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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. The victim and perpetrator may be dating, cohabiting, married, divorced, or separated. They are heterosexual, gay or lesbian.2 They may have children in common. The relationships may be of short or long duration. The intimate context of the violence is important in understanding the nature of the problem and in developing effective interventions. To an outside observer, domestic violence may look like strangerto-stranger violence (e.g., punching, slapping, kicking, choking). Domestic violence victims experience traumas similar to those of victims of stranger violence (e.g., burns, internal injuries, head injuries, bruises, stab wounds, broken bones, muscle damage, psychological trauma). However, the intimate context of domestic violence shapes the way in which both the perpetrator and the victim relate to and are affected by the violence. And, unfortunately, the intimate context all too often leads those outside the relationship to take domestic violence less seriously than other types of violence. In domestic violence, perpetrators have on-going access to their victims, know their daily routines and vulnerabilities, and can continue after violent episodes to exercise considerable physical and emotional control over their daily lives. In addition, these perpetrators have knowledge of their victims (e.g., prior medical conditions, allegiance to their children) which they use to target their assaults (e.g., withholding medications, grabbing victims from behind, threatening to harm the children), increasing the victims’ trauma and fear. Victims of domestic violence not only deal with the particularities of a specific trauma (e.g., head injury) and the fear of future assaults by a known assailant, but must also deal with the complexities of an intimate relationship with that assailant. Many perpetrators believe that they are entitled to use tactics of control with their partners and too often find social supports for those beliefs. It is the “family” nature of these relationships that sometimes gives the perpetrator social, if not legal, permission Health care providers may want to become familiar with the legal definition of domestic violence in their jurisdiction and note the similarities and differences in the ways domestic violence is defined. 2 For the purposes of this manual, masculine pronouns are generally used when referring to perpetrators of domestic violence, while feminine pronouns are generally used to reference victims. This is not meant to detract from those cases where the victim is male or the perpetrator is female. This pronoun usage reflects the fact that the majority of domestic violence victims are female. The U.S. Department of Justice estimates that 95% of reported assaults on spouses or ex-spouses are committed by men against women (Douglas, 1991). There are no prevalence figures for domestic violence in gay and lesbian relationships, but experts (Lobel, 1986; Renzetti, 1992; Letellier, 1994) indicate that domestic violence is a significant problem in same-sex relationships as well. Consequently, some of the examples in the manual are specific to gay, lesbian or heterosexual relationships, while others apply to all