are the signs of TBI?
If someone has memory loss, confusion/disorientation, or a loss of consciousness following an impact to the brain, they may have sustained a TBI.
What are the most common effects?
The impact of TBI depends on the severity (i.e., mild, moderate, or severe) and number of brain injuries sustained.
Effects, which can be short- or long-term, can be physical (e.g., dizziness, headaches, blurred vision, nausea, vomiting, slurred speech, ringing in ears), cognitive (e.g., confusion, delayed response to questions, difficulty focusing, memory loss, reduced cognitive flexibility), and psychological (e.g., depression, anxiety, PTSD, moodiness).48,53-55
In addition, moderate TBI can cause loss of consciousness for up to 24 hours; severe TBI can cause loss of consciousness for over 24 hours (i.e., coma) and fatality via brain death.53
Important information for practice:
It is essential that providers understand the connection between TBI and DV/SV – including signs, symptoms, and effects – so that they can provide an accurate diagnosis and appropriate care to survivors. For example, a common and dangerous mistake is attributing the physical symptoms of mild TBI to mental health disorders and then misdiagnosing.54
Providers should screen for past or present DV, and if the person screens positive for DV, conduct additional screening for TBI using established tools, such as the HELPS brain injury screening tool.54 For more information on the HELPS, see here.
How common is DV during pregnancy?
Estimates vary widely based on sample (e.g., population-based versus clinical), number and specificity of questions about DV, and what forms of violence are assessed. Generally, rates are between 1% and 20% of all pregnant women experience IPV, although rates as high as 28% have been identified.56,57
Pregnant women who are younger, Native American or Black, and without a high school degree have a higher risk of DV than their counterparts.57
What is the impact of DV during pregnancy?
DV during pregnancy, which can take multiple forms (e.g., physical, sexual, coercive control), is particularly harmful due to the negative impact it wields, on not only survivors, but also their children. In addition to the physical, mental, and behavioral health effects already described in this unit, survivors who are abused while pregnant are at heightened risk for missed prenatal appointments, miscarriage, depression, suicide, and homicide.57,58
DV during pregnancy also substantially increases risk for preterm births, low birthweight, and small-for-gestational-age infants.59
Important information for practice:
Although all providers need to be educated about DV during pregnancy and be prepared to respond appropriately, it is particularly important for those who work in the fields related to obstetrics and gynecology.
Best practices include sensitive and safe screening for DV (see Unit 3); active non-judgmental listening; supportive, empowering, survivor-defined care; and informed referrals.60 In order to do the latter, providers must be knowledgeable about available resources both within their own setting and in the community (see Unit 4).
Thus far in this unit, we have focused on the ways in which domestic and sexual violence victimization affects survivors. However, the negative impact of DV/SV also “radiates” out to affect survivors’ loved ones61, especially their children.62,63 It is essential for providers to have a basic understanding of the effects of DV/SV on children (this includes adolescents) and some familiarity with current best practices for working with children who are experiencing or have experienced DV/SV.
First, Two Caveats
We prefer the phrase “experience DV/SV” instead of “exposed to DV/SV.” The term exposed or exposure implies that children are somehow passive and detached rather than directly affected and, at times, involved either voluntarily or involuntarily.64,65
The topic of children and DV/SV is complex and sensitive to say the least. It is beyond the scope of this relatively short training to cover this topic to the extent that it deserves. Thus, we encourage you to consider the overview we provide as a foundation and then pursue additional training. For example, in the larger DV training that Simmons University offers, there is an entire unit on children and DV/SV and a reference section with current and seminal articles on the topic.
In What Ways Do Children Experience DV/SV?
People often erroneously equate experiencing DV/SV with witnessing it. Although it is true that children are often physically present during an incident (especially children aged 0-5),66 bearing witness is only one of a variety of ways and situations in which children can experience DV/SV. Other ways include hearing incidents, witnessing the aftermath of incidents (e.g., effects on survivor and damage to physical space), sensing the fear and anxiety of the abused parent, feeling physically and emotionally unsafe in the home, being used as a tool to control the survivor, and being the indirect target of violence (e.g., when a child tries to intervene in an incident).
When children are the direct targets of violence, regardless of whether the intent is to manipulate and upset the survivor, those situations fall into the category of child maltreatment. Child maltreatment can include physical, psychological, and sexual abuse as well as neglect and custodial interference.67
Overlap between Child Maltreatment and Experience of DV/SV
Research has demonstrated that it is common for children to experience maltreatment and parental/caretaker DV/SV. Findings from a well-cited study that collected data from a representative sample of youth indicate that youth who witnessed partner violence are anywhere from 3 to 9 times more likely to experience maltreatment, with the range dependent on the specific type of maltreatment.67
Although it is also important to be aware of this high overlap, it is just as important to remember that the two do not always co-occur. In other words, providers should not assume that the presence of one indicates the presence of the other. Instead, providers should screen for child maltreatment when there is evidence of domestic violence (and vice versa) to determine appropriate next steps.
Impact of Experiencing DV/SV
An abundant body of literature suggests that childhood experiences of DV/SV can have profound immediate and long-term negative effects.62,68 The type and severity of these effects vary according to age and developmental stage.69 In addition, there is a cumulative effect; that is, experiencing DV/SV along with other forms of violence, such as child maltreatment and community violence, substantially increases a child’s risk for negative physical and mental health outcomes.62,68,70 Finally, certain factors moderate the severity of the impact. For example, one of the most important protective factors for children is a secure attachment with the non-violent parent or other close adult, such as a family member or teacher.65
As described in the larger version of this training, below is a list of potential effects developed by Elena Cohen,69 that we augmented with additional effects based on input from other expert practitioners (noted with an asterisk). We encourage you to review the full document here, as there are very helpful recommendations for working with children based on the effects they are demonstrating.
Early Childhood (0-5 Years)
Insecure or anxious attachment
Avoids eye contact
Avoids "mouthing" objects in environment (e.g., hands, toes, toys)*
Unable to self-soothe
Higher startle response
Higher anxiety when caregiver leaves
Regress
Biological effects on brain structure and functioning*
Withdrawal*
School Age (6-12 Years)
Low self-esteem
Poor academic performance
Struggles with classroom rules
Anxiety
Risk-taking behaviors
Nightmares*
Aggression
Adolescent (12-18 Years)
Self-harming (eating disorders, cutting)
Depression*
Withdrawal*
Increased risky behavior
Substance use
Running away from home
Self-blame*
This concludes the content of Unit 1. Please proceed to Unit 2.
1. Johnson MP. A Typology of Domestic Violence: Intimate Terrorism, Violent Resistance, and Situational Couple Violence. Boston, MA: Northeastern University Press; 2008.
2. Mennicke A & Kulkarni S. Understanding gender symmetry within an expanded partner violence typology. Journal of Family Violence. 31: 1013–1018.
3. Hardesty JL, Crossman KA, Haselschwerdt ML, Raffaelli M, Ogolsky BG, Johnson MP. Toward a standard approach to operationalizing coercive control and classifying violence types. Journal of Marriage and Family. 2015;77(4):833-843. doi:10.1111/jomf.12201.
4. Stark E. Coercive Control: the Entrapment of Women in Personal Life. New York: Oxford University Press; 2007.
5. Coker AL, Davis KE, Arias I, et al. Physical and mental health effects of intimate partner violence for men and women. American Journal of Preventative Medicine. 2002;23(4):260-268. doi:10.1016/S0749-3797(02)00514-7.
6. Coker AL, Smith PH, McKeown RE, King MJ. Frequency and correlates of intimate partner violence by type: Physical, sexual, and psychological battering. American Journal of Public Health. 2000;90(4):553-559.
7. Sheridan DJ, Nash KR. Acute injury patterns of intimate partner violence victims. Trauma, Violence, & Abuse. 2007;8:281-289.
8. Bonomi AE, Thompson RS, Anderson M, et al. Intimate partner violence and women’s physical, mental, and social functioning. American Journal of Preventive Medicine. 2006;30(6):458-466. doi:10.1016/j.amepre.2006.01.015.
9. Coker AL, Smith PH, Bethea L, King MR, McKeown RE. Physical health consequences of physical and psychological intimate partner violence. Arch Fam Med. 2000;9(5):451-457.
10. Coker AL, Smith PH, Fadden MK. Intimate partner violence and disabilities among women attending family practice clinics. Journal of Women's Health. 2005;14(9):829-838. doi:10.1089/jwh.2005.14.829.
11. Kwako LE, Glass N, Campbell J, Melvin KC, Barr T, Gill JM. Traumatic brain injury in intimate partner violence: A critical review of outcomes and mechanisms. Trauma, Violence, & Abuse. 2011;12(3):115-126. doi:10.1177/1524838011404251.
12. Smith SG, Basile KC, Gilbert LK, Merrick MT, Patel N, Walling M., & Jain A. National Intimate Partner and Sexual Violence Survey (NISVS): 2010-2012 state report. 2017. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
13. Bundock L, Howard LM, Trevillion K, Malcolm E, Feder G, Oram S. Prevalence and risk of experiences of intimate partner violence among people with eating disorders: A systematic review. Journal of Psychiatric Research. 2013;47(9):1134-1142. doi:10.1016/j.jpsychires.2013.04.014.
14. Dillon G, Hussain R, Loxton D, Rahman S. Mental and physical health and intimate partner violence against women: A review of the literature. International Journal of Family Medicine. 2013;2013(5):1-15. doi:10.1155/2013/313909.
15. Jordan CE, Campbell R, Follingstad D. Violence and women's mental health: The impact of physical, sexual, and psychological aggression. Annu Rev Clin Psychol. 2010;6(1):607-628. doi:10.1146/annurev-clinpsy-090209-151437.
16. Joshi M, Thomas KA, Sorenson SB. “I didn't know I could turn colors”: Health problems and health care experiences of women strangled by an intimate partner. Social Work in Health Care. 2012;51:798-814. doi:10.1080/00981389.2012.692352.
17. Goodman LA, & Smyth KF. A call for a social network-oriented approach to services for survivors of intimate partner violence. Psychology of Violence. 2011:1: 79–92.
18. Sylaska KM, & Edwards KM. Disclosure of intimate partner violence to informal social support network member: A review of the literature. Trauma, Violence, & Abuse. 2014.15:3–21.
19. Goodman LA, Smyth KF. A call for a social network-oriented approach to services for survivors of intimate partner violence. Psychology of Violence. 2011;1(2):79-92. doi:10.1037/a0022977.
20. Goodman LA, Banyard V, Woulfe J, Ash S, Mattern G. Bringing a network-oriented approach to domestic violence services: A focus group exploration of promising practices. Violence Against Women. 2015;22(1):64-89. doi:10.1177/1077801215599080.
21. Cafferky BM, Mendez M, Anderson JR, Stith SM. Substance use and intimate partner violence: A meta-analytic review. Psychology of Violence. 2016. doi:10.1037/vio0000074.
22. Hughes T, McCabe SE, Wilsnack SC, West BT, Boyd CJ. Victimization and substance use disorders in a national sample of heterosexual and sexual minority women and men. Addiction. 2010;105(12):2130-2140. doi:10.1111/j.1360-0443.2010.03088.x.
23. Smith P, Murray C, Coker AL. The coping window: A contextual understanding of the methods women use to cope with battering. Violence & Victims. 2010.
24. Ullman SE, Relyea M, Peter-Hagene L, Vasquez AL. Trauma histories, substance use coping, PTSD, and problem substance use among sexual assault victims. Addictive Behaviors. 2013;38(6):2219-2223. doi:10.1016/j.addbeh.2013.01.027.
25. Latta RE, Goodman LA. Intervening in partner violence against women: A grounded theory exploration of informal network members’ experiences. The Counseling Psychologist. 2011;39(7):973-1023. doi:10.1177/0011000011398504.
26. Adams AE, Sullivan CM, Bybee D, Greeson MR. Development of the scale of economic abuse. Violence Against Women. 2008;14(5):563-588. doi:10.1177/1077801208315529.
27. Showalter K. Women's employment and domestic violence: A review of the literature. Aggression and Violent Behavior. 2016;31:37-47. doi:10.1016/j.avb.2016.06.017.
28. Loya RM. Rape as an economic crime: The impact of sexual violence on survivors’ employment and economic well-being. Journal of Interpersonal Violence. 2014;30(16):2793-2813. doi:10.1177/0886260514554291.
29. Voth Schrag RJ, Edmond T. School sabotage as a form of intimate partner violence: Provider perspectives. Affilia. 2017;32(2):171-187. doi:10.1177/0886109916689785.
30. Brewer N, Thomas KA, Higdon J. Intimate partner violence, health, sexuality, and academic performance among a national sample of undergraduates. Journal of American College Health. May 2018:683-692. doi:10.1080/07448481.2018.1454929.
31. Jordan CE, Combs JL, Smith GT. An exploration of sexual victimization and academic performance among college women. Trauma, Violence, & Abuse. 2014;15(3):191-200. doi:10.1177/1524838014520637.
32. Thomas KA, Goodman L, Putnins S. “I have lost everything”: Trade-offs of seeking safety from intimate partner violence. American Journal of Orthopsychiatry. 2015;85:170-180. doi:10.1037/ort0000044.
33. Sorenson SB, Joshi M, Sivitz E. Knowing a sexual assault victim or perpetrator: A stratified random sample of undergraduates at one university. Journal of Interpersonal Violence. 2014;29(3):394-416. doi:10.1177/0886260513505206.
34. Walters ML, Chen J, Breiding MJ. The National Intimate Partner and Sexual Violence Survey: 2010 Findings on Victimization by Sexual Orientation. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2012.
35. Patch M, Anderson JC, Campbell JC. Injuries of women surviving intimate partner strangulation and subsequent emergency health care seeking: An integrative evidence review. J Emerg Nurs. 2018;44:384-393. doi:10.1016/j.jen.2017.12.001.
36. Glass N, Laughon K, Campbell J, et al. Non-fatal strangulation is an important risk factor for homicide of women. J Emerg Med. 2008;35(3):329-335. doi:10.1016/j.jemermed.2007.02.065.
37. Breiding MJ, Chen J, Black MC. Intimate Partner Violence in the United States - 2010. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2014.
38. Pritchard AJ, Reckdenwald A, Nordham C. Nonfatal strangulation as part of domestic violence: A review of research. Trauma, Violence, & Abuse. 2017;18(24):407-424. doi:10.1177/1524838015622439.
39. Faugno D, Waszak D, Strack GB, Brooks MA, Gwinn CG. Strangulation forensic examination: Best practice for health care providers. Advanced Emergency Nursing Journal. 2013;35(4):314-327. doi:10.1097/TME.0b013e3182aa05d3.
40. Strack G, McClane G, Hawley D. A review of 300 attempted strangulation cases - Part I: Criminal legal issues. J Emerg Med. 2001;21(3):303-309. doi:10.1016/S0736-4679(01)00399-7.
41. Holbrook DS, Jackson MC. Use of an alternative light source to assess strangulation victims. Journal of Forensic Nursing. 2013;9(3):140-145. doi:10.1097/JFN.0b013e31829beb1e.
42. Baker RB, Sommers MS. Physical injury from intimate partner violence: Measurement strategies and challenges. JOGNN. 2008;37:228-233. doi:10.1111/j.1552-6909.2008.00226.x.
43. Deutsch LS, Resch K, Barber T, Zuckerman Y, Stone JT, Cerulli C. Bruise documentation, race and barriers to seeking legal relief for intimate partner violence survivors: A retrospective qualitative study. J Fam Viol. October 2017:1-7. doi:10.1007/s10896-017-9917-4.
44. McClane GE, Strack GB, Hawley D. A review of 300 attempted strangulation cases Part II: clinical evaluation of the surviving victim. J Emerg Med. 2001;21(3):311-315.
45. Thomas KA, Joshi M, Sorenson SB. “Do you know what it feels like to drown?”: Strangulation as coercive control in intimate relationships. Psychology of Women Quarterly. 2014;38(1):124-137. doi:10.1177/0361684313488354.
46. Messing JT, Thomas KA, Ward-Lasher AL, Brewer NQ. A comparison of intimate partner violence strangulation between same-sex and different-sex couples. Journal of Interpersonal Violence. March 2018:886260518757223. doi:10.1177/0886260518757223.
47. Valera EM. Increasing our understanding of an overlooked public health epidemic: Traumatic brain injuries in women subjected to intimate partner violence. Journal of Women's Health. 2018;27(6):735-736. doi:10.1089/jwh.2017.6838.
48. Zieman G, Bridwell A, Cárdenas JF. Traumatic brain injury in domestic violence victims: A retrospective study at the Barrow Neurological Institute. Journal of Neurotrauma. 2017;34(4):876-880. doi:10.1089/neu.2016.4579.
49. Brain Injury Association of America. Brain injury overview. biausa.org. https://www.biausa.org/brain-injury/about-brain-injury/basics/overview. Accessed March 5, 2019.
50. Brain Injury Association of America. Understanding brain injury. biausa.org. https://www.biausa.org/brain-injury/about-brain-injury/basics/under-standing-the-injury. Accessed February 5, 2019.
51. Valera EM, Berenbaum H. Brain injury in battered women. Journal of Consulting and Clinical Psychology. 2003;71(4):797-804. doi:10.1037/0022-006X.71.4.797.
52. Wong JY-H, Fong DY-T, Lai V, Tiwari A. Bridging intimate partner violence and the human brain: A literature review. Trauma, Violence, & Abuse. 2014;15(1):22-33. doi:10.1177/1524838013496333.
53. Brain Injury Association of America. Injury severity. biausa.org. https://www.biausa.org/brain-injury/about-brain-injury/basics/injury-severity. Accessed March 5, 2019.
54. Campbell JC, Anderson JC, McFadgion A, et al. The effects of intimate partner violence and probable traumatic brain injury on central nervous system symptoms. Journal of Women's Health. 2018;27(6):761-767. doi:10.1089/jwh.2016.6311.
55. Valera E, Kucyi A. Brain injury in women experiencing intimate partner-violence: Neural mechanistic evidence of an “invisible” trauma. Brain Imaging Behav. 2017;11:1664-1677. doi:10.1007/s11682-016-9643-1.
56. Bailey BA. Partner violence during pregnancy: Prevalence, effects, screening, and management. Int J Womens Health. 2010;2:183-197.
57. Chisholm CA, Bullock L, Ferguson JE. Intimate partner violence and pregnancy: Epidemiology and impact. The American Journal of Obstetrics & Gynecology. 2017;217(2):141-144. doi:10.1016/j.ajog.2017.05.042.
58. Alhusen JL, Ray E, Sharps P, & Bullock L. Intimate partner violence during pregnancy: Maternal and neonatal outcomes. Journal of Women’s Health. 2015:24:100–106.
59. Donovan BM, Spracklen CN, Schweizer ML, Ryckman KK, Saftlas AF. Intimate partner violence during pregnancy and the risk for adverse infant outcomes: A systematic review and meta-analysis. BJOG. 2016;123(8):1289-1299. doi:10.1111/1471-0528.13928.
60. Chisholm CA, Bullock L, Ferguson JE. Intimate partner violence and pregnancy: screening and intervention. The American Journal of Obstetrics & Gynecology. 2017;217(2):145-149. doi:10.1016/j.ajog.2017.05.043.
61. Riger S, Raja S, Camacho J. The radiating impact of intimate partner violence. Journal of Interpersonal Violence. 2002;17(2):184-205.
62. Dube SR, Anda RF, Felitti VJ, Edwards VJ, Williamson DF. Exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: Implications for health and social services. Violence & Victims. 2002;17:3-17. doi:10.1891/vivi.17.1.3.33635.
63. Anda RF, Felitti VJ, Bremner JD, et al. The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience. 2006;256:174-186. doi:10.1007/s00406-005-0624-4.
64. Callaghan JEM, Alexander JH, Sixsmith J, Fellin LC. Beyond “witnessing”: Children’s experiences of coercive control in domestic violence and abuse. Journal of Interpersonal Violence. 2016;35(2):088626051561894–31. doi:10.1177/0886260515618946.
65. Davies J, & Lyon E. Domestic violence advocacy: Complex lives/Difficult choices. 2014. Thousand Oaks, CA: Sage.
66. Fantuzzo JW, Fusco RA. Children’s direct exposure to types of domestic violence crime: a population-based investigation. J Fam Viol. 2007;22(7):543-552. doi:10.1007/s10896-007-9105-z.
67. Hamby S, Finkelhor D, Turner H, Ormrod R. The overlap of witnessing partner violence with child maltreatment and other victimizations in a nationally representative survey of youth. Child Abuse & Neglect. 2010;34(10):734-741. doi:10.1016/j.chiabu.2010.03.001.
68. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine. 1998;14(4):245-258.
69. Cohen E. Impact of Exposure to Violence and Other Traumatic Events on Stages of Development (Birth to Adolescence). North Bethesda, MD: Safe Start Center; 2013:1-4.
70. Cronholm PF, Forke CM, Wade R, et al. Adverse Childhood Experiences: Expanding the concept of adversity. American Journal of Preventive Medicine. 2015;49(3):354-361. doi:10.1016/j.amepre.2015.02.001.