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Domestic violence is a problem of epidemic proportions with far-reaching consequences for individual victims, their children and their communities. Domestic violence results in death, serious injury, and chronic medical and mental health issues for victims, their children, the perpetrators, and others. The lethal outcome of domestic violence is tragically evident in media reports that describe a steady stream of homicides against victims, their children, family or friends, those who are trying to protect them, innocent bystanders, and perpetrators. Discussing what is known about homicides and suicides is only one way to understand the lethal nature of domestic violence. At this time there is little research measuring the impact of assaults and abuse in terms of permanent and health-shattering injuries and illnesses. For every homicide victim of domestic violence, there are many victims struggling with major health problems who did not die when shot, stabbed, clubbed, burned, choked, beaten or thrown by their abusers. Thousands of these victims struggle with the health consequences of being trapped in abusive relationships without being identified by health care providers or provided with proper treatment (Hamberger, Saunders & Honey, 1992). Domestic violence presents unique challenges to the health care system and requires specialized responses from health care providers. Before providers are able to effectively and efficiently respond to patients experiencing domestic violence they must first understand the nature and etiology of the problem as well as its impact INTRODUCTION: THE HEALTH IMPACT OF DOMESTIC VIOLENCE on victims, children, and the community as a whole. This chapter provides the framework for that understanding by reviewing the definition and causes of domestic violence as well as specific issues related to victims, perpetrators, and children. CHAPTER 1 16 I. DEFINITION OF DOMESTIC VIOLENCE Domestic violence has many names: wife abuse, marital assault, woman battery, spouse abuse, wife beating, conjugal violence, intimate violence, battering, partner abuse, for example. Sometimes these terms are used interchangeably to refer to the problem, while at other times a particular term is used to reflect a specific meaning (e.g., “woman abuse” to highlight the fact that most victims are women). In addition to these multiple terms, there are different behavioral and legal definitions for domestic violence. With so many varying terms and definitions, there can be a lack of clarity about what is meant by domestic violence, leading to inconsistenDEFINITION OF DOMESTIC VIOLENCE Domestic violence is a pattern of assaultive and coercive behaviors, including physical, sexual, and psychological attacks, as well as economic coercion, that adults or adolescents use against their intimate partners. Key elements of domestic violence: 1. Conduct perpetrated by adults or adolescents against their intimate partners in current or former dating, married or cohabiting relationships of heterosexuals, gay men, and lesbians. 2. A pattern of assaultive and coercive behaviors, including physical, sexual, and psychological attacks as well as economic coercion. 3. A pattern of behaviors including a variety of tactics — some physically injurious and some not, some criminal and some not — carried out in multiple, sometimes daily episodes. 4. A combination of physical attacks, terrorist acts, and controlling tactics used by perpetrators that result in fear as well as physical and psychological harm to victims and their children. 5. A pattern of purposeful behavior, directed at achieving compliance from or control over the victim. FIGURE 1-1 cies in identification, assessment, and interventions as well as inconsistencies in research. For the purpose of this manual, a behavioral definition of domestic violence is used rather than a legal definition, since a behavioral definition is more comprehensive and more relevant to the health care setting.1 (See Figure 1-1) Domestic violence is herein defined by (1) the relationship context of the violence, (2) the perpetrator’s behaviors, and (3) the function those behaviors serve. Throughout this manual, the terms “domestic violence,” “abuse,” and “battering” will be used interchangeably. A. Relationship Context