Article

Intimate Partner Violence in Self-Identified Lesbians: A Systematic Review of Its Prevalence and Correlates

TRAUMA, VIOLENCE, & ABUSE 1-14 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1524838015584363 tva.sagepub.com

Laura Badenes-Ribera1, Amparo Bonilla-Campos2, Dolores Frias-Navarro1, Gemma Pons-Salvador3, and Hector Monterde-i-Bort1

Abstract This article presents the first systematic review on intimate partner violence (IPV) in self-identified lesbians in same-sex couples. Studies published from January 1990 to December 2013 were analyzed. Of the 687 studies reviewed, 59 were preselected, of which 14 studies were selected that met the inclusion and methodological quality criteria. A summary is presented of the characteristics of the studies, the participants, the prevalence of IPV victimization and perpetration, and its correlates. All the studies were carried out in the United States and used a nonprobabilistic sampling method. The majority of participants were White with a high educational level. The results indicate that all the forms of violence occur, but the most prevalent is emotional/ psychological violence. The correlates positively associated with IPV are certain personality characteristics, fusion, previous IPV experience, a family history of violence, and alcohol consumption. This review finds significant limitations in the analyzed literature. Methodological recommendations are made for future studies. Keywords lesbian battering, intimate partner violence, domestic violence, systematic review

Introduction The study of violence in same-sex couples began at the end of the 1980s and the beginning of the 90s (Brand & Kidd, 1986; Island & Letellier, 1991; Kalichman & Rompa, 1995; Lobel, 1986; Renzetti, 1988). Since then, the number of studies analyzing this topic has gradually increased, with research carried out in different countries such as the United States, Canada, Australia, the United Kingdom, Germany, and China, among others (Barrett & St. Pierre, 2013; Chong, Mak, & Kwong, 2013; Frankland & Brown, 2013; Hester, Donovan, & Fahmy, 2010; Krahe´ & Berger, 2013). The results of these studies have yielded disparate prevalence rates and correlates. Recent empirical evidence indicates that violence in same-sex couples affects one quarter to nearly three quarters of same-sex relationships (Stiles-Shields & Carroll, 2014). This variability partly responds to the different sampling and methodological characteristics of the studies (Baker, Buik, Kim, Moniz, & Nava, 2013; Burke & Follingstad, 1999; Finneran & Stephenson, 2013; Lewis, Milletich, Kelley, & Woody, 2012; Murray & Mobley, 2009). For example, differences are found in the definition of intimate partner violence (e.g., physical violence, emotional and psychological violence, and sexual violence), the measures of partner violence, the time period to which the violence corresponds

(e.g., over the lifetime, in the past 12 months, and 6 months), the partner relationship being studied (e.g., stable partner and occasional), the definition of sexual orientation (e.g., identity, behavior, and sexual attraction), and the participants who make up the study sample (e.g., general population, battered people, people with substance abuse problems, and among other specific conditions). Regarding the type of sampling, the stigmatization of homosexuality and relationships between same-sex partners make it difficult to carry out studies with representative samples, so that the majority of the studies were conducted with small convenience samples. Moreover, as West (2012) points out, the majority of the victimization surveys with

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Department of Methodology of the Behavioral Sciences, Faculty of Psychology, University of Valencia, Valencia, Spain 2 Department of Personality, Evaluation and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain 3 Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain Corresponding Author: Laura Badenes-Ribera, Facultad de Psicologı´a, Universidad de Valencia, Avda, Blasco Iba´n˜ez, 21. 46010 Valencia, Spain. Email: [email protected]

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representative samples have not evaluated the participants’ sexual orientation. In the few cases where it was evaluated, the sex of the perpetrator of the violence was not taken into account. Therefore, it is not possible to know whether the partner violence reported took place in a relationship between people of the same sex or between people of different sexes (e.g., Roberts, Austin, Corliss, Vandermorris, & Koenen, 2010; Walters, Chen, & Breiding, 2013). In these cases, the assumption is often made that the sexual orientation is fixed throughout life, that there is consistency between the sexual orientation and the sexual behavior and, therefore, that the partner’s sex is the same as that of the person reporting the IPV. Consequently, the ratios of reported violence may be inflated by including violence perpetrated by partners of the opposite sex and by partners of the same sex (Murray & Mobley, 2009). Thus, it is important to evaluate the sex of the perpetrator or whether the violence took place in a relationship between people of the same sex (Rothman, Exner, & Baughman, 2011). Moreover, as Messinger (2014) points out, there is a persisting dilemma when defining the population under study according to the partner’s sex (namely, same-sex relationships) or the sexual orientation (meaning relationships with at least one sexual minority partner). This question is complicated by the use of different criteria in defining sexual orientation, which can lead to confusion when the results of different studies are compared. As mentioned by Baker, Buik, Kim, Moniz, and Nava (2013), it is not the same thing to be involved in same-sex relations (a behavior) as it is to identify oneself as a lesbian, gay, bisexual, or transgender person (identity). In fact, very few studies have approached both aspects simultaneously and offered segregated data based on these criteria (see Kann et al., 2011). The study by Roberts, Austin, Corliss, Vandermorris, and Koenen (2010), using data from a representative survey, evaluated sexual orientation in three dimensions: identity, attraction, and the partner’s sex, although the small sample size did not allow them to divide the group of women identified as lesbians and bisexuals into the latter two dimensions. In the case of women identified as heterosexual, they found that having had a same-sex partner was associated with higher rates of domestic violence victimization, although, as mentioned previously, the data did not specify the sex of the partner perpetrating the violence. In addition, Goldberg and Meyer (2013) combined questions of sexual identity and sexual activity (referring only to the past year) to classify the subjects in mutually exclusive categories of sexual orientation. However, in the case of self-identified lesbians, the authors did not report the prevalence of victimization in same-sex versus opposite-sex relationships. In spite of the lack of evidence about the way the different aspects of the definition of sexual orientation can affect IPV, various studies suggest that sexual identity is more strongly associated with victimization and mental health than sexual attraction and sexual behavior are (McCabe, Bostwick, Hughes, West, & Boyd, 2010; Roberts et al., 2010). Furthermore, Lewis, Milletich, Kelley, and Woody (2012) suggest that

sexual identity, specifically the lesbian identity, can act as a protective factor in coping with the stress associated with belonging to a minority, although the evidence in this regard is scant and contradictory. In any case, sexual identity is shown to be a potential moderator factor of IPV for lesbian, gay, bisexual (LGB) people through the impact of the minority stress they experience within a heterosexist social context (Lewis, Milletich, Derlega, & Padilla, 2014; Stiles-Shields & Carroll, 2014). On the other hand, there is evidence of variability in the IPV patterns in same-sex relationships in women from different sexual minorities, in terms of both prevalence and factors that can be correlated with this experience in each case, whether the sexual orientation is evaluated through identity or behavior (Balsam & Szymanski, 2005; Goldberg & Meyer, 2013; Gumienny, 2010; Lewis et al., 2012; Messinger, 2011; Roberts et al., 2010, Walters et al., 2013). For example, according to the study by Messinger (2011), using data from a national survey that defined the sexual orientation behaviorally based on the history of marriage or living together, the victimization in same-sex couples was more frequent in women defined as gays than in women categorized as bisexual, regarding control behaviors (55.56% vs. 6.82%), verbal aggression (44% vs. 13.04%), physical aggression (25% vs. 6.12%), and sexual abuse (3.57% vs. 0%). However, this study did not explore non-cohabiting relationships in same-sex partners or the way the sexual identity (which may or may not coincide with the relationship history) can be related to the IPV, for example, through the stress associated with belonging to a minority or forms of aggression specific to the LGB population (Baker et al., 2013; Barrett & St Pierre, 2013). In this regard, Balsam and Syzmanski (2005) found that women identified as bisexual, compared to lesbians, were more likely to report LGBspecific aggression against a female partner in the past year (46.2% vs. 15.2%), while lesbians reported greater psychological aggression against a female partner at some time in life. Therefore, it is advisable to analyze partner violence separately in lesbians and bisexual women or separately from different sexual minorities in general (Mason, Lewis, Milletich, Kelley, Minifie, & Derlega, 2014). Without ignoring the complexity of the definition of sexual orientation and, therefore, the need to use combined criteria, as well as the lack of a fixed sexual identification throughout life, in this study we followed the recommendation of better describing the sexual orientation and the sex of the partner in the study of IPV relations. Thus, in carrying out the literature review, we tried to (1) establish a clear and potentially significant criterion for defining the sexual orientation and (2) ensure that the violence was studied in samesex relationships. Thus, the purpose of our study is to provide a systematic review that determines the prevalence and correlates of intimate partner violence in same-sex relationships of selfidentified lesbians. Self-identified lesbians are understood to be women who classify themselves as lesbians or gay women (e.g., through self-report data; typically described using distinct

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categories such as gay, lesbian, or bisexual; or through sexual orientation measures). There are narrative reviews on same-sex intimate partner violence (e.g., Klostermann, Kelley, Milletich, & Mignone, 2011; McClennen, 2005; Murray, Mobley, Buford, & SeamanDeJohn, 2007; Stiles-Shields & Carroll, 2014), lesbian battering (e.g., West, 2002), and IPV in sexual minority women (Lewis et al., 2012), as well as systematic reviews on methodological issues of studies on same-sex intimate partner violence (Murray & Mobley, 2009), IPV in the LGB population (West, 2012), and sexual assault in the lesbian and gay (LG) population (Rothamn, et al., 2011). However, the present study is the first systematic review on same-sex intimate partner violence in self-identified lesbians. This review clarifies and summarizes the current body of scientific knowledge on same-sex IPV in lesbians in response to calls for more rigorous research on same-gender IPV (Mason et al., 2014). Moreover, it identifies gaps in the current literature and offers recommendations to improve the investigation of IPV in same-sex relationships.

and abusive lesbian relationship. A total of 1,091 studies were identified, 487 from PsycInfo and 604 from Pubmed. In addition, a manual search was performed in the following publications: Journal of Homosexuality; Journal of Lesbian Studies; Journal of Gay & Lesbian Social Service; Journal of GLBT Family Studies; Journal of LGBT Health Research; Journal of LGBT Issues in Counseling; Journal of Interpersonal Violence; Journal of Aggression, Maltreatment & Trauma; Trauma, Violence, & Abuse; Journal of Family Violence; Psychology of Women Quarterly; Violence Against Women; and Women & Therapy, identifying a total of 92 studies. A manual review was also conducted of the reference lists from the studies included in this review, from relevant studies on intimate partner violence between lesbian women, and from previous literature reviews, locating only one additional study. Finally, researchers and/or experts on same-sex intimate partner violence were contacted. In all, 1,184 studies were identified. Duplicated studies were eliminated (n ¼ 497). Therefore, the total number of studies to review was 687.

Study Selection Procedure

Method A systematic review of the literature was carried out (PeresteloPe´rez, 2013; Sa´nchez-Meca, 2010; Shea et al., 2007; Wright, Brand, Dunn, & Spindler, 2007).

Inclusion Criteria Studies had to meet the following inclusion criteria: (1) they had to have been published between January 1990 and December 2013, (2) they had to have been published in a peer-reviewed journal, (3) they had to consist of an original quantitative study; and (4) they had to have used a sample composed, at least partly, of participants who self-identified as lesbians and/or gay women. In addition, (5) the participants who self-identified as lesbians and/or gay women had to have been analyzed as a separate group within the study, and (6) they had to have been part of the general population. That is, the study population could not belong to a specific population, such as drug users; persons accessing domestic violence assistance resources; or samples coming from psychological treatment, therapies, prison, racial minorities, and so on. Moreover, (7) the study had to measure, in some way, intimate partner violence in same-sex relationships, (8) the study had to report on the prevalence of IPV and/or its correlates, (9) the sample size had to be equal to or greater than 50, and (10) the participants who self-identified as lesbians and/or gay women had to be 16 years old or more.

Search Strategy An electronic search was conducted from August 2013 to January 2014 in the Pubmed and PsycInfo databases using the following terms: intimate partner violence and lesbian, lesbian domestic violence, lesbian violence, lesbian battering,

The selection was carried out in two phases (preselection and selection), both performed independently by two researchers. Cohen’s k index was used to calculate the level of interrater agreement. In the preselection phase, the titles and abstracts of the 687 studies located were scanned, and relevant studies were preselected based on the inclusion criteria. Interrater agreement was 90%. A total of 59 studies were preselected. In the selection phase, the complete text of the 59 preselected studies were reviewed. Given the degree of agreement, and to guarantee greater reliability in the study selection, a consensus process was initiated when there was disagreement about the studies. Forty-four studies were excluded, 2 because the complete text was not available, and 42 because they did not fit the inclusion criteria (1 study was not original, 1 study was qualitative, 10 studies were not composed of selfidentified lesbians, 21 studies did not analyze self-identified lesbians as a separate group, in 3 studies the sample was from a specific population, 3 did not evaluate IPV, 1 study did not report on the prevalence of IPV, in 1 study the sample size was less than 30 subjects, and, finally, in 1 study the participants were less than 16 years old). Therefore, 15 primary studies were selected.

Rating the Methodological Quality of the Primary Studies The methodological quality of the 15 selected studies was rated according to the standardized criteria of the ‘‘Methodological criteria rating guide for descriptive studies on same-sex partner violence’’ developed by Murray and Mobley (2009, pp. 369–370). This rating guide is an adaptation of the evaluation criteria for methodological quality used by Burke and Follingstad (1999), Heneghan, Horwitz, and Leventhal (1996), and Murray and Graybeal (2007). The evaluation was performed

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independently by two researchers. Disagreements were resolved by consensus between the reviewers. The rating guide consists of 15 criteria with a dichotomous response scale. The presence of the criterion is given 1 point and its absence 0 points. The total score is 15 points. Some items are, for example, ‘‘Does the study specify how participants’ sexual orientation is measured or categorized?’’ ‘‘Are the partners within the same relationship and (a) not both included in the same sample or (b) paired in the analysis of the data?’’ ‘‘Do the variables measured represent multiple levels (attitudinal, behavioral, and observational)?’’ ‘‘Are eligibility criteria for participation in the study specified?’’ ‘‘Is the study clear as to types(s) of abuse measured within the study?’’ or ‘‘Are definitions of the types of abuse measured presented?’’ The studies were classified based on their degree of methodological quality. A stratification system was used that was similar to those used by Heneghan, Horwitz, and Leventhal (1996), Murray and Graybeal (2007), and Murray and Mobley (2009). The studies were classified as (1) acceptable studies: studies that received at least 11 points (70% of the total score), (2) adequate studies: studies with a score between 6 and 10 points (between 40% and 69% of the total score), and (3) unacceptable studies: studies that obtain scores of between 0 and 5 points (less than 40% of the total score). The present review included studies rated as ‘‘acceptable studies’’ or ‘‘adequate studies.’’ Only the study by Carvalho, Lewis, Derlega, Winstead, and Viggiano (2011) was considered unacceptable, with a score of less than 40% of the total (nonprobabilistic sample, lack of inclusion and exclusion criteria, inadequate treatment of the members of the same couple, unspecified timing of data collection, IPV measured through a specific question about victimization, not specifying the type of IPV evaluated or providing a definition of IPV, no control of social desirability, and, finally, the participation conditions were not standardized because the survey was online). Therefore, the study was excluded from the systematic review. The rest of the studies were considered adequate, obtaining a score of between 40% and 69% of the total, and they were included in the review. However, none of the studies was considered acceptable, given that they all presented various methodological limitations (e.g., nonprobabilistic sampling, not specifying exclusion or inclusion criteria, not establishing standardized participation conditions, not specifying the timing of data collection, not controlling social desirability, etc.).

Results The study selection process is presented in Figure 1.

Description of the Studies Table 1 describes the main characteristics of the 14 studies. All of the studies were carried out in the United States, and they used a cross-sectional design and nonprobabilistic sampling methods (e.g., mailing list of a lesbian organization, snowball sampling through lesbian and lesbian, gay, bisexual and transgender [LGBT] organizations, pride events, and other community contacts). Nine studies established sample inclusion criteria. Five studies included self-identified lesbian women as a criterion for participating in the study sample (Balsam, Rothblum, & Beauchaine, 2005; Lie & Gentlewarrier, 1991; Lie, Schilit, Bush, Montagne, & Reyes, 1991; Scherzer, 1998; Turell, 2000). One study included women who were or had been in an intimate relationship with another women in the period indicated (Eaton et al., 2008), another study included women over the age of 18 who were or had been in an intimate relationship with another woman (Balsam & Szymanski, 2005), and finally, two studies included self-identified lesbian women who were or had been in an intimate relationship with another woman during the 6–12 months prior to the study (Miller, Greene, Causby, White, & Lockhart, 2001; Telesco, 2003). The studies’ sample sizes ranged from 104 (Schilit, Lie, & Montagne, 1990; Schilit, Lie, Bush, Montagne, & Reyes, 1991) to 1,099 participants (Lie & Gentlewarrier, 1991). In all the studies, the majority of the participants were White, with different percentages of other ethnic groups. Only two studies were conducted exclusively with White women (WaldnerHaugrud, Vaden, & Magruder, 1997; Waldner-Haugrud & Vaden, 1997). The participants’ ages ranged between 16 (1 study) and 60 or more (1 study), with a mean age of approximately 34. The participants’ educational level was specified in 10 studies. It was rated in two different ways: (a) by years of education (two studies) and (b) by educational level reached (eight studies). For years of education received, the mean was 14.2 years (Eaton et al., 2008), with a median of 16 years (Lie et al., 1991). For the educational level reached, the majority of the participants had higher studies (university). Income level was evaluated in 11 studies. In general, the participants’ income level was medium (above US$17,000), while it was mediumhigh in only three studies (income above US$30,000).

Data Extraction The data were extracted by two reviewers independently. Disagreements were resolved by consensus. Data were extracted on study characteristics (authors and year, research design, geographic location, definition of violence, and measurement instrument), sample characteristics (size, age, ethnicity, educational level, and income level), prevalence of victimization and perpetration of intimate partner violence, and IPV correlates.

Definition of IPV Ten different definitions of violence were used (taking into account that one study can use different definitions). The majority (57.14%) used their own definitions for the study (eight studies). The definition itself could consist of 1 item, such as, ‘‘if you are currently in a lesbian relationship, is it abusive?’’ (Schilit et al., 1990, p. 58) and ‘‘have you ever been

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Studies identified (N=1184) -Databases → n=1091 -Scientific Journals → n=92 -References → n=1 Duplicated Studies Excluded Studies → n=497 Studies to review N =687 Read Title and Abstract Excluded Studies → n=628 Pre-selected studies N =59

Selected Studies N =15

Read Complete Text - Non-original investigation: 1 - Qualitative Research: 1 - Lesbians not self-identified: 10 - Lesbians not analysed as a separate group: 21 - Not general population: 3 - Does not evaluate Intimate Partner Violence: 3 - Does not report on prevalence: 1 - Sample size < 30: 1 - Age of participants < 16:1 - Text not available: 2 Excluded Studies → n=44

Rating of methodological quality Excluded Studies → n =1 Studies Included N =14 Figure 1. Flow process in selecting the primary studies.

abused by a female lover/partner?’’ (Lie & Gentlewarrier, 1991, p. 46). Or the definition could consist of a checklist of abusive behaviors based on standardized instruments (Lie & Gentlewarrier, 1991), lists developed by other authors (Eaton et al., 2008; Lie et al., 1991), lists from battered women shelters (Turell, 2000), a community survey to evaluate the needs of LG people (Rose, 2003), or the authors’ own lists to evaluate different types of violence (Schilit et al., 1991) or some specific type of violence (Waldner-Haugrud & Vaden, 1997). The rest of the studies (six) used a validated scale. The most frequently utilized scale was the Conflict Tactics Scale (five studies). Different versions of this scale were used (original scale, modified scale, and revised scale). Moreover, the psychological maltreatment of women inventory was used in one study, and the abusive behaviors inventory was employed in another. Four studies included the evaluation of intimate

partner violence tactics that are relevant/specific to lesbians or LGB people (Balsam & Szymanski, 2005; Eaton et al., 2008, Scherzer, 1998; Turell, 2000). Three studies related the violence to the existence of abusive behaviors in the couple (Miller et al., 2001; Schilit et al., 1990, 1991). For the purposes of the present review, their results were included as estimations of the prevalence of victimization.

Prevalence of Victimization in Intimate Partner Violence All the studies reported on the prevalence of at least one form of intimate partner violence at some point in their lives (see Table 2). Five victimization time periods were used. These periods ranged from having experienced some type of intimate partner violence in the past year (two studies) to having experienced it at some time in life (five studies). Two studies

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Table 1. Description of Primary Studies. Year

Study

N

Sampling Method

Age (mean)

Ethnicity

Level of Education

Location

Violence Definition

White: 93%, Hispanic: 2%, Black: 1%, NA: 1%, other: 3% White: 87%, Black: 4%, Hispanic: 3%, other: 5% White: 90.3%

Education beyond the undergraduate level: 41%

Tucson

Unique

Not reported

Michigan

Unique

Mdn ¼ 16 years

Tucson

Unique

Beyond the undergraduate level: 41%

Tucson

Unique

> Possessing or in the process of obtaining a college degree > Possessing or in the process of obtaining a college degree At least some college education: 97%

Iowa

M-CTS

Iowa

Unique

Not reported

Houston

Unique

Not reported

Southeast United States

CTS

1990 Schilit, Lie, and Montagne

104

Mailing list of a lesbian organization

34.7

1991 Lie and Gentlewarrier

1,099

Convenience sample of women’s music festival

30.6

1991 Lie, Schilit, Bush, Montagne, and Reyes

174

Mdn ¼ 34

1991 Schilit, Lie, Bush, Montagne, and Reyes

104

Mailing list of a lesbian organization and snowball sampling Mailing list of a lesbian organization

1997 Waldner-Haugrud, Vaden, and Magruder 1997 Waldner-Haugrud and Vaden

118

Snowball sampling

32

White: 93%, Hispanic: 2%, Black: 1%, NA:1%, other: 3% White: 100%

111

Snowball sampling

32

White: 100%

1998 Schezer

256

Snowball sampling and surveys in public place

2000 Turella

250

Snowball sampling

2001 Miller, Greene, Causby, White, and Lockhart

284

2003 Rose

229

2003 Telesco

105

2005 Balsam, Rothblum, and Beauchainea

332

Convenience sample of women’s music festival Convenience sample of gay pride event Convenience sample from LGBT Community Center Convenience sample from advertisements

34.7

Not reported

38.1

Not reported

Black: 44%, API: 12%, NA: 2%, Latin: 10%, AA: 10%, other: 11% White: 75%, Latin: 8%, AA: 9%, Br:4%, NA: 3%, other: 1% >White

San M-CTS Francisco

30

White: 79%

At least some college education: 85%

St. Louis

Unique

40

White: 67%, AA: 22%, Latin: 11%

At least a bachelor’s degree: 28%

New York

ABI

EA: 91.7%, AA: 1.1%, AsA: 0.5%, Latin:2.5%, NA: 0.6%, Br: 2.7%, other: 0.8%

Not reported

National (United States)

CTS-2

36.6

(continued)

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Table 1. (continued) Year

Study

N

Sampling Method

Age (mean)

Violence Definition

Ethnicity

Level of Education

Location

Some or no high school: 1%, high school diploma: 3%, some college: 20%, college degree: 30%, some graduate school: 16%, graduate/professional school: 30% 14.2 years

National, (United States) 3% Canada

M-CTS-2

Atlanta

Unique

2005 Balsam and Szymanskia

210

Convenience sample of ‘‘pride’’ event and snowball sampling

34.75

EA:85%, AA: 6%, L/H: 2%, AsA: 1%, NA: 1%, Br: 4%

2008 Eaton et al.a

189

Convenience sample of gay pride event

33.3

White:82.03%, AA: 9.68%, L/H: 2.76%, AsA: 0.92%, other: 4.61%

Note. Mdn ¼ median. > ¼ majority. Ethnicity: L/H ¼ Latin/Hispanic; LGBT ¼ lesbian, gay, bisexual and transexual; Br ¼ biracial; EA ¼ European American; AA ¼ African American; AsA ¼ Asian American; NA ¼ Native American; API ¼ Asian and Pacific Islander. Violence definition: CTS-2 ¼ Conflicts Tactics Scale Revised; M-CTS ¼ Conflicts Tactics Scale Modified; ABI ¼ abusive behavior inventory. a Sociodemographic data calculated on the total sample.

Table 2. Victimization in IPV Recall Period (%). Year

Study

Any IPV

Current or most recent relationship 1990 Schilit, Lie, and Montagne 1991 Lie et al. 1998 Scherzer Last year 2001 Miller et al. 2003 Rose Last 5 years 2008 Eaton et al. Lifetime 1991 Lie and Gentlewarrier 1991 Lie et al. 1991 Schilit et al. 1997 Waldner-Haugrud and Vaden 1997 Waldner-Haugrud et al. Not specified 2000 Turell 2005 Balsam et al.

37.5 9.6

12.2

Physical

Sexual

Psychological/Emotional

11.6 17

8.9

24 31e

46.1a, 14.1b 8.7

2.2

7.4

3 45

0.6 56.8

18 64.5

43.39 50.2 51.5 44.2

45d 47.5

2.6–37.9 55, 58f 37.65c

26.7 14 L, 11Gf

84Le, 77Ge,f

Note. Blank table cells were not measured or not reported. CTS ¼ Conflicts Tactics Scale; IPV ¼ intimate partner violence. Physical ¼ physical. a Physical aggression (CTS). bPhysical violence (CTS). cPhysical assault. Sexual ¼ sexual, dcoercion. Psychological ¼ psychological, eEmotional abuse. fGay women.

did not specify the recollection period, at least in the data analysis presented here (Balsam et al., 2005; Turell, 2000), and three studies did not use a specific time frame but instead referred to intimate partner violence within the current or most recent relationship. Victimization prevalence ranged between 9.6% and 51.5% (Lie et al., 1991), both referring to the perception of the current or past intimate relationships, respectively, as abusive. For lists of behaviors, the data ranged between 12.2% (Rose, 2003) and 73.4% (Lie et al., 1991), with the majority of the studies showing a prevalence of around 40%–50% (with

higher rates corresponding to longer periods of time evaluated). The most frequently evaluated form of intimate partner violence was physical violence (nine studies), with a prevalence ranging between 2.6% for a specific behavior—using a weapon (Waldner-Haugrud et al., 1997)—and 3% for multiple forms of physical abuse as the only form of violence in the couple (Lie & Gentlewarrier, 1991), and 58% (Turell, 2000). Prevalence rates for physical violence received at some time in life (around 40–50%) were higher than those found in the most recent relationships (between 9% and 17%), and they were higher for milder forms of physical aggression than

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Table 3. Prevalence of Intimate Partner Violence (IPV) Perpetration by Recall Period (%). Year

Study

Current relationship 1991 Lie et al. 2003 Telesco Last year 2005 Balsam and Szymanski Lifetime 1991 Lie and Gentlewarrier 1991 Lie et al. 1997 Waldner-Haugrud et al.

Any IPV

Physical

Sexual

Psychological/Emotional

22.6 17a, 75b

10.3 2–20b

11

21.2 21–71b 15.2c

3.8, 26.3d 67.5 38

4.7 32.5 29.3

.6 31.4

14.7 61 16.3

Note. Blank table cells were not measured or not reported. IPV ¼ intimate partner violence; LGB ¼ lesbian, gay, bisexual. Psychological ¼ psychological. a One incident of abuse. bMore than one incident of abuse. cLGB-specific tactics of psychological aggression. dPerpetrator and victim.

for more severe forms of violence. The least evaluated violence was economic violence (1 study), with a prevalence of 46% in lesbians and 33% in gay women (Turell, 2000). The second most evaluated form of violence was psychological/ emotional violence (7 studies), with a prevalence rate that ranged between 7.4%, specifically for stalking (Rose, 2003) and 18% for psychological/emotional/verbal abuse as the only form of violence in the couple (Lie & Gentlewarrier, 1991), and 64.5% (Lie et al., 1991). Two studies defined violence as emotional abuse, reporting a victimization prevalence of between 31% (Scherzer, 1998) and 84% (Turell, 2000). The study by Scherzer included relevant behaviors for lesbians (e.g., threats to out the partner). Sexual violence was evaluated in six studies, with its prevalence ranging between 0.6% for nonconsensual sex or sexual torture as the only form of violence in the couple (Lie & Gentlewarrier, 1991) or 2.2% for sexual assault (Rose, 2003), and 56.8% (Lie et al., 1991).

Prevalence of Intimate Partner Violence Perpetration Prevalence of intimate partner violence perpetration (see Table 3) was only evaluated in five studies, with different recollection periods (at some point in life or in the past year) or with no specific time period (within the current intimate relationship). Intimate partner violence perpetration was evaluated in a general sense by four studies. Perpetration ratios oscillated between 17% and 75% (Telesco, 2003). The most frequently evaluated form of IPV was psychological/emotional violence (five studies), with a prevalence ratio of between 14.7% for psychological/emotional/verbal abuse as the only form of violence toward the partner (Lie & Gentlewarrier, 1991) and 71% for a specific behavior such as looking angrily at the partner (Telesco, 2003). The highest abuse rates were found in behaviors with lower levels of severity—from 21% to 71% (Telesco, 2003). Another specific behavior was making threats, with a prevalence ratio of 16.3% (Waldner-Haugrud et al., 1997). Finally, only one study evaluated the perpetration of specific psychological violence in same-sex couples in the past year, finding a rate of 15.2% (Balsam & Szymanski, 2005).

Physical violence was evaluated in four studies and presented ratios of between 1% for a specific behavior like frequently pushing the partner (Telesco, 2003) and 32.5% (Lie et al., 1991). Another specific behavior was hitting the partner with an object, with a rate of 3.5% (Waldner-Haugrud et al., 1997), and a rate of 4.7% for multiple forms of physical abuse as the only form of violence toward the partner (Lie & Gentlewarrier, 1991). Once again, the highest rates of abuse were found in behaviors with lower levels of severity, and the rates tended to be higher as longer time periods were evaluated. Two studies evaluated sexual violence perpetration, which ranged between 0.6% for nonconsensual sex or sexual torture as the only form of violence toward the partner and 1.4% for a combined form of sexual, physical, and psychological violence (Lie & Gentlewarrier, 1991), and 31.4% (Lie et al., 1991).

Correlates of Intimate Partner Violence Only 11 studies evaluated possible correlates of intimate partner violence in self-identified lesbians in same-sex relationships. The correlates can be grouped in six categories: (1) sociodemographic characteristics, (2) personality characteristics, (3) relational characteristics, (4) history of intimate partner violence, (5) history of family violence, and (6) health. Regarding the sociodemographic questions, only two studies analyzed the relationship between sexual orientation and IPV (Balsam & Syzmanski, 2005; Eaton et al., 2008), and they obtained contradictory results. Balsam and Syzmanski found statistically significant differences in IPV between bisexual women and lesbians. Bisexual women were more likely than lesbians to report LGB-specific aggression against a female partner in the past year, while lesbians reported more lifetime psychological aggression against a female partner than bisexual women. However, Eaton et al. did not report any statistically significant differences among bisexual women, heterosexual women, and lesbians. The personality characteristics were analyzed in two studies (Miller et al., 2001; Telesco, 2003). The correlates analyzed were low self-esteem, need to control, independence (Miller et al., 2001), dependence, jealousy, femininity, masculinity, and power (Telesco, 2003). The studies presented contradictory results for the dependence–independence trait. In the study by

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Miller, Greene, Causby, White, and Lockhart, lesbians were asked to describe themselves by using a list of six personality traits reflecting independence (higher score indicated greater independence). This study found a positive and statistically significant relationship between independence and greater use of both physical aggression and physical violence conflict tactics in the relationship. Telesco measured dependence through a combination of items based on the study by Renzetti (1992) and items of his own creation. This author found a positive but not statistically significant relationship between dependence and IPV perpetration. Moreover, jealousy, low self-esteem, and the need to control were positively and significantly associated with IPV. The relational characteristics were analyzed in only one study (Miller et al., 2001). Miller et al. analyzed the association between the levels of their own fusion and their partner’s fusion with physical aggression and physical violence. Lesbians were asked how often she or her partner felt the need to share recreational and social activities, felt the need to do everything together, felt the need for independent time with friends, made regular phone calls to partner while at work, insisted on sharing professional services, attempted mind reading as a form of communication, and insisted on sharing money and clothing (a higher score indicated greater fusion). The results revealed a positive and statistically significant association between their own fusion levels and the partner’s fusion levels with IPV. The past experience with partner violence was analyzed in one study (Lie et al., 1991). Lie et al. observed a positive and statistically significant relationship between IPV victimization in past relationships and victimization/perpetration in the current relationship with a woman. They also found a positive and statistically significant relationship between IPV perpetration in past intimate partner relationships and victimization/perpetration in the current relationship. The family history of violence was analyzed in two studies (Lie et al., 1991; Schilit et al., 1991). The results indicated positive and statistically significant relationships between experiencing or witnessing violence in the family of origin and intimate partner violence victimization/perpetration. Finally, regarding the health correlates, only the study by Schilit, Lie, and Montagne (1990) examined the relationship between substance use and IPV (Schilit et al., 1990). They found a positive and statistically significant relationship between alcohol consumption and IPV. However, there was no statistically significant relationship between drug use and intimate partner violence.

Discussion The purpose of this systematic review was to synthesize the current body of knowledge about intimate partner violence in self-identified lesbians in same-sex couples. In general terms, the findings situate the victimization rate at between 9.6% and 73.4% (Lie et al., 1991) and the perpetration rate at between 17% and 75% (Telesco, 2003). However, previous reviews establish a range of between 20% and 50% (Burke,

Jordan, & Owen, 2002; McClennen, 2005; Murray et al., 2007). The discrepancy between the rates could be explained by the sample considered, that is, the present review only analyzed studies that used samples of self-identified lesbians extracted from the general population, analyzed them separately from other groups of women (bisexual women, women with a history of living with another woman . . . ), and specified the sex of the perpetrator. Consequently, all of the studies analyzed were based on convenience samples. The studies based on probabilistic samples tend to provide lower rates of prevalence of victimization than convenience studies, which may explain the high magnitude of the rates found in the studies reviewed here. For example, Goldberg and Meyer (2013) found that the women who self-identified as lesbians reported ratios of victimization of 10.23% in IPV in the past year and of victimization of 31.87% at some time in life. Moreover, Roberts et al. (2010) reported a prevalence of victimization of 16.10%. Finally, Walters, Chen, and Breiding (2013) found that 43.8% of lesbian women had been victims of rape, physical violence, and/or stalking by an intimate partner during their lifetime. On the other hand, these studies with probabilistic samples show that lesbian women have suffered more violence from their partners than heterosexual women, but less IPV than bisexual women. Thus, Walters et al. (2013) found that 44% of lesbian women, 61% of bisexual women, and 35% of heterosexual women have experienced physical violence, stalking, or rape as a result of IPV. Goldberg and Meyer (2013) found that bisexual women presented higher ratios of victimization in couple violence in the past year (27.48%) and at some time in life (51.99%) than lesbian women (10.23% and 31.87%, respectively). In 95% of the cases, the violence experienced by bisexual women in the past year was perpetrated by a male partner. Moreover, Roberts et al. (2010) also report a greater prevalence of victimization through domestic violence in bisexual women (20.17%) and in heterosexual women with a same-sex couple history (23.81%) than in women identified as lesbians (16.10%). However, Messinger (2011) found that the victimization in same-sex couples was more frequent in women defined as gays than in women categorized as bisexuals. Furthermore, the results of this review show that the prevalence rate of both IPV victimization and perpetration varies depending on the severity of the behaviors evaluated. The highest rates correspond to milder forms of violence, compared to more severe forms. The rates also vary depending on whether they refer to specific behaviors or unique forms of violence, compared to combined indexes of violence, or whether the studies use a global or general measure of abuse or specific behavior indicators. However, knowing how frequent and severe a certain violent behavior is does not reveal anything about the type of intimate partner violence being analyzed (Kimmel, 2002). Types of IPV are differentiated by the context of control in which they develop, and not by the frequency or nature of the violent acts (Johnson, 2006; Pence, 2006). For example, Frankland and Brown (2013), in a sample of same-

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sex couples, found higher rates of physical aggression in ‘‘situational couple violence’’ than in ‘‘intimate terrorism.’’ The authors suggest that the physical violence does not have to be frequent when one member of the couple has already established a high degree of control over the other. Moreover, in this study the ratios of physical aggression were higher in situations of ‘‘violent resistance’’ than in ‘‘situational couple violence,’’ leading the authors to conclude that measuring physical violence without measuring the control in the cases of ‘‘violent resistance’’ could cause an individual to be labeled as a ‘‘perpetrator’’ and his or her partner as a ‘‘victim.’’ Therefore, there is a need to evaluate the context in which the violence occurs (Johnson, 2010; Kimmel, 2002; Renzetti, 1992; West, 2012) and, with it, identify the type of partner violence in order to implement efficacious interventions. Of the studies reviewed here, only one (Lie et al., 1991) evaluated the use of violence (as self-defense vs. mutual aggression) in addition to the combined occurrence of victimization and perpetration within the relationship. This situation arose in one third of the past relationships with a male partner, in two thirds of the previous relationships with a female partner, and in almost 20% in the current lesbian relationships. Moreover, it was more likely for the use of violence to be characterized as self-defense in opposite-sex relationships, while in same-sex relationships it was more frequently described as mutual aggression. The mere comparison of rates of violence does not make it possible to clarify to what degree the relationship can be based on dynamics of control and domination, or what factors could influence the recognition of the use or experience of abuse (Scherzer, 1998; Waldner-Haugrud et al., 1997). In addition, it is important to point out the limitation involved in asking the participants if they have suffered abuse, without defining what is meant by abuse (e.g., Lie & Gentlewarrier, 1991, for ‘‘verbal/emotional/psychological abuse’’), and evaluate the violence or abuse that exists in the couple (e.g., Schilit et al., 1990). This latter strategy does not make it possible to distinguish between victimization and perpetration, inflating the data in some cases, above all when the presence of couples in the sample is not controlled (Murray & Mobley, 2009; Waldner-Haugrud et al., 1997). The former could cause the abuse to be underestimated because participants may not consider milder forms of abuse. Therefore, it is recommended that researchers clearly specify their definitions of abuse, ideally using objective scales of identifiable behaviors, and separating types of abuse for the analyses (Burke & Follingstad, 1999). Regarding the forms of violence, emotional/psychological violence was experienced and perpetrated the most, as found in studies about partner violence in lesbians and women with a prior history of same-sex partners (e.g., Matte & LaFontaine, 2011; McClennen, Summers, & Daley, 2002; Messinger, 2011) and in heterosexual women. However, few studies evaluated the specific psychological tactics of same-sex partner violence (homophobic control). Therefore, future studies should consider including the evaluation of intimate partner violence tactics that are specific/relevant to lesbians or LGB people (Lewis

et al., 2012; West, 2012). Sexual violence was the least frequently studied form of intimate partner violence, both regarding victimization and perpetration. In this case, the prevalence ratios must be viewed with caution, given that the definitions of violence used are quite broad and include behaviors (such as sexual insults) that could be categorized as verbal/emotional/ psychological violence, as the authors themselves recognize (Lie et al., 1991), or they refer to physical and psychological sexual abuse tactics (Waldner-Haugrud & Vaden, 1997). Moreover, the abused lesbians had been victims of more than one form of abuse by their partner, as found in previous studies with lesbians (McClennen et al., 2002; Renzetti, 1992) and heterosexual women (Garcı´a-Moreno, Jansen, Ellsberg, Heise, & Watts, 2005). Specifically, the study by Lie and Gentlewarrier (1991) indicates a prevalence of combined forms of sexual, physical, and psychological violence of 28.6% in the case of victimization and 10.8% for perpetration. Finally, regarding the correlates of partner violence, in the studies analyzed, jealousy, the need to control, independence, and low self-esteem were found to be related to IPV. IPV was also associated with high levels of fusion in the partner, prior experiences of victimization, and/or perpetration of intimate partner violence, being a victim of or witnessing violence in the family of origin, and alcohol consumption. Although the evidence for these associations is scarce, the findings agree with other studies on same-sex couples (Bimbi, Palmadessa, & Parsons, 2008; Burke & Owen, 2006; Causby, Lockhart, & White, 1995; Craft, Serovich, McKenry, & Lim, 2008; Fortunata & Khon, 2003; Gumienny, 2010; Lockhart, White, Causby, & Isaac, 1994; McClennen et al., 2002; Renzetti, 1988, 1992). Thus, for example, Bimbi et al. (2008), in a combined sample of lesbian and nonlesbian women, found that IPV was related to the use of alcohol and certain drugs like cocaine. Burke and Owen (2006) pointed out that low selfesteem is related to same-sex partner violence. Fortunata and Khon (2003) found higher levels of substance abuse and more experiences of childhood physical and sexual abuse in a combined sample of lesbian and bisexual women who mistreat their partners than in the women who do not. Gumienny (2010) found that the tactics of power and control, fusion, internalized homophobia, and family history of violence predicted aggression in couple relationships between women. McClennen, Summers, and Daley (2002) found that jealousy, high levels of fusion, dependence, and the use of substances were associated with partner violence in lesbian women. The different factors involved in intimate partner violence in self-identified lesbians, according to this review, can be placed at different levels of an ecological model (Baker et al., 2013), mainly at the individual level, of the personal history and the dyadic relationship, some of which have been specifically associated with lesbian relationships (jealousy, fusion, and dependence; McClennen et al., 2002; Renzetti, 1992; Waldner-Haugrud et al., 1997). The apparent contradiction in the results on dependence in the studies by Miller et al. (2001) and Telesco (2003) can be explained, among other factors, by differences in the violence evaluated (abuse in the

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relationship vs. perpetration) as well as in the definition and operationalization of the dependence-independence construct (as a personality trait vs. relational characteristic). In fact, according to Renzetti (1992), the role this construct plays in IPV can be understood based on the tensions and conflicts that it can produce in the dynamic of the relationship. The study by Miller et al. suggests that there can also be a personal disposition to this type of dynamic, but without clarifying whether it is associated with a greater probability of victimization or perpetration of violence. There is a need for more research on this question in order to better understand the interpersonal dynamic and the role played by the power differentials in abusive relationships between lesbians (Messinger, 2014; Murray et al., 2007). However, none of the studies analyzed examined sexual minority stress as a possible correlate of partner violence in self-identified lesbians (analyzed as a separate group), which is related to factors at the social macro-system level, specifically the influence of heterosexism. The literature has linked sexual minority stress to IPV (Edwards & Sylaska, 2013; Gumienny, 2010). Only the study by Carvalho et al. (2011), included in preselected studies but not part of this review, analyzed this question. In their study, sexual minority stress was associated with IPV victimization and perpetration. Specifically, stigma consciousness was associated with IPV victimization and perpetration, and openness was associated with IPV victimization. However, internalized homophobia was unrelated to IPV. Therefore, future studies should clarify the relationship between sexual minority stress and IPV in self-identified lesbians. Thus, Lewis, Milletich, Derlega, and Padilla (2014) found that internalized homophobia and social constraints in talking with friends about sexual identity issues were associated with the frequency of past-year psychological aggression in lesbian women’s intimate relationships through rumination and relationship satisfaction. Furthermore, another question to take into account in future studies is the need to broaden the research on correlates of IPV, particularly those related to health, beyond the use of alcohol and drugs, and clarify their relationship with violence in lesbian couples.

Conclusion The systematic review shows that IPV occurs in the couple relationships of self-identified lesbians with other women. All forms of IPV take place, and, in addition to the correlates associated with IPV in opposite-sex couples, there are factors specific to the LG population that stem from the homophobic context in which they are immersed, or that are characteristics of the relationship dynamics that can be established between lesbian women (e.g., homophobic control and fusion). The high rates of IPV suggest that there is a need to develop and implement programs for violence prevention in same-sex couples that take into account the specific characteristics of abuse in lesbian and gay men couples and in sexual minority couples, in general.

The IPV in same-sex relationships is linked to heterosexism and factors fomented by a homophobic context. In this sense, it would be necessary to develop intervention programs directed to the LG population that would teach them strategies for coping with the discrimination and prejudice they may experience in a heterosexual-dominated society. These strategies can buffer the interiorizing of heterosexist attitudes, thus reducing the IPV in same-sex relationships (Lewis et al., 2014). In addition, there is also a need for education and training programs in same-sex partner violence for service providers not specifically serving LGBT people (e.g., health care, social services, criminal justice professionals, etc.). Heterosexism among service providers has kept many victims of same-sex intimate partner violence from seeking help. Moreover, the abusers have used it as a tool to dissuade victims from asking for help (Messinger, 2014). Finally, as many victims find it difficult to recognize the abuse, there is also a need for education programs and campaigns directed toward the LGBT community itself, in order to increase the knowledge about same-sex couple abuse. These information campaigns would also allow abused lesbian women to have information about the available service providers in situations of partner abuse, which would facilitate help seeking in these situations. These programs and campaigns would have to have economic support from public institutions.

Limitations The main limitation of this systematic review is the low number of studies analyzed. However, this fact is a result of the strict inclusion and methodological quality criteria for the primary studies, in order to assure the quality of the evidence they provide. Thus, it was considered more important to summarize the evidence from studies with high methodological quality than to use a larger number of studies with lower quality. On the other hand, this review refers to studies focused on a specific population, self-identified lesbians, and the results cannot be considered representative of IPV in women from other sexual minorities (bisexual women or women who have sex with women but do not self-identify as LB) or lesbian women who are not open about their sexual identity. In the same way, the results cannot be generalized to the IPV in self-identified lesbians in relationships with the opposite sex. A general limitation in the research on IPV in same-sex couples is the fact that studies do not consider the sexual orientation of the partners of the participants, a limitation that should be taken into account in future studies, in addition to the sex of the partner (Messinger, 2014).

Future Research Directions Given the methodological limitations detected in the primary studies (Burke & Follingstad, 1999; Murray & Mobley, 2009), future studies should use the same definitions of partner violence and forms of violence (e.g., Centers for Disease Control and Prevention, 2010); report on the same recollection

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periods; evaluate the sexual orientation of the participants (preferably using multiple-choice scales based on sexual identity); evaluate the sex, gender identity, and sexual orientation of the participants’ partners; and analyze the data in separate groups (sexual identity and period of recollection). This would facilitate the integration of the results in later meta-analytic studies and the comparison of different studies. It would also be advisable to use multiple methods for evaluating IPV, given that it is a complex phenomenon (Follingstad & Rogers, 2013; West, 2012), and control the social desirability problems associated with self-reports of these types of behaviors (Follingstad & Rogers, 2013; Frankland & Brown, 2013; Murray & Mobley, 2009). Finally, given the lack of studies on these topics beyond the Anglo-Saxon setting, it is necessary to investigate the existence of this phenomenon in other societies and cultures. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was possible due to the economic support of the VALiþd program for predoctoral Training of Research Personnel (ACIF/2013/167). Conselleria d’Educacio´, Cultura i Sport, Generalitat Valenciana (Spain).

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Author Biographies Laura Badenes-Ribera is a PhD student in the University of Valencia (Spain). She is graduated in psychology, criminology, and laws. She is a master in psychology and criminology. She gets a grant for predoctoral training of research personnel (ACIF/2013/167) from Generalitat Valenciana, Spain. Amparo Bonilla-Campos is an associate professor in the University of Valencia. Valencia (Spain). She is a specialist in domestic violence and gender studies. She conducts research in the areas of stereotyping, prejudice, and discrimination. Dolores Frias-Navarro is an associate professor in the University of Valencia (Spain) and is specialized in research methods. She conducts research in the areas of stereotyping, prejudice, and discrimination. Gemma Pons-Salvador is an associate professor in the University of Valencia (Spain). She is a specialist in treatment and prevention of conflicts and family violence. She has worked for more than a decade as a psychologist of social services. Hector Monterde-i-Bort is an associate professor in the University of Valencia (Spain) and a specialist in statistics, measurement, and computing applied to Psychology. He conducts research in the areas of stereotyping, prejudice, discrimination, safety, mobility and quality of life.

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