Scand J SOCMed, Vol. 20, No. 3
Do not forget the battered male! A cotnpnmfive sttidy of fntiiily ntrd rioii-fntiiily violetice victittrs
Bo K. Bergman, M.D.’ and Bo G . Brismar, M.D.2 From rlic I Depnrtnietiis of Psycliiarry ntrd ’Surgery, Karolitiskn Iiisriiute, Hiidditige Hospitnl, Httdditige, Swederi.
Do iiot forge: the baiiered male! A coinparative stiidy of jariiily and iion-family violence victinu. Bergman, B. K., Brismar, B. G . (Department of Psychiatry and Surgery, Karolinska Institute, Huddinge Hospital, Huddinge, Sweden). Scatid I SOCbled 1992. 3 (179-183). This study is based on interviews with and psychiatric ratings of female family violence victims and male non-family violence victims. Despite differences in the type of violence and the relation to the assailant, the psychological consequences of the battering were very much the same in the two groups. The background and present social situation of the victims were very similar. The conclusion drawn with regard to the medical services, is that both groups of victims need the same attention and treatment when attending the emergency department. Apart from routine medical care, they might need treatment for alcohol problems, depression or other psychiatric conditions frequently occurring in victims of violence. Key ,cords: spouse abuse, violence, alcoholism, depression.
From research on family violence, a lot of knowledge has been accumulated on background and precipitating factors as well as the psychological consequences of the violence. It has been claimed that girls who experience violence during childhood will, like their mothers, become victims of violence as adults (5). In the same way, boys will grow up to be wife-beaters ( 6 ) . The role of alcohol as a precipitating factor in family violence and wifebeating is also well-documented (7). The psychological consequences in the battered wife, commonly described as the “battered wife syndrome”, comprise both somatic, psychosomatic and psychiatric symptoms (8). The battered male and his background, as well as factors precipitating male-to-male violence and the consequences there of are less well studied. The aim of this study is to compare the female and male victim in these aspects and to discuss practical implications for the medical services.
INTRODUCTION
This study is based on interviews with 49 battered wives and 19 battered males seeking emcrgency medical care at the Huddinge Hospital, Stockholm, Sweden. The battered women were admitted to the hospital within the framework of a special treatment programme for battered wives (9). Thirty-nine percent of the women were admitted for serious injuries, i. e. fractures, thoracic or abdominal trauma. Fourteen per cent had concussions, the rest were admitted mainly for medico-social reasons. The battered males constituted a consecutive series of patients with injuries requiring in-patient care in the department of surgery during a four-month period in 1990. Twenty-seven per cent were seriously injured and 67 percent had concussion, no one died from the injuries, however. Four males refused to participate. The victims were interviewed one or two days after the physical abuse while still in the surgical ward. They were questioned about their present social situation, growing up conditions and any history of previous violence. They were rated psychiatrically on the Comprehensive Psychopathological Rating Scale (CPRS) (10). Twenty-four items were used, 10 of which constituate a depression rating scale,
MATERIAL AND METHODS Patients with injuries due to battering are common in emergency departments .(l). For many reasons, during the last few decades, most research, special task forces and treatment programmes have been focused on the female victim. She is generally the victim of family violence, beaten by her husband or cohabitant. The violence typically takes place indoors and is repeated at more or less regular intervals ( 2 ) .In contrast, the battered male, who is the most common battered victim seen in the emergency room (3) is often injured outdoors in non-family violence. As in the cases of family violence, the assailant is nearly always a male, but not necessarily one aquainted (4)with the victim. Thus, the emotional and practial bonds are not the same between assailant and victim for battered males and battered females. 12’
Scand J SOChled 20
180
B. K . Bergman and B. G. Brisniar
Table I. Cfiildliood living conditions of battered woitieii arid battered males Battered wives (n=49)
Father hit mother Battered as a child During some period of childhood reared outside parental home Alcohol habits of biological father Alcoholic High consumer Low consumer or abstinent Alcohol habits of biological mother Alcoholic High consumer Low consumer or abstinent
YO
Battered males (n=19) Yo
49 78
39 74
20
5
22
21
27 51
11 68
8
5 0 95
4
88
MADRS, according to Montgomery and Asberg (11). A three point-scale was used. The psychiatric ratings were supplemented with the victims’ psychiatric history, including any history of alcohol or drug abuse. The female victims had all been beaten by their husband or steady partner, while the males had been abused by “friends” (53%) or strangers (47%). The mean age of the women was 33 and of the males, 38. In all 68 cases a male was the assailant. Ninty-two per cent of the female victims, compared to 32% of the male victims, had been beaten in their own home or in the home of the assailant. Fourty-nine per cent of the battered wives and 37% of the battered males were born abroad, which is a much higher proportion than in the general population of the catchment area (12). The victims generally had a lower social class background and most were unskilled workers, had other unqualified jobs or drew early retirement pensions. In both groups the most common mechanisms of violence were punching, kicking and knocking down. The female victims generally experienced a more prolonged abuse including several mechanisms of violence like headbanging against wall or floor and strangle grips. The males were generally knocked down intially and then kicked when in lying position. Sfaticrics. The x2 test, Fisher’s exact test and the Goodness-of-Fit test were used for intergroup comparisons.
RESULTS History of violence A s shown in Table I, a majority of both battered wives and battered males had experienced violence, and alcoholism during childhood. The vast majority of the victims reported some violence; either father hitting mother o r child abuse, o r both. Half of the female victims had fathers who were characterized S a n d f Soc hfed 20
as alcoholics or heavy consumers of alcohol, compared to 32 per cent of the male victims. In adulthood, ninty-four per cent of the females reported that they had been beaten before, compared to 42% of the males. The latter had, however, been assailants t o approximately the same extent. Fourty-seven per cent of the males admitted that they had physically abused someone at some time and 37% said that they had been involved in abusive events more than once.
Alcohol and driig abiise Either the assailant or the victim, or both, were drunk in eight cases out of ten when violence erupted, with n o differences between family and non-family violence. In the histories of alcohol and drug abuse there was a consistent tendency for the males to have shown somewhat more signs and symptoms, although without significant differences between the groups. Alcohol dependency was reported by one third of the male and one fourth of the female victims (Table 11). Approximately one fifth of the victims had abused drugs a t some time. Psychological cotiseqiiences The assessment of the victims psychiatric status one to two days after the physical abuse revealed extensive depressive symptoms in both groups. Seventeen Table 11. Alcohol and drug addiction iti battered wotiieta arid battered tnales and alcohol introxicatiota at the present mnftreatnient Battered Battered wives males (n=49) (n=19)
Ever felt alcohol- dependent History of blackouts eye-openers loss of control delusions seizures Ever abused cannabis amphetamineheroin Influence of alcohol at victimization Both under the i ~ f l ~ ~ e n c e Only the assailant Only the victim Neither or unknown
YO
YO
24
37
41 29 20 8 2
53 42 37 21 16
24 16
21 21
55 22 2 20
68 5
5 21
D o not forget tlte battered male!
Table 111. Mean ratings of the itents included in the depression rating scale (MADRS) by battered wonieri and battered males Battered vives
Inner tension Reduced sleep Pessimistic thoughts Concentration difficulties Reported sadness Reduced appetite Apparent sadness Suicidal thoughts Inability to feel Lassitude Average score
(n=49)
Battered males (n=19)
YO
YO
1 .o
0.7 0.7
0.8 0.5 0.8 0.8 0.6 0.7 0.5 0.4 0.5 0.7
0.6 0.7 0.5 0.7 0.4 0.4 0.7 0.6 0.6
of the female victims (35%) and six of the males (32%) scored more than ten points on the depression rating scale, indicating depression of a moderate to serious degree. An analysis of the ten symptoms included in the rating scale did not reveal any major differences between the groups (Table 111). The battered women had a non-significant tendency to report sadness and inner tension more often than the males, but the average score ended up equal for the two groups. For the other symptoms rated on the psychiatric rating scale, the female family violence victims had somewhat more pronounced complaints, mainly involving psychosomatic conditions (Table IV).The symptoms classified as signs of “asthenia” were also more common in the battered women, especially fatiguability. The aggressiveparanoid symptoms and the general “neurotic” symptoms did not show any differences, however.
DISCUSSION In this study the most common family violence victim, the female, has been compared with the typical non-family violence battering victim, the male. We have studied social background factors, alcohol and drug abuse and psychological consequences of the battering in victims of violence apprearing in an emergency department. The aim has been to discuss practical implications for the medicial services concerning the care of these patients.
181
The female victims had generally been battered at home by their husband or steady partner, while the males had been beaten out of doors by other males; “friends” or strangers. These differences are in accord with previous studies (13). However, in most other respects the differences between the two study groups are small. Interparental violence in the family of origin was reported by 39% of the male victims and 49% of the females and about three fourths of them had been physically abused themselves as children. Similar results have been reported by Appleton (l),also based on battered women seeking hospital emergency services. This is definitely a larger proportion than expected. In a control group used in our previous studies, comprising 49% women admitted to an orthopaedic ward for injuries of other origin than battering, 24% reported some violence in the family of origin (14). In male wife-beaters this background factor seems to be even more important. The proportions reported range from about 50 to 90% (1, 15-17). Thus, it seems that violence in the family of origin, both interparental and child abuse, is an important predictor of involvement in violent behaviour as an adult. This seems to hold true not only for family violence but also for non-family violence. Table IV. Mean ratings of tlte 13 i t e m front the Contpreltensive Psycliopatltological Rating scale (CPRS) by battered wonten and battered riides Battered wives
Somatic complains Aches and pains Autonomic disturbances hluscujar tension Asth&ia symptoms Fatiguability Worrying over trifles Indecision Aggressive-paranoid symptoms Hostile feeling Morbid jealousy Ideas of persecution Neurotic symptoms Phobias Hypochondriasis Compulsive thoughts Rituals
(n=49)
Battered males (n=19)
YO
YO
0.8 l.la* 1.0”
0.4 0.4
0.7” 0.6 0.4
0.1 0.4 0
0.5 0.4 0.4
0.4 0.3
0.4 0.1
0.6 0.3 0 0.1
0 0.2
0.8
0.3
** pco.01 Scand J Soc hfed 20
182
B . K . Bergninrr and B. G. Brisninr
Every other father of the battered women and one out of every three fathers of the battered males were high consumers of alcohol. These proportions are much higher than in the general male Swedish population, where the incidence of alcoholism in the male population does not exceed 10% (IS). Appleton found in his study (1) that twice as many mothers and fathers of battered wives drank more than moderately compared to parents of non-battered women. Apart from that, little interest has been given to the abuse of alcohol in the home of violence victims. T h e connection between alcohol abuse and violent behaviour, including wife battering is, however, well documented (7, 15). As both alcoholism and violence a r e transmitted from one generation to the next, these findings stress the importance of protecting the child. A child who grows u p in a family where the father abuses his wife and children, and is a high consumer of alcohol, will probably be at greater risk of being involved in violent behaviour as an adult. This conclusion is further supported by the finding of alcohol problems in both groups of victims. Intoxication with alcohol was the case in the vast majority of the battering episodes, and, as many as one fourth of the females and one third of the males admitted current addiction. T h e abuse of alcohol by the female victims was more common than reported in most studies, however (19-20). O n e explanation, proposed by Labell (16), might be that most such studies are based on women in shelters, which are probably a quite different group from battered women seeking hospital emergency care. Thus, both the figures on alcohol abuse by victims obtained from shelter studies, which a r e generally below lo%, and our figures are probably true. The same reasoning could b e applied to the male situation. Thus, in victimized patients seen in the emergency room, alcohol problems are common. And so is drug addiction. In these two groups of victims, about one out of five had abused amphetamine o r heroin a t some time, which is about four times the incidence in the general Swedish population (21). Of course, problems with alcohol and drugs should, if possible be treated. Staying sober probably reduces the risk of being physically abused. The assessment of psychiatric status revealed mainly depressive symptoms in the two groups of victims with minor differences between the groups. O n e third of the victims in each group were classified as moderately t o deeply depressed. Depression in Scand J SOCMed 20
battered women has been reported previously (8). This study concludes that male and female victims, regardless of the type of violence, show depressive symptoms t o an equal extent. This also raises the question of trait versus state. Thus, d o these persons have a depressed mood, which might be a possible cause of the abuse, o r d o they report depressive symptoms emerging as a consequence of the battering. In this study we cannot answer that question as the patients’ psychiatric status was not followed up at a later occasion. However, we conclude that the physician should be aware of depressive symptoms in these patients and always consider following them up and possibly treating them. In this respect, there seems to b e no differences between the two groups of victims. T h e female group had more somatic complaints and fatiguability than the male one. Psychosomatic disorders have previously been described as an important component of the “battered wife syndrome” (22). In this case the present study gives some support for the specificity of the symptomatology of the battered wife as compared to the battered male. It can b e noted that neither aggressive-paranoid symptoms nor more general “neurotic” symptoms were very common. If they had appeared, hostile feelings and ideas of persecution would have been understandable. O n e explanation is that such symptoms were concealed by the depressive symptoms dominating after the trauma. CONCLUSION It is concluded that female family violence victims and male non-family violence victims presenting in the emergency room have a similar background and report similar psychological symptoms after the abuse. Thus, both battered wives and battered males might be $need of follow-up examinations o r treatment for alcohol o r drug addiction, depression o r other psychiatric disorders. They should both be given proper care, which includes not only routine medical care but also greater attention t o psychological and psychiatric conditions frequently appearing in these patients. REFERENCES 1. Appleton W. The battered woman syndrome. Ann Emerg Med 1980; 9: 84-91. 2. Straus MA, Gelles RJ, Steinmetz SK. Behind closed doors. New York: Anchor Doubleday, 1980.
Do not forget the bottered ntale! 3. Brismar B, TurnCr K. Battered women. A surgical problem. Acta Chir Scand 1982; 148: 103-5. 4. Curtis LA. Criminal violence. Nassachusetts: Lexingtons Books, 1974. 5 . Gelles RJ. Violence in the family. A review of reserach in the seventies. Journal of hlarriage and the Family 19SO; 42: 873-85. 6. Stewart hlA, deBlois CS. Wife abuse among families attending a child psychiatric clinic. J Am Acad Child Psychiatry 1981; 20: 8-15-62. 7. Kaufman Kantor G, Straus MA. Substance abuse as a precipitant of wife abuse victimization. Am J Drug Alcohol Abuse 1989; 15: 173-89. 8. Jaffc P, Wolffe D, Wilson S, Zak L. Emotional and physical health problems of battered women. Can J Psychiatry 1986; 31: 625-9. 9. Bergman-B. Battered wives: Why are they beaten and why do they stay? Dissertation. Department of Psychiatry: Karolinska Institute, Stockholm, Sweden, 1987. 10. Asberg hl, Perris C, Schallin D, Sedvall, G . The CPRS-development and application of a psychiatric rating scale. Acta Psychiatr Scand 1978; Suppl 271: 5-29. 11. hlontgomery S, Asberg hi. A new dcpression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382-9. 12. Statistical Abstract of Sweden. Stockholm: Liber, 1990. 13. Wikstrom PO. Everyday violence in contemporary Sweden. Stockholm: Libcr, 1985. 14. Bergman B, Larsson G , Brismar B, Klang hl. Battered wives and female alcoholics. A comparative social and psychiatric study. J Adv Nurs 1989; 14: 727-34.
183
15. Gayford JJ. The aetiology of repeated serious physical
16. 17. 18.
19.
20.
21.
22.
assaults by husbands on wives (wife battering). hled Sci Law 1979; 19: 19-24. Labell LS. Wife abuse: A sociaological study of battered women and their mates. Victimology: An International Journal 1979: 4: 258-67. Fitch FJ, Papantonio A. hlen whoe batter: Some pertinent characteristics. J Nerv hient Dis 1983; 171: 190-2. Ojesjo L. An epedimemiological investigation of alcoholism in a total propulation; the Lundby study. Dissertation. Dept of Social and Forensic Psychiatry: Univ of Lund, Sweden, 19S3. Roy hi. A current survey of 150 eases. In: Roy hl, ed. Battered women: A psychosociological study of domestic violence. New York: Van Nostrand Reinhold, 1977. Carlson BE. Battered women and their assailants. Social Work 1977; 22: 455-60. Torstensson hl. Drug-abusers in a metropolitan cohort. Project hletropolitan 25, a longitudinal study of a Stockholm cohort. University of Stockholm, Siveden: Dept of Sociology, 1987. Viken R. Family violence. Aids to recognition. Postgrad hled 1982; 71: 115-22.
Address for offprints: Bo Bergman Dept. of Psychiatry Huddinge Hospital S-141 86 Huddingc Sweden
Scand J SOChied 20
Do not forget the battered male! A cotnpnmfive sttidy of fntiiily ntrd rioii-fntiiily violetice victittrs
Bo K. Bergman, M.D.’ and Bo G . Brismar, M.D.2 From rlic I Depnrtnietiis of Psycliiarry ntrd ’Surgery, Karolitiskn Iiisriiute, Hiidditige Hospitnl, Httdditige, Swederi.
Do iiot forge: the baiiered male! A coinparative stiidy of jariiily and iion-family violence victinu. Bergman, B. K., Brismar, B. G . (Department of Psychiatry and Surgery, Karolinska Institute, Huddinge Hospital, Huddinge, Sweden). Scatid I SOCbled 1992. 3 (179-183). This study is based on interviews with and psychiatric ratings of female family violence victims and male non-family violence victims. Despite differences in the type of violence and the relation to the assailant, the psychological consequences of the battering were very much the same in the two groups. The background and present social situation of the victims were very similar. The conclusion drawn with regard to the medical services, is that both groups of victims need the same attention and treatment when attending the emergency department. Apart from routine medical care, they might need treatment for alcohol problems, depression or other psychiatric conditions frequently occurring in victims of violence. Key ,cords: spouse abuse, violence, alcoholism, depression.
From research on family violence, a lot of knowledge has been accumulated on background and precipitating factors as well as the psychological consequences of the violence. It has been claimed that girls who experience violence during childhood will, like their mothers, become victims of violence as adults (5). In the same way, boys will grow up to be wife-beaters ( 6 ) . The role of alcohol as a precipitating factor in family violence and wifebeating is also well-documented (7). The psychological consequences in the battered wife, commonly described as the “battered wife syndrome”, comprise both somatic, psychosomatic and psychiatric symptoms (8). The battered male and his background, as well as factors precipitating male-to-male violence and the consequences there of are less well studied. The aim of this study is to compare the female and male victim in these aspects and to discuss practical implications for the medical services.
INTRODUCTION
This study is based on interviews with 49 battered wives and 19 battered males seeking emcrgency medical care at the Huddinge Hospital, Stockholm, Sweden. The battered women were admitted to the hospital within the framework of a special treatment programme for battered wives (9). Thirty-nine percent of the women were admitted for serious injuries, i. e. fractures, thoracic or abdominal trauma. Fourteen per cent had concussions, the rest were admitted mainly for medico-social reasons. The battered males constituted a consecutive series of patients with injuries requiring in-patient care in the department of surgery during a four-month period in 1990. Twenty-seven per cent were seriously injured and 67 percent had concussion, no one died from the injuries, however. Four males refused to participate. The victims were interviewed one or two days after the physical abuse while still in the surgical ward. They were questioned about their present social situation, growing up conditions and any history of previous violence. They were rated psychiatrically on the Comprehensive Psychopathological Rating Scale (CPRS) (10). Twenty-four items were used, 10 of which constituate a depression rating scale,
MATERIAL AND METHODS Patients with injuries due to battering are common in emergency departments .(l). For many reasons, during the last few decades, most research, special task forces and treatment programmes have been focused on the female victim. She is generally the victim of family violence, beaten by her husband or cohabitant. The violence typically takes place indoors and is repeated at more or less regular intervals ( 2 ) .In contrast, the battered male, who is the most common battered victim seen in the emergency room (3) is often injured outdoors in non-family violence. As in the cases of family violence, the assailant is nearly always a male, but not necessarily one aquainted (4)with the victim. Thus, the emotional and practial bonds are not the same between assailant and victim for battered males and battered females. 12’
Scand J SOChled 20
180
B. K . Bergman and B. G. Brisniar
Table I. Cfiildliood living conditions of battered woitieii arid battered males Battered wives (n=49)
Father hit mother Battered as a child During some period of childhood reared outside parental home Alcohol habits of biological father Alcoholic High consumer Low consumer or abstinent Alcohol habits of biological mother Alcoholic High consumer Low consumer or abstinent
YO
Battered males (n=19) Yo
49 78
39 74
20
5
22
21
27 51
11 68
8
5 0 95
4
88
MADRS, according to Montgomery and Asberg (11). A three point-scale was used. The psychiatric ratings were supplemented with the victims’ psychiatric history, including any history of alcohol or drug abuse. The female victims had all been beaten by their husband or steady partner, while the males had been abused by “friends” (53%) or strangers (47%). The mean age of the women was 33 and of the males, 38. In all 68 cases a male was the assailant. Ninty-two per cent of the female victims, compared to 32% of the male victims, had been beaten in their own home or in the home of the assailant. Fourty-nine per cent of the battered wives and 37% of the battered males were born abroad, which is a much higher proportion than in the general population of the catchment area (12). The victims generally had a lower social class background and most were unskilled workers, had other unqualified jobs or drew early retirement pensions. In both groups the most common mechanisms of violence were punching, kicking and knocking down. The female victims generally experienced a more prolonged abuse including several mechanisms of violence like headbanging against wall or floor and strangle grips. The males were generally knocked down intially and then kicked when in lying position. Sfaticrics. The x2 test, Fisher’s exact test and the Goodness-of-Fit test were used for intergroup comparisons.
RESULTS History of violence A s shown in Table I, a majority of both battered wives and battered males had experienced violence, and alcoholism during childhood. The vast majority of the victims reported some violence; either father hitting mother o r child abuse, o r both. Half of the female victims had fathers who were characterized S a n d f Soc hfed 20
as alcoholics or heavy consumers of alcohol, compared to 32 per cent of the male victims. In adulthood, ninty-four per cent of the females reported that they had been beaten before, compared to 42% of the males. The latter had, however, been assailants t o approximately the same extent. Fourty-seven per cent of the males admitted that they had physically abused someone at some time and 37% said that they had been involved in abusive events more than once.
Alcohol and driig abiise Either the assailant or the victim, or both, were drunk in eight cases out of ten when violence erupted, with n o differences between family and non-family violence. In the histories of alcohol and drug abuse there was a consistent tendency for the males to have shown somewhat more signs and symptoms, although without significant differences between the groups. Alcohol dependency was reported by one third of the male and one fourth of the female victims (Table 11). Approximately one fifth of the victims had abused drugs a t some time. Psychological cotiseqiiences The assessment of the victims psychiatric status one to two days after the physical abuse revealed extensive depressive symptoms in both groups. Seventeen Table 11. Alcohol and drug addiction iti battered wotiieta arid battered tnales and alcohol introxicatiota at the present mnftreatnient Battered Battered wives males (n=49) (n=19)
Ever felt alcohol- dependent History of blackouts eye-openers loss of control delusions seizures Ever abused cannabis amphetamineheroin Influence of alcohol at victimization Both under the i ~ f l ~ ~ e n c e Only the assailant Only the victim Neither or unknown
YO
YO
24
37
41 29 20 8 2
53 42 37 21 16
24 16
21 21
55 22 2 20
68 5
5 21
D o not forget tlte battered male!
Table 111. Mean ratings of the itents included in the depression rating scale (MADRS) by battered wonieri and battered males Battered vives
Inner tension Reduced sleep Pessimistic thoughts Concentration difficulties Reported sadness Reduced appetite Apparent sadness Suicidal thoughts Inability to feel Lassitude Average score
(n=49)
Battered males (n=19)
YO
YO
1 .o
0.7 0.7
0.8 0.5 0.8 0.8 0.6 0.7 0.5 0.4 0.5 0.7
0.6 0.7 0.5 0.7 0.4 0.4 0.7 0.6 0.6
of the female victims (35%) and six of the males (32%) scored more than ten points on the depression rating scale, indicating depression of a moderate to serious degree. An analysis of the ten symptoms included in the rating scale did not reveal any major differences between the groups (Table 111). The battered women had a non-significant tendency to report sadness and inner tension more often than the males, but the average score ended up equal for the two groups. For the other symptoms rated on the psychiatric rating scale, the female family violence victims had somewhat more pronounced complaints, mainly involving psychosomatic conditions (Table IV).The symptoms classified as signs of “asthenia” were also more common in the battered women, especially fatiguability. The aggressiveparanoid symptoms and the general “neurotic” symptoms did not show any differences, however.
DISCUSSION In this study the most common family violence victim, the female, has been compared with the typical non-family violence battering victim, the male. We have studied social background factors, alcohol and drug abuse and psychological consequences of the battering in victims of violence apprearing in an emergency department. The aim has been to discuss practical implications for the medicial services concerning the care of these patients.
181
The female victims had generally been battered at home by their husband or steady partner, while the males had been beaten out of doors by other males; “friends” or strangers. These differences are in accord with previous studies (13). However, in most other respects the differences between the two study groups are small. Interparental violence in the family of origin was reported by 39% of the male victims and 49% of the females and about three fourths of them had been physically abused themselves as children. Similar results have been reported by Appleton (l),also based on battered women seeking hospital emergency services. This is definitely a larger proportion than expected. In a control group used in our previous studies, comprising 49% women admitted to an orthopaedic ward for injuries of other origin than battering, 24% reported some violence in the family of origin (14). In male wife-beaters this background factor seems to be even more important. The proportions reported range from about 50 to 90% (1, 15-17). Thus, it seems that violence in the family of origin, both interparental and child abuse, is an important predictor of involvement in violent behaviour as an adult. This seems to hold true not only for family violence but also for non-family violence. Table IV. Mean ratings of tlte 13 i t e m front the Contpreltensive Psycliopatltological Rating scale (CPRS) by battered wonten and battered riides Battered wives
Somatic complains Aches and pains Autonomic disturbances hluscujar tension Asth&ia symptoms Fatiguability Worrying over trifles Indecision Aggressive-paranoid symptoms Hostile feeling Morbid jealousy Ideas of persecution Neurotic symptoms Phobias Hypochondriasis Compulsive thoughts Rituals
(n=49)
Battered males (n=19)
YO
YO
0.8 l.la* 1.0”
0.4 0.4
0.7” 0.6 0.4
0.1 0.4 0
0.5 0.4 0.4
0.4 0.3
0.4 0.1
0.6 0.3 0 0.1
0 0.2
0.8
0.3
** pco.01 Scand J Soc hfed 20
182
B . K . Bergninrr and B. G. Brisninr
Every other father of the battered women and one out of every three fathers of the battered males were high consumers of alcohol. These proportions are much higher than in the general male Swedish population, where the incidence of alcoholism in the male population does not exceed 10% (IS). Appleton found in his study (1) that twice as many mothers and fathers of battered wives drank more than moderately compared to parents of non-battered women. Apart from that, little interest has been given to the abuse of alcohol in the home of violence victims. T h e connection between alcohol abuse and violent behaviour, including wife battering is, however, well documented (7, 15). As both alcoholism and violence a r e transmitted from one generation to the next, these findings stress the importance of protecting the child. A child who grows u p in a family where the father abuses his wife and children, and is a high consumer of alcohol, will probably be at greater risk of being involved in violent behaviour as an adult. This conclusion is further supported by the finding of alcohol problems in both groups of victims. Intoxication with alcohol was the case in the vast majority of the battering episodes, and, as many as one fourth of the females and one third of the males admitted current addiction. T h e abuse of alcohol by the female victims was more common than reported in most studies, however (19-20). O n e explanation, proposed by Labell (16), might be that most such studies are based on women in shelters, which are probably a quite different group from battered women seeking hospital emergency care. Thus, both the figures on alcohol abuse by victims obtained from shelter studies, which a r e generally below lo%, and our figures are probably true. The same reasoning could b e applied to the male situation. Thus, in victimized patients seen in the emergency room, alcohol problems are common. And so is drug addiction. In these two groups of victims, about one out of five had abused amphetamine o r heroin a t some time, which is about four times the incidence in the general Swedish population (21). Of course, problems with alcohol and drugs should, if possible be treated. Staying sober probably reduces the risk of being physically abused. The assessment of psychiatric status revealed mainly depressive symptoms in the two groups of victims with minor differences between the groups. O n e third of the victims in each group were classified as moderately t o deeply depressed. Depression in Scand J SOCMed 20
battered women has been reported previously (8). This study concludes that male and female victims, regardless of the type of violence, show depressive symptoms t o an equal extent. This also raises the question of trait versus state. Thus, d o these persons have a depressed mood, which might be a possible cause of the abuse, o r d o they report depressive symptoms emerging as a consequence of the battering. In this study we cannot answer that question as the patients’ psychiatric status was not followed up at a later occasion. However, we conclude that the physician should be aware of depressive symptoms in these patients and always consider following them up and possibly treating them. In this respect, there seems to b e no differences between the two groups of victims. T h e female group had more somatic complaints and fatiguability than the male one. Psychosomatic disorders have previously been described as an important component of the “battered wife syndrome” (22). In this case the present study gives some support for the specificity of the symptomatology of the battered wife as compared to the battered male. It can b e noted that neither aggressive-paranoid symptoms nor more general “neurotic” symptoms were very common. If they had appeared, hostile feelings and ideas of persecution would have been understandable. O n e explanation is that such symptoms were concealed by the depressive symptoms dominating after the trauma. CONCLUSION It is concluded that female family violence victims and male non-family violence victims presenting in the emergency room have a similar background and report similar psychological symptoms after the abuse. Thus, both battered wives and battered males might be $need of follow-up examinations o r treatment for alcohol o r drug addiction, depression o r other psychiatric disorders. They should both be given proper care, which includes not only routine medical care but also greater attention t o psychological and psychiatric conditions frequently appearing in these patients. REFERENCES 1. Appleton W. The battered woman syndrome. Ann Emerg Med 1980; 9: 84-91. 2. Straus MA, Gelles RJ, Steinmetz SK. Behind closed doors. New York: Anchor Doubleday, 1980.
Do not forget the bottered ntale! 3. Brismar B, TurnCr K. Battered women. A surgical problem. Acta Chir Scand 1982; 148: 103-5. 4. Curtis LA. Criminal violence. Nassachusetts: Lexingtons Books, 1974. 5 . Gelles RJ. Violence in the family. A review of reserach in the seventies. Journal of hlarriage and the Family 19SO; 42: 873-85. 6. Stewart hlA, deBlois CS. Wife abuse among families attending a child psychiatric clinic. J Am Acad Child Psychiatry 1981; 20: 8-15-62. 7. Kaufman Kantor G, Straus MA. Substance abuse as a precipitant of wife abuse victimization. Am J Drug Alcohol Abuse 1989; 15: 173-89. 8. Jaffc P, Wolffe D, Wilson S, Zak L. Emotional and physical health problems of battered women. Can J Psychiatry 1986; 31: 625-9. 9. Bergman-B. Battered wives: Why are they beaten and why do they stay? Dissertation. Department of Psychiatry: Karolinska Institute, Stockholm, Sweden, 1987. 10. Asberg hl, Perris C, Schallin D, Sedvall, G . The CPRS-development and application of a psychiatric rating scale. Acta Psychiatr Scand 1978; Suppl 271: 5-29. 11. hlontgomery S, Asberg hi. A new dcpression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382-9. 12. Statistical Abstract of Sweden. Stockholm: Liber, 1990. 13. Wikstrom PO. Everyday violence in contemporary Sweden. Stockholm: Libcr, 1985. 14. Bergman B, Larsson G , Brismar B, Klang hl. Battered wives and female alcoholics. A comparative social and psychiatric study. J Adv Nurs 1989; 14: 727-34.
183
15. Gayford JJ. The aetiology of repeated serious physical
16. 17. 18.
19.
20.
21.
22.
assaults by husbands on wives (wife battering). hled Sci Law 1979; 19: 19-24. Labell LS. Wife abuse: A sociaological study of battered women and their mates. Victimology: An International Journal 1979: 4: 258-67. Fitch FJ, Papantonio A. hlen whoe batter: Some pertinent characteristics. J Nerv hient Dis 1983; 171: 190-2. Ojesjo L. An epedimemiological investigation of alcoholism in a total propulation; the Lundby study. Dissertation. Dept of Social and Forensic Psychiatry: Univ of Lund, Sweden, 19S3. Roy hi. A current survey of 150 eases. In: Roy hl, ed. Battered women: A psychosociological study of domestic violence. New York: Van Nostrand Reinhold, 1977. Carlson BE. Battered women and their assailants. Social Work 1977; 22: 455-60. Torstensson hl. Drug-abusers in a metropolitan cohort. Project hletropolitan 25, a longitudinal study of a Stockholm cohort. University of Stockholm, Siveden: Dept of Sociology, 1987. Viken R. Family violence. Aids to recognition. Postgrad hled 1982; 71: 115-22.
Address for offprints: Bo Bergman Dept. of Psychiatry Huddinge Hospital S-141 86 Huddingc Sweden
Scand J SOChied 20
