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While many victims are able to maintain their independent thoughts and actions, others believe what the perpetrators say because the victims are isolated from contrary information. Through his victim’s isolation, the perpetrator prevents discovery of the abuse and avoids being held responsible for it. The perpetrator isolates the victim by acting jealous and interrupting social/ support networks. Some perpetrators act very possessive about their victims’ time and attention. They often accuse them of sexual infidelity and of other supposed infidelities, such as spending too much time with children, the extended family, at work, or with friends. They claim that family or friends are trying to ruin their relationship. This jealousy about alleged lovers, friends, or family is a tactic of control. e. Use of children Some abusive acts are directed against or involve the children in order to control or punish the adult victim (e.g., physical attacks against a child, sexual use of the children, forcing children to watch the abuse of the victim, engaging children in the abuse of the victim). A perpetrator may use children to maintain control over his partner by not paying child support, requiring the children to spy, requiring that at least one child always be in the company of the victim, threatening to take children away from her, involving her in long legal fights over custody, or kidnapping or taking the children hostage as a way to force the victim’s compliance. Children are also drawn into the assaults and are sometimes injured simply because they are present (e.g., the victim is holding an infant when pushed against the wall) or because the child attempts to intervene in the fight. 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. We have sited this 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. 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 Domestic violence occurs in a relationship where the perpetrator and victim are known to each other. It occurs in both adult and adolescent intimate relationships.