Women's Decisions to Not Seek Formal Help for Partner Violence: A Comparison of Intimate Terrorism and Situational Couple Violence.

511701 research-article2013

JIVXXX10.1177/0886260513511701Journal of Interpersonal ViolenceLeone et al.

Article

Women’s Decisions to Not Seek Formal Help for Partner Violence: A Comparison of Intimate Terrorism and Situational Couple Violence

Journal of Interpersonal Violence 2014, Vol. 29(10) 1850–1876 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0886260513511701 jiv.sagepub.com

Janel M. Leone,1 Megan E. Lape,2 and Yili Xu2

Abstract This study examined the help-seeking decisions of low-income women (n = 389) in two types of physically violent heterosexual relationships— intimate terrorism (i.e., physical violence used within a general pattern of coercive control) and situationally violent (i.e., physical violence that is not part of a general pattern of coercive control). Intimate terrorism victims were significantly more likely than situational couple violence victims to cite fear as a reason for not seeking help from the police, medical centers, and counselors/agencies. In contrast, situational couple violence victims more often said that they did not need help. Regression analyses also indicate that additional violence-related factors predict women’s help-seeking. Findings emphasize the importance of distinguishing between types of male partner violence and recognizing women’s exertions of personal choice and perceptions of dangerousness when examining their decisions about seeking help from service providers.

1The

Sage Colleges, Albany, NY, USA University, NY, USA

2Syracuse

Corresponding Author: Janel M. Leone, The Sage Colleges, 140 New Scotland Avenue, Albany, NY 12208 USA. Email: [email protected]

Downloaded from jiv.sagepub.com at Monash University on March 8, 2015

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Keywords coercive control, criminal justice system, formal help-seeking decisions, male partner violence, minority women In general, women in violent relationships actively seek help to end the violence against them (Campbell, Rose, Kub, & Nedd, 1998; Coker, Derrick, Lumpkin, Aldrich, & Oldendick, 2000; Leone, Johnson, & Cohan, 2007), and the majority of women in controlling, violent relationships eventually escape (Merritt-Gray & Wuest, 1995). However, research examining female victims’ help-seeking decisions has regarded partner violence as a unitary phenomenon and investigates women’s help-seeking as a function of experiencing any physical violence (e.g., Barrett & Pierre, 2011; Brabeck & Guzmán, 2008; Fanslow & Robinson, 2010; Fugate, Landis, Riordan, Naureckas, & Engel, 2005; Sabina & Tindale, 2008). Making distinctions among violence types would yield more specific, focused conclusions about partner violence and the mechanisms that connect it to women’s help-seeking decisions. For example, it is estimated that less than half of domestic violence incidents are reported to the police (U.S. Department of Justice, 1998), yet it is unclear why this is the case. The current study utilizes Johnson’s typology of partner violence (Johnson, 1995, 2001, 2008) to examine how intimate terrorism and situational couple violence are differently associated with women’s helpseeking decisions.

Johnson’s Typology of Intimate Partner Violence Johnson (1995, 2001, 2008; Johnson & Ferraro, 2000) has argued that two major forms of male partner violence exist. Intimate terrorism is physical violence embedded in a general pattern of power and control over one’s partner, where the violent partner exercises wide-ranging and pervasive coercive control meant to demonstrate his power and ultimately entrap the partner in the relationship. In contrast, situational couple violence is physical violence against a partner that is situationally provoked, where one person may react physically to the tensions of a specific encounter or conflict. Unlike intimate terrorism, situational couple violence is “rooted in the events of a particular situation rather than a relationship-wide attempt to control” (Johnson, 2008, p. 12). This control-based typology defines violence types on the basis of the underlying motivation to use physical violence, as demonstrated in the general context of controlling behavior (e.g., isolation, threats, economic abuse) in which the violence exists. Intimate terrorists entrap victims in the relationship by creating tremendous fear of further physical and sexual violence, by


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diminishing victims’ personal and financial resources, and by creating an environment for victims in which support networks may be geographically and socially inaccessible (Johnson, 2008). Intimate terrorism is associated with more severe, more frequent physical violence compared with situational couple violence (Johnson & Leone, 2005; Leone et al., 2007; Leone, Johnson, Cohan, & Lloyd, 2004), yet the two types are not defined in terms of the physical violence; intimate terrorism is not a more severe “stage” of situational couple violence. Given that intimate terrorism and situational couple violence have different dynamics and different effects on victims, it is likely that women’s reactions to them will also differ. Other research has distinguished between types of male perpetrators of intimate partner violence by focusing on their psychological, personality, and physiological traits rather than coercive controlling behavior (see HoltzworthMunroe & Meehan, 2004; Holtzworth-Munroe, Meehan, Stuart, Herron, & Rehman, 2000; Holtzworth-Munroe & Stuart, 1994; Jacobson & Gottman, 1998) For example, Holtzworth-Munroe and Stuart (1994) conducted extensive research on male partners’ personality characteristics, the severity of violence perpetration, and extent of violence. Their findings suggest a tripartite typology of male perpetrators including “family only,” “generally violent/antisocial,” and “dysphoric/borderline.” Subsequent research has expanded this typology by examining male perpetrators’ distal and proximal risk factors (see Waltz, Babcock, Jacobson, & Gottman, 2000) and variations in physiological indicators (see Jacobson & Gottman, 1998). Critical analysis of these typologies suggests a meaningful overlap with Johnson’s typology of intimate terrorism and situational couple violence. That is, Holtzworth-Munroe and Stuart’s (1994) “family only” group corresponds closely to situational couple violence whereas, despite variations in personality and physiological characteristics, their “generally violent/antisocial” and “dysphoric/borderline” groups likely reflect two subgroups of intimate terrorism (Johnson, 2008). These men are engaged in broad patterns of controlling behavior and are highly violent. Moreover, they are impulsive, accepting of violence against women, and have traditional, hostile attitudes toward women—characteristics associated with the increased use of violence against women. This convergence in typology research compels us to more completely understand differences in the individual characteristics between and among groups of violent male partners, but perhaps most significantly in the potential risks that these men pose to their female victims. The current study focuses on Johnson’s typology by emphasizing the importance of violent male partner’s behavioral patterns to better understand women’s decision making and choices about seeking help for the abuse that they experience.


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Victim Help-Seeking Decisions as a Function of Violence Type Victims of intimate terrorism seek help at a higher rate, and are significantly more likely than victims of situational couple violence to contact formal help sources following a violent incident. Leone et al. (2007) found that 70% of intimate terrorism victims versus 44% of situational couple violence victims utilized formal help in the 12 months following a violent incident. Intimate terrorism victims were significantly more likely than situational couple violence victims to contact the police, a medical center, and a counselor/agency. Such evidence suggests that the increased risk of injury, psychological distress, and physical danger necessitates that intimate terrorism victims seek out legal and medical help. However, these findings also raise questions about some women’s decisions not to seek formal help following a violent incident. Why did 30% of intimate terrorism victims and 56% of situational couple violence victims not contact any formal help sources following a violent incident? The current study seeks to answer this question by investigating how the type of violence that women experience is associated with their decisions not to contact formal help sources. Research concerning women’s decision-making process regarding formal help-seeking for partner violence is relatively sparse, and to our knowledge no studies have examined this issue differentiating between intimate terrorism and situational couple violence. The literature on partner violence helpseeking includes agency samples (e.g., women receiving services from violence shelters, hospitals, courts) and community samples (e.g., respondents to relatively large population-based surveys). It is possible to extrapolate differences in help-seeking decisions by comparing these two populations of victims across sampling frames. Agency samples are generally dominated by victims of intimate terrorism, whereas community samples are generally dominated by situational couple violence victims (Johnson, 1995, 2001, 2008). Situational couple violence victims would rarely be in violence shelters or court samples because they are unlikely to experience a level of danger requiring such intervention, and intimate terrorism victims are unlikely to respond to general, community surveys for fear that their abusive partner would retaliate physically. Agency samples of partner violence victims (likely intimate terrorism victims) tend to report fear for their lives and their children’s lives (Meyer, 2011; Zoellner et al., 2000), isolation (Fleury, Sullivan, Bybee, & Davidson, 1998; Fleury-Steiner, Bybee, Sullivan, Belknap, & Melton, 2006; Murdaugh, Hunt, Sowell, & Santana, 2004; Wolf, Ly, Hobart, & Kernic, 2003), and being physically prevented by the abusive partner (Fugate et al., 2005; Wolf et al., 2003)


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as barriers to seeking formal help. In contrast, victims responding to population-based surveys (likely situational couple violence victims) report not seeking help due largely to privacy concerns (Rodriguez, Sheldon, Bauer, & Parez-Stable, 2001). Two previously published studies have utilized data from the Chicago Women’s Health Risk Study (CWHRS), the data source used in the current study, to examine factors associated with victim help-seeking decisions. First, Fugate et al. (2005) examined reasons for not seeking formal help among 491 women who experienced at least one type of physical violence by an intimate partner in the previous 12 months. Most women in the sample who did not contact a formal or informal help source stated that help was “not needed” or “not useful.” Specifically, 38% of the women cited this reason for not contacting the police or a counselor/agency, and about 74% reported this for not contacting a medical center. The researchers combined “fear” with “privacy and confidentiality issues,” and reported that this reason was given by about 18% of respondents who did not contact a counselor/agency, 9% who did not contact a medical center, and 13% who did not contact police. Second, Davies, Block, and Campbell (2007) examined decisions about seeking police help among 500 women who experienced at least one incident of physical violence or the threat of physical violence in the previous 12 months. Consistent with Fugate et al., Davis et al. found that women’s most common reason (29%) for not calling the police following a violent incident was that they believed that help was not needed because the incident was either too minor or not serious enough. Only 6% of the women stated “fear of further abuse” as their reason for not calling the police.

Rationale and Hypotheses for the Current Study Existing research concerning women’s decisions to seek formal help has generally lacked a clear definition of the type of violence being studied and has typically not specified to whom findings can be generalized. Much of this research does not consider the different contexts that characterize intimate terrorism and situational couple violence, and how these contexts may be differentially associated with women’s decisions about help-seeking. A main concern with Fugate et al. (2005) and Davies et al. (2007) is that lumping together all women who experienced physical violence leads to generalized conclusions about “intimate partner violence.” That is, both studies conclude that women overwhelmingly report not seeking help because they regard help as unnecessary; this likely dilutes the seriousness and dangerousness of intimate terrorism, and fails to give an accurate voice to the fear often reported by intimate terrorism victims. The current study extends this research by utilizing the CWHRS data and investigating whether experiences of intimate terrorism


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or situational couple violence are differentially associated with victims’ decisions not to contact the police, medical centers and counselors/agencies following a violent incident. These data are unique in that the sample includes women seeking regular health care services and women seeking emergency medical care. In other words, the data likely include a mix of respondents who have experienced either situational couple violence (i.e., women seeking regular health care services) or intimate terrorism (i.e., women seeking emergency medical care for violence-related health problems). We seek to answer two main research questions. First, are intimate terrorism and situational couple violence differentially associated with victims’ reasons for not seeking help from police, medical centers, and counselors/ agencies? That is, do women who experience partner violence that is used in the service of general control have different reasons for not seeking formal help compared with women who experience partner violence that is more situationally specific and not a part of a general pattern of power and control? Second, if these differences exist, are they influenced by other violence-related factors (e.g., violence severity) or health consequences associated with victimization (e.g., posttraumatic stress disorder [PTSD], depression, injuries, perceived social support)? Three main hypotheses guide this study. First, we predicted that intimate terrorism victims would be more likely than situational couple violence victims to cite fear as a reason for not seeking formal help. Previous research indirectly supports this hypothesis by showing that fear is a primary reason for not seeking help among agency samples of women (likely tapping into intimate terrorism; see Meyer, 2011). Unlike situationally violent men, intimate terrorists isolate their victims from support sources, and use intimidation, coercion, and economic abuse that, when coupled with more severe, frequent physical violence creates an environment of dependency, isolation, and fear (Johnson, 2008). These consequences can lead to fear of retaliation by the partner and/or diminished resources (Fleury-Steiner et al., 2006). Second, we predicted that situational couple violence victims would be more likely than intimate terrorism victims to report that formal help was not needed. By definition, intimate terrorism involves tremendous coercive control, and is associated with severe physical violence that is likely to result in injury. Compared with situationally violent relationships, intimate terrorism is, on average, more dangerous for women and more likely to force them into needing immediate intervention services. Thus, reporting that help is not needed is expected to be more strongly associated with situational couple violence than intimate terrorism. Finally, we predicted that factors more strongly associated with intimate terrorism, such as increased physical violence, psychological distress, and injuries would influence the predicted link between violence type and


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help-seeking decisions. Specifically, we predicted that physical violence severity, an increase in violence severity/frequency, PTSD and depression symptoms, and violence-related injury would be positively associated with reporting fear as a reason for not seeking formal help and negatively associated with reporting that formal help was not needed. For example, women who reported less severe physical violence or fewer symptoms of PTSD would be more likely to report that they did not need help from formal help sources and less likely to report fear.

Method Design and Participants The current study utilizes a subgroup of respondents to the CWHRS. The CWHRS was conducted to identify risk factors associated with partnerperpetrated, life-threatening injury or death (Block, 2000). CWHRS targeted neighborhoods in Chicago that, based on the Chicago Homicide Dataset, had high rates of lethal intimate violence relative to other Chicago areas. Data were collected from June 1997 to April 1998 at four medical sites— Chicago Women’s Health Center, Roseland Health Center, Erie Family Health Center, and Cook County Hospital. All of the medical sites provide walk-in and point-of-service routine medical services (e.g., Adult Medicine, Obstetrics/Gynecology). Cook County Hospital also provides Level 1 trauma and emergency services. A short screening instrument, which included a three-item partner violence measure, based on the Intimate Violence Screening Tool developed by the Chicago Department of Health (Sheridan & Taylor, 1993), was instituted into the standard intake procedure for all women receiving any type of medical treatment (violence-related or not) in each medical site. The screener was instituted into the standard intake procedure at each site. A total of 2,616 female patients who entered one of the four health care centers were asked the following three questions: “Has your intimate partner ever hit, slapped, kicked or otherwise physically hurt or threatened you?”, “Has your intimate partner ever forced you to engage in sexual activities that made you feel uncomfortable?” and “Are you afraid of your intimate partner?” Of the women screened, only those who were at least 18 years old and who had been in an intimate relationship (with a current or former partner) in the past year were eligible for the study. Women who affirmed any of the three partner violence screening questions were coded “Abused” by the screening staff. Women who answered “no” to all of the questions or who reported on an experience that occurred more than a year before the screening were coded “Not Abused.”


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There were 2,214 valid cases (an estimated 385 completed screening instruments were inadvertently destroyed by one of the medical sites) that included 528 “Abused” women (24%) and 1,653 “Not Abused” women (75%). In addition, 33 women were ineligible because of age or relationship status. The CWHRS attempted to interview all “Abused” women and about 40% of the “Not Abused” women. Approximately 86% (n = 497) of the “Abused” women and 8% (n = 208) of the “Not Abused” women were interviewed. Face-to-face interviews lasting 45 minutes were conducted in private, secure rooms by trained female health professionals at the medical sites. Respondents were informed of the study’s purpose and signed informed consent forms. See Block (2000) for more information on participant screening and selection. The sample for the current study consists of a subset of the 497 “Abused” women on the basis of four criteria. Current study participants (a) answered either “yes” or “no” to all coercive control questions, as these responses were used to distinguish between violence types; (b) reported experiencing at least one incident of physical violence in the prior year; (c) reported that all violence was committed by the same intimate partner; and (d) reported that the partner was male. These criteria yielded a sample of 389 women. The mean age of the current study’s sample was 31 years (SD = 9.06). With regard to race, 66.3% of the women were African American, 23.9% were Hispanic, and 9.8% were of another racial background. Eighty-one percent of the women had children, and the average number of children was 2.74 (SD = 1.79). Most women (72%) completed high school or earned an equivalent degree, 61.6% reported working part- or full-time and 72.8% of women reported an annual household income of less than US$20,000.

Measures Sociodemographic characteristics. Seven respondent and relationship sociodemographic characteristics were examined. Respondent age was a continuous variable (in years). Respondent race was coded as “African American,” “Hispanic,” and “Other.” Respondent highest education was measured as an ordinal variable with responses ranging from “no schooling” (1) to “some graduate school” (8). Whether the respondent was employed was coded “not employed” (0) and “employed” (1). Whether the respondent had children with the partner was coded 0 = no; 1 = yes. Whether the respondent had access to money was based on the 0 = no; 1 = yes question: “Do you have any money or income of your own that you control?” Length of relationship was based on a median split and was coded as “3 years or less” (0) and “more than 3 years” (1). Household income was excluded due to missing data.


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Independent variables Type of partner violence. Intimate terrorism and situational couple violence were defined by responses to five dichotomous (0 = no; 1 = yes) questions included in the Coercive Control Scale (α = .72), which highly resembles the Power and Control Wheel developed by Pence and Paymar (1993). These questions were, “In the past year, an intimate partner . . . ” “was jealous and didn’t want you to talk to another man”; “tried to limit your contact with family or friends”; “insisted on knowing who you are with and where you are at all times”; “called you names to put you down or made you feel bad”; “prevented you from knowing or having access to family income, even if you asked.” Physical violence severity and/or frequency were not used to categorize violence types because types are defined by the context of the violence, not the violence itself. Recall, however, that all women in the sample reported physical violence in the 12 months prior to the study and that physical violence variables were included in all analyses. A Ward’s Method cluster analysis of the five items that made up the Coercive Control Scale was used to categorize partner violence as either intimate terrorism or situational couple violence. Ward’s method of cluster analysis is a hierarchical agglomerative clustering process that selects each new case (respondent) to add to a cluster based on its effect on the overall homogeneity of the cluster (Aldenderfer & Blashfield, 1984). This is the most common method for categorizing violence types (see Frye, Manganello, Campbell, Walton-Moss, & Wilt, 2006; Johnson, 2008) because it empirically differentiates experiences of controlling behaviors among violence victims. Results showed a large increase between the one and two cluster solutions, suggesting that a two cluster solution was optimal for these data. Cluster 1 (n = 124) included women who experienced a distinct pattern of control tactics by their partner that was all five types of coercive control. We labeled this cluster “Intimate Terrorism.” Cluster 2 (n = 239) included women exposed to less patterned controlling behaviors and who reported four or fewer control items. We labeled this cluster “Situational Couple Violence.” The percentage of each group who reported each of the five control items is presented in Table 1. These two groups represent distinct forms of physical violence based on the violent partner’s attempts to control his partner, where intimate terrorism is defined by physical violence used in the general service of power and control, and situational couple violence is defined by physical violence that does not exist within a context of general power and control. Physical violence Physical violence severity. The Physical Violence Scale was a summed score of eight dichotomous (0 = no; 1 = yes) questions regarding respondents’


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Leone et al. Table 1. Items on the Coercive Control Scale by Violence Type. Situational Couple Intimate Terrorism Violence (n = 239) (n = 124)

% yes

“In the past year, an intimate partner . . . ” “was jealous and didn’t want 73.6 you to talk to another man” “tried to limit your contact 38.5 with family or friends” “insisted on knowing who 70.3 you are with and where you are at all times” “called you names to put you 57.3 down or made you feel bad” “prevented you from 19.7 knowing or having access to family income, even if you asked”

% yes

χ2

100

39.55**

100

128.17**

100

45.79**

100

73.60**

100

211.46**

**p < .01.

experiences of physical violence. This measure was taken from the Statistics Canada (1993) modification of the Conflict Tactics Scales (Straus, 1979). Examples of questions include, “In the past year has an intimate partner pushed, grabbed or shoved you”; “slapped you”; “beaten you up, for example, hit you repeatedly”; and “forced you into a sexual activity you did not want to do, by threatening you, holding you down, or hurting you in some way.” (α = .81). Increase in physical violence frequency/severity. Whether the respondent experienced an increase in violence frequency/severity was assessed by two dichotomous (no/yes) questions. “Has the physical violence increased in the frequency over the past year?” and “Has the physical violence increased in severity over the past year?” Responses affirming either variable were coded yes (1). Responses not affirming either variable were coded no (0). Consequences of violence PTSD. PTSD symptoms were measured by summing 17 dichotomous (0 = no; 1 = yes) responses to the PTSD Symptom Scale (PSS-1; Foa, Riggs, Dancu, & Rothbaum, 1993). Questions are based on criteria that define PTSD in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.;


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DSM-IV; American Psychiatric Association, 1994) and represent intrusive/ re-experiencing symptoms (e.g., “Repeated disturbing memories, thoughts, or images of the stressful situation”), avoidance symptoms (e.g., “Avoiding activities or situations because they reminded you of your stressful situation”), and arousal symptoms (e.g., “Feeling jumpy or easily startled”). This section of the survey immediately followed questions about physical violence perpetrated by an intimate partner. Respondents who affirmed any of the items about partner violence were instructed to think about those incidents and report if they had been bothered by any of the PTSD symptoms during the past month. Recall that all women included in the current study affirmed at least one item regarding partner violence; respondents therefore reported on these incidents. (α = .90) Depression. Respondents’ depression symptoms were assessed by the mean score of the following four items from the Medical Outcomes Study (Hays, Sherbourne, & Mazel, 1995): “During the past month, how much of the time have you felt downhearted and blue?”; “have you felt so down in the dumps that nothing could cheer you up?”; “have you been a happy person?”; and “have you felt calm and peaceful?” Response options ranged from “none of the time” (0) to “all of the time” (4). The last two items were reverse coded so that higher scores signify more symptoms. (α = .80). Injuries. Whether the respondent was injured in the past year due to partner violence was based on the question, “Were you or anyone else ever injured in [a violent] incident?’’ Response options were “yes, someone else,” “no, no one was injured,” or “I was the only one injured.” Responses were coded yes (1) if the woman answered, “I was the only one injured” and no (0) if either of the other two responses was affirmed. All participants were asked this question. Perceived social support. Respondents’ perceived social support was measured by summing 12 dichotomous (0 = no; 1 = yes) responses to the Social Support Network Scale (Block, 2000). Examples of these questions are “Someone I’m close to makes me feel confident in myself,” “I have someone to stay with in an emergency,” and “I have someone to borrow money from in an emergency.” Higher scores indicate higher perceived social support. (α = .85). Dependent variables. All women in the current study reported at least one incident of physical violence in the 12 months prior to the study and were asked questions about their use of formal help sources. The current study focused on women’s reasons for not using three types of formal help sources:


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the police, a medical center, and a counselor/agency. The help-seeking questions in the CWHRS were introduced by the following statement: The next questions are about the incidents that happened in the past year . . . When incidents like this happen, sometimes women get help or advice from a friend, sometimes they call an agency or counselor, and sometimes they contact a medical center or police. On the other hand, sometimes they decide it is best not to contact anyone. I am going to describe some of these possibilities and I would like you to tell me if you ever did any of these things in the past year.

Women were then asked: “Did you contact the police after any of these incidents [of violence] in the past year?”, “Did you contact a doctor or medical center after any of this (these) incident(s) in the past year?” and “Did you contact an agency or counselor in the past year?” Responses were categorized (0 = no, 1 = yes) separately for “Police,” “Medical Center,” and “Counselor.” If a respondent answered “no” to any of the above three questions, she was subsequently asked to provide up to three reasons for not seeking that specific type of help. Interviewers recorded specific phrases that women used or marked a general reason checklist within the interview schedule. The current study developed a basic coding scheme that focused on the similarities of women’s responses to each of the questions and how well these responses fit together conceptually. Three researchers independently examined all responses to each question about formal help non-use and identified common themes. The researchers then met as a group to review the identified themes and discuss discrepancies. Discussions continued until consensus about the placement of each response was achieved. Existing research concerning women’s decisions about help-seeking suggests that “fear” and perceptions that help was “not needed” are primary reasons that women report formal help non-use (see Fugate et al., 2005; Meyer, 2011). Based on these findings, we focused on these two specific reasons. Fear included responses such as “fear of further abuse,” “scared,” “consequences,” “threatened her with death,” and “fear abuser will find out and abuse more.” Help was not needed included responses like “wasn’t serious enough,” “not a big deal,” “no reason to,” “did not need to,” and “wasn’t necessary.”

Plan of Analysis The current study examined the extent to which the type of partner violence that a woman experiences predicts her decisions about seeking formal help. First, preliminary analyses were conducted for each of the study variables by Violence Type to determine the independence of Violence Type, our primary


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predictor variable. Next, we utilized a hierarchical logistic regression strategy because it examines how the variance in the dependent variables (i.e., reasons for not seeking help) can be explained by one or a set of new independent variables (e.g., the Physical Violence Scale) over and above that variance explained by an earlier variable (i.e., Violence Type). Four models were run for each of the two dependent variables. Step 1 included demographic variables and Violence Type. Step 2 added in Physical Violence variables. Step 3 added in the consequences of violence variables (i.e., PTSD and depression symptoms, injuries, perceived social support). Finally, for each dependent variable we examined the interaction between Violence Type and each of the six additional independent variables: the Physical Violence Scale, Increased Frequency/Severity, PTSD, Depression, Injury in the Past Year, and Perceived Social Support. The results of these interaction analyses are presented in text only.

Results Preliminary analyses (Table 2) indicate that intimate terrorism and situational couple violence victims differed on three of the six sociodemographic variables. Intimate terrorism victims were older, less likely to be employed, and had been in the relationship for more years. The two groups also differed on all six physical violence and consequences of violence variables—intimate terrorism victims reported more severe physical violence that was more likely to increase in frequency/severity, and reported more symptoms of PTSD and depression, higher rates of violence-related injury, and less perceived social support. These findings are consistent with prior research showing that intimate terrorism is linked to more severe physical and psychological outcomes for victims (Johnson & Leone, 2005; Leone et al., 2004). Additional findings (not shown) indicate that 53.7% of respondents (n = 209) contacted at least one of the three formal help sources examined. In fact, significant differences existed depending on the type of violence women experienced: 70.2% of intimate terrorism victims sought some type of formal help versus 44.4% of situational couple violence victims χ2(1, N = 389) = 24.18, p < .01. Intimate terrorism victims were significantly more likely than situational couple violence to seek help from the police (49.6% vs. 31.0%), χ2(1, N = 389) = 13.22, p < .01; a medical center (44.0% vs. 18.5%), χ2(1, N = 389) = 28.97, p < .01; and a counselor (24.8% vs. 14.1%), χ2(1, N = 389) = 6.99, p < .01. Furthermore, intimate terrorism victims reported seeking help from significantly more formal help sources compared with situational couple violence victims (M = 1.18, SD = 1.00 vs. M = 0.64, SD = 0.83), F(1, 387) = 33.56, p < .01. Thus, the majority of women sought formal help; yet, intimate


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Leone et al. Table 2. Descriptive Statistics by Violence Type.

Sociodemographics Respondent age (range = 18-62) Respondent race African American Hispanic Other Respondent education (range = 1-9) Respondent employed Respondent had access to money Length of relationship Physical violence Physical violence scale (range = 1-8) Increased frequency/severity Consequences of violence PTSD (range = 1-17) Depression (range = 1-4) Injured in past year Perceived social support (range = 1-12)

Situational Couple Violence

Intimate Terrorism

M (SD)/%

M (SD)/%

F/χ2

29.02 (8.89)

33.63 (8.63)

64.5 25.4 10.1 3.85 (1.21) 31.6 75.8 3.02 (1.66)

69.5 21.3 9.2 3.79 (1.22) 21.3 74.5 3.48 (1.66)

24.68** 0.60 0.25 4.74* 0.77 7.10**

3.30 (2.22) 32.4

5.89 (1.98) 131.69** 72.9 58.74**

8.64 (4.81) 1.82 (0.88) 38.7 8.78 (3.19)

13.22 (3.95) 2.37 (0.96) 57.9 7.62 (3.30)

92.32** 33.45** 12.52** 11.68**

Note. For Respondent Highest Education, 1 = no schooling, 2 = elementary school, 3 = some high school, 4 = high school/GED, 5 = some college, 6 = trade or vocational school, 7 = 4-year college, 8 = some graduate school, 9 = graduate or professional degree. PTSD = posttraumatic stress disorder. *p < .05. **p < .01.

terrorism victims were more likely to seek each type of help and, on average, to seek help from more sources versus situational couple violence victims. Table 3 presents the reasons for not seeking help by Violence Type. Consistent with study predictions, intimate terrorism victims were significantly more likely than situational couple violence victims to cite “fear” as a reason for not contacting each of the three help sources. In contrast, intimate terrorism victims were significantly less likely to report “not needing help” as a reason for not contacting each of the three help sources. Most striking is the finding that nearly one in three of the intimate terrorism victims who did not contact the police cited fear as a determining factor, and about one in nine reported not contacting a counselor/agency because of this reason.


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Table 3. Reasons for Not Seeking Help by Violence Type (% Yes).

Police Fear of further abuse Not needed Medical center Fear of further abuse Not needed Counselor/agency Fear of further abuse Not needed

Situational Couple Violence

Intimate Terrorism

(n = 168) 10.7 33.9 (n = 205) 0.5 86.8 (n = 210) 3.3 32.4

(n = 72) 31.0 8.3 (n = 83) 4.8 62.7 (n = 106) 11.3 10.4

χ2 14.27** 16.69** 6.50* 21.47** 7.95** 18.19**

Cramer’s V 0.25** 0.26** 0.15** 0.28** 0.16** 0.24**

*p < .05. **p < .01.

Tables 4 through 6 present the results of the hierarchical logistic regression analyses. These multivariate analyses allow us to examine preliminary findings within the context of additional factors. With regard to reasons for not contacting the police (Table 4), intimate terrorism victims had nearly 3 times the odds of reporting “fear” as a reason for police non-use compared with situational couple violence victims (Step 1). Consistent with study predictions, this association decreased significantly after considering the physical violence variables and injury (Steps 2 and 3). Intimate terrorism victims were significantly less likely than situational couple violence victims to report that the police were “not needed” (Step 1). Also consistent with study predictions was the finding that higher scores on the physical violence scale and increased violence frequency/severity were associated with lower odds of reporting that police help was “not needed” (Step 2). More depression symptoms were linked to higher odds of reporting that police help was “not needed” (Step 3). There were no significant interaction effects between Violence Type and each of the other independent variables. Second, with regard to not contacting a medical center (Table 5), intimate terrorism victims had nearly 14 times higher odds of situational couple violence victims of reporting “fear.” Moreover, intimate terrorism victims had half the odds of reporting that help was “not needed,” even after considering all other additional variables (Step 3). No significant interaction effects existed between Violence Type and each of the other independent variables. Finally, Violence Type was significantly associated with both reasons for not contacting a counselor/agency (Table 6). Intimate terrorism victims had


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Table 4. Odds Ratios Summaries of Variables Predicting Reasons for Not Seeking Police Help (n = 221). Fear of Further Abuse Predictor Variables

Step 1

Step 2

Step 3

Not Needed Step 1

Step 2

Step 3

Violence type and demographics Violence type 2.94** 0.98 1.20 0.15** 0.62 0.55 (intimate terrorism) Respondent age 0.99 0.99 0.99 1.01 0.99 0.99 Respondent race Hispanic 0.70 1.15 1.43 1.60 1.17 0.95 Other 1.12 1.15 1.32 0.78 0.67 0.80 Respondent education 1.03 1.06 1.10 0.97 0.97 1.00 Respondent employed 0.57 0.73 0.65 0.54 0.37* 0.37* Respondent had 0.91 1.05 0.85 2.51 2.10 1.91 access to money Length of relationship 1.14 1.20 1.35 1.02 0.97 0.96 Physical violence Physical violence scale 1.36** 1.26 0.67** 0.74* Increased frequency/ 2.61* 3.28* 0.16** 0.15** severity Consequences of violence PTSD 0.96 0.91 Depression 1.01 2.18* Injured in past year 3.03* 0.33 Perceived social 1.15 1.02 support Constant 0.16* 0.02** 0.01** 0.21* 2.52 1.37 013.35 32.93** 44.54** 24.84** 64.26** 75.41** Model χ2 df 008 10 14 8 10 14 19.57 11.62*0 39.43** 11.14* Δχ2 Note. For Respondent Race, reference group is African American. For Relationship Status, reference group is Former Partner. For Violence Type, reference group is Situational Couple Violence. PTSD = posttraumatic stress disorder.

more than three times the odds of reporting “fear” (Step 1) and less than a third of the odds of reporting that help was “not needed” (Step 1). Consistent with study predictions, Violence Type was no longer significantly linked to “fear” after considering violence-related variables and health consequences of violence (Steps 2 and 3). That is, regardless of Violence Type, PTSD symptoms were positively and significantly linked to higher odds


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Table 5. Odds Ratios Summaries of Variables Predicting Reasons for Not Seeking Help From Medical Centers (n = 265). Fear of Further Abuse Predictor Variables

Step 1

Violence type and demographics Violence type (intimate 13.50** terrorism) Respondent age 0.91 Respondent race Hispanic 0.85 Other 3.15 Respondent education 1.53 Respondent employed 0.78 Respondent had access 2.52 to money Length of relationship 1.62 Physical violence Physical violence scale Increased frequency/ severity Consequences of violence PTSD Depression Injured in past year Perceived social support Constant 0.01* 9.89 Model χ2 df 8 Δχ2

Step 2

Step 3

Not Needed Step 1

Step 2

Step 3

3.61* 14.33**

0.21

0.50

0.52*

0.93

0.91

1.03

1.03

1.03

2.45 1.74 1.80 2.06 4.19

18.40 0.77 1.39 2.40 7.98

1.64 0.42 1.00 1.77 1.23

0.86 0.34* 0.93 1.33 0.90

0.87 0.33 0.90 1.37 0.90

1.96

2.71

1.06

1.06

1.04

1.54 1.01

4.20 1.00

0.71** 0.46

0.72** 0.42

0.62 0.46 0.61 0.54 0.00 0.00 18.00 24.01* 10 14 8.10* 6.02

0.97 0.86 1.11 0.93 1.97 21.76** 19.85* 27.22** 53.77** 55.21** 8 10 14 26.55** 1.44

Note. For Respondent Race, reference group is African American. For Relationship Status, reference group is Former Partner. For Violence Type, reference group is Situational Couple Violence. PTSD = posttraumatic stress disorder. *p < .05. **p < .01.

of reporting “fear.” Having access to money nearly doubled the odds of reporting that help from counselors was “not needed,” however this finding was no longer significant after considering the violence-related variables and health consequences of violence variables (Steps 2 and 3). No significant interaction effects existed between Violence Type and each of the other independent variables.


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Table 6. Odds Ratios Summaries of Variables Predicting Reasons for Not Seeking Help from Counselor/Agency (n = 293). Fear of Further Abuse Predictor Variables

Step 1

Step 2

Step 3

Not Needed Step 1

Step 2

Step 3

Violence type and demographics Violence type (intimate 3.43* 2.19 1.13 0.28** 0.56 0.69 terrorism) Respondent age 1.01 1.01 0.98 0.98 0.99 0.99 Respondent race Hispanic 0.64 0.78 0.52 0.51 0.37* 0.47 Other 1.91 1.84 1.99 0.27 0.24* 0.25 Respondent education 1.13 1.14 1.13 1.15 1.12 1.18 Respondent employed 0.98 1.09 0.99 1.56 1.39 1.32 Respondent had access 0.88 1.06 1.16 2.40* 2.02 1.94 to money Length of relationship 1.09 1.10 1.04 0.96 0.96 0.94 Physical violence Physical violence scale 1.08 0.95 0.83* 0.90 Increased frequency/ 2.00 1.48 0.54 0.64 severity Consequences of violence PTSD 1.45** 0.91 Depression 1.05 1.28 Injured in past year 0.87 0.62 Perceived social support 1.11 1.06 Constant 0.01** 0.00** 0.24* 0.73 0.35 10.46 12.71 27.80* 38.86** 51.63** 60.07** Model χ2 df 8 10 14 8 10 14 2.25 15.09** 12.78** 8.43 Δχ2 Note. For Respondent Race, reference group is African American. For Relationship Status, reference group is Former Partner. For Violence Type, reference group is Situational Couple Violence. PTSD = posttraumatic stress disorder. *p < .05. **p < .01.

Discussion The current study demonstrates empirically that fear of further abuse is a significant obstacle to formal help-seeking among lower income, minority women subjected to physical violence embedded in a larger pattern of coercive control (i.e., intimate terrorism). When intimate terrorism victims choose not to seek formal help, they do so primarily because they are fearful that the


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violent partner will find out, retaliate violently and/or increase the violence. In contrast, not seeking help because it is not needed is significantly more common among women who experience less controlling physical violence (i.e., situational couple violence). These findings challenge the generalized conclusions of Fugate et al. (2005) and Davies et al. (2007) by emphasizing that not seeking formal help because it is deemed unnecessary is seemingly extraneous to women in highly dangerous, coercively controlling violent relationships. In some cases, physical violence severity, whether the violence escalated, and health consequences associated with physical violence more strongly predicted decisions about formal help-seeking than did violence type. These differences were specific to the type of help source being examined. For example, considering all other factors, intimate terrorism victims were significantly more likely to report fear as a reason for not seeking medical care and significantly less likely to report that medical help was unnecessary. However, with regard to police non-use, the severity/frequency of the physical violence, whether it escalated, and whether the woman had been injured were significantly and positively linked to fear, while at the same time significantly and negatively linked to regarding police help as unnecessary. In other words, irrespective of violence type, women’s decisions to seek police help were most strongly linked to the specific nature of the physical violence that they endured. This is not necessarily surprising. For abusive partners, particularly intimate terrorists, the physical violence itself is a mechanism of control and a demonstration of dominance. Intimate terrorists use violence to remind their victim that he is willing and able to impose physical punishment against her if she defies him or fails to comply with his demands (Johnson, 2008). Calling the police would be a significant act of noncompliance and defiance, and the consequence for the victim could be lethal. Victims know that when violence is threatened, it will likely be delivered (Dutton & Goodman, 2005). Physical violence that is less severe, less frequent, and less escalating is more characteristic of situational couple violence versus intimate terrorism, and victims who experience less severe physical violence are less likely to be in imminent danger. Finally, regardless of violence type, employed women had significantly lower odds of reporting not needing police help. In other words, compared with unemployed women, employed women tended to not contact the police due to reasons other than not needing help. It may be that employed women pose a substantial “threat” to their partners who may persuade them not to call the police due to the social or career consequences of involving the police. At the same time, employed women may feel that the police will be less inclined to help because they are economically “capable” of protecting


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themselves and leaving if they “wanted.” In either scenario, it is important to recognize that although women may be employed they are not always allowed access to money. Health-related factors were significantly yet differentially associated with women’s decisions about seeking formal help. Regardless of violence type, violence-related injury and PTSD symptoms increased the odds of citing fear as a reason for not contacting the police and a counselor/agency, respectively, yet depression symptoms increased the odds of reporting that police help was unnecessary. All three health-related factors are significantly more prevalent among victims of intimate terrorism compared with situational couple violence, which is expected given their link to more chronic, severe and controlling partner violence (see Campbell, 2002). The findings regarding injury and PTSD are not unforeseen because women who have been injured know that their partner is capable and willing to use severe, even lethal violence against them. But why would injury and PTSD seem to increase fear while depression seems to increase the feeling that police help is not needed? Kirkwood’s (1993) pioneering work on women’s process of escaping from abuse may explain the link between depression and deeming police assistance unnecessary. Her findings suggest that for some women the increased depression associated with highly controlling physical violence leads to a tremendous sense of hopelessness, and feelings of not being able to change their circumstances; nearly one third of the women in her study contemplated suicidal. Other research has documented the significant and inverse link between depression and self-esteem (see Foa, Cascardi, Zoellner, & Feeny, 2000) and the increased risk of suicidal behavior among intimate terrorism victims (Leone, 2011). It might be that women with increased depression choose not to seek help because they believe it will not work or will be ineffective. Moreover, some women in Kirkwood’s study reported that their husbands used their depression against them by threatening to have them institutionalized as a way of convincing them that their depression was caused by their own psychological illness and not his violence toward her. In this instance, perhaps women’s reports that the police were unnecessary were based on a belief that if they contacted the police then they would be institutionalized. Findings from the current study speak directly to the need for more complex and multifaceted theory to better explain and predict coping and survival strategies used by women experiencing different types of partner violence. Specifically, generalized findings about “victim behavior” often neglect an understanding of self-agency and informed decision making that intimate terrorism victims use to protect themselves and their children from additional harm. It is common for the general public to ask questions like “why doesn’t she just leave?” or “why doesn’t she just get help?” in response to male


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partner violence against women. Feminist scholars consistently answer this question by referring to the vast literature indicating that women in severely abusive, violent relationships do seek help and do eventually escape (see Fleury et al., 1998; Gondolf, 1998; Leone et al., 2007; Merritt-Gray & Wuest, 1995; Meyer, 2011). In fact, the majority of women in this study sought formal help. However, the escaping and help-seeking process can be extremely dangerous and involve a high degree of risk for victims entrapped by intimate terrorists. Calling the police or disclosing abuse to a medical provider can result in more severe, even lethal, violence against a victim, particularly if the perpetrator is not held accountable. Fleury-Steiner et al. (2006) found that nearly one in five women are physically re-abused after a violent partner has been arrested and released, and Block (2004) found that leaving or trying to end the relationship is an immediate precipitating factor in 45% of cases in which men kill female partners. These statistics speak to the legitimate fears that women have about what will happen to them if they attempt to call the police, go to a shelter, or escape an intimate terrorist, and indicate that women take these fears into account in their decision making. The current study supports existing research by demonstrating how coping with, seeking help for, and potentially escaping a violent partner is a complex and multi-faceted issue (see Foa et al., 2000). Conceptual and empirical models that highlight the complex linkages among environmental and psychological factors, women’s resilience, and coping can further advance our understanding of women’s decision-making processes. Moreover, the current findings challenge us to recognize that not all women who experience male partner violence, particularly women who experience situational couple violence, feel they need formal help. Indeed most situational couple violence victims who reported not seeking help from police, medical centers, and counselors did so because they believed these services were not needed. In these cases, leaving or seeking formal help might not be necessary to end the violence. Leone et al. (2007)’s findings that situational couple violence victims are equally or more likely than intimate terrorism victims to utilize informal help sources indicates that possibly many of these victims’ needs are being met by friends and family. In the short- and longterm, situational couple violence victims might rely on familiar people to validate their experiences, make recommendations about counseling or anger-management, and/or provide a place to “cool off.” The current study’s findings have important implications for service providers. First, not contacting a formal help source because of fear indicates a victim’s perceptions of danger and perhaps her lack of confidence in the criminal justice system’s ability to adequately protect her. Such concerns may result from the intimate terrorist’s threats and the victim’s previous


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experiences with the criminal justice system (Fleury-Steiner et al., 2006; Wuest & Merritt-Gray, 1999). Community service providers, particularly the police, who can effectively assess victim safety and perpetrator dangerousness will better protect victims and hold the violent partner accountable. Campbell’s (1995) work on danger assessment has shown to be effective in identifying perpetrators most at risk of killing their female partner. Second, women who believe that they do not need help, particularly situational couple violence victims, are not necessarily in denial or putting their partner’s needs before their own. Rather, they may know based on previous experiences that the physical violence is an isolated incident and is not part of a larger pattern of abuse necessitating urgent police or shelter intervention. This is not to suggest that physical violence of any kind within an intimate relationship is acceptable and should be tolerated. Instead, it is important for service providers to recognize and value women’s individual needs and requests for help sources that they believe are most likely to fulfill these needs. Finally, just as service providers’ perceptions of victims and responses to victims’ decisions must be modified so must the discourse surrounding intimate partner violence. We need to regularly ask “what type of violence are we talking about?” In doing so we will not only be more accurate in our assessment and understanding of these phenomena, but we will also be more successful in developing and delivering effective interventions for victims. Limitations of the current study can inform future research. First, the violence-related factors examined here are not comprehensive and future research might consider other factors possibly associated with victims’ formal help-seeking such as general health, social integration, and childhood trauma in attempting to understand differences between intimate terrorism and situational couple violence. Second, to adequately compare violence types based on Johnson’s (2008) typology it is necessary to have data that are population based (likely dominated by situational couple violence) and agency based (likely dominated by intimate terrorism). The CWHRS data were chosen for the current analyses because they represent both of these sampling frames—women seeking routine medical treatment unrelated to violence and women seeking trauma and emergency services for violencerelated injuries likely caused by intimate terrorism. We recognize that although these data are relatively dated and that more recent data might yield slightly different findings, they include the necessary information to adequately answer the research questions. Third, physical violence severity, as measured by The Physical Violence Scale, was the sum of eight different physical violence acts experienced by the respondent. While more severe physical violence is presumably associated with using a wide range of violent acts against a partner, it is also possible that a woman who is subjected to one


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type of violence frequently and severely would score lower on this measure than a woman who experiences several different types of violence less frequently and/or less severely. Finally, the current study used a cluster analysis to create the Intimate Terrorism and Situational Couple Violence groups. Cluster analysis is a data-driven, partitioning technique that groups a collection of people into distinct categories; it is possible that different clusters may emerge with different data. Nonetheless, the fact that the Intimate Terrorism group affirmed all five of the coercive control items whereas the Situational Couple Violence group did not, that the difference between groups for each item was statistically significant (see Table 1), and that the two groups differed on all six measures pertaining to physical violence and its consequences (see Table 2) suggests an inherent difference between groups. More recent research pertaining to this typology has relied on a similar cutoff to define violence types (see Johnson, Leone, & Xu, 2008). Despite limitations, the differences in formal help-seeking decisions between intimate terrorism and situational couple violence victims are dramatic and reflect differences in physical and psychological consequences for victims. Distinguishing between types of violence based on the element of coercive control allows for a more focused assessment of victims’ needs, their perceptions of dangerousness, and their evaluations of their individual situations. As suggested here, some intimate terrorism victims may choose not to follow the dominant cultural script to seek help after a violent incident—due largely to deficiencies in institutional support, their own concern for the effectiveness of help sources in protecting them, and in some cases being prevented by the violent partner. We need to reconsider the language that we use to describe victim behavior so that it more adequately reflects the context of the women’s lives and experiences. In many cases, regardless of the type of violence that women experience, their choices about where to go for help reflect their own thought processes, their assessment of danger, and their perceived needs. In many cases, women’s help-seeking decisions reflect their own personal agency and needs rather than potential “barriers” to help sources. For many women not seeking formal help means keeping themselves and possibly their children safe. 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) received no financial support for the research, authorship, and/or publication of this article.


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Author Biographies Janel M. Leone is an assistant professor of Law and Society at The Sage Colleges in Albany, New York. Her research focuses on the intersections between intimate partner victimization and race, class, and gender by exploring victims’ physical and psychological health, perceived social support and coping, and use of the criminal justice system. She earned a BA in sociology from Franklin and Marshall College and a PhD in human development and family studies with a minor in women’s studies from the Pennsylvania State University. Megan E. Lape is a research and evaluation consultant and adjunct instructor at Syracuse University, New York. Her research focuses on emerging adulthood, substance use, parent child relationships, race, class, gender, and resiliency. She earned a BA in psychology from the State University of New York and a PhD in child and family studies from Syracuse University. Yili Xu is a doctoral candidate in the Department of Child and Family Studies at Syracuse University, New York. Her research interests are in the areas of parent and child relationships. She earned an MS in child and family studies from Syracuse University.


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