Category Archives: Trauma

Connecting the Dots: An Overview of the Links of Multiple Forms of Violence

The following is a summary of Connecting the Dots: An Overview of the Links of Multiple Forms of Violence (Center for Disease Control, 2014). The aim of the report is, firstly, to highlight the often overlooked connections between various forms of violence including child abuse, intimate partner violence, bullying, and community violence. The report goes on to urge service providers to break down the walls that currently exist between specialized fields in order to more adequately address the harms created by violent behavior and to prevent continued perpetuation.

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“Professionally we have silos, and we operate in these silos we’ve got to break down. Across the country, people working to prevent child abuse are right across the hall from people working on violence against women, and they don’t work together. As we go into communities to bring everybody to the table, don’t let people say, ‘I work on child abuse, but this is about gang violence.’ Don’t let people say, ‘I work on violence against women, and this is about child abuse.’ This thing, all this violence, is connected.” -Deborah Prothrow-Stith, MD, Adjunct Professor, Harvard School of Public Health

Risk Factors and Protective Factors

Violent behavior is incredibly complex and is influenced by a myriad of risk factors–the things that put an individual at greater risk for experiencing and perpetrating violence–and protective factors–things that increase resiliency and decrease the likelihood that someone will engage in or be victim to violence. The CDC has identified the following risk and protective factors with regards to violent behavior:

Examples of risk factors are: rigid social beliefs about what is “masculine” and “feminine,” lack of job opportunities, and family conflict

Examples of protective factors are: connection to a caring adult or access to mental health services

The Impact of Violence on Development

-Children who grow up in safe and nurturing environments “learn empathy, impulse control, anger management and problem-solving—all skills that protect against violence”
-Children who grow up in persistently violent, unstable, and/or unsafe environments often interpret situations to be threatening and are more likely to respond violently (fight) or to avoid the situation together (flee)
-These responses, termed fight-or-flight, “are survival skills that people are born with and often override other skills that enable non-violent conflict resolution, such as impulse control, empathy, anger management, and problem-solving skills”

Community Context and the Co-Occurrence of Multiple Forms of Violence

-Low social cohesion within communities and lack of economic opportunities are associated with higher rates of intimate partner violence, child abuse and maltreatment, and youth violence
-Individuals who lack adequate support from friends, family members, or neighbors, have been found to perpetrate partner abuse, child maltreatment, and/or elder abuse at rates higher than their more socially integrated counterparts
-Witnessing community violence is a risk factor for being bullied and for perpetrating sexual violence
-Access to mental health and substance abuse services in addition to coordination of resources and services across community agencies increases communities’ resiliency to violence

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Young men can end the cycle of domestic violence

This short film explores the intergenerational transmission of domestic abuse and what a group of young men are doing to break the cycle of violence that has impacted their own lives.

Shame and Batterer Intervention

Shame is a highly complex and potentially dangerous human emotion often associated with intolerable feelings of humiliation, disgrace, and embarrassment (Mills, 2008). In contrast to guilt which focuses on behavior, shame refers to a particular state of emotionality where an individual’s entire sense of self is targeted for critique (Tangney, 1996 cited in Kivisto et al. 2011).

Understanding this difference is hugely important to the study of violent and aggressive behavior–and thus to the field of domestic violence–primarily because of the differential impact guilt and shame are thought to have on the promotion of violent behavior. Whereas guilt has been found to deter aggression, both towards ourselves and against others, shame tends to promote anger and violence (Tangney, 1996, cited in Kivisto et al. 2011). Shame is experienced as such an intensely painful emotion that it is suppressed at all costs. It eventually and inevitably erupts though, displaying itself in harmful behaviors that can include self-mutilation, substance abuse, and suicidal ideation (Mills, 2008). Shame can also result in the externalization of this pain, manifesting in violence directed at other people (Mills, 2008; Gilligan, 1999).

This fact holds particular relevance for the domestic violence field. Specifically, research on the link between shame and aggression provides often overlooked insight into the etiology of partner violence in addition to shedding light on why traditional models of intervention and treatment–exemplified by Duluth-style programs–have failed to break the cycle of violence and keep victims safe.

Shame and Partner Violence

It is well established that one of the single greatest predictors for the perpetuation of partner violence is having witnessed physical aggression between parents in one’s family of origin. Dutton, van Ginkel, and Starzomski (1995, cited in Kivisto et al. 2011) found however, that when parental physical violence was controlled for, shaming experiences were more strongly correlated with adult perpetuation of partner violence. To be sure, direct shaming of children can co-occur with parental physical violence, and further, physical violence against children is shame-inducing in that such experiences communicate to children that they are unloveable (Gilligan, 1999). The importance of Dutton and colleagues findings however underscore the powerful and potentially dangerous role of shame in the promotion of violent acting out.

Taken together, findings such as these highlight the powerful effect that shame has on the developing child’s personality and on the likelihood of adult perpetration of aggressive and physical forms of partner violence: “Early shaming experiences contribute to the formation of the ‘abusive personality’, characterized by high levels of chronic anger and an attributional style of externalizing blame, and parental physical abusiveness provides the modeling of behaviors to express anger characteristic of this type of personality”.

Unfortunately, advocates and professionals working in the domestic violence field have strongly resisted the inclusion of psychological factors in theories of causation (Corvo & Johnson, 2003). The traditional paradigm favors instead, an ideologically based explanation that conceptualizes partner violence as culturally sanctioned behavior, deployed consciously and strategically by men against their female partners, in order to exert their (men’s) perceived right to power and control (Corvo & Johnson, 2003). Attempts to expand the etiological parameters established by feminist discourse in the field are dismissed as making excuses for a perpetrator’s violent behavior or worse, as victim-blaming. Critics of this rigid framework contend however, that seeking to understand why someone behaves the way they do hardly justifies the bad behavior. In the end, disrupting the cycle of violence is only possible to the extent that we accurately identify the root causes of such behavior.

To date, the ideological stranglehold that posits a singular theory of causation for domestic violence has prevented the development of more accurate and precise etiological theories; stunted scientific inquiry into more effective interventions and treatment models; and given birth to federal and state policies which rely almost exclusively on punitive, criminal justice-based responses to domestic violence. In spite of a growing body of research which challenges the efficacy and safety of Duluth-style programs, it remains the treatment of choice for domestically violent individuals (Corvo & Johnson, 2003).

Implications for Treatment

If early experiences of direct shaming put children at risk for adult perpetration of partner violence, then it is no wonder that current interventions have have failed to meaningfully address abusive behavior. Besides failing to target the root cause(s) of violent behavior, interventions that rely on punitive, anti-therapeutic responses can be seen as shame inducing themselves and thus might contribute to continued incidents of partner abuse. Corvo and Johnson (2003) contend for example that much of our legal, clinical, and social responses are rooted in the ‘vilification of the batterer’: “The popular, policy, and ‘scientific’ designation of perpetrators of partner violence as being appropriate targets for dismissive, degrading, and stereotypical characterizations”. Such a response is likely to activate the perpetrators trauma history and could reinforce, rather than uproot, maladaptive behaviors.

Advocates who ascribe to the Duluth Model assert that if domestic violence perpetrators could just unlearn their patriarchal socialization, they could stop being abusive. The above cited research indicates that partner violence is far more complicated than that though, often–although not always–having roots in a abusers own long and painful history of victimization.

This is not to say that we should adopt a universal policy of addressing partner violence solely through a psychological lens. We should however, investigate and develop theories of causation that identify all of the social, psychological, and biological factors that potentially contribute to partner violence. Interventions should be tailored to the unique needs of each victim and perpetrator rather than the one size fits all approach of Duluth-style programs. Finally, professionals in the field must resist conceptualizations of perpetrators as treatment resistant villains who are undeserving of help and should utilize intervention models that are responsive, holistic, and that affirm the humanity of all those involved in the treatment process.

How childhood trauma affects health across a lifetime

Pediatrician Nadine Burke Harris discusses the detrimental impact of traumatic childhood experiences on physical and mental health outcomes across the lifespan. Harris ardently calls on healthcare professionals to take seriously the treatment of prevention of trauma:

“The science is clear: Early adversity dramatically affects health across a lifetime. Today, we are beginning to understand how to interrupt the progression from early adversity to disease and early death, and 30 years from now, the child who has a high ACE score and whose behavioral symptoms go unrecognized, whose asthma management is not connected, and who goes on to develop high blood pressure and early heart disease or cancer will be just as anomalous as a six-month mortality from HIV/AIDS”