February 15, 2023

Studio Talk Podcast: Real Conversations About Mental Health

A Conversation About Domestic Violence/Intimate Partner Abuse

Season 2 Episode 7

In this episode our co-hosts discuss domestic violence/intimate partner abuse. The discussion covers this very difficult and complex issue and makes an effort to clarify and provide important information about it. 

Host Xiomara A. Sosa leads the conversation with co-hosts Victoria Lockridge and Lisa Early. She provides tips on how to recognize domestic violence/intimate partner abuse, what to safely do about it and how to provide resources and support. The co-hosts have an honest and open discussion regarding this difficult subject matter and invite the listeners to safely share their stories with them in the comments. 

As always, Studio Talk Podcast encourages their listeners to provide feedback, comments as well as their opinions and experiences about their own experiences with major life transitions that impacted their mental health. The discussion offers resources and references for listeners to review and examine and listeners are encouraged to do their own research and draw their own conclusions about the issues discussed. As with most issues, there are negatives and positives found and the co-hosts recognize that as reality and have an honest conversation about it.

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Following are some points for reference/statistics about domestic violence/intimate partner abuse: 

• 33 million people/15% are current or former victims.
• 85% of these victims are women. 
• Annual result of 1,200 and 2 million injuries estimated to be women. 
• 600,000 injuries estimated to men. 
• For every reported incident it’s estimated that 10-30 incidents are not. 
• Acts of DV occur every 15 seconds in the US. 
• 3 women are murdered by their partners every day.
• Half of all couples experience at least one violent incident and in ¼ of these couples violence is a common occurrence. 
• 95% of men who physically abuse their partners also psychologically abuse them.
• Psychological abuse is a stronger predictor of PTSD than physical abuse among women. 
• 20% of all murders in the US are committed within families, 13% by spouses. 
• 85% of all spousal abuse are committed by men.
• Financial abuse occurs in 99% of cases of abuse and is often the main reason why victims stay with or return to the abuser. 
• 37% of women who go to the emergency report DV
• Battering is the single major cause of injury to women, more frequent than car accidents, muggings and rapes combined. 
• 21% of victims of intimate violence lose their jobs. 
• 1 in 4 female suicides were victims of family violence. 
• 2011 SC ranked first in the country with homicide rates for female victims by male offenders. SC’s rate for this kind of homicide is more than twice the national average.
• Verbal abuse early in the relationships predicts subsequent physical spousal abuse. 
• Children are emotionally traumatized by witnessing violence, many of them grow up to repeat the pattern as a victim or an abuser. 
• Victims of DV are 3 times more likely to be victimized again than are victims of other types of crimes. 
• A boy who witnesses his mother being abused is 10 times more likely to become a perpetrator as an adult.
• The most dangerous time for a victim is when leaving the relationship. 50% of injuries and 75% of domestic homicides happen after the relationships end. Research suggests it takes up to 7 times of trying to leave to actually leave, and it’s the most lethal time as well. 
• DV is one of the most common crimes. 
• 33 million people/15% are current or former victims.
• 85% of these victims are women. 
• Annual result of 1,200 and 2 million injuries estimated to be women. 
• 600,000 injuries estimated to men. 
• For every reported incident it’s estimated that 10-30 incidents are not. 
• Acts of DV occur every 15 seconds in the US. 
• 3 women are murdered by their partners every day.
• Half of all couples experience at least one violent incident and in ¼ of these couples violence is a common occurrence. 
• 95% of men who physically abuse their partners also psychologically abuse them.
• Psychological abuse is a stronger predictor of PTSD than physical abuse among women. 
• 20% of all murders in the US are committed within families, 13% by spouses. 
• 85% of all spousal abuse are committed by men.
• Financial abuse occurs in 99% of cases of abuse and is often the main reason why victims stay with or return to the abuser.
• 37% of women who go to the emergency report DV
• Battering is the single major cause of injury to women, more frequent than car accidents, muggings and rapes combined. 
• 21% of victims of intimate violence lose their jobs. 
• 1 in 4 female suicides were victims of family violence. 
• 2011 SC ranked first in the country with homicide rates for female victims by male offenders. SC’s rate for this kind of homicide is more than twice the national average.
• Verbal abuse early in the relationships predicts subsequent physical spousal abuse. 
• Children are emotionally traumatized by witnessing violence, many of them grow up to repeat the pattern as a victim or an abuser. 
• Victims of DV are 3 times more likely to be victimized again than are victims of other types of crimes. 
• A boy who witnesses his mother being abused is 10 times more likely to become a perpetrator as an adult.
• The most dangerous time for a victim is when leaving the relationship. 50% of injuries and 75% of domestic homicides happen after the relationship ends. Research suggests it takes up to 7 times of trying to leave to actually leave, and it’s the most lethal time as well. 

Definition of Domestic Violence/Intimate Partner Abuse:

Domestic violence is a pattern of behaviors used to gain or maintain power and control. 

Understanding the Impact of Domestic Violence

1 in 4 women and 1 in 9 men in the U.S. will experience intimate partner violence, making it a serious public health issue

Understanding Domestic Violence

This article uses the term domestic violence to refer to any behavior occurring in a romantic relationship that causes physical, sexual, or mental harm, regardless of whether people live in the same household. Domestic violence can occur between any two partners, regardless of gender or sexual orientation.

Another term, intimate partner violence (IPV), is also often used to refer to violence that occurs between romantic partners, while the term domestic violence is sometimes reserved for violence that takes place in a household.

In either case, the abuser could be a current spouse, former spouse, or dating partner.

Domestic violence is not uncommon. One in four women and one in nine men in the United States have reported experiencing sexual violence, physical violence, and/or stalking in their lifetime.

The actual rate of domestic violence and sexual assault is unknown because many experiencing it are afraid to disclose or report it.

Abuse does not need to have multiple occurrences or be carried out over years to be considered domestic violence. Even one episode can have serious impacts and should not be overlooked.

Domestic violence includes any of the following:

• Physical violence: hitting, kicking, slapping, or other types of physical force that are intended to hurt the partner.
• Sexual violence: forced, or attempted forcing, of a partner to engage in sexual acts when the partner does not consent or isn’t capable of consenting. This includes both sexual events and non-physical events, like sexting.
• Psychological aggression: verbal and non-verbal communication to erode a person’s self-worth, harm the partner mentally or emotionally, or exert control or power over the partner.
• Stalking: repeated, unwanted attention and/or contact that triggers fear or worry about partner safety, or the safety of others that are close to the victim. Stalking means the communication isn’t consensual and may include verbal, written, or implied threats.

Controlling behaviors are harmful to relationships and may point to more severe domestic abuse. Controlling behaviors are actions, whether verbal or physical, that limit a partner’s mobility or access to friends, family, or environments outside of the home. 

The victim may also be deprived of food, money, or access to health care.

According to the American College of Obstetricians and Gynecologists, reproductive coercion can also occur. This includes behavior in a relationship related to reproductive health and may happen with or without physical or sexual violence. This includes but is not limited to refusal to practice safe sex, intentional exposure to sexually transmitted infections, tampering with or sabotaging contraception, or controlling access to health services.

In addition, domestic violence can occur in younger persons and is often referred to as teen dating violence (TDV), which impacts millions of teens in the United States. Approximately 11 million women and 5 million men who reported experiences of intimate partner violence shared that they first experienced sexual or physical violence or stalking before the age of 18.

Recognizing the Signs of Domestic Violence

Domestic violence can take many forms. It’s important to recognize that the signs may differ depending on the relationship.

Some of the more common signs of domestic violence include physical aggression, such as slapping, hitting, or pushing.

Abusive partners can have unpredictable moods that often change quickly and drastically. They may verbally threaten their partner, call them names, swear at them—or they may threaten to hurt themselves, their partner, or loved ones.

Abusers may minimize their partner’s feelings. They can show jealousy, suspicion, and anger, even if it’s unwarranted.

Other signs of domestic abuse include someone trying to control their partner’s time. They may monitor activities, such as attending classes or seeing friends and family.

An abuser may isolate their partner by limiting phone use or forcing their partner to stay at home. They may control funds, including making financial decisions alone or taking their partner’s money without permission.

If these behaviors are noticed in a partner, it may be time to address them.

Short- and Long-Term Impacts of Domestic Violence

The impacts of domestic violence are far-reaching. Below, we’ve highlighted some of the health outcomes associated with exposure to it.

The potential physical impacts of domestic violence include symptoms related to:

• Heart / cardiovascular issues
• Gastrointestinal / digestive issues
• Chronic pain
• Sexual / reproductive issues
• Symptoms of pulmonary or musculoskeletal conditions
• Traumatic brain injury

Domestic abuse can also result in death.

Mental Health Effects of Domestic Violence

According to the American Psychiatric Association (APA), 20% of survivors develop mental health conditions. These include:

• Major depressive disorder
• Generalized anxiety disorder
• Post-traumatic stress disorder
• Substance use disorders

The APA states that survivors of domestic violence may blame themselves for the abuse they received. They can become self-critical, self-destructive, and suicidal. Chronic abuse can create trauma responses that interfere with future relationships.

Survivors may struggle with emotional regulation, dissociation, numbing, and have trouble reading social cues.

Researchers have found that mental health outcomes of domestic violence can become a vicious cycle. Survivors can believe they are powerless to control violent behavior or to develop resources to change their situation. This can potentially set up a long-term pattern of violent partnerships.

Violence also affects the children of those involved. According to the World Health Organization (WHO), children of people experiencing abuse are more likely to be abused. They also tend to have poorer school performance than their peers and higher rates of illness, including depression and anxiety.

Witnessing domestic abuse is considered an adverse childhood experience (ACE). Such toxic stress in early life is linked to several negative health outcomes in adulthood, ranging from depression and substance use disorder to diabetes and heart disease.

Children who grow up in the presence of domestic violence are more likely to experience it themselves once they reach adulthood. Boys from such environments are more likely to become perpetrators of violence, while girls are more likely to be victimized in adulthood.

Domestic abuse can affect relationships outside the home. Support from extended family, friends, and community can protect someone from domestic violence. Social support is important as people recover from the effects of violence. However, abusers often isolate victims from family and friends in an effort to control them.

Treating the Mental Health Effects of Domestic Violence

Mental health professionals who treat survivors of violence use a trauma-informed approach. When counseling patients, they consider the distress the patient experienced and how it shapes the person’s beliefs and behavior. This approach focuses on creating a sense of safety and empowerment for patients.

Therapists target treatment toward the mental health conditions a patient presents with, such as PTSD or depression. In treatment, patients can strengthen communication, learn stress management, and reduce feelings of isolation. Such skills may protect against future incidences of domestic violence.

In addition to individual counseling, group therapy can be helpful for survivors. In the context of a group, they can learn from others’ experiences and can shed feelings of isolation and secrecy.

How Domestic Violence Is Identified

Health care providers should talk to patients regularly about relationship safety. Domestic abuse can be discussed in many settings including:

• Routine primary care visits
• Abortion appointments
• OB-GYN appointments
• Home visits by health department staff
• Therapy sessions

To reduce stigma for patients experiencing intimate partner violence, all patients should be asked about their relationships—not just those whom providers believe to be at risk.

Fear of offending a patient or being rushed for time can prevent health care workers from having necessary conversations about abuse.

Ideally, all staff, including receptionists, counselors, and physicians should receive training about domestic abuse. With the right skills, staff can be prepared to identify and address this serious issue.

Talking to Patients About Domestic Violence

When asking about domestic violence, providers should avoid using stigmatizing language, such as “batterer.” They should keep in mind that a patient experiencing abuse is likely emotionally attached to their partner.

According to Futures Without Violence, survivors want providers to listen, to be nonjudgmental, offer information and support, and not push for disclosure.

The Futures Without Violence CUES intervention is an example of an evidence-based method used in healthcare settings to address abuse. In this model, providers practice the following.

Confidentiality

Providers make sure at least part of the appointment is done in private (e.g., a partner, family, friends, or caregiver is not present). They also share any limits of confidentiality before talking with patients.

Universal Education and Empowerment

Providers make it clear to patients that they are a safe person to talk with. Providers normalize how relationship stress can affect health.

Support

Providers are prepared to offer health promotion strategies, care plans, and referrals to domestic/sexual abuse shelters and hotlines.

Screening Tools for Domestic Violence

Multiple screening tools are available to identify abuse. These questionnaires inquire about a patient’s experiences of violence in a relationship. Depending on the situation and type of screener, clinicians can ask the questions directly, or they can hand them to patients as a form.

When providers use screening tools as part of standard intake forms for health appointments, they can help patients understand that all patients are asked these questions, regardless of whether abuse is suspected.

The Kaiser Family Foundation (KFF) provides an extensive list of screening tools. Examples of these questionnaires include:

Hurt, Insult, Threaten, Scream (HITS)

The HITS screening tool consists of questions rated on a five-point Likert scale (answers range from “never” to “frequently”). HITS questions can be asked by a provider or filled out by the patient. The score ranges from 4 to 20 points. A score of 11 or above indicates abuse.

Slapped, Threatened, Throw (STaT)

Designed in a hospital emergency department, STaT is a simple but effective way to screen patients for domestic violence. As its name indicates, the tool asks patients if their partner has slapped them, threatened them, or thrown things. Patients can fill out the form on their own and hand it to medical staff.

Assessing Risk

Assessing and identifying domestic violence has limitations, since victims have varying comfort levels about disclosing. They may fear further abuse or financial repercussions.

Interactions with providers can make a difference, however.

According to the Kaiser Family Foundation (KFF), 76% of domestic violence interventions in primary care settings resulted in at least one benefit. Such benefits include safety planning, health improvements, and reductions in violence.

Sixty percent of women were more likely to end an unsafe relationship after discussing the issue with a healthcare worker.

When patients report domestic violence, providers should connect them with support resources, including social services, mental health treatment, advocacy organizations, and shelters.

If a patient discloses an immediate threat, providers should connect them directly with a domestic abuse or sexual violence shelter.

If possible, the person disclosing abuse should be provided with an alternate phone, or access to an alternate phone, since many abusive partners monitor communications.

Even when patients choose not to disclose abuse, conversations with providers are important. Through interventions, patients become aware of resources available to them, and will be more likely to reach out for help in the future.

Understanding the Impact of Domestic Violence on Minority Populations

Racial and Ethnic Minorities and Domestic Violence

Domestic violence can happen to anyone. However, statistics show that it affects communities differently.

According to the CDC’s National Intimate Partner and Sexual Violence Survey, 45% of Black non-Hispanic women and 56% of multiracial non-Hispanic women experienced IPV in their lifetimes compared to 37% of white women.

Asian or Pacific Islander non-Hispanic women had lifetime rates of abuse at 18%. However, research suggests that underreporting could be a factor in this population’s low rate.

Alaska Native non-Hispanic men (40%), Black non-Hispanic men (40%), and multiracial non-Hispanic men (42%) experienced higher rates of abuse than white non-Hispanic men (30%).

More research needs to be done on the connection between ethnicity and domestic violence. However, we do know that systemic racism and discrimination contribute to disparities.

For example, out of fear of discrimination, Black survivors of violence may avoid seeking health care or reporting abuse to law enforcement. They are more likely to turn to family, friends, and their churches or other religious organizations. Black women may fear judgment from within their own communities, feel pressured to keep their family together, or become influenced by the stereotype of the strong Black woman.

Health care workers, members of law enforcement, and clergy should make every effort to understand the unique experiences of ethnic minorities and domestic violence. They must address inequities and connect survivors with culturally competent care.

LGBTQ+ People and Domestic Violence

LGBTQ+ people experience domestic violence at similar or higher rates as non-LGBTQ+ people.

According to the American Psychiatric Association (APA), LGBTQ+ people may not disclose abuse because they fear perpetuating negative stereotypes about the LGBTQ+ community.

Like other minority populations, LGBTQ+ people may have negative experiences with the health care system and may not trust providers.

The APA cautions providers against viewing abuse through a stereotypical gender binary of a masculine-presenting person inflicting violence on a feminine-presenting person. Instead, providers should consider whether one person is exerting power and control over another.

When helping LGBTQ+ people, providers should consider connecting patients to LGBTQ-specific organizations, such as the National LGBTQ Institute on IPV and the NW Network.

Immigrants and Domestic Violence

Immigrants have unique vulnerabilities to domestic violence. Abusive partners may use a person’s immigration status as a form of control, by threatening to disclose undocumented status or refusing to fill out immigration paperwork.

Immigrants may face language and cultural barriers when seeking help. They may struggle to understand their new country’s support network.

Research on domestic violence risk factors for refugee and immigrant women identify the following vulnerabilities:

• Stress of adapting to a new culture
• Cultural beliefs that accept violence
• Types of relationships that can lead to power differences (e.g., marriages to U.S. military personnel, marriages through international dating services)
• Institutional discrimination
• Language barriers and lack of knowledge of available services
• Lack of disclosure due to fear of deportation
• Social isolation—immigrants may not have family and friends nearby for support

Providers who work with immigrants should have an understanding of their patients’ culture of origin. They should also be aware of legal issues immigrants face. In the U.S., for example, providers can let patients know that the Violence Against Women Act can prevent them from being deported.

Immigrants who experience domestic violence face several challenges at the same time. The APA reports that providers were most helpful in addressing abuse when they offered a range of services such as language classes, driver’s education, and employment assistance.

When People With Disabilities Experience Domestic Violence

People with disabilities can experience the same types of abuse as other survivors. However, for those with disabilities, the danger is compounded. Abusers may withhold medication; prevent the use of equipment, such as a cane or wheelchair; or interfere with a person’s ability to bathe or use the bathroom.

According to the Kaiser Family Foundation (KFF), women with physical health conditions were 22% more likely to experience abuse than those without disabilities. Women with mental health challenges were 67% more likely to experience abuse than those without mental illness.

According to the U.S. Department of Health and Human Services, signs of abuse include a person’s lack of contact with friends and family; visible bruising; unexplained sprains, fractures, or dislocations; and appearing hungry or malnourished.

The National Coalition Against Domestic Violence states that hospitals, hotlines, agencies, and other organizations can take steps to ensure people with disabilities are connected with help. These include:

• Training staff to work with people who have disabilities
• Keeping referral lists of organizations that specialize in the intersection of domestic violence and disability
• Having materials (e.g., brochures, websites) geared towards people with disabilities

If you are concerned that someone you know is experiencing abuse, contact your state’s adult protective services department.

How Domestic Violence Can Be Prevented

Research connects an increased risk of domestic violence perpetration by men against women and mental health conditions, including antisocial personality disorder, substance use disorder, post-traumatic stress disorder (PTSD), depression, and anxiety.

According to a 2012 study in Sweden, the hyperarousal symptoms of PTSD, lack of inhibition caused by substance use, and difficulties in emotional regulation seen in anxiety and depression may be linked to the aggression of domestic violence. The study supported prioritizing assessment and treatment of mental health conditions to prevent abuse as part of a broader approach to address the issue.

The CDC emphasizes that domestic violence is preventable and occurs across the life span. In preventing domestic abuse, it’s important to consider the risk factors that can cause someone to become violent.

The CDC places risk factors in individual, relationship, and community categories.

Individual risk factors include having few friends and being unemployed. Risk factors in relationships include experiencing physical discipline as a child and associating with aggressive peers. At the community level, risk factors involve few interactions between neighbors and easy access to drugs and alcohol.

Prevention involves creating protective factors. Prevention efforts span the individual to institutional level. They include healthy relationship programs for couples, early childhood home visitation, changing the social environments of neighborhoods, and providing treatment and support for survivors.

What Can I Do If I’m In an Abusive Relationship?

It’s important to know the signs of intimate partner violence. If you feel unsafe in your relationship for any reason, it is not your fault. It’s important to reach out for help.

Talk to a trusted person outside your home, such as a nurse, social worker, clergyperson—or contact your local domestic violence prevention center or shelter. If you are in immediate danger, call the police (911).

When making calls or using the internet, keep in mind that controlling partners often monitor the phone and web activity of their partners. You should also know where you keep important documents or other essential items in case you need to leave in a hurry.

No matter your situation, know that there is hope. Recovery from the effects of violence is possible. It begins with reaching out. With support, many survivors find safety and go on to have healthy relationships.

The Mental Health Implications of Domestic Violence During COVID-19

The COVID-19 pandemic has magnified conditions for trauma, stress, financial insecurity, and isolation; each known to have unique and cumulative effects in exacerbating the frequency and severity of domestic violence [1]. Large-scale public health measures, such as physical distancing and lockdowns, have reduced COVID-19 transmission but paradoxically created conditions for domestic violence perpetrators to exercise increased financial, physical and psychological control [1, 2]. Isolation at home means that many survivors of domestic violence are unable to access telephone helplines, services, finance, informal social supports or safe shelter [2, 3]. Similarly, the closure of schools has resulted in children spending significantly more time at home than usual, placing them at greater risk of witnessing and/or experiencing any violence occurring in their homes. Domestic violence has enduring effects for mental health [4], and will create a significant increased need for trauma-informed services both during and after the COVID-19 pandemic.

Mental Health Consequences of Domestic Violence

The mental health effects of domestic violence are likely to be severe and long-lasting [4]. Exposure to violence and abuse increase one’s risk of experiencing post-traumatic stress disorder, depression, anxiety, substance use, and suicidal behaviours [4, 8]. The most commonly employed element of domestic violence–coercive control—is a pattern of domination enacted through tactics designed for intimidation and entrapment, and has particularly damaging effects for mental health [2, 6]. Coercive control strategies include social and physical isolation, shaming and belittlement, micromanagement of daily activities, and constant surveillance. These strategies aim to terrorize, hurt and overwhelm victims, and predict intimate partner homicide [9]. Control strategies may differ by culture and setting, and during the COVID-19 pandemic perpetrators are capitalizing on the isolating conditions of lockdowns and home quarantine to enforce separations from social support networks, increase control of victims’ actions and finances, and exacerbate fear within the household [1, 3, 10]. Practitioners are also seeing the use of digital coercive control, whereby perpetrators utilize technology to monitor and track their victims, creating a sense of omnipresence, isolation, and ostracism [9]. Coercive control has significant implications for survivors’ mental health, through prolonged, repeated trauma that is both inescapable and unpredictable in nature.

Chronic and repeated trauma often manifests a more complex pattern of psychological symptoms compared with a single trauma event [11]. In addition to the defined symptoms of post-traumatic stress disorder (PTSD), people with complex PTSD are more likely to experience dissociation; alterations in memory, identity, and personality; negative self-concept; disturbances in relationships and impaired functioning [11]. Similarities in the pattern of psychological symptoms resulting from domestic violence are evident across cultures, with large-scale community surveys indicating that women who have experienced domestic violence are at higher risk of complex mental health difficulties and suicidal thoughts than women who had not experienced violence [2, 12]. Mental health difficulties disrupt economic engagement and livelihoods, which will have significant implications for post-COVID economic recovery. A growing mental health crisis—triggered by pandemic stressors, infection and compounded by domestic violence—will thus require specialized trauma-informed services.

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The Role of Mental Health Service Providers

Addressing domestic violence requires a multi-pronged approach involving trauma-informed and culturally secure legal services and policing, tailored mental health services, and broad societal efforts [8]. As we transition into new stages of the pandemic, mental health services must be prepared for an influx in demand and caseload, with required attention to the psychological impacts of trauma. In high-income settings, it is vital that psychologists, psychiatrists, mental health nurses and general practitioners are provided sufficient training to identify the incidence and mental health effects of domestic violence, and that clinicians are confident and capable in delivering evidence-based, trauma-informed care that is culturally secure and tailored to the unique circumstances of the pandemic. The implementation of trauma-informed practices in domestic violence services has demonstrated significant improvements in women’s safety-related empowerment and self-efficacy [13].

In low-income settings, where mental health resources are scarce, task shifting will be an important priority for government and non-government services. Task shifting involves the training and ongoing supervision of lay-providers to enable competent delivery of psychological interventions in areas with few mental health professionals. Culturally-adapted psychological interventions are effective in improving psychological symptoms when delivered by trained lay-providers, fostering a broader coverage of mental healthcare while improving cost-efficiencies, reducing mental health stigma and creating employment opportunities in low-resource settings [14]. Training lay-providers to deliver mental health programs for people affected by domestic violence and abuse during the pandemic will support broader treatment accessibility and improve prevention efforts, particularly in rural and remote communities where isolation intensifies the risk of trauma [14]. Remote and asynchronous learning can also help accelerate the training of lay-providers to meet the anticipated large demand [15]. Further, the implementation of telehealth services will expand treatment coverage, enabling greater access to mental health providers [3], while reducing transmission risk for providers and the community. During lockdowns, the continual presence of the perpetrator within the home will restrict survivors’ ability to discuss their situation via phone; however telehealth and online services have potential to reduce isolation, disseminate safety information, and enable safety planning and referrals via coded messages and disguised phone apps [3, 16].

Conclusion

The compounding mental health impacts of stress, infection and violence have created acute strains on mental health systems worldwide, requiring significant investment and innovation by services and governments. Mental health services must immediately coordinate efforts to scale up training of professionals and lay-providers and establish sustainable systems for culturally-secure, trauma-informed mental healthcare. Ongoing economic investment in established domestic violence services and growth of the mental health sector will be critical in supporting violence survivors throughout the pandemic.

Red Flags of Abuse

Get Help for Yourself or a Friend

Domestic violence encompasses a spectrum of behaviors that abusers use to control victims. The following list includes warning signs that someone may be abusive. If you or a friend experience these behaviors from a partner, remember: it is not your fault and there are advocates waiting to help.

“Red flags” include someone who:

• Wants to move too quickly into the relationship.
• Early in the relationship flatters you constantly, and seems “too good to be true.”
• Wants you all to him- or herself; insists that you stop spending time with your friends or family.
• Insists that you stop participating in hobbies or activities, quit school, or quit your job.
• Does not honor your boundaries.
• Is excessively jealous and accuses you of being unfaithful.
• Wants to know where you are all of the time and frequently calls, emails, and texts you throughout the day.
• Criticizes or puts you down; says you are crazy, stupid, and/or fat/unattractive, or that no one else would ever want or love you.
• Takes no responsibility for his or her behavior and blames others.
• Has a history of abusing others.
• Blames the entire failure of previous relationships on his or her former partner; for example, “My ex was totally crazy.”
• Takes your money or runs up your credit card debt.
• Rages out of control with you but can maintain composure around others.

According to the National Domestic Violence Hotline, some warning signs include the following:1

• Their partner insults them in front of other people.
• They are constantly worried about making their partner angry.
• They make excuses for their partner’s behavior.
• Their partner is extremely jealous or possessive.
• They have unexplained marks or injuries.
• They’ve stopped spending time with friends and family.
• They are depressed or anxious, or you notice changes in their personality.

If you think your friend or family member is being abused, be supportive by listening to them and asking questions about how they’re doing. The person being abused may not be ready or able to leave the relationship right now.

Abuse is never the fault of the vic