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community. Successful interventions must be based on an understanding of the victim’s behavior as normal responses to violence perpetrated by an intimate. Rather than viewing the victim’s behaviors as masochistic, passive, crazy, or inappropriate, they should be viewed as survival strategies which contribute to the victim’s safety and the safety of her children. B. The Perpetrators Perpetrators come into the health care system both for problems related to their abusive behaviors and for those that are not. They are patients in emergency departments, primary care practices, or specialty clinics. They may be inpatients or outpatients. There are few published studies of prevalence for domestic violence perpetrators in the various clinics serving men (except Gondolf & Foster, 1991). However, certain medical centers (e.g., Veterans Administration Medical Centers, military medical facilities, some HMO’s) with on-site perpetrator intervention programs do report receiving referrals of abusers from medical personnel who see these patients in a wide variety of medical clinics. Perpetrators sometimes seek health care assistance for physical injuries they caused to themselves in the process of striking their partners or when terrorizing them with attacks against property (e.g., broken hands, feet, limbs, back injuries, head injuries, internal injuries, muscle strains, burns, cuts). Sometimes they are seeking medical attention for illnesses aggravated by their abusive behavior (e.g., diabetes, asthma, high blood pressure, heart problems, depression). Sometimes they have injuries from suicide attempts made to coerce their partners to remain in the relationship. One abuser shattered the CHAPTER 1 34 bone of his lower leg when the sledgehammer he was using to destroy his partner’s apartment kicked back.) Another terrorized his partner by telephoning her and threatening for 30 minutes to kill himself with dynamite. As she listened helplessly, he blew off one of his arms. Both men were identified as domestic violence perpetrators by medical personnel during treatment for their physical injuries and were referred to domestic violence intervention programs. Sometimes perpetrators are seeking medical care for injuries caused by the victims’ desperate attempts to protect themselves or their children or by victims who strike back after years of abuse (e.g., injuries from objects being thrown, burns, knife or gunshot wounds). Sometimes the batterers are in the system for problems totally unrelated to their abusive behavior (e.g., bone marrow transplant, spinal cord injury, post traumatic stress disorder, schizophrenia, gall bladder surgery). There is no simple, predictive profile that can be used to determine whether or not someone is a perpetrator of domestic violence. However, there are some common characteristics of abusers that are helpful to keep in mind when interacting either with a victim or with a perpetrator. 1. PERPETRATORS OF DOMESTIC VIOLENCE CAN BE FOUND IN ALL AGE, RACIAL, SOCIOECONOMIC, EDUCATIONAL, SEXUAL ORIENTATION, OCCUPATIONAL, AND RELIGIOUS GROUPS Perpetrators are a very heterogeneous population whose primary commonalty is their use of violence. They may be young, old, or in-between. They may be artists, athletes, teachers, health care providers, professionals, working class, unemployed, middle class, rich, or poor. They may be Protestant, Catholic, Muslim, Jewish, Buddhist, agnostic, or atheist. Perpetrators do not fit into any specific personality or diagnostic category. While there is a great deal of discussion in the literature about the psychological profile of batterers, especially as it relates to predicting outcome in their rehabilitation (Saunders, 1993), it is premature to offer personality profile(s) for abusers. There appear to be clusters of personality characteristics for different abusers (Tolman & Bennett, 1990; Hamberger & Hastings, 1990; Saunders, 1992), just as there are clusters of personality characteristics for non-abusers. The literature suggests that there are different types of batterers who use different controlling tactics to different degrees (Gondolf, 1988; Issac, Cockran, Brown & Adams, 1994). Part of this variance may be explained by different types of batterers or by the

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