Intimate Partner Violence in the United States — 2010

National Center for Injury Prevention and Control Division of Violence Prevention Intimate Partner Violence in the United States — 2010 is a publication of the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention

Centers for Disease Control and Prevention Thomas Frieden, MD, MPH, Director

National Center for Injury Prevention and Control Daniel Sosin, MD, MPH, FACP, Acting Director

Division of Violence Prevention Howard Spivak, MD, Director

Suggested Citation: Breiding, M.J., Chen J., & Black, M.C. (2014). Intimate Partner Violence in the United States — 2010. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Intimate Partner Violence in the United States — 2010

February 2014

National Center for Injury Prevention and Control Centers for Disease Control and Prevention Atlanta, Georgia ii The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

TABLE OF CONTENTS

Tables and Figures...... iv Acknowledgments...... vi Executive Summary...... 1 Key findings...... 1 Implications for prevention...... 4

1 . Background and Methods ...... 7 Methods...... 8 Survey instrument...... 8 Survey administration...... 9 Statistical testing and inference ...... 9 Additional methodological information ...... 10

2 . Prevalence and Frequency of Individual Forms of Intimate Partner Violence. . . . .13 Sexual violence by an intimate partner ...... 13 Physical violence by an intimate partner...... 15 Stalking by an intimate partner...... 17 Psychological aggression by an intimate partner...... 19 Control of reproductive or sexual health by an intimate partner...... 22 Overlap of rape, physical violence, and stalking across relationships in lifetime reports of violence by an intimate partner...... 22

3 . Prevalence of Intimate Partner Violence by Sociodemographic Characteristics. . . . 27 Prevalence of rape, physical violence, or stalking by an intimate partner by race/ethnicity...... 27 Lifetime prevalence of rape, physical violence, or stalking by an intimate partner by sexual orientation...... 30 Twelve-month prevalence of intimate partner rape, physical violence, or stalking by current household income...... 31 Twelve-month prevalence of intimate partner rape, physical violence, or stalking by age at time of survey...... 33 Twelve-month prevalence of intimate partner rape, physical violence, or stalking by experiences of food and housing insecurity...... 34 Prevalence of rape, physical violence, or stalking by an intimate partner among U.S. natives and foreign-born residents...... 35

4 . Impact of Intimate Partner Violence...... 37 Lifetime prevalence of rape, physical violence, or stalking by an intimate partner with IPV-related impact...... 37 Distribution of IPV-related impacts among lifetime victims of rape, physical violence, or stalking by an intimate partner...... 39 Lifetime prevalence of rape, physical violence, or stalking by an intimate partner with physical injury . . 40 Distribution of physical injury types among lifetime victims of rape, physical violence, or stalking by an intimate partner...... 41 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 iii

5 . Accumulation of Intimate Partner Violence Behaviors Experienced by Individual Perpetrators ...... 43 Maximum number of sexually violent behaviors experienced in an individual relationship ...... 43 Maximum number of physically violent behaviors experienced in an individual relationship ...... 45 Maximum number of stalking behaviors experienced in an individual relationship ...... 46 Maximum number of psychologically aggressive behaviors experienced in an individual relationship ...47 Maximum number of IPV-related impacts experienced in an individual relationship ...... 48 Overlap of rape, physical violence, and stalking within relationships in lifetime reports of violence by an intimate partner ...... 49

6 . Characteristics of Intimate Partner Violence Victimization ...... 51 Number of perpetrators in lifetime reports of violence by an intimate partner ...... 51 Sex of perpetrator among victims of rape, physical violence, or stalking by an intimate partner ...... 51 Age at the time of first IPV experience among those who experienced rape, physical violence, or stalking by an intimate partner ...... 51

7 . Services and Disclosure Related to Intimate Partner Violence Victimization . . . . 55 Services needed among lifetime victims of rape, physical violence, or stalking by an intimate partner ...... 55 Services received among victims who needed services ...... 56 Disclosure among lifetime victims of rape, physical violence, or stalking by an intimate partner ...... 57 Degree of helpfulness of disclosure among those who disclosed lifetime rape, physical violence, or stalking by an intimate partner ...... 58

8 . Physical and Mental Health Conditions by Victimization History ...... 61 9 . Discussion ...... 65 Highlights and cross-cutting findings ...... 65 Limitations ...... 68

10 . Implications for Prevention ...... 73 Primary prevention ...... 73 Secondary and tertiary prevention ...... 74 Conclusion ...... 75

References ...... 77

Appendix A: Violence Victimization and Other Domains Assessed ...... 81 Violence domains ...... 81 Other domains assessed ...... 82 Appendix B: Victimization Questions ...... 85 iv The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

TABLES AND FIGURES Section 2 Prevalence and Frequency of Individual Forms of Intimate Partner Violence Table 2.1 Lifetime Prevalence of Sexual Violence by an Intimate Partner — U.S. Women and Men, NISVS 2010...... 13 Table 2.2 Twelve-month Prevalence of Sexual Violence by an Intimate Partner — U.S. Women and Men, NISVS 2010...... 14 Figure 2.1 Lifetime Prevalence of Physical Violence by an Intimate Partner — U.S. Women and Men, NISVS 2010...... 15 Figure 2.2 Twelve-month Prevalence of Physical Violence by an Intimate Partner — U.S. Women and Men, NISVS 2010...... 16 Figure 2.3 Number of Times Individual Physically Violent Behaviors Were Experienced among Victims of Physical Violence by an Intimate Partner, by Sex — NISVS 2010 . . . . .17 Table 2.3 Lifetime and 12-month Prevalence of Stalking by an Intimate Partner — U.S. Women and Men, NISVS 2010...... 17 Figure 2.4 Lifetime Reports of Stalking by an Intimate Partner among Victims by Type of Tactic Experienced — NISVS 2010...... 18 Figure 2.5 Lifetime Prevalence of Psychological Aggression by an Intimate Partner — U.S. Women and Men, NISVS 2010...... 19 Figure 2.6 Twelve-month Prevalence of Psychological Aggression by an Intimate Partner — U.S. Women and Men, NISVS 2010...... 21 Figure 2.7 Number of Times Individual Psychologically Aggressive Behaviors Were Experienced among Victims of Psychological Aggression by an Intimate Partner, by Sex — NISVS 2010. . . . .23 Figure 2.8 Overlap of Lifetime Intimate Partner Rape, Physical Violence, or Stalking among Women — NISVS 2010...... 24 Figure 2.9 Overlap of Lifetime Intimate Partner Rape, Physical Violence, or Stalking among Men — NISVS 2010...... 24

Section 3 Prevalence of Intimate Partner Violence by Sociodemographic Characteristics Table 3.1 Lifetime Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Race/Ethnicity — U.S. Women, NISVS 2010...... 28 Table 3.2 Lifetime Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Race/Ethnicity — U.S. Men, NISVS 2010...... 29 Table 3.3 Twelve-month Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Race/Ethnicity — U.S. Women and Men, NISVS 2010...... 30 Table 3.4 Lifetime Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Sexual Orientation — U.S. Women, NISVS 2010...... 31 Table 3.5 Lifetime Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Sexual Orientation — U.S. Men, NISVS 2010...... 32 Table 3.6 Twelve-month Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Current Household Income — U.S. Women and Men, NISVS 2010...... 32 Table 3.7 Twelve-month Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Age at Time of Survey — U.S. Women and Men, NISVS 2010 ...... 33 Table 3.8 Twelve-month Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Experiences of Food and Housing Insecurity within the 12 months Prior to Taking the Survey — U.S. Women and Men, NISVS 2010...... 34 Table 3.9 Lifetime and 12-month Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, U.S. Natives and Foreign-Born — U.S. Women and Men, NISVS 2010 ...... 35 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 v

Section 4 Impact of Intimate Partner Violence Figure 4.1 Lifetime Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner with IPV-related Impact — U.S. Women and Men, NISVS 2010 ...... 38 Figure 4.2 Distribution of IPV-related Impacts among Victims of Rape, Physical Violence, or Stalking by an Intimate Partner, by Sex — NISVS 2010 ...... 39 Table 4.1 Lifetime Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner with Specific IPV-related Injuries — U.S. Women and Men, NISVS 2010 ...... 40 Figure 4.3 Distribution of Specific IPV-related Injuries Experienced among Female and Male Victims of Rape, Physical Violence, or Stalking by an Intimate Partner — NISVS 2010 ...... 41

Section 5 Accumulation of Intimate Partner Violence Behaviors Experienced by Individual Perpetrators Figure 5.1 Distribution of the Number of Discrete Sexually Violent Behaviors Experienced by Victims, Maximum Number by an Individual Perpetrator — NISVS 2010 ...... 44 Figure 5.2 Distribution of the Number of Discrete Physically Violent Behaviors Experienced by Victims, Maximum Number by an Individual Perpetrator — NISVS 2010...... 45 Figure 5.3 Distribution of the Number of Discrete Stalking Behaviors Experienced by Victims, Maximum Number by an Individual Perpetrator — NISVS 2010 ...... 46 Figure 5.4 Distribution of the Number of Discrete Psychologically Aggressive Behaviors Experienced by Victims, Maximum Number by an Individual Perpetrator — NISVS 2010 ...... 47 Figure 5.5 Distribution of the Number of Discrete IPV-related Impacts by Victims, Maximum Number by an Individual Perpetrator — NISVS 2010 ...... 48 Table 5.1 Lifetime Prevalence of Overlapping Forms of Rape, Physical Violence, or Stalking by an Individual Perpetrator — U.S. Women and Men, NISVS 2010 ...... 49

Section 6 Characteristics of Intimate Partner Violence Victimization Figure 6.1 Number of Perpetrators among those Who Experienced Rape, Physical Violence, or Stalking by an Intimate Partner — NISVS 2010 ...... 51 Figure 6.2 Age at Time of First IPV among Female Victims of Rape, Physical Violence, or Stalking by an Intimate Partner — NISVS 2010 ...... 52 Figure 6.3 Age at Time of First IPV among Male Victims of Rape, Physical Violence, or Stalking by an Intimate Partner — NISVS 2010 ...... 52

Section 7 Services and Disclosure Related to Intimate Partner Violence Victimization Figure 7.1 Services Needed among Lifetime Victims of Rape, Physical Violence, or Stalking by an Intimate Partner, by Sex — NISVS 2010...... 55 Table 7.1 Proportion of Female Lifetime Victims of Rape, Physical Violence, or Stalking by an Intimate Partner Who Received Needed Services — NISVS 2010 ...... 56 Figure 7.2 Disclosure among Lifetime Victims of Rape, Physical Violence, or Stalking by an Intimate Partner, by Sex — NISVS 2010...... 57 Table 7.2 Degree of Helpfulness of Various Sources among those Who Disclosed Lifetime Rape, Physical Violence, or Stalking by an Intimate Partner — NISVS 2010 ...... 59

Section 8 Physical and Mental Health Conditions by Victimization History Table 8.1 Prevalence of Physical and Mental Health Conditions among those with and without a History of Rape, Physical Violence, or Stalking by an Intimate Partner — U.S. Women and Men, NISVS 2010 ...... 62 Table 8.2 Association between Physical and Mental Health Conditions and the Experience of Rape, Physical Violence, or Stalking by an Intimate Partner — U.S. Women and Men, NISVS 2010 .....63 vi The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Acknowledgments

We would like to acknowledge the following individuals who contributed to the development and support of this report: Kathleen Basile, Linda Dahlberg, Alex Crosby, Faye Floyd, Leroy Frazier, Jeff Hall, E. Lynn Jenkins, Melissa Merrick, Nimesh Patel, Sharon Smith, Margie Walling, Mikel Walters, Paula Orlosky Williams, and RTI International. Finally, we would like to acknowledge Mark Stevens for his significant contribution in providing statistical support for this report.

Recognition is given to the team of people that substantially contributed to the original development of the National Intimate Partner and Sexual Violence Survey, including: Kathleen Basile, Michele Black, Matthew Breiding, James Mercy, Linda Saltzman, and Sharon Smith (contributors listed in alphabetical order). The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 1

EXECUTIVE SUMMARY

Intimate partner violence (IPV) is a that increase the risk of HIV, and which is a measure of an estimate’s significant public health problem. endorse other unhealthy behaviors reliability, was calculated for all IPV includes physical violence, (Breiding, Black, & Ryan, 2008; estimates in this report. If the RSE sexual violence, stalking, and Coker et al., 2002). was greater than 30%, the estimate psychological aggression (including was deemed unreliable and is coercive tactics) by a current or Findings in this report are based not reported. Consideration was former intimate partner. In addition on data from the National Intimate also given to the case count. If the to the immediate impact, IPV has Partner and Sexual Violence Survey estimate was based on a numerator lifelong consequences. A number (NISVS). NISVS is an ongoing, < 20, the estimate is also not of studies have shown that beyond nationally representative, random reported. Estimates for certain types injury and death, victims of IPV digit dial telephone survey of violence reported by subgroups are more likely to report a range that collects information about are not shown because the number of acute and chronic mental and experiences of intimate partner of people reporting a specific type physical health conditions (Black, violence, sexual violence, and of victimization was too few to 2011; Coker, Smith, & Fadden, stalking from non-institutionalized calculate a reliable estimate. These 2005; Coker, Davis, Arias, Desai, English- and/or Spanish-speaking non-reportable estimates are noted Sanderson, Brandt, & Smith, 2002). women and men aged 18 or older in the report so the reader can easily Many survivors of these forms of in the United States. This report determine what was assessed and violence experience physical injury; provides findings from the 2010 data where gaps remain. depression, anxiety, low self-esteem, collection pertaining to intimate and suicide attempts; and other partner violence. Some of the key A detailed description of the health conditions such as gastro- topics covered in this report are: violence types measured, as well as intestinal disorders, substance • Overall lifetime and 12-month the verbatim violence victimization abuse, sexually transmitted diseases, prevalence of IPV victimization questions, are presented in the and gynecological or pregnancy • Prevalence of IPV victimization Appendices of the report. complications. These conditions by sociodemographic variables, can lead to hospitalization, such as race/ethnicity, sexual disability, or death. orientation, and income Key Findings During the past decade, our • Impact of IPV victimization Sexual Violence by an understanding of the biological • Characteristics of IPV victimization Intimate Partner response to acute and chronic such as number of lifetime • Nearly 1 in 10 women in the stress that links IPV with negative perpetrators, sex of perpetrator, United States (9.4%) has been health conditions has deepened and age at first IPV victimization raped by an intimate partner (Black, 2011; Crofford, 2007; • Services needed and disclosure in her lifetime, including Pico-Alfonso, Garcia-Linares, related to IPV victimization completed forced penetration, Celda-Navarro, Herbert, & Martinez, attempted forced penetration, 2004). Additionally, a number of or alcohol/drug facilitated The findings presented in this completed penetration. behavioral factors are likely to report are based on complete play a role in the link between IPV interviews from the NISVS survey. • Approximately 1 in 45 men and adverse health conditions, as Complete interviews were (2.2%) has been made to victims of IPV are more likely to obtained from 16,507 adults (9,086 penetrate an intimate partner smoke, engage in heavy/binge women and 7,421 men) in 2010. during his lifetime. drinking, engage in behaviors The relative standard error (RSE), 2 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

• An estimated 16.9% of women an intimate partner in the lifetime prevalence of rape, and 8.0% of men have experienced 12 months preceding the physical violence, or stalking sexual violence other than rape survey than women (18.1% compared to White non-Hispanic (being made to penetrate an and 13.9%, respectively). men (28.2%). intimate partner, sexual coercion, unwanted sexual contact, and Overlap of Rape, Physical Rape, Physical Violence, non-contact unwanted sexual Violence, and Stalking or Stalking by an Intimate experiences) by an intimate • Among those who experienced Partner, by Sexual Orientation partner in their lifetime. rape, physical violence, or stalking • Bisexual women had a significantly by an intimate partner in their higher prevalence of lifetime Physical Violence by an lifetime, male victims (92.1%) rape, physical violence, or Intimate Partner were significantly more likely stalking by an intimate partner • Women and men experienced than female victims (56.8%) to (61.1%) compared to lesbian many types of physical violence experience physical violence only. women (43.8%) and heterosexual ranging from being slapped • Among male victims, 6.3% women (35.0%). to having a knife or gun used experienced both physical • The lifetime prevalence of rape, against them. violence and stalking in their physical violence, or stalking by • Women had a significantly higher lifetime; too few men reported an intimate partner was 29.0% lifetime prevalence of severe other combinations of rape, among heterosexual men, 37.3% physical violence by an intimate physical violence, and stalking to among bisexual men, and 26.0% partner (24.3%) compared to produce reliable estimates. among gay men. men (13.8%). • Among female victims, 14.4% • Approximately 2.7% of women experienced physical violence Rape, Physical Violence, and 2.0% of men experienced and stalking; 8.7% experienced or Stalking by an Intimate severe physical violence in the both rape and physical violence; Partner by Food and 12 months preceding the survey. 12.5% experienced rape, physical Housing Insecurity violence, and stalking. • Women and men who Stalking by an Intimate Partner experienced food insecurity • Women had a significantly higher Rape, Physical Violence, in the past 12 months (11.6% lifetime prevalence of stalking or Stalking by an Intimate and 8.2%, respectively) had a by an intimate partner (10.7%) Partner, by Race/Ethnicity significantly higher 12-month compared to men (2.1%). • Black non-Hispanic women prevalence of rape, physical violence, or stalking by an • Women had a significantly higher (43.7%) and multiracial non- intimate partner compared to 12-month prevalence of stalking Hispanic women (53.8%) had women and men who did not by an intimate partner (2.8%) a significantly higher lifetime experience food insecurity (3.2% compared to men (0.5%). prevalence of rape, physical violence, or stalking by an and 4.0%, respectively). intimate partner, compared to • Women and men who Psychological Aggression White non-Hispanic women experienced housing insecurity by an Intimate Partner (34.6%); Asian or Pacific in the past 12 months (10.0% • Nearly half of U.S. women Islander non-Hispanic women and 7.9%, respectively) had a (48.4%) and half of U.S. men (19.6%) had significantly lower significantly higher 12-month (48.8%) have experienced at least prevalence than White non- prevalence of rape, physical one psychologically aggressive Hispanic women. violence, or stalking by an behavior by an intimate partner intimate partner compared to during their lifetime. • American Indian or Alaska Native non-Hispanic men (45.3%), Black women and men who did not • Men had a significantly higher non-Hispanic men (38.6%), and experience housing insecurity prevalence of experiencing multiracial non-Hispanic men (2.3% and 3.1%, respectively). psychological aggression from (39.3%) had a significantly higher The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 3

Impact of Violence by an • Among victims of psychological who reported that they always Intimate Partner aggression by an intimate received those services (49.0%). • Women were significantly more partner, the proportion of female • Less than 50% of women who likely than men to experience victims that experienced more needed housing or victim’s rape, physical violence, or than the median number (four or advocate services during their stalking by an intimate partner more) of unique psychologically lifetime received them. and report at least one impact aggressive behaviors by an • Among victims of rape, physical related to experiencing these individual intimate partner was violence, or stalking by an or other forms of violent higher than the proportion of intimate partner, the proportion behavior in the relationship (e.g., male victims. that disclosed their victimization psychological aggression, being to someone was higher among made to penetrate someone else, Age at the Time of First women (84.2%) than among sexual coercion). IPV Victimization men (60.9%). The proportion of • Female victims of rape, physical • Among those who ever men that described disclosure as violence, or stalking were experienced rape, physical “very helpful” was significantly significantly more likely than violence, or stalking by an lower than the proportion of male victims to experience intimate partner, more than women that described disclosure each of the IPV-related impacts 1 in 5 female victims (22.4%) as “very helpful” for the following measured including fear, concern and more than 1 in 7 male victims sources of disclosure: police, for safety, need for medical care, (15.0%) experienced some form psychologists/counselors, injury, need for housing services, of intimate partner violence for friends, and family members. and having missed at least one the first time between the ages • Among victims of lifetime rape, day of work or school. of 11 and 17 years. physical violence, or stalking • 47.1% of female victims and by an intimate partner, 21.1% Maximum Number of Violent 38.6% of male victims were of female victims and 5.6% of Behaviors Experienced in an between 18 and 24 years of age male victims disclosed their Individual Relationship when they first experienced victimization to a doctor or nurse. • Among victims of sexual violence violence by an intimate partner. by an intimate partner, the Health Conditions proportion of female victims Need for Services, Disclosure • Men and women with a lifetime that experienced more than the • Female victims of rape, physical history of rape, physical violence, median number (two or more) of violence, or stalking were or stalking by an intimate partner unique sexually violent behaviors significantly more likely than were more likely to report by an individual intimate partner male victims to report a need frequent headaches, chronic was higher than the proportion for services at some point pain, difficulty sleeping, activity of male victims. during their lifetime due to their limitations, and poor physical • Among victims of physical experience with IPV (36.4% and health in general compared to violence by an intimate partner, 15.6%, respectively). those without a history of these the proportion of female victims • Among victims of rape, physical forms of IPV. Women who have that experienced more than the violence, or stalking who experienced these forms of median number (three or more) reported a need for services violence were also more likely of unique physically violent at some point during their to report asthma, irritable bowel behaviors by an individual lifetime, the proportion of men syndrome, diabetes, and poor intimate partner was higher than who reported that they always mental health compared to the proportion of male victims. received those services (33.0%) women who did not experience was significantly lower than the these forms of violence. proportion of female victims 4 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Implications for This report identified groups that violence. While much is known are at most risk for IPV victimization. about risks factors at the individual Prevention While primary prevention programs and couple level, there have been Centers for Disease Control and exist, it is unknown whether they few studies examining community Prevention's (CDC’s) key focus on are effective within specific groups and societal-level factors related preventing IPV is the promotion of of people, particularly among those to perpetration of IPV. As risk respectful, nonviolent relationships identified in this report as being and protective factors for IPV through individual, relationship, most at risk. Further work needs to perpetration are better understood, community, and societal change. be done to adapt and test existing additional research is needed to This strategy is focused on strategies for specific groups as well develop and evaluate strategies to principles such as identifying ways as develop and test other strategies effectively prevent the first-time to interrupt the development of IPV to determine whether they are perpetration of IPV. This includes perpetration; better understanding effective in preventing IPV. research that addresses the social the factors that contribute to and economic conditions such as respectful relationships and protect Positive and healthy parent- poverty, sexism, and other forms of against IPV; creating and evaluating child relationships can provide discrimination and social exclusion new approaches to prevention; the foundation for the primary that increase risk for perpetration and building community capacity prevention of IPV. Children benefit and victimization. Such research to implement strategies that from safe, stable, and nurturing will complement efforts focused on are based on the best available familial environments that preventing initial victimization and evidence. Community capacity can facilitate respectful interactions the recurrence of victimization. be enhanced by building upon and and open communication. Other joining well-organized, broad-based opportunities to build parent-child Beyond primary prevention, coalitions that effectively create relationships include programs to secondary and tertiary prevention change in communities. promote effective parenting skills programs are essential for and efforts to include and support mitigating the short- and long-term The principal focus of CDC is relationships between fathers and consequences of IPV among primary prevention, prioritizing the children. Beyond providing children victims, as well as reducing the prevention of public health burdens, an opportunity to share with their violence-related health burden such as IPV, from occurring in the parents the experiences they have across the life span. This report first place. This report suggests had with dating violence and other examined a range of services that IPV victimization begins at forms of violence, parents who that victims reported needing as an early age with nearly 70% of model healthy, respectful intimate a result of IPV at some point in female victims and nearly 54% of relationships free from violence their lifetime and whether they male victims having experienced foster these relationship patterns received them, including medical IPV prior to age 25. This suggests in their children. care, housing, victim’s advocacy, that primary prevention of IPV legal and community services. The must begin at an early age. CDC’s The focus of this report is on vast majority of women who were approach to primary prevention describing the public health burden victims of IPV indicated that they of IPV is the promotion of healthy of victimization. In order to better needed medical services; nearly half relationship behaviors among understand how to prevent partner needed housing, victim’s advocacy, young people, with the goal of violence, CDC also supports work and community services; and a third reaching adolescents prior to their that seeks to better understand needed legal services. Among the first relationships. By influencing the causes of IPV perpetration. female victims who needed at least relationship behaviors and patterns Research examining risk and one of these services at some point early through dating violence protective factors is important for during their lifetime, less than half prevention programs, it is possible understanding how perpetration indicated that they received any to promote healthy relationship of violence develops and to of the needed services. Among the behaviors and patterns that can be determine the optimal strategies male victims who needed at least carried forward into adulthood. for preventing intimate partner one of these services, two-thirds The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 5

stated that they did not receive health burden of IPV in the United any of the needed services. This States. While progress has been indicates that, across the lifetime made in understanding factors of the current U.S. adult population, that contribute to IPV and how to a significant gap exists between a prevent IPV from occurring, this need for services and the receipt report demonstrates that of those services. Future work is much more needs to be done to needed to understand the degree reduce the negative impact of to which this gap exists currently, IPV on women and men in the and whether an existing gap is due United States. to services being unavailable or because available services are not being utilized. Better understanding the barriers to service utilization is important.

Disclosing victimization experiences is a necessary first step for victims to be able to obtain the resources and services they need. One primary method by which IPV victims may disclose victimization and receive appropriate help is through disclosure to medical professionals. The results in this report suggest that a majority of male and female victims did not disclose their victimization to a health care professional. While 84.2% of female victims and 60.9% of male victims disclosed their IPV victimization to someone, only 21% of female victims and 5.6% of male victims reported having disclosed their victimization to a medical professional at some point in their lifetime. These findings suggest a need to better understand how to overcome the barriers that may prevent victims from disclosing to a medical professional and those barriers that may make some medical professionals feeling reticent to inquire about IPV victimization, even among those patients that shown signs of victimization. This report provides updated, detailed information describing the public 6 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 7

1: Background and Methods

Intimate partner violence (IPV) immune, and endocrine systems with IPV victimization is necessary includes physical violence, sexual (Black, 2011). to better inform intervention and violence, stalking, and psychological prevention efforts. aggression (including coercive The primary purpose of this tactics) by a current or former report is to describe the public To address the need for greater intimate partner. The violence health burden of IPV in the contextualization of prevalence may occur among cohabitating or United States and to provide estimates, this report examines the: noncohabitating romantic or sexual information about the context • Frequency of individual partners and among opposite or of victimization experiences. By IPV behaviors same-sex couples. IPV is a major context of victimization we are • Overlap of IPV violence types public health problem with serious referring to factors such as the • Impact of IPV victimization long-term physical and mental frequency, pattern, and impacts of health consequences, as well as the violence experienced. In recent • Experience of multiple forms of significant social and public health years, researchers have called for IPV within individual relationships costs (e.g., Breiding, Black, & Ryan, studies of IPV prevalence to better • Services needed as a result of 2008; Logan & Cole, 2007; Randall, examine and describe the context IPV victimization 1990). A number of studies have of victimization (Langinrichsen- shown that, beyond injury and Rohling, 2010; Houry, Rhodes, This report also provides a more death, victims of IPV are more likely Kemball, Click, Cerulli, McNutt, detailed and comprehensive to report a range of negative mental & Kaslow, 2008; Harned, 2001; examination of the burden of IPV and physical health conditions Kelly & Johnson, 2008). Moving in the United States relative to that are both acute and chronic beyond a focus upon whether a The National Intimate Partner and in nature (Black, 2011; Crofford, person has or has not experienced Sexual Violence Survey (NISVS): 2007; Pico-Alfonso, Garcia-Linares, IPV allows for a description of 2010 Summary Report (Black et al., Celda-Navarro, Herbert, & Martinez, the broad range of victimization 2011). This report presents findings 2004). For example, victims of IPV experiences. Prevalence estimates on the: are more likely to smoke, engage can encompass, but not fully • Prevalence of individual IPV in heavy/binge drinking, engage in describe, experiences ranging from behaviors behaviors that increase the risk of chronic, severe IPV to one-time, • Prevalence of IPV victimization HIV, and endorse other unhealthy less severe IPV victimization. The by sociodemographic variables, behaviors (Breiding, Black, & Ryan, call by IPV researchers for greater such as race/ethnicity, sexual 2008). Additionally, a number of context recognizes that the orientation, recent food and studies over the past decade have variation in motives, frequency, housing insecurity, and income improved our understanding of severity, chronicity, and impact, the biologic response to acute among other factors, cannot be • Characteristics of IPV victimization and chronic stress that links IPV fully represented by a dichotomous including the number of lifetime with negative health conditions prevalence estimate. In other words, perpetrators, sex of perpetrator, (Crofford, 2007; Pico-Alfonso et overall IPV prevalence estimates, and age at first IPV victimization al., 2004). Elevated health risks while providing useful information, • Associations between IPV have been observed in relation to are but one indicator of the public victimization and physical and multiple body systems including health burden of a complex and mental health conditions the nervous, cardiovascular, wide-ranging set of experiences. • Disclosure of IPV victimization gastrointestinal, genitourinary, An improved understanding of the reproductive, musculoskeletal, range of experiences associated 8 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Further, it includes confidence characteristics of respondents, landline telephone and 54.8% were intervals around prevalence demographic characteristics of conducted by cell phone. estimates, as well as statistical perpetrators (age, sex, race/ethnicity), testing comparing prevalence and detailed information about The overall weighted response between sociodemographic groups the patterns and impact of the rate for the 2010 National Intimate (e.g., sex, race/ethnicity, income violence by specific perpetrators. Partner and Sexual Violence Survey level) to inform prevention practice For example, NISVS: ranged from 27.5% to 33.6%. This by identifying populations at • Links each individual act range reflects differences in how greatest risk of IPV victimization. of violence with a specific the proportion of the unknowns perpetrator, enabling the that are eligible is estimated. collection of all forms of The weighted cooperation rate Methods violence committed by a specific was 81.3%. A primary difference perpetrator and allowing for between response and cooperation Data Source an examination of how different rates is that a percentage of Data for this report are from the forms of violence co-occur telephone numbers with unknown National Intimate Partner and Sexual across the life span and within household status are part of the Violence Survey (NISVS), which was individual relationships denominator in calculating a launched by the Centers for Disease • Collects information on a range response rate. The cooperation rate Control and Prevention's (CDC’s) of negative impacts (e.g., injury, reflects the proportion who agreed National Center for Injury Prevention absence from school or work, to participate in the interview and Control in 2010. NISVS is an need for medical care) resulting among those who were contacted ongoing, national random digit from experiences of violence by and determined to be eligible. The dial telephone survey of the individual perpetrators cooperation rate obtained for the non-institutionalized English- and/ 2010 NISVS data collection indicates • Gathers information from or Spanish-speaking U.S. population that once contact was made and respondents on a range of aged 18 or older. NISVS assesses a eligibility determined, the majority short- and long-term physical broad range of experiences related of respondents chose to participate and mental health conditions to sexual violence, stalking, and in the interview. intimate partner violence. It was that may be associated with the designed to provide national and experience of violence state level prevalence estimates Survey Instrument for lifetime victimization and NISVS uses a dual-frame sampling victimization in the 12 months strategy that includes both The median length of the interview prior to taking the survey. While landline and cell phones. was 24.7 minutes. The survey the current report is limited to NISVS began collecting data in included behaviorally specific violence perpetrated by an intimate January 2010 from 50 states and questions that assess intimate partner, the NISVS survey collects the District of Columbia. This report partner violence experiences related information about sexual violence is based on data that was gathered to sexual violence; physical violence; by any perpetrator, stalking by any from January 22, 2010, through stalking; psychological aggression perpetrator, physical violence by December 31, 2010. In 2010, a including expressive aggression and an intimate partner, psychological total of 18,049 interviews were coercive control; and control of repro- aggression by an intimate partner, conducted (9,970 women and ductive or sexual health. Questions and control of reproductive or sexual 8,079 men) in the U.S. general were asked in relation to violence health by an intimate partner. population. This includes 16,507 experienced over the lifetime and completed and 1,542 partially during the 12 months prior to the In addition to collecting lifetime completed interviews. A total interview. A description of the and 12-month prevalence data, of 9,086 women and 7,421 violence types measured is provided the survey collects information men completed the survey. in Appendix A. A list of the specific on the age at the time of the Approximately 45.2% of interviews violence victimization questions used first victimization, demographic were conducted by respondents' in the survey is in Appendix B. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 9

Survey Administration physically or emotionally unsafe. if the respondent completed Interviewers also checked in with the screening, demographic, Graduated Informed the respondents several times general health questions, and all Consent Process during the interview to make sure questions on all five sets of violence Following recommended guidelines they wanted to proceed. At the victimization, as applicable. The for sensitive study topics such as IPV end of the interview, respondents estimated number of victims (Sullivan & Cain, 2004; WHO, 2001), were provided telephone numbers affected by a particular form of a graduated informed consent for the National Domestic Violence violence was calculated based on protocol was used. Specifically, Hotline and the Rape, Abuse & U.S. population estimates from the to ensure respondent safety and Incest National Network. census projections by state, sex, confidentiality, the initial person age, and race/ethnicity (http://www. who answered the telephone was census.gov/popest/states/asrh/). provided general non-specific Statistical Testing information about the survey topic. Analyses were conducted stratified The specific topics of the survey and Inference by the sex of the respondent. (e.g., physical aggression, harassing Statistical inference for prevalence As prevalence and population behaviors, and unwanted sexual and population estimates estimates were based on a sample activity) were only revealed to the were made based on weighted population, there is a degree of individual respondent selected. analyses, where complex sample uncertainty associated with these After a single adult respondent in a design features, such as dual estimates. The smaller the sample household was randomly selected sampling frames, stratified upon which an estimate is based, to participate, the interviewer sampling, and unequal sample the less precise the estimate administered an International selection probabilities, were becomes and the more difficult Review Board (IRB)-approved taken into account. All analyses it is to distinguish the findings informed consent that provided were conducted using SUDAAN™ from what could have occurred information on the voluntary statistical software for analyzing by chance. The relative standard and confidential nature of the data collected through complex error (RSE) is a measure of an survey, the benefits and risks of sample design. estimate’s reliability. The RSE was participation, the survey topic, and calculated for all estimates in this telephone numbers to speak with Within categories of violence report. If the RSE was greater than staff from the CDC or project staff (e.g., any physical violence by an 30%, the estimate was deemed from the Research Triangle Institute, intimate partner, other sexual unreliable and was not reported. International (RTI) (contracted by violence by an intimate partner), Consideration also was given to the CDC to administer the survey). respondents who reported the case count. If the estimate more than one subcategory of was based on a numerator less Respondent Safety violence are included only once than or equal to 20, the estimate Interviewers were trained to in the summary estimate, but is also not reported. Tables where remind respondents that they are included in each relevant specific estimates are missing due could skip any question and could subcategory. The denominators to high RSEs or small case counts stop the interview at any time. in prevalence calculations include are presented in full with missing Interviewers also established a persons who answered a question unreliable estimates noted by an safety plan with the respondents or responded with don’t know or asterisk so that the reader can so that respondents would refused. Missing data (instances in clearly see what was assessed and know what to do if they needed which all questions for constructing where data gaps remain. to stop an interview for safety an outcome of interest were not reasons. Specifically, interviewers fully administered) were excluded Statistical significance testing was suggested that respondents answer from analyses. The estimates conducted comparing prevalence questions in a private setting presented in this report are based estimates of subgroups when both and instructed them to just say on complete interviews. An estimates met the reliability criteria. “goodbye” if at any time they felt interview is defined as “complete” A two-tailed t-test (alpha = .05) 10 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

was conducted to assess the interviewer recruitment, training, difference in prevalence between and monitoring; and sample two groups. A statistically distributions and demographic significant difference in prevalence characteristics (Black et al., 2011). was established between two estimates when p < .05. In addition, a number of health conditions were assessed in this survey and were examined with respect to lifetime rape, physical violence, or stalking by an intimate partner. Chi-square tests were conducted to examine the association between victimization and dichotomous health conditions, controlling for relevant sociodemographic variables and other forms of victimization measured by NISVS (rape and stalking by non-intimates). A p-value of .05 was set as the threshold for establishing statistical significance. Statistical analyses for this report were performed by statisticians from the CDC.

Additional Methodological Information The 2010 NISVS Summary Report provides additional methodological information related to the 2010 NISVS including features that distinguish NISVS from other national surveys; efforts to ensure data quality and respondent confidentiality; IRB and OMB approval; mid-year changes to the survey instrument; weighting procedures; response rate and cooperation rate formulas; sampling strategy; data quality assurance; survey development; cognitive testing of the survey instrument; advance letters sent to respondents; incentives to respondents for participation; The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 11 12 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 13

2: Prevalence and Frequency of Individual Forms of Intimate Partner Violence

Sexual Violence by facilitated penetration. Too few men reported rape by an intimate Nearly 1 in 10 women an Intimate Partner partner to produce reliable Lifetime Prevalence estimates for overall rape or in the U.S. has Nearly 1 in 10 women in the United individual types of rape. States (9.4% or approximately been raped by an 11.2 million) has been raped by Approximately 1 in 6 women intimate partner in an intimate partner in her lifetime (15.9% or nearly 19 million) and (Table 2.1). More specifically, 1 in 12 men in the United States her lifetime; 2.2% of 6.6% of women have experienced (8.0% or approximately 9 million), completed forced penetration have experienced sexual violence U.S. men have been by an intimate partner, 2.5% other than rape by an intimate made to penetrate have experienced attempted partner in their lifetime. Women forced penetration, and 3.4% had a significantly higher lifetime an intimate partner. have experienced alcohol/drug prevalence of sexual violence

Table 2 .1 Lifetime Prevalence of Sexual Violence by an Intimate Partner — U .S . Women and Men, NISVS 2010

Women Men Estimated Estimated Weighted % 95% CI Number of Weighted % 95% CI Number of Victims1 Victims1 Rape 9.4# 8.5 – 10.3 11,162,000 * Completed forced penetration 6.6# 5.9 – 7.4 7,859,000 * Attempted forced penetration 2.5# 2.1 – 3.0 2,975,000 * Completed alcohol/drug facilitated penetration 3.4# 2.9 – 4.0 4,098,000 * Other Sexual Violence 15.9† 14.8 – 17.1 18,973,000 8.0 7.1 – 9.0 9,050,000 Made to penetrate * 2.2# 1.7 – 2.7 2,442,000 Sexual coercion2 9.8† 8.9 – 10.8 11,681,000 4.2 3.5 – 5.0 4,744,000 Unwanted sexual contact3 6.4† 5.7 – 7.2 7,633,000 2.6 2.1 – 3.3 2,999,000 Non-contact unwanted sexual experiences4 7.8† 7.0 – 8.7 9,298,000 2.7 2.2 – 3.3 3,049,000 1 Rounded to the nearest thousand. 2 Pressured in a nonphysical way (includes, for example, threatening to end the relationship, using influence or authority). 3 Includes unwanted kissing in a sexual way, fondling, or grabbing sexual body parts. 4 Includes someone exposing their sexual body parts, flashing, or masturbating in front of the victim, someone making a victim show his or her body parts, someone making a victim look at or participate in sexual photos or movies, or someone harassing the victim in a public place in a way that made the victim feel unsafe. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. † Statistically significant difference (p < .05) in prevalence. # Formal statistical testing was not undertaken because the number experiencing these behaviors was too small to generate a reliable estimate for at least one of the comparison groups. 14 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

other than rape by an intimate Twelve-month Prevalence partner compared to men (p < .05). In the 12 months prior to taking Approximately 1 in 4 However, approximately 2.2% of the survey, 0.6% or an estimated women and nearly men have been made to penetrate 686,000 women in the United States an intimate partner at some point were raped by an intimate partner 1 in 7 men in the U.S. in their lifetime; too few women (Table 2.2). Too few men reported were made to penetrate an intimate rape by an intimate partner in the have experienced partner to produce a reliable 12 months prior to taking the survey severe physical estimate. The lifetime prevalence of to produce a reliable estimate. sexual coercion, unwanted sexual Also, 2.3% of women, and 2.5% violence by an intimate contact, and non-contact unwanted of men, experienced other forms sexual experiences by an intimate of sexual violence by an intimate partner at some point partner were all significantly higher partner in the 12 months prior to in their lifetime. for women than men (p < .05). the survey. Approximately 0.5% of men were made to penetrate an intimate partner in the 12 months

Table 2 .2 12-month Prevalence of Sexual Violence by an Intimate Partner — U S. . Women and Men, NISVS 2010

Women Men Estimated Estimated Weighted % 95% CI Number Weighted % 95% CI Number of Victims1 of Victims1 Rape 0.6# 0.4 – 0.9 686,000 * Completed forced penetration 0.4# 0.2 – 0.7 472,000 * Attempted forced penetration * * Completed alcohol/drug facilitated penetration * * Other Sexual Violence 2.3 1.9 – 2.8 2,747,000 2.5 2.0 – 3.1 2,793,000 Made to penetrate * 0.5# 0.3 – 0.9 586,000 Sexual coercion2 1.7† 1.3 – 2.1 1,978,000 1.0 0.7 – 1.4 1,143,000 Unwanted sexual contact3 0.5 0.4 – 0.8 645,000 0.9 0.6 – 1.4 1,031,000 Non-contact unwanted sexual experiences4 0.7 0.5 – 1.0 836,000 0.8 0.5 – 1.2 882,000 1 Rounded to the nearest thousand. 2 Pressured in a nonphysical way (includes, for example, threatening to end the relationship, using influence or authority). 3 Includes unwanted kissing in a sexual way, fondling, or grabbing sexual body parts. 4 Includes someone exposing their sexual body parts, flashing, or masturbating in front of the victim, someone making a victim show his or her body parts, someone making a victim look at or participate in sexual photos or movies, or someone harassing the victim in a public place in a way that made the victim feel unsafe. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. † Statistically significant difference (p < .05) in prevalence. # Formal statistical testing was not undertaken because the number experiencing these behaviors was too small to generate a reliable estimate for at least one of the comparison groups. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 15

preceding the survey, whereas too partner in their lifetime, compared with a fist or something hard; being few women were made to penetrate to 28.1% of men, a statistically kicked; being slammed against an intimate partner to produce a significant difference (p < .05) something; being hurt by choking reliable estimate. With the exception (Figure 2.1). Examining the or suffocating; being beaten; being of sexual coercion, where the prevalence of more severe burned on purpose; and having a 12-month estimate was significantly forms of physical violence, gun or knife used on them. higher for women than men (p < .05), 24.3% of women (or approximately none of the other estimates were 29 million) have experienced severe Approximately 1 in 3 women significantly different. physical violence by an intimate (30.4%) and 1 in 4 men (25.6%) in partner in their lifetime, compared the United States has been slapped, to 13.8% of men (approximately pushed, or shoved by an intimate Physical Violence by 15.6 million), also a statistically partner at some point in their significant difference (p < .05). lifetime. The lifetime prevalence an Intimate Partner Additionally, prevalence of the of being slapped, pushed, or Lifetime Prevalence following severe physically violent shoved by an intimate partner was Approximately 32.9% of women in behaviors were significantly higher significantly higher among women the United States have experienced (p < .05) for women than men: compared to men (p < .05). physical violence by an intimate being hurt by pulling hair; being hit

Figure 2 1. Lifetime Prevalence of Physical Violence by an Intimate Partner — U S. . Women and Men, NISVS 2010 32.9† Any physical violence 28.1 30.4† Slapped, pushed, or shoved 25.6 20.4† Slapped 18.3 27.5† Pushed or shoved 19.4 24.3† Any severe physical violence 13.8 10.4† Hurt by pulling hair 2.9 14.2† Hit with a fist or something hard 9.4 7.1† Kicked 4.3 Women 17.2† Slammed against something 2.7 Men 9.7† Tried to hurt by choking or suffocating 1.1 11.2† Beaten 2.6 1.1† Burned on purpose 0.6 4.6† Used a knife or gun 2.8 0 5 10 15 20 25 30 35 Percent

† Statistically significant difference (p < .05) in prevalence. 16 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Twelve-month Prevalence higher for women (p < .05). All other violent behaviors among victims The prevalence of physical violence comparisons that were conducted of physical violence by an intimate victimization by an intimate partner were not statistically significant. partner. The proportion experiencing in the 12 months prior to taking the the following behaviors 11 or more survey was 4.0% among women Frequency of Individual times was significantly higher (p < .05) compared to 4.7% among men Physically Violent Behaviors for female victims, in comparison (Figure 2.2). The prevalence of severe Respondents who reported that to male victims: slapped, pushed, physical violence victimization they had experienced a particular or shoved; hurt by pulling hair; hit by an intimate partner in the 12 physically violent behavior were with a fist or something hard; kicked; months prior to taking the survey asked how many times in their and beaten. Formal statistical testing was 2.7% among women compared lifetime they had experienced that comparing the frequency of being to 2.0% among men. The 12-month behavior by that specific intimate hurt by choking or suffocating 11 or prevalence of being slapped and partner. Response options included more times, comparing women and being kicked was significantly higher once, two to five times, six to 10 men, was not undertaken because for men, whereas the prevalence times, 11 to 50 times, or more than the number of men reporting this of being hurt by hair pulling, being 50 times. Figure 2.3 displays the behavior 11 or more times within slammed against something, and higher frequency categories (11 to 50, an individual relationship was too being beaten was significantly more than 50) of individual physically small to generate a reliable estimate.

Figure 2 2. 12-month Prevalence of Physical Violence by an Intimate Partner — U S. . Women and Men, NISVS 2010 4.0 Any physical violence 4.7 3.6 Slapped, pushed, or shoved 4.5 1.6 Slapped 2.7† 3.4 Pushed or shoved 3.8 2.7 Any severe physical violence 2.0 0.8† Hurt by pulling hair 0.3 Women 1.1 Hit with a fist or something hard 1.4 Men 0.3 Kicked 0.7† 1.5† Slammed against something 0.4 Tried to hurt by choking or suffocating 0.9# * 0.7† Beaten 0.3 Burned on purpose * * Used a knife or gun * *

0 1 2 3 4 5 Percent

† Statistically significant difference (p < .05) in prevalence. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. # Formal statistical testing was not undertaken because the number experiencing these behaviors was too small to generate a reliable estimate for at least one of the comparison groups. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 17

Similarly, the number of women and Stalking by an victim felt very fearful or believed men who reported the following that they or someone close to behaviors 11 or more times was too Intimate Partner them would be harmed or killed small to generate reliable estimates Lifetime and was significantly higher for women for statistical testing between groups: 12-month Prevalence (10.7% or an estimated 12.8 million) being burned on purpose and having The lifetime prevalence of stalking than for men (2.1% or an estimated a knife or gun used on them. by an intimate partner in which the 2.4 million), p < .05 (Table 2.3).

Figure 2 3. Number of Times Individual Physically Violent Behaviors Were Experienced among Victims of Physical Violence by an Intimate Partner, by Sex — NISVS 2010

† Slapped W 15.2 12.0 M 6.9 3.1 † Pushed or shoved W 17.7 11.6 M 11.3 4.3 † Hit with a fist or something hard W 18.7 10.6 M 10.8 3.8 11-50 times † Kicked W 17.5 8.3 M 6.7 * >50 times † Hurt by pulling hair W 20.2 10.5 M 14.2 * W = Women Slammed against something W 15.2 8.7 M * M = Men Tried to hurt by choking or suffocating W# 9.8 5.0 M * Beaten W† * 21.2 17.3 M * Burned on purpose W# * M * Used a knife or gun W# * M * 0 5 10 15 20 25 30 35 40 Percent

† Statistically significant difference (p < .05) in the proportion of victims that experienced the behavior 11 or more times in an individual relationship. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. # Formal statistical testing was not undertaken because the number experiencing these behaviors was too small to generate a reliable estimate for at least one of the comparison groups.

Table 2 .3 Lifetime and 12-month Prevalence of Stalking by an Intimate Partner — U S. . Women and Men, NISVS 2010

Lifetime 12-month Weighted % 95% CI Estimated Number of Victims1 Weighted % 95% CI Estimated Number of Victims1 Women 10.7† 9.8 – 11.7 12,786,000 2.8† 2.3 – 3.4 3,353,000 Men 2.1 1.7 – 2.8 2,427,000 0.5 0.3 – 0.7 519,000 1 Rounded to the nearest thousand. † Statistically significant difference (p < .05) in prevalence. 18 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Similarly, the 12-month prevalence commonly reported tactics of stalking by an intimate partner in experienced include: receiving which the victim felt very fearful or unwanted phone calls (77.4% of Nearly half of women believed that they or someone close female victims; 83.7% of male and men in the U.S. to them would be harmed or killed victims); being approached, such was significantly higher for women as at home or work (64.8% of have experienced (2.8% or an estimated 3.4 million) female victims; 52.1% of male than men (0.5% or an estimated victims); and being watched or psychological 519,000), p < .05). followed (37.4% of female victims; aggression by an 28.1% of male victims) (Figure Tactics Used in Lifetime 2.4). There were no significant intimate partner Reports of Stalking differences between female and Victimization by an male victims with respect to in their lifetime. Intimate Partner the likelihood of experiencing Among lifetime victims of stalking particular stalking tactics. by an intimate partner, the most

Figure 2 4. Lifetime Reports of Stalking by an Intimate Partner among Victims by Type of Tactic Experienced — NISVS 2010

100

83.7 77.4 Women 80 Men 64.8

60 52.1 Percent

40 37.4

26.9 28.1 26.3 23.4

20 17.8 12.1# 8.8#

* * 0 Unwanted Unwanted Unwanted Watched or Approached Left strange Snuck into phone calls emails or gifts followed or showed up items home or car messages

# Formal statistical testing was not undertaken because the number experiencing these behaviors was too small to generate a reliable estimate for at least one of the comparison groups. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 19

Psychological have experienced at least one by an intimate partner during psychologically aggressive their lifetime. Four in 10 women Aggression by an behavior by an intimate partner (41.1%) and 4 in 10 men (42.5%) Intimate Partner during their lifetime (Figure 2.5). have experienced at least one Four in 10 women (40.3%) and form of coercive control by an Lifetime Prevalence approximately 3 in 10 men (31.9%) intimate partner during their Nearly half of all women (48.4%) have experienced at least one lifetime. The lifetime prevalence and half of all men (48.8%) form of expressive aggression of experiencing expressive

Figure 2 .5 Lifetime Prevalence of Psychological Aggression by an Intimate Partner — U S. . Women and Men, NISVS 2010

48.4 Any psychological aggression 48.8 40.3† Any expressive aggression 31.9 23.3† Acted very angry in a way that seemed dangerous 12.9 19.7† Told you were a loser, a failure, or not good enough 13.5 25.9† Called names like ugly, fat, crazy, stupid 16.5 23.4† Insulted, humiliated, made fun of 12.6 15.8† Told you no one else would want you 7.3 41.1 Any coercive control 42.5 17.9† Tried to keep from seeing family and friends 12.0 16.9† Made decisions that should have been yours to make 15.1 Kept track of by demanding to know where you were 25.4 and what you were doing 26.8 Made threats of physical harm 18.7† 8.5 Threatened to hurt himself/herself or commit suicide 15.2† because he/she was upset 10.5 Threatened to hurt pet or take pet away 4.7† 1.8 Threatened to hurt someone you love 5.9† 1.7 Hurt someone you love 5.5† 2.3 Threatened to take your child away from you 8.8† Women 5.5 Kept you from leaving when you wanted to go 14.8† Men 8.3 Kept you from having your own money to use 9.1† 5.5 Destroyed something that was important to you 16.3† 12.2 Said things like, "if I can't have you then no one can." 11.2† 6.5 0 10 20 30 40 50 Percent

† Statistically significant difference (p < .05) in prevalence 20 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

aggression by an intimate partner good enough; being called names was significantly higher for women, like ugly, fat, crazy, or stupid; being compared to men (p < .05). With insulted, humiliated, or made fun Nearly 1 in 9 women the exception of having an intimate of; and being told no one else and more than 1 in partner keeping track of them by would want them (p < .05). There demanding to know where they were no significant differences for 48 men in the U.S. were and what they were doing, the remaining specific expressive the lifetime prevalence of individual aggression behaviors. have experienced psychologically aggressive stalking by an behaviors was significantly higher The prevalence of coercive control among women, compared to by an intimate partner in the intimate partner at men (p < .05). 12 months prior to taking the survey was significantly higher some point in their Twelve-month Prevalence among men (15.2%) than among lives in which they The prevalence of psychological women (10.7%) (p < .05). With aggression by an intimate partner respect to the specific coercive felt very fearful or was significantly higher among control behaviors, men had a men (18.1%) than among women significantly higher 12-month believed that they (13.9%) in the 12 months preceding prevalence (p < .05) than women or someone close the survey, p < .05 (Figure 2.6). in relation to having a partner who made decisions that should to them would be The overall prevalence of expressive have been theirs to make, and aggression by an intimate partner having a partner who kept track harmed or killed. in the 12 months prior to the survey of them by demanding where was not significantly different (p < .05) they were and what they were between women and men (10.4% doing. Women had a significantly and 9.3%, respectively), although higher 12-month prevalence there were significant differences (p < .05) than men with regard to for specific behaviors. Women had having an intimate partner who a significantly higher 12-month made threats to physically harm prevalence (p < .05), compared to them. There were no significant men, with respect to being told differences for the remaining they were a loser, a failure, or not specific coercive control behaviors. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 21

Figure 2 6. 12-month Prevalence of Psychological Aggression by an Intimate Partner — U S. . Women and Men, NISVS 2010

13.9 Any psychological aggression 18.1† 10.4 Any expressive aggression 9.3 3.5 Acted very angry in a way that seemed dangerous 3.1 Told you were a loser, a failure, or not good enough 4.6† 3.5 Called names like ugly, fat, crazy, stupid 6.5† 4.8 Insulted, humiliated, made fun of 4.7† 3.4 Told you no one else would want you 2.6† 1.6 Any coercive control 10.7 15.2† Tried to keep from seeing family and friends 2.3 2.8 Made decisions that should have been yours to decide 3.2 5.8† Kept track of by demanding to know where you were 6.0 and what you were doing 9.2† Made threats of physical harm 2.4† 1.6 Threatened to hurt himself/herself or commit suicide 2.2 because he/she was upset 2.0 0.5 Threatened to hurt pet or take pet away 0.4 0.8 Threatened to hurt someone you love 0.5 Hurt someone you love 0.7 0.6 Women Threatened to take your child away from you 1.3 1.3 Men 2.0 Kept you from leaving when you wanted to go 2.0 1.2 Kept you from having your own money to use 1.6 2.1 Destroyed something that was important to you 1.7 Said things like, "if I can't have you then no one can." 1.6 1.8 0 5 10 15 20 Percent

† Statistically significant difference (p < .05) in prevalence. 22 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Frequency of Individual generate a reliable estimate for at 14.4% of female victims and Psychologically least one of the comparison groups: 6.3% of male victims experienced Aggressive Behaviors partner threatened to hurt or take a physical violence and stalking, a Respondents who reported that pet away. statistically significant difference they had experienced a particular (p < .05). Too few men reported psychologically aggressive behavior other combinations of rape, physical were asked how many times in their Control of Reproductive violence, and stalking to produce lifetime they had experienced that reliable estimates. Among female behavior by that specific intimate or Sexual Health by an victims, 12.5% experienced all partner. Response options included: Intimate Partner three forms; 8.7% experienced both once, two to five times, six to 10 rape and physical violence; 4.4% Approximately 4.8% of women in times, 11 to 50 times, or more than experienced rape only; and 2.6% the United States had an intimate 50 times. Figure 2.7 displays the experienced stalking only. partner who tried to get them percentage of women and men who pregnant when they did not experienced each of the individual Among those who experienced want to become pregnant, while psychologically aggressive physical violence only, there were no 8.7% of men in the United States behaviors 11 to 50 times, and more significant differences in prevalence have had an intimate partner than 50 times, within an individual between female and male victims who tried to get pregnant when relationship. The proportion of who reported experiencing severe they did not want her to become female victims that experienced a physical violence only by a partner pregnant, a statistically significant particular behavior 11 or more times (10.3% and 8.7%, respectively). difference, p < .05 (data not shown). within an intimate relationship For victims who experienced a Approximately 6.7% of women in was significantly higher than the combination of severe physical the United States had an intimate proportion of male victims that violence and slapping, pushing, or partner who refused to use a experienced a particular behavior shoving by a partner, the prevalence condom, while 3.8% of men in the 11 or more times with respect was significantly higher for female United States have had an intimate to the following psychologically victims than male victims (55.4% partner who refused to use a aggressive behaviors: partner acted and 37.5%, respectively; p < .05). condom, a statistically significant very angry in a way that seemed The prevalence of experiencing difference, p < .05. dangerous; were told they were a slapping, pushing, or shoving only loser, a failure or not good enough; was significantly higher among male called names like ugly, fat, crazy, or victims than female victims (53.8% stupid; were insulted, humiliated, Overlap of Rape, and 34.3%, respectively; p < .05). or made fun of; told no one else Physical Violence, would want them; partner made and Stalking across decisions that should have been theirs to make; partner kept track Relationships in of them by demanding to know Lifetime Reports where they were and what they were doing; partner made threats of Violence by an to physically harm them; kept them Intimate Partner from having their own money to Among those who experienced use; partner destroyed something rape, physical violence, or stalking that was important to them; partner by an intimate partner in their said things like “if I can’t have you lifetime, male victims (92.1%) were then no one can.” The difference significantly more likely than female in the frequency of the following victims (56.8%) to experience behavior was not tested as the physical violence only, (p < .05) number reporting a frequency of (Figures 2.8 and 2.9). In addition, 11 or more times was too small to The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 23

Figure 2 7. Number of Times Individual Psychologically Aggressive Behaviors Were Experienced among Victims of Psychological Aggression by an Intimate Partner, by Sex — NISVS 2010

Acted very angry in a way that seemed dangerous M 18.9 11.7 W† 20.4 21.9

Told you were a loser, a failure, or not good enough M 20.5 17.5 W† 26.8 35.2

Called names like ugly, fat, crazy, stupid M 20.1 19.4 W† 26.3 29.7

Insulted, humiliated, made fun of M 16.9 12.6 W† 24.9 19.2

Told you no one else would want you M 13.1 16.6 W† 24.9 26.0

Tried to keep from seeing family and friends M 28.0 22.2 W 28.2 28.3

Made decisions that should have been yours to decide M 28.3 22.6 W† 30.8 32.5

Kept track of by demanding to know where M 29.0 36.0 you were and what you were doing W† 28.4 45.2

Made threats of physical harm M 19.5 10.3 W† 25.0 21.8

Threatened to hurt himself/herself or commit M 13.3 3.3 suicide because he/she was upset W 13.0 3.8 11 to 50 times Threatened to hurt pet or take pet away M * W# 10.3 6.0 > 50 times

Threatened to hurt someone you love M * W = Women W# 22.6 14.3 M = Men Hurt someone you love M 18.4 15.2 W 16.6 15.0

Threatened to take your child away from you M 14.6 13.8 W 14.9 10.5

Kept you from leaving when you wanted to go M 20.3 12.2 W 23.7 14.6

Kept you from having your own money to use M 28.5 33.3 W† 31.6 42.9

Destroyed something that was important to you M 10.5 3.5 W† 19.6 9.3

Said things like, "if I can't have you then no one can." M 13.8 12.9 W† 23.3 22.3

0 10 20 30 40 50 60 70 80 Percent

† Statistically significant difference (p < .05) in the proportion of victims that experienced the behavior 11 or more times in an individual relationship. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. # Formal statistical testing was not undertaken because the number experiencing these behaviors was too small to generate a reliable estimate for at least one of the comparison groups. 24 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Figure 2 .8 Overlap of Lifetime Intimate Partner Rape, Physical Violence, and Stalking among Women — NISVS 2010

Severe physical violence only Rape, physical 10.3% violence and stalking 12.5%

Physical violence and stalking Severe physical 14.4% Physical violence only Slapped, pushed, violence and shoved only slapped, pushed, 56.8% or shoved Rape and stalking 34.3% 55.4% 0.6% Rape and physical violence 8.7%

Stalking only 2.6% Rape only 4.4%

Figure 2 .9 Overlap of Lifetime Intimate Partner Rape, Physical Violence, and Stalking among Men — NISVS 2010

Other combinations *

Slapped, pushed, shoved only 53.8% Physical violence only 92.1% Severe physical violence and slapped, pushed, or shoved 37.5% Physical violence and stalking Severe physical 6.3% violence only 8.7%

* Estimate is not reported; relative standard error > 30% or cell size ≤ 20. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 25 26 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 27

3: Prevalence of Intimate Partner Violence by Sociodemographic Characteristics

Prior research has established that Prevalence of Rape, the prevalence of intimate partner violence can vary with respect to Physical Violence, More than 4 in 10 a number of sociodemographic or Stalking by an lesbian women, 6 in characteristics. This section Intimate Partner examines the prevalence of rape, 10 bisexual women physical violence, or stalking by Race/Ethnicity by an intimate partner by race/ Lifetime Prevalence and, more than 1 ethnicity, current household among Women in 3 heterosexual income, respondent age, sexual Approximately 4 out of every 10 orientation, the experience of Black non-Hispanic women women have food or housing security within (43.7%) and American Indian or the preceding 12 months, and Alaska Native women (46.0%), and experienced rape, whether the respondent was 1 in 2 multiracial non-Hispanic physical violence, born inside or outside of the women (53.8%) in the United United States. Both lifetime and States have been a victim of rape, and/or stalking by 12-month prevalence are examined physical violence, or stalking by an except in cases where a particular intimate partner in their lifetime an intimate partner sociodemographic characteristic (Table 3.1). About one-third of during their lifetime. is unlikely to have bearing on a White non-Hispanic women particular prevalence estimate (e.g., (34.6%), more than one-third of the experience of food or housing Hispanic women (37.1%), and security within the preceding about one-fifth of Asian or Pacific 12 months on lifetime prevalence) Islander non-Hispanic women or if there are an insufficient number (19.6%) have experienced rape, of reliable estimates in which to physical violence, or stalking present a table (e.g., 12-month by an intimate partner in their prevalence by sexual orientation). lifetime. Black and multiracial non-Hispanic women had a As a point of reference for the significantly higher prevalence demographic comparisons, of rape, physical violence, or approximately 35.6% of women stalking by an intimate partner and 28.5% of men in the United compared to White non-Hispanic States have experienced rape, women (p < .05); Asian or Pacific physical violence, or stalking by Islander non-Hispanic women an intimate partner at some point had significantly lower prevalence in their lifetime (p < .05), and 5.9% compared to White non-Hispanic and 5.0%, respectively, experienced women (p < .05). rape, physical violence, or stalking by an intimate partner in the 12 months preceding the survey (data not shown). 28 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Table 3 .1 Lifetime Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Race/Ethnicity1 — U .S . Women, NISVS 2010

Non-Hispanic American Asian or Indian or Hispanic Black White Pacific Multiracial Alaska Islander Native Weighted % 8.4 12.2 9.2 20.1† Rape 95% CI 6.1 – 11.6 9.4 – 15.6 8.2 – 10.3 * * 14.2 – 27.8 Estimated Number of Victims2 1,273,000 1,768,000 7,475,000 273,000 Weighted % 35.2 41.0† 31.7 45.9† 50.4† Physical 95% CI 30.3 – 40.5 36.4 – 45.7 30.1 – 33.4 * 33.3 – 59.0 41.9 – 58.9 violence Estimated Number of Victims2 5,317,000 5,955,000 25,746,000 399,000 683,000 Weighted % 10.6 14.6† 10.4 18.9† Stalking 95% CI 8.0 – 14.0 11.3 – 18.6 9.3 – 11.5 * * 13.2 – 26.3 Estimated Number of Victims2 1,599,000 2,123,000 8,402,000 256,000

Rape, Weighted % 37.1 43.7† 34.6 19.6† 46.0 53.8† physical 95% CI 32.1 – 42.4 39.0 – 48.4 32.9 – 36.3 11.8 – 30.7 33.5 – 59.2 45.2 – 62.2 violence, or stalking Estimated Number of Victims2 5,596,000 6,349,000 28,053,000 1,110,000 400,000 729,000 1 Race/ethnicity was self-identified. The American Indian or Alaska Native designation does not indicate being enrolled or affiliated with a tribe. 2 Rounded to the nearest thousand. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. † Statistically significant difference (p < .05) in prevalence when compared to White non-Hispanic women. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 29

Lifetime Prevalence by an intimate partner during non-Hispanic men had significantly among Men their lifetime (Table 3.2). The higher prevalence of rape, physical Nearly half (45.3%) of American estimated prevalence of these violence, or stalking compared to Indian or Alaska Native men and forms of violence by an intimate White non-Hispanic men (p < .05). almost 4 out of every 10 Black partner among Hispanic and White and multiracial non-Hispanic men non-Hispanic men was 26.6% and Twelve-month Prevalence (38.6% and 39.3%, respectively) in 28.2%, respectively. American among Women the United States have experienced Indian or Alaska Native men, Black Black non-Hispanic women had rape, physical violence, or stalking non-Hispanic men, and multiracial a significantly higher prevalence

Table 3 .2 Lifetime Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Race/Ethnicity1 — U .S . Men, NISVS 2010

Non-Hispanic American Asian or Indian or Hispanic Black White Pacific Multiracial Alaska Islander Native Weighted %

Rape 95% CI * * * * * * Estimated Number of Victims2

Weighted % 26.3 36.8† 28.1 45.3† 38.8† Physical 95% CI 21.9 – 31.2 31.6 – 42.3 26.3 – 29.9 * 31.5 – 59.8 29.4 – 49.2 violence Estimated Number of Victims2 4,277,000 4,595,000 21,524,000 365,000 507,000 Weighted % 1.7 Stalking 95% CI * * 1.2 – 2.3 * * * Estimated Number of Victims2 1,282,000

Rape, Weighted % 26.6 38.6† 28.2 45.3† 39.3† physical 95% CI 22.2 – 31.6 33.3 – 44.2 26.4 – 30.0 * 31.5 – 59.8 29.8 – 49.6 violence, or stalking Estimated Number of Victims2 4,331,000 4,820,000 21,596,000 365,000 513,000 1 Race/ethnicity was self-identified. The American Indian or Alaska Native designation does not indicate being enrolled or affiliated with a tribe. 2 Rounded to the nearest thousand. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. † Statistically significant difference (p < .05) in prevalence when compared to White non-Hispanic men. 30 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

(p < .05) of rape, physical violence, Twelve-month Prevalence Lifetime Prevalence or stalking by an intimate partner in among Men the 12 months prior to the survey, Approximately 9.9% of Black of Rape, Physical compared to White non-Hispanic non-Hispanic men in the United Violence, or Stalking women (9.2% and 5.1%, respectively) States experienced rape, physical by an Intimate Partner (Table 3.3). Among other racial/ violence, or stalking by an intimate ethnic groups, 8.7% of multiracial partner in the 12 months preceding by Sexual Orientation non-Hispanic women and 8.1% of the survey, as compared to 6.2% Prevalence among Women Hispanic women experienced rape, of Hispanic men and 4.2% of More than 4 in 10 lesbian physical violence, or stalking in White non-Hispanic men. Black women (43.8%), 6 in 10 bisexual the 12 months prior to the survey. non-Hispanic men had a significantly women (61.1%), and over 1 in Prevalence of these forms of violence higher 12-month prevalence of 3 heterosexual women (35.0%) were not significantly different rape, physical violence, or stalking have experienced rape, physical than the prevalence among White as compared to White non-Hispanic violence, or stalking by an intimate non-Hispanic women (p < .05). men (p < .05). partner at some point in their

Table 3 .3 Twelve-month Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Race/Ethnicity1 — U .S . Women and Men, NISVS 2010

Non-Hispanic Asian or American Hispanic Black White Pacific Indian or Multiracial Islander Alaska Native Weighted % 8.1 9.2† 5.1 8.7 Women 95% CI 5.6 – 11.6 6.6 – 12.5 4.3 – 6.2 * * 5.0 – 14.6 Estimated Number of Victims2 1,220,000 1,333,000 4,177,000 118,000 Weighted % 6.2 9.9† 4.2 Men 95% CI 4.2 – 9.2 7.0 – 13.9 3.5 – 5.1 * * * Estimated Number of Victims2 1,016,000 1,240,000 3,247,000 1 Race/ethnicity was self-identified. The American Indian or Alaska Native designation does not indicate being enrolled or affiliated with a tribe. 2 Rounded to the nearest thousand. † Statistically significant difference (p < .05) in prevalence when compared to White non-Hispanic women/men. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 31

lifetime (Table 3.4). This translates some point in their lifetime (Table partner violence by sexual to 714,000 lesbian women, 3.5). No significant differences orientation is available in The 2.0 million bisexual women, and in prevalence were found when National Intimate Partner and Sexual 38.3 million heterosexual women. comparing gay, bisexual, and Violence Survey: 2010 Findings on The prevalence of lifetime rape, heterosexual men. This translates Victimization by Sexual Orientation physical violence, or stalking to 708,000 gay men, 711,000 (Walters, Chen, & Breiding, 2013). by an intimate partner was bisexual men, and 30.3 million significantly higher among bisexual heterosexual men. However, these women compared to lesbian and numbers predominantly represent Twelve-month Prevalence heterosexual women (p < .05), the experience of physical violence whereas there was no significant as too few men reported rape, of Intimate Partner difference in prevalence between and too few gay and bisexual men Rape, Physical Violence, lesbian and heterosexual women. reported stalking, to produce or Stalking by Current reliable estimates. The prevalence Prevalence among Men of physical violence by an intimate Household Income More than 1 in 4 gay men (26.0%), partner was 25.2% among gay men, Prevalence among Women more than 1 in 3 bisexual men 37.3% among bisexual men, and The 12-month prevalence of rape, (37.3%), and nearly 3 in 10 28.7% among heterosexual men. physical violence, or stalking by an heterosexual men (29.0%) have intimate partner was significantly experienced rape, physical violence, More detailed information related higher among women with a or stalking by an intimate partner at to the prevalence of intimate combined household income of

Table 3 .4 Lifetime Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Sexual Orientation1 — U S. . Women, NISVS 2010

Lesbian Bisexual Heterosexual

Estimated Estimated Estimated Weighted Weighted Weighted 95% CI Number 95% CI Number 95% CI Number % % % of Victims2 of Victims2 of Victims2

Rape HB * 22.1 14.9-31.5 731,000 9.1 8.3-10.1 9,984,000 Physical violence HB, BL 40.4 28.8-53.2 659,000 56.9 46.6-66.7 1,886,000 32.3 30.8-33.9 35,291,000 Stalking HB * 31.1 22.0-42.0 1,030,000 10.2 9.3-11.2 11,126,000

Rape, physical violence, 43.8 31.8-56.6 714,000 61.1 50.7-70.6 2,024,000 35.0 33.5-36.6 38,290,000 or stalking HB, BL

1 Sexual orientation is self-identified. 2 Rounded to the nearest thousand. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. HB Statistically significant difference (p < .05) in prevalence between heterosexual and bisexual groups. BL Statistically significant difference (p < .05) in prevalence between bisexual and lesbian groups. 32 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Table 3 .5 Lifetime Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Sexual Orientation1 — U S. . Men, NISVS 2010

Gay Bisexual Heterosexual

Estimated Estimated Estimated Weighted Weighted Weighted 95% CI Number 95% CI Number 95% CI Number % % % of Victims2 of Victims2 of Victims2

Rape * * * Physical violence 25.2 16.7 – 36.1 685,000 37.3 24.1 – 52.7 711,000 28.7 27.1 – 30.3 29,926,000 Stalking * * 2.1 1.6 – 2.8 2,222,000 Rape, physical 26.0 17.4 – 37.0 708,000 37.3 24.1 – 52.7 711,000 29.0 27.4 – 30.7 30,250,000 violence, or stalking 1 Sexual orientation is self-identified. 2 Rounded to the nearest thousand. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20.

Table 3 .6 Twelve-month Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Current Household Income — U S. . Women and Men, NISVS 2010

Under $25k $25k to < $50k $50k to < $75k $75k+

Weighted % 9.7† 5.9† 3.0 2.8 Women 95% CI 8.0 – 11.8 4.2 – 8.1 2.0 – 4.5 2.0 – 3.9 Estimated Number of Victims1 3,789,000 1,646,000 485,000 754,000 Weighted % 6.9† 6.6† 2.9 3.4 Men 95% CI 5.4 – 8.9 4.9 – 8.7 1.8 – 4.6 2.4 – 4.8 Estimated Number of Victims1 2,129,000 1,715,000 474,000 1,114,000 1 Rounded to the nearest thousand. † Statistically significant difference (p < .05) in evalencepr when compared to the $75k+ income group. Statistical comparisons are made across level of income, not across sex of respondent. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 33

less than $25,000, and between Twelve-month Prevalence among Men $25,000 and $50,000, than for Approximately 9.8% of men who women with a combined income Prevalence of Intimate were 18 to 24 years old at the time over $75,000, p < .05 (Table 3.6). Partner Rape, Physical of the survey experienced rape, The prevalence of rape, physical Violence, or Stalking by physical violence, or stalking by an violence, or stalking by an intimate intimate partner in the 12 months partner reported by women in Age at Time of Survey preceding the survey, as compared these income groups was 9.7% Prevalence among Women to 8.6% of men 25 to 34 years of and 5.9%, respectively, compared Approximately 14.8% of women age, 5.6% of men 35 to 44 years with 2.8% for women in the highest who were 18 to 24 years old at the of age, 3.3% of men 45 to 54 years income group. time of the survey experienced of age, and 1.4% of men 55 years rape, physical violence, or stalking of age or older. The 12-month Prevalence among Men by an intimate partner in the 12 prevalence of rape, physical The 12-month prevalence of rape, months preceding the survey, as violence, or stalking by an intimate physical violence, or stalking by an compared to 8.7% of women 25 to partner was significantly lower intimate partner was significantly 34 years of age, 7.3% of women 35 among men in the three older higher among men with a to 44 years of age, 4.1% of women age groups compared with 18 to combined household income of 45 to 54 years of age, and 1.4% of 24 year old men (p < .05). There less than $25,000, and between women 55 years of age or older were no significant differences in $25,000 and $50,000, than for men (Table 3.7). Women aged 25 years prevalence between men in the with a combined income over and older at the time of the survey 25 to 34 age group compared with $75,000 (p < .05). The prevalence of had a significantly lower 12-month 18 to 24 year old men. rape, physical violence, or stalking prevalence of rape, physical by an intimate partner reported violence, or stalking by an intimate by men in these income groups partner, compared to those in the 18 was 6.9% and 6.6%, respectively, to 24 year old age group (p < .05). compared with 3.4% for men in the highest income group.

Table 3 .7 Twelve-month Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Age at Time of Survey — U S. . Women and Men, NISVS 2010

18-24 years 25-34 years 35-44 years 45-54 years 55+ years Weighted % 14.8 8.7† 7.3† 4.1† 1.4† Women 95% CI 11.2 – 19.3 6.8 – 11.2 5.2 – 10.1 3.0 – 5.7 0.9 – 2.3 Estimated Number of Victims1 2,184,000 1,833,000 1,463,000 908,000 576,000 Weighted % 9.8 8.6 5.6† 3.3† 1.4† Men 95% CI 7.3 – 13.2 6.5 – 11.3 4.0 – 7.7 2.2 – 4.8 0.8 – 2.3 Estimated Number of Victims1 1,540,000 1,766,000 1,203,000 705,000 477,000 1 Rounded to the nearest thousand. † Statistically significant difference (p < .05) in prevalence when compared to 18 to 24 year old women/men. Statistical comparisons are made across age at time of survey, not across sex of respondent. 34 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Twelve-month having enough money to pay your housing insecurity (2.3%) in the rent or mortgage?” Responses of 12 months prior to taking the Prevalence of Intimate “always,” “usually,” or “sometimes” survey (p < .05). Partner Rape, Physical were classified as a “yes” response; Violence, or Stalking responses of “rarely” or “never” were Prevalence among Men classified as a “no” response. The 12-month prevalence of rape, by Experiences of Food physical violence, or stalking and Housing Insecurity The 12-month prevalence of rape, by an intimate partner was physical violence, or stalking by an significantly higher among men Prevalence among Women intimate partner was significantly who experienced food insecurity Food and housing insecurity higher among women who in the 12 months prior to taking are two key measures of the experienced food insecurity in the survey (8.2%) compared to potential influence of the social the 12 months prior to taking the those who did not experience food environment on health. In the survey (11.6%) compared to those insecurity (4.0%; p < .05). Similarly, National Intimate Partner and who did not experience food men who experienced housing Sexual Violence Survey (NISVS) insecurity (3.2%; p < .05). Similarly, insecurity had a significantly they were measured using two women who experienced housing higher prevalence of rape, physical questions: “In the past 12 months, insecurity had a significantly violence, or stalking by an intimate how often would you say you were higher prevalence of rape, physical partner in the 12 months prior to worried or stressed about having violence, or stalking by an intimate the survey (7.9%), compared with enough money to buy nutritious partner in the 12 months prior to those who did not experience meals?” and “In the past 12 months, the survey (10.0%) compared with housing insecurity (3.1%) in the how often would you say that you those who did not experience past 12 months (p < .05). were worried or stressed about

Table 3 .8 Twelve-month Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, by Experiences of Food and Housing Insecurity within the 12 Months Prior to Taking the Survey — U S. . Women and Men, NISVS 2010

Food Insecurity Housing Insecurity Yes No Yes No Weighted % 11.6† 3.2 10.0† 2.3 95% CI 9.6 – 13.9 2.6 – 3.9 8.5 – 11.7 1.8 – 3.0 Women Estimated Number of 4,388,000 2,594,000 5,506,000 1,475,000 Victims1 Weighted % 8.2† 4.0 7.9† 3.1 95% CI 6.4 – 10.5 3.3 – 4.8 6.5 – 9.6 2.4 – 3.9 Men Estimated Number of 2,281,000 3,410,000 3,637,000 2,054,000 Victims1 1 Rounded to the nearest thousand. † Statistically significant difference (p < .05) in prevalence. Statistical comparisons are made across food and housing insecurity status, not across sex of respondent. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 35

Prevalence of Rape, to women born outside of the United by an intimate partner in the States (24.0%), p < .05 (Table 3.9). 12 months preceding the survey, Physical Violence, Similarly, men who were born in the compared to 4.1% of women born or Stalking by an United States were significantly more outside of the United States. Among Intimate Partner likely to experience rape, physical men, 5.1% who were born in the violence, or stalking by an intimate United States experienced rape, among U .S . Natives and partner in their lifetime (30.2%), physical violence, or stalking by an Foreign-Born Residents compared to men born outside of intimate partner in the 12 months the United States (17.0%; p < .05). preceding the survey, compared Lifetime Prevalence to 4.6% of men born outside of The lifetime prevalence of rape, Twelve-month Prevalence the United States. The differences physical violence, or stalking by an Approximately 6.1% of women born between native and foreign-born intimate partner was significantly in the United States experienced populations were not statistically higher among those women born in rape, physical violence, or stalking significant for women or men. the United States (37.3%), compared

Table 3 .9 Lifetime and 12-month Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner, U .S . Natives and Foreign-Born — U .S . Women and Men, NISVS 2010

U.S. Native Foreign-Born Weighted % 37.3† 24.0 Lifetime 95% CI 35.7 – 38.9 19.5 – 29.2 Estimated Number of Victims1 37,435,000 3,903,000 Women Weighted % 6.1 4.1 12-month 95% CI 5.3 – 7.1 2.3 – 7.0 Estimated Number of Victims1 6,152,000 660,000 Weighted % 30.2† 17.0 Lifetime 95% CI 28.6 – 32.0 13.5 – 21.3 Estimated Number of Victims1 28,506,000 2,851,000 Men Weighted % 5.1 4.6 12-month 95% CI 4.4 – 6.1 2.9 – 7.3 Estimated Number of Victims1 4,851,000 774,000 1 Rounded to the nearest thousand. † Statistically significant difference (p < .05) in prevalence. Statistical comparisons are made across birthplace, not across sex of respondent. 36 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 37

4: Impact of Intimate Partner Violence

To inform intimate partner violence regard to the time period in which prevention efforts and achieve a impact occurred, and asked in more complete picture of the true relation to the totality of intimate 1 in 10 women and burden of intimate partner violence partner violence experienced nearly 1 in 25 men within populations, it is important (sexual violence, physical violence, to measure and understand factors stalking, psychological aggression, have experienced beyond whether or not a person and control of reproductive or has ever experienced IPV. Evidence sexual health) in that relationship. rape, physical violence, from several studies suggests a A description of the IPV-related or stalking by an dose-response effect of violence; impacts assessed is provided in as the frequency and severity of Appendix A. intimate partner and violence increases, the impact of the violence on the health of victims missed at least one also becomes increasingly severe Lifetime Prevalence of day of work or school (Campbell, 2002; Cox, Coles, Nortje, Bradley, Chatfield, Thompson, & Rape, Physical Violence, as a result of these or Menon, 2006). However, given that or Stalking by an other forms of intimate IPV victimization can range from a Intimate Partner with single act experienced once (e.g., partner violence in one slap) to multiple acts of severe IPV-related Impact violence over the course of many Nearly 3 in 10 women (28.8%) and that relationship. years, it is difficult to represent nearly 1 in 10 men (9.9%) have this variation in the severity of experienced rape, physical violence, violence experienced by victims in a or stalking by an intimate partner straightforward manner. and reported at least one measured impact related to experiencing these or other forms of violent behavior in To address these issues, the National that relationship (Figure 4.1). Women Intimate Partner and Sexual Violence were significantly more likely than Survey (NISVS) included a number men to experience rape, physical of questions to assess a range of violence, or stalking by an intimate impacts that victims of IPV may partner during their lifetime and have experienced. This information experience an IPV-related impact as provides not only a measure a result of these or other forms of of the severity of the violence violence in that relationship (p < .05). experienced, but also documents the magnitude of particular negative More than 1 in 4 women (25.7%) impacts to better focus preventive was fearful, more than 1 in 5 women services and response. Impact was (22.2%) was concerned for her measured using a set of indicators safety, and more than 1 in 5 women that represent a range of direct (22.3%) experienced at least one impacts that may be experienced post-traumatic stress disorder by victims of IPV. IPV-related (PTSD) symptom as a result impact was assessed in relation to of violence experienced in a individual perpetrators, without relationship in which 38 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Figure 4 .1 Lifetime Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner with IPV-related Impact — U S. . Women and Men, NISVS 2010

† Any IPV-related impact1,2,3 28.8 9.9 † Fearful 25.7 5.2 Concerned for safety 22.2† 4.5 Any PTSD symptoms4 22.3† 4.7 Injury 14.8† 4.0 Needed medical care 7.9† 1.6 Needed housing services 2.4† 0.4 Women Needed victim's advocate services 2.7# * Men Needed legal services 7.6† 3.1 Contacted crisis hotline 2.1# * Missed at least one day of work/school 10.0† 3.9 Contracted a sexually transmitted disease5 1.5# * Became pregnant5 1.7# NA

0 5 10 15 20 25 30 Percent

1 Includes experiencing any of the following: being fearful, concerned for safety, any PTSD symptoms, need for health care, injury, contacting a crisis hotline, need for housing services, need for victim’s advocate services, need for legal services, missed at least one day of work or school. For those who reported being raped, it also includes having contracted a sexually transmitted disease or having become pregnant (if female). 2 IPV-related impact questions were assessed in relation to specific perpetrators and asked in relation to any form of IPV experienced (sexual violence, physical violence, stalking, expressive aggression, coercive control, and control of reproductive or sexual health) in that relationship. 3 By definition, all stalking incidents result in impact because the definition of stalking includes the impacts of fear and/or concern for safety. 4 Includes: nightmares; tried not to think about or avoided being reminded of; felt constantly on guard, watchful, or easily startled; felt numb or detached. 5 Asked only of those who reported rape by an intimate partner. * Estimate not reported; relative standard error > 30% or cell size ≤ 20. † Statistically significant difference (p < .05) in prevalence. # Formal statistical testing was not undertaken because the number experiencing these behaviors was too small to generate a reliable estimate for at least one of the comparison groups.

rape, physical violence, or stalking In contrast, 1 in 20 men (5.2%) Women had a significantly higher occurred. More than 1 in 7 women was fearful, 1 in 25 men (4.0%) lifetime prevalence (p < .05) than men (14.8%) experienced an injury and experienced an injury, and nearly for a number of individual IPV-related 1 in 10 women (10.0%) missed at 1 in 25 men (3.9%) missed at least impacts including: being fearful, being least one day of work or school, as a one day of work or school as a concerned for safety, experiencing result of violence experienced in a result of violence experienced in a one or more PTSD symptoms, being relationship in which rape, physical relationship in which rape, physical injured, needing medical care, violence, or stalking took place. violence, or stalking occurred. needing housing services, needing legal services, and having missed at least one day of work or school. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 39

Distribution of Among victims of rape, physical Among women who experienced violence, or stalking by an intimate rape, physical violence, or IPV-related Impacts partner, approximately 8 in 10 women stalking by an intimate partner, among Lifetime Victims (80.8%) and more than 1 in 3 men 72.2% were fearful, 62.3% were of Rape, Physical (34.7%) experienced one or more concerned for their safety, 62.6% of the impacts measured within a experienced at least one PTSD Violence, or Stalking relationship, a statistically significant symptom, 41.6% were injured as by an Intimate Partner difference (p < .05) (Figure 4.2). a result of the violence, and 28.0%

Figure 4 .2 Distribution of IPV-related Impacts among Victims of Rape, Physical Violence, or Stalking by an Intimate Partner, by Sex — NISVS 2010

Any IPV-related impact1,2,3 80.8† 34.7 Fearful 72.2† 18.4 62.3† Concerned for safety 15.7 4 62.6† Any PTSD symptoms 16.4 41.6† Injury 13.9 22.1† Needed medical care 5.5 6.9† Needed housing services 1.5 Needed victim's advocate services 7.5# * 21.2† Needed legal services 10.8 Contacted crisis hotline 5.9# * Women 28.0† Missed at least one day of work/school 13.6 Men Contracted a sexually transmitted disease5 4.3# * Became pregnant5 4.8# NA 0 20 40 60 80 100 Percent

1 Includes experiencing any of the following: being fearful, concerned for safety, any PTSD symptoms, need for health care, injury, contacting a crisis hotline, need for housing services, need for victim’s advocate services, need for legal services, missed at least one day of work or school. For those who reported being raped, it also includes having contracted a sexually transmitted disease or having become pregnant (if female). 2 IPV-related impact questions were assessed in relation to specific perpetrators and asked in relation to any form of IPV experienced (sexual violence, physical violence, stalking, expressive aggression, coercive control, and control of reproductive or sexual health) in that relationship. 3 By definition, all stalking incidents result in impact because the definition of stalking includes the impacts of fear and/or concern for safety. 4 Includes: nightmares; tried not to think about or avoided being reminded of; felt constantly on guard, watchful, or easily startled; felt numb or detached. 5 Asked only of those who reported rape by an intimate partner. * Estimate not reported; relative standard error > 30% or cell size ≤ 20. † Statistically significant difference (p < .05) in prevalence. # Formal statistical testing was not undertaken because the number experiencing these behaviors was too small to generate a reliable estimate for at least one of the comparison groups. 40 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

missed at least one day of work other forms of violence in that States experienced rape, physical or school as a result of these or relationship including: being violence, or stalking by an intimate other forms of violence in that fearful, being concerned for safety, partner and reported at least one relationship. In contrast, among experiencing one or more PTSD injury related to experiencing these men who experienced rape, symptoms, being injured, needing or other forms of violent behavior physical violence, or stalking by medical care, needing housing within that relationship. In terms an intimate partner, 18.4% were services, needing legal services, of severity, 12.8% of women and fearful, 15.7% were concerned for and having missed at least one day 3.1% of men have experienced their safety, 16.4% experienced at of work or school (p < .05). minor scratches or bruises; 10.4% least one PTSD symptom, 13.9% of women and 2.3% of men have were injured, and 13.6% missed at experienced cuts, major bruises, or a least one day of work or school as Lifetime Prevalence of black eye; 3.2% of women and 0.6% a result of these or other forms of of men have experienced broken violence in that relationship. Rape, Physical Violence, bones or teeth; 5.2% of women and or Stalking by an 0.5% of men have been knocked Among victims of rape, physical Intimate Partner with out; and 4.4% of women and 1.1% violence, or stalking by an intimate of men have experienced some partner, a significantly higher Physical Injury other type of injury (Table 4.1). The proportion of women than men As mentioned previously, more prevalence of each type of injury experienced individual IPV-related than 1 in 7 women (14.8%) and was significantly higher for women impacts as a result of these or 1 in 25 men (4.0%) in the United compared to men (p < .05).

Table 4 .1 Lifetime Prevalence of Rape, Physical Violence, or Stalking by an Intimate Partner with Specific IPV-related Injuries1 — U S. . Women and Men, NISVS 2010

Women Men Estimated Estimated Type of Injury Weighted % 95% CI Number Weighted % 95% CI Number of Victims2 of Victims2 Any injury 14.8† 13.7 – 15.9 17,640,000 4.0 3.4 – 4.7 4,483,000 Minor bruises or scratches 12.8† 11.8 – 13.9 15,257,000 3.1 2.6 – 3.8 3,540,000 Cuts, major bruises, or black eyes 10.4† 9.5 – 11.4 12,395,000 2.3 1.9 – 2.9 2,647,000 Broken bones or teeth 3.2† 2.7 – 3.7 3,773,000 0.6 0.4 – 1.0 729,000 Knocked out after getting hit, slammed 5.2† 4.6 – 5.9 6,202,000 0.5 0.3 – 0.9 581,000 against something, or choked Other injury 4.4† 3.8 – 5.0 5,204,000 1.1 0.8 – 1.5 1,257,000 1 IPV-related injury was assessed in relation to specific perpetrators and asked in relation to any form of IPV experienced (sexual violence, physical violence, stalking, expressive aggression, coercive control, and control of reproductive or sexual health) in that relationship. 2 Rounded to the nearest thousand. † Statistically significant difference (p < .05) in prevalence. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 41

Distribution of Physical intimate partner reported at least one injury related to experiencing Among victims of rape, Injury Types among these or other forms of violent Lifetime Victims of behavior in that relationship. Figure physical violence, or Rape, Physical Violence, 4.3 shows the proportion of victims stalking by an intimate that experienced specific injuries or Stalking by an as a result of violence within a partner, approximately Intimate Partner relationship in which rape, physical 4 in 10 female victims violence, or stalking occurred. As shown in Figure 4.2, 41.6% of Female victims were significantly and 1 in 7 male female victims and 13.9% of male more likely than male victims to victims reported victims who experienced rape, experience each of the individual physical violence, or stalking by an types of injuries (p < .05). experiencing a physical injury as a result of the violence within that relationship.

Figure 4 3. Distribution of Specific IPV-related Injuries1 Experienced among Female and Male Victims of Rape, Physical Violence, or Stalking by an Intimate Partner — NISVS 2010

41.6† Any injury 13.9

† Minor bruises or scratches 36.0 11.0

Cuts, major bruises, or black eyes 29.2† 8.2

Broken bones or teeth 8.9† 2.3 Women Knocked out after getting hit, slammed 14.6† Men against something, or choked 1.8

12.3† Other injury 3.9

0 10 20 30 40 50 Percent

1 IPV-related injury was assessed in relation to specific perpetrators and asked in relation to any form of IPV experienced (sexual violence, physical violence, stalking, expressive aggression, coercive control, and control of reproductive or sexual health) in that relationship. † Statistically significant difference (p < .05) in prevalence. 42 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 43

5: Accumulation of Intimate Partner Violence Behaviors Experienced by Individual Perpetrators

The unique method of data This section provides information Maximum Number collection utilized by the National related to: Intimate Partner and Sexual • The total number of unique of Sexually Violent Violence Survey (NISVS) allows behaviors experienced by victims Behaviors Experienced for an examination of the totality in an individual relationship, within in an Individual of a victimization experience each of the four violence subtypes related to individual intimate (sexual violence, physical violence, Relationship partners. Specifically, by linking stalking, and psychological NISVS measures nine types of violent behaviors experienced aggression), with the maximum sexually violent behaviors: rape to specific intimate partner(s), number utilized for those with (completed forced penetration, NISVS is better able to describe multiple perpetrators attempted forced penetration, the victim’s experience within a • The total number of unique alcohol/drug facilitated particular relationship. Whereas impacts experienced by victims penetration); being made previous methods only allow for an • The prevalence of the overlap to penetrate someone else examination of a victim’s experience of rape, physical violence, and (completed forced penetration, across multiple perpetrators, they stalking within a single relationship attempted forced penetration, do not allow for the disentangling alcohol/drug facilitated of violent behaviors by perpetrators. penetration); sexual coercion, The following analyses examine The method utilized by NISVS allows unwanted sexual contact; and violence experienced in individual for a better understanding of the non-contact, unwanted sexual relationships across the life span. context in which an individual act of experiences. Figure 5.1 displays a For those with multiple perpetrators, violence is experienced, specifically distribution describing the largest the maximum number of violent whether an act of violence occurred number of discrete sexually violent behaviors experienced is analyzed. in isolation or whether the violence behaviors experienced by an For example, if a respondent was part of a larger pattern of individual intimate partner. Across reported an intimate partner that violent behaviors. This method male and female victims, the perpetrated two unique physically can also be utilized to connect the median number of unique sexually violent behaviors, and another that combined victimization experiences violent behaviors experienced perpetrated five unique physically within an individual relationship to was one. Among victims of sexual violent behaviors, they would be specific impacts experienced as a violence by an intimate partner, the considered to have experienced five result of victimization. proportion of female victims that unique physically violent behaviors experienced more than the median within an individual relationship. number (two or more) of unique sexually violent behaviors by an individual intimate partner was higher than the proportion of male victims (p < .05). 44 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Figure 5 1. Distribution of the Number of Discrete Sexually Violent Behaviors Experienced by Victims, Maximum Number by an Individual Perpetrator1 — NISVS 2010

54.4 1 72.8

2 22.7 2 13.9 Women

12.4 Men 3 8.0

5.7 4 * Sexually Violent Behaviors Experienced Behaviors Violent Sexually

3.6 5 *

0 10 20 30 40 50 60 70 80

Percent

1 Victims who experienced sexual violence by multiple intimate partners are included once in relation to the relationship in which they experienced the largest number of discrete sexually violent behaviors. 2 Estimates not reported for > 5 behaviors experienced, relative standard error > 30%, or cell size ≤ 20 for both women and men. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 45

Maximum Number a distribution of the maximum of physical violence by an intimate number of discrete physically violent partner, the proportion of female of Physically Violent behaviors experienced among victims that experienced more than Behaviors Experienced victims of physical violence by an the median number (three or more) in an Individual individual intimate partner. Across of unique physically violent behaviors male and female victims of physical by an individual intimate partner was Relationship violence, the median number of higher than the proportion of male NISVS measures 10 discrete physically unique physically violent behaviors victims (p < .05). violent behaviors. Figure 5.2 provides experienced was two. Among victims

Figure 5 2. Distribution of the Number of Discrete Physically Violent Behaviors Experienced by Victims, Maximum Number by an Individual Perpetrator1 — NISVS 2010

27.7 1 45.6

16.1 2 24.0 2 12.6 3 13.4

4 10.1 7.8

5 7.5 3.8 Women 6 7.9 2.1 Men

7 7.7 Physically Violent Behaviors Experienced Behaviors Violent Physically 1.8

8 5.7 *

9 3.8 *

0 10 20 30 40 50 Percent

1 Victims who experienced physical violence by multiple intimate partners are included once in relation to the relationship in which they experienced the largest number of discrete physically violent behaviors. 2 Estimates not reported for > 9 behaviors experienced, relative standard error >30%, or cell size ≤ 20 for both women and men. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. 46 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Maximum Number of provides a distribution of the was two. There was no significant maximum number of discrete difference between male and Stalking Behaviors stalking behaviors experienced female victims of stalking with Experienced in an by an individual intimate partner regard to having experienced more Individual Relationship among stalking victims. Across than the median number (three or male and female victims of stalking, more) of unique stalking behaviors NISVS measures seven discrete the median number of unique by an individual intimate partner. stalking behaviors. Figure 5.3 stalking behaviors experienced

Figure 5 .3 Distribution of the Number of Discrete Stalking Behaviors Experienced by Victims, Maximum Number by an Individual Perpetrator1 — NISVS 2010

29.6 1 44.2

26.2 2

2 16.8

19.3 3 24.4 Women

15.7 Men 4 *

6.0

Stalking Behaviors Experienced Stalking Behaviors 5 *

2.7 6 *

0 10 20 30 40 50 Percent

1 Victims who experienced stalking by multiple intimate partners are included once in relation to the relationship in which they experienced the largest number of discrete stalking behaviors. Individual stalking behaviors are counted only when the criteria for stalking were met with respect to an individual perpetrator. Consequently, those who are shown as having experienced one stalking behavior will have experienced that behavior multiple times by the same perpetrator. 2 Estimates not reported for > 6 behaviors experienced, relative standard error > 30%, or cell size ≤ 20 for both women and men. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 47

Maximum Number of the largest number of discrete aggression by an intimate partner, psychologically aggressive the proportion of female victims of Psychologically behaviors experienced by an that experienced more than the Aggressive Behaviors individual intimate partner among median number (four or more) of Experienced in an victims of psychological aggression. unique psychologically aggressive Across male and female victims of behaviors by an individual intimate Individual Relationship stalking, the median number of partner was higher than the NISVS measured a total of 18 discrete unique psychologically aggressive proportion of male victims (p < .05). psychologically aggressive behaviors. behaviors experienced was three. Figure 5.4 provides a distribution Among victims of psychological

Figure 5 4. Distribution of the Number of Discrete Psychologically Aggressive Behaviors Experienced by Victims, Maximum Number by an Individual Perpetrator1 — NISVS 2010

1 22.0 33.6 2 13.4 18.4 3 9.0 14.2 4 8.4 9.1 2 5 7.1 6.3 6 6.7 4.5 7 6.4 3.1 8 4.8 3.4 9 4.2 2.5 Women 10 4.2 1.5 Men 11 2.6 1.6 12 2.5 1.1

Psychologically Aggressive Behaviors Experienced Behaviors Aggressive Psychologically 13 2.7 * 14 2.5 * 15 1.6 * 16 1.0 * 17 0.6 *

0 5 10 15 20 25 30 35

Percent

1 Victims who experienced psychological aggression by multiple intimate partners are included once in relation to the relationship in which they experienced the largest number of discrete psychologically aggressive behaviors. 2 Estimates not reported for > 17 behaviors experienced, relative standard error >30%, or cell size ≤ 20 for both women and men. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. 48 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Maximum Number of Figure 5.5 displays the distribution impacts experienced. Among of the largest number of discrete victims of rape, physical violence, or IPV-related Impacts IPV-related impacts experienced by stalking by an intimate partner that Experienced in an victims as a result of IPV perpetrated experienced IPV-related impact, the Individual Relationship by an individual intimate partner. proportion of female victims that Examining the maximum number experienced more than the median NISVS measures 11 different of IPV-related impacts experienced number (three or more) of unique intimate partner violence as a result of IPV perpetrated by impacts by an individual intimate (IPV)-related impacts for women an individual intimate partner, the partner was higher than the and men, as well as pregnancy as median number was three unique proportion of male victims (p < .05). a consequence of rape for women.

Figure 5 .5 Distribution of the Number of Discrete IPV-related Impacts1 by Victims, Maximum Number by an Individual Perpetrator2 — NISVS 2010

1 10.6 29.9

2 12.2 22.8

3 20.1 15.4 3 4 18.1 14.0

5 14.2 9.8

11.3 6 4.5 Women 6.5 7 *

IPV-Related Impacts Experienced IPV-Related Men 3.9 8 *

9 1.7 *

10 1.0 *

0 5 10 15 20 25 30 Percent

1 Includes experiencing any of the following: being fearful, concerned for safety, any post-traumatic stress disorder symptoms, need for health care, injury, contacting a crisis hotline, need for housing services, need for victim’s advocate services, need for legal services, missed at least one day of work or school. For those who reported being raped, it also includes having contracted a sexually transmitted disease or having become pregnant. IPV-related impact questions were assessed in relation to specific perpetrators, without regard to the time period in which they occurred, and asked in relation to any form of IPV experienced (sexual violence, physical violence, stalking, expressive aggression, coercive control, and control of reproductive or sexual health) in that relationship. By definition, all stalking incidents result in impact because the definition of stalking includes the impacts of fear and concern for safety. 2 Victims who experienced IPV-related impact by multiple intimate partners are included once in relation to the relationship in which they experienced the largest number of discrete impacts. 3 Estimates not reported for > 10 impacts experienced, relative standard error > 30%, or cell size ≤ 20 for both women and men. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 49

Overlap of Rape, of different forms of violence the same relationship to produce within an individual relationship. reliable estimates. Also, 8.7% of Physical Violence, Approximately 6.2% of women in U.S. women have experienced and Stalking within the United States have experienced physical violence and stalking in Relationships in rape and physical violence in the same relationship, as compared the same relationship, whereas to 1.7% of U.S. men, a statistically Lifetime Reports too few men reported both rape significant difference (p < .05). of Violence by an and physical violence in the Finally, 3.5% of women experienced same relationship to produce all three forms of violence (rape, Intimate Partner reliable estimates (Table 5.1). physical violence, stalking) in the In contrast to the analyses in Approximately 3.9% of U.S. women same relationship, whereas too Section 3 that examined the have experienced rape and stalking few men reported all three forms overlap of violence across the in the same relationship during in the same relationship to produce life span, NISVS data can also their lifetime, while too few men reliable estimates. be used to look at the overlap reported both rape and stalking in

Table 5 .1 Lifetime Prevalence of Overlapping Forms of Rape, Physical Violence, or Stalking by an Individual Perpetrator — U .S . Women and Men, NISVS 2010

Women Men Estimated Estimated Violence Experienced Weighted % 95% CI Number Weighted % 95% CI Number of Victims1 of Victims1 Rape and physical violence 6.2# 5.5 – 7.0 7,377,000 * Rape and stalking 3.9# 3.3 – 4.5 4,622,000 * Physical violence and stalking 8.7† 7.9 – 9.7 10,407,000 1.7 1.3 – 2.2 1,875,000 Rape, physical violence, and stalking 3.5# 3.0 – 4.1 4,195,000 * 1 Rounded to the nearest thousand. * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. † Statistically significant difference (p < .05) in prevalence. # Formal statistical testing was not undertaken because the number experiencing these behaviors was too small to generate a reliable estimate for at least one of the comparison groups. 50 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 51

6: Characteristics of Intimate Partner Violence Victimization

This section describes a number Sex of Perpetrator Age at the Time of First of characteristics of intimate partner violence (IPV) victimization, among Victims of IPV Experience among including the number of lifetime Rape, Physical Violence, those Who Experienced perpetrators among victims, the or Stalking by an Rape, Physical Violence, sex of perpetrators, and the age of victims of rape, physical violence, Intimate Partner or Stalking by an or stalking at the time of the first Approximately 97.1% of female Intimate Partner IPV victimization. victims of rape, physical violence, or Among those who ever experienced stalking by an intimate partner had rape, physical violence, or stalking Number of Perpetrators only male perpetrators, whereas by an intimate partner, more than in Lifetime Reports 2.1% had only female perpetrators 1 in 5 female victims (22.4%) and (data not shown). Among men, more than 1 in 7 male victims of Violence by an 96.9% who experienced rape, (15.0%) experienced some form Intimate Partner physical violence, or stalking by an of intimate partner violence for intimate partner had only female The majority of women (70.8%) and the first time between the ages of perpetrators, whereas 2.8% had only 11 and 17 years (Figures 6.2 and men (73.1%) who ever experienced male perpetrators. The number of rape, physical violence, or stalking by 6.3). Additionally, 47.1% of female female and male victims reporting victims and 38.6% of male victims an intimate partner were victimized victimization by both male and by one partner only (Figure 6.1). were between 18 and 24 years of female perpetrators was too small age when they first experienced Approximately 20.9% of female to produce a reliable estimate. victims and 18.6% of male victims violence by an intimate partner. were victimized by two partners; and 8.3% of female victims and 8.3% of male victims were victimized by three or more intimate partners.

Figure 6 .1 Number of Perpetrators among those Who Experienced Rape, Physical Violence, or Stalking by an Intimate Partner — NISVS 2010

Women 70.8% 20.9% 8.3%

Men 73.1% 18.6% 8.3%

1 2 3 or more 52 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Figure 6 .2 1 in 5 women and Age at Time of First IPV1 among Female Victims of Rape, Physical Violence, or Stalking by an Intimate Partner — 1 in 7 men who ever NISVS 2010 2.5% experienced rape, physical violence, or stalking by an 6.8% 11-17 22.4% intimate partner first 18-24 21.1% experienced some 25-34

35-44 form of intimate

45+ partner violence 47.1% between 11 and 17 years of age.

1 IPV includes physical violence, all forms of sexual violence, stalking, psychological aggression, and control of reproductive or sexual health.

Figure 6 .3 Age at Time of First IPV1 among Male Victims of Rape, Physical Violence, or Stalking by an Intimate Partner — NISVS 2010

15.0% 11-17

5.5% 18-24 38.6% 25-34 10.3% 35-44

45+ 30.6%

1 IPV includes physical violence, all forms of sexual violence, stalking, psychological aggression, and control of reproductive or sexual health. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 53 54 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 55

7: Services and Disclosure Related to Intimate Partner Violence Victimization

In addition to understanding the a relationship and also their patterns Services Needed among number of people who are victims of disclosure. Further, this section of intimate partner violence (IPV), describes the proportion of victims Lifetime Victims of it is also important to estimate the who received services among those Rape, Physical Violence, number of people who need services who needed them, as well as the or Stalking by an as a result of victimization, as well perceived helpfulness of disclosure as the number who were able to among victims that disclosed their Intimate Partner receive the needed services. These victimization experience. Questions Among lifetime victims of rape, estimates inform efforts to provide a about services and disclosure were physical violence, or stalking by an coordinated community response asked in relation to the violence intimate partner, female victims for victims of IPV. It also provides experienced by an individual perpe- (36.4%, or 15.5 million women) were information that is necessary to trator and for any violence committed significantly more likely than male focus preventive services and allocate by that perpetrator. It is important to victims (15.6%, or 5.0 million men) resources to the most heavily note that victimization experiences to report that they needed services affected populations. This section could have occurred several years ago as a result of these or other forms estimates the proportion of IPV and that the service needs reported of violence they experienced in victims that needed services as a relate to the victimization and not the relationship (Figure 7.1). With result of the violence experienced in to any particular time period. respect to specific service needs as

Figure 7 .1 Services Needed among Lifetime Victims of Rape, Physical Violence, or Stalking by an Intimate Partner, by Sex — NISVS 2010

36.4† Any services 15.6

22.1† Medical care 5.5

6.9† Housing services 1.5 Women 7.5# Victim's advocate services * Men 6.1† Community services 1.1

21.2† Legal services 10.8

0 5 10 15 20 25 30 35 40 Percent

* Estimate is not reported; relative standard error > 30% or cell size ≤ 20. † Statistically significant difference (p < .05) in prevalence. # Formal statistical testing was not undertaken because the number experiencing these behaviors was too small to generate a reliable estimate for at least one of the comparison groups.

0 20 40 60 80 100 Percent 56 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

a result of the violence experienced Services Received care, 89.5% said that they always in the relationship, 22.1% of female received them. Among the 2.4% of victims needed medical care, among Victims who women in the United States who 21.2% needed legal services, 7.5% Needed Services experienced rape, physical violence, needed victim’s advocate services, or stalking and reported they Female Victims who 6.9% needed housing services, needed housing services, 48.3% Needed Services and 6.1% needed community always received them. Additionally, Among lifetime victims of rape, services. Among men who were among the 2.7% of women in the physical violence, or stalking, those victims of rape, physical violence, United States who experienced who reported a need for each of or stalking by an intimate partner, rape, physical violence, or stalking the individual services were asked 10.8% needed legal services, 5.5% and reported they needed victim’s whether they ever received that needed medical care, 1.5% needed advocate services, 46.4% always service. Overall, approximately half housing services, and 1.1% needed received them. Among the 7.6% of of the female victims (49.0%) who community services. For each of women in the United States who needed services reported that they these services, except for advocacy experienced rape, physical violence, always received the services that services, the proportion of female or stalking and reported they were needed (Table 7.1). However, victims reporting that they needed needed legal services, 33.1% always 44.9% of female victims who a particular service was significantly received them. Finally, among the needed services reported that they higher than the proportion of male women in the United States who did not receive any of the needed victims who said they needed experienced rape, physical violence, services. Additionally, 6.1% of the same service (p < .05). Formal or stalking and reported they female victims who needed services statistical testing comparing the needed community services, 49.6% reported that they received some need for advocacy services was not always received them. but not all of the needed services. undertaken because the number With respect to specific services, of men reporting the need for Male Victims who among the 7.9% of women in the advocacy services was too small Needed Services United States who experienced to generate a reliable estimate. Among victims of rape, physical rape, physical violence, or stalking violence, or stalking who reported and reported they needed medical a need for services, the proportion

Table 7 .1 Proportion of Female Lifetime Victims of Rape, Physical Violence, or Stalking by an Intimate Partner Who Received Needed Services — NISVS 20101

Always Received Needed Service(s) Did Not Receive Any Needed Service(s) Service Weighted % 95% CI Weighted % 95% CI Any services 49.0 44.7 – 53.3 44.9 40.7 – 49.2 Medical care 89.5 84.8 – 92.9 9.1 5.9 – 13.6 Housing services 48.3 38.7 – 58.0 51.5 41.8 – 61.1 Victim’s advocate services 46.4 37.5 – 55.6 50.4 41.3 – 59.4 Community services 49.6 39.5 – 59.8 45.1 35.2 – 55.3 Legal services 33.1 28.5 – 38.1 63.6 58.4 – 68.4 1 6.1% of female victims who needed services received some but not all of the needed services. Too few female victims received some but not all needed services, for the individual services, to calculate reliable estimates. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 57

of men who reported that they physical violence, or stalking and Disclosure among always received those services reported they needed legal services, (33.0%) was significantly lower than 10.9% always received those services, Lifetime Victims of the proportion of female victims significantly lower than the 33.1% Rape, Physical Violence, who reported that they always of female victims that needed legal or Stalking by an received those services (49.0%), services and always received those p < .05. Nearly 2 in 3 male victims services (p < .05). Too few male victims Intimate Partner (65.7%) who reported a need for reported a need for other individual Among victims of lifetime rape, services never received any of the services to calculate reliable estimates physical violence, or stalking by an needed services (data not shown). that break down the degree to which intimate partner, 84.2% of women individual services were received, and 60.9% of men disclosed the With respect to specific services, and, therefore, formal statistical 0 5 10 15 20 25 30violence 35 they experienced 40 to another among the 3.1% of men in the comparisons between women and person (Figure 7.2). The proportion Percent United States who experienced rape, men were not made. of female victims who disclosed

Figure 7 .2 Disclosure among Lifetime Victims of Rape, Physical Violence, or Stalking by an Intimate Partner, by Sex — NISVS 2010

84.2† Any disclosure 60.9

36.3† Police 12.6

21.1† Doctor/Nurse 5.6

36.5† Psychologist/Counselor 18.7 Women 5.9# Crisis hotline Men *

† Friend 70.6 48.4

Family member 51.9† 31.6

† Intimate partner 30.5 17.7

† Other 6.6 4.2

0 20 40 60 80 100 Percent

* Estimate is not reported; relative standard error > 30% or cell size ≤ 20. † Statistically significant difference (p < .05) in prevalence. # Formal statistical testing was not undertaken because the number experiencing these behaviors was too small to generate a reliable estimate for at least one of the comparison groups. 58 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

their IPV experience was significantly Degree of Helpfulness higher than the proportion of male victims who disclosed their of Disclosure among Among those who experiences to someone else (p < .05). those Who Disclosed experienced rape, Some of the most common groups of Lifetime Rape, Physical people that victims of rape, physical physical violence, or Violence, or Stalking by violence, or stalking disclosed their stalking by an intimate victimization to included: a friend an Intimate Partner (70.6% of female victims, 48.4% partner during their of male victims); a family member It has been well established (51.9% of female victims, 31.6% that disclosure of victimization lifetime, more than 1 of male victims); a psychologist or experiences can be very helpful counselor (36.5% of female victims, to IPV victims as a way to elicit in 3 female victims and 18.7% of male victims); and the police support (Sylaska & Edwards, 2013). more than 1 in 7 male (36.3% of female victims, 12.6% of However, such disclosures also have male victims). Additionally, 21.1% led to negative reactions, such as victims reported the of female victims and 5.6% of male victim-blaming, pressure to leave an victims disclosed their victimization abusive relationship, or minimizing need for at least one to a doctor or nurse. The proportion the abuse (Sylaska & Edwards, 2013). service as a result of of female victims who disclosed their In the National Intimate Partner experience with IPV was significantly and Sexual Violence Survey (NISVS), their victimization. higher than the proportion of victims of IPV who disclosed their male victims who disclosed their experience with IPV were asked experience with IPV for each of the about the degree of helpfulness groups of people that were examined of the disclosure (very helpful, (p < .05). While 5.9% of female somewhat, a little, not at all) in Among those who relation to each source of help victims disclosed to a crisis hotline, experienced rape, formal statistical testing comparing consulted. Information about the disclosure to a crisis hotline was not helpfulness of each source was physical violence, or undertaken because the number of asked in relation to victimization men reporting disclosure to a crisis from each perpetrator mentioned stalking by an intimate by the respondent. hotline was too small to generate a partner, 84.2% of reliable estimate. women and 60.9% of men disclosed their experience with IPV to someone else. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 59

Female victims of rape, physical to be “not at all helpful.” A similar in proportions between male and violence, or stalking who chose to pattern was found for male victims. female victims reporting disclosure disclose their experiences generally to a doctor or nurse or to an found most sources to be “very The proportion of male victims intimate partner being “very helpful” helpful” or “somewhat helpful” who considered their disclosure is not significant. Formal statistical (Table 7.2). With the exception of being “very helpful” is significantly testing comparing disclosure to a disclosure to police, the percentage lower than the proportion of crisis hotline was not undertaken of victims who found disclosure female victims who considered because the number of men to the various sources to be “not their disclosure being “very helpful” reporting disclosure to a crisis at all helpful” ranged from 10% for the following sources of help: hotline was too small to generate (psychologist/counselor/friend) to police, psychologist/counselors, a reliable estimate. 15% (intimate partner). In contrast, friends, family members, and 33.7% found disclosure to the police “other” (p < .05). The difference

Table 7 .2 Degree of Helpfulness of Various Sources among those Who Disclosed Lifetime Rape, Physical Violence, or Stalking by an Intimate Partner — NISVS 2010

Very (%) Somewhat (%) A little (%) Not at all (%) Women Police 36.5 22.2 14.2 33.7 Doctor/nurse 45.6 29.9 14.0 11.6 Psychologist/counselor 54.0 31.3 12.7 10.1 Crisis hotline 50.0 20.6 18.5 14.3 Friend 47.0 34.9 16.8 10.2 Family member 49.8 31.5 15.3 11.8 Intimate partner 40.6 33.7 16.0 15.0 Other 61.0 27.0 * *

Men Police 21.0 17.8 13.1 52.0 Doctor/nurse 41.2 26.4 17.8 20.9 Psychologist/counselor 40.6 29.9 19.3 16.3 Crisis hotline * * * * Friend 36.6 37.5 18.8 15.1 Family member 38.2 38.9 16.9 11.7 Intimate partner 34.0 30.3 14.8 23.4 Other 34.7 27.0 * * * Estimate is not reported; relative standard error > 30% or cell size ≤ 20. Note: Row totals may add up to more than 100% due to the possibility of respondents disclosing to the same source more than once related to having more than one perpetrator. 60 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 61

8: Physical and Mental Health Conditions by Victimization History

Previous research suggests that result directly from a physical victims of intimate partner injury, others may result from violence (IPV) make more visits to the biological impacts of stress Men and women with health providers over their lifetime; on nearly all body systems a lifetime history of have more hospital stays; have (e.g., nervous, cardiovascular, longer duration of hospital stays; gastrointestinal, reproductive, and rape, physical violence, and are at risk of a wide range of immune systems). Furthermore, or stalking by an physical, mental, reproductive, and some research indicates that other health conditions over their victims of violence are more intimate partner were lifetime compared to nonvictims likely to adopt health-risk coping (Black, 2011; Coker et al., 2002). behaviors such as smoking and more likely to report Many studies document increased the harmful use of alcohol or drugs frequent headaches, risk for a number of adverse (Campbell, 2002; Coker et al., 2002). physical, mental, reproductive, and chronic pain, difficulty other health conditions among This section compares the sleeping, activity those who have experienced prevalence of various health intimate partner violence. Most conditions among persons with limitations, and poor studies that evaluate the adverse a lifetime history of rape, physical physical health in health consequences of intimate violence, or stalking by an intimate partner violence are based on partner in relation to those who general compared female victims of such violence; have not experienced these forms less is known about the risk for of IPV in their lifetime. Respondents to those without a adverse health events among men were asked about a number of history of these forms (Breiding, Black, & Ryan, 2008). health conditions: asthma, irritable bowel syndrome, diabetes, high of IPV. Women who The cross-sectional nature of the blood pressure, frequent headaches, have experienced National Intimate Partner and chronic pain, difficulty sleeping, Sexual Violence Survey (NISVS) activity limitations, and whether these forms of does not allow for a determination they considered their physical of causality or the temporality health and mental health to be violence were also of violence victimization and poor. Verbatim health questions more likely to report associated health conditions. are available within the National However, extensive research Intimate Partner and Sexual Violence asthma, irritable bowel describes a number of mechanisms Survey (NISVS): 2010 Summary Report syndrome, diabetes, that link chronic stress to a wide (Black et al., 2011). range of adverse health conditions and poor mental (Black, 2011). While some health health compared to conditions may women who did not experience these forms of violence. 62 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Among Women asthma (p < .001), irritable bowel of rape, physical violence, or With the exception of high blood syndrome (p < .001), diabetes stalking by an intimate partner, pressure, the prevalence of reported (p < .05), frequent headaches compared to women who have not adverse mental and physical health (p < .001), chronic pain (p < .001), experienced these forms of violence conditions was significantly higher difficulty sleeping (p < .001), and (p < .001). The experience of rape, among women with a history of activity limitations (p < .001). physical violence, or stalking by an rape, physical violence, or stalking Additionally, the percentage of intimate partner was significantly by an intimate partner compared to women who considered their associated (p < .05) with each of women without a history of these physical or mental health to be the health conditions except for forms of violence (Table 8.1). This poor was significantly higher high blood pressure, even after includes a higher prevalence of among women with a history controlling for age, race/ethnicity,

Table 8 .1 Prevalence of Physical and Mental Health Conditions among those with and without a History of Rape, Physical Violence, or Stalking by an Intimate Partner — U .S . Women and Men, NISVS 2010

Women Men Weighted % Weighted % p-value2 p-value2 Health Condition History No History1 History No History1 Asthma 23.1 15.5 < .001 14.4 13.0 ns3 Irritable bowel syndrome 12.0 7.7 < .001 4.2 3.6 ns3 Diabetes 12.9 10.3 < .05 9.7 10.6 ns3 High blood pressure 28.1 27.1 ns3 30.1 29.3 ns3 Frequent headaches 29.5 17.4 < .001 16.0 9.8 < .001 Chronic pain 30.0 17.8 < .001 23.7 13.5 < .001 Difficulty sleeping 38.4 22.4 < .001 32.7 19.1 < .001 Activity limitations 35.7 20.9 < .001 29.1 18.7 < .001 Poor physical health 6.7 2.7 < .001 4.9 2.8 < .01 Poor mental health 3.6 1.2 < .001 2.6 1.4 ns3 1 No history of rape, physical violence, or stalking by an intimate partner. 2 p-values determined using chi-square test of independence in SUDAAN™. 3 Nonsignificant difference. The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 63

income, education, and the (p < .001), difficulty sleeping experience of rape and stalking experience of rape and stalking (p < .001), activity limitations by non-intimates. There were no by non-intimates (Table 8.2). (p < .001), and considered their significant differences between physical health to be poor (p < .01). the two groups of men in the Among Men Each of these health conditions prevalence of asthma, irritable Compared to men without a history was significantly associated bowel syndrome, diabetes, high of rape, physical violence, or stalking (p < .05) with having experienced blood pressure, and self-assessed by an intimate partner, men with rape, physical violence, or stalking poor mental health. such histories had a significantly by an intimate partner, even after higher prevalence of frequent controlling for age, race/ethnicity, headaches (p < .001), chronic pain income, education, and the

Table 8 .2 Association between Physical and Mental Health Conditions and the Experience of Rape, Physical Violence, or Stalking by an Intimate Partner — U .S . Women and Men, NISVS 2010

Comparison of History vs. No Comparison of History vs. No History among Women History among Men Health Condition AOR1 95% CI AOR1 95% CI Asthma 1.4* 1.2 – 1.7 1.1 0.9 – 1.4 Irritable bowel syndrome 1.5* 1.2 – 1.9 1.3 0.9 – 2.0 Diabetes 1.3* 1.0 – 1.6 1.0 0.8 – 1.3 High blood pressure 1.1 0.9 – 1.3 1.1 0.9 – 1.4 Frequent headaches 1.6* 1.4 – 2.0 1.4* 1.1 – 1.8 Chronic pain 1.6* 1.4 – 1.9 2.0* 1.6 – 2.4 Difficulty sleeping 1.7* 1.5 – 2.0 1.8* 1.5 – 2.2 Activity limitations 1.8* 1.5 – 2.1 1.7* 1.4 – 2.1 Poor physical health 2.0* 1.4 – 3.0 2.2* 1.4 – 3.3 Poor mental health 2.0* 1.2 – 3.3 1.4 0.8 – 2.5 1 Adjusted odds ratio controlling for age, race-ethnicity, income, education, and the experience of rape and stalking by non-intimates. * Statistically significant, p < .05. 64 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 65

9: Discussion

Highlights and than rape; approximately violence experiences and do not 1 in 4 has experienced severe speak to differences in severity Cross-Cutting Findings physical violence and nearly among victims. Beyond reporting the overall 1 in 3 has been slapped, pushed, prevalence of individual forms of or shoved; more than 1 in 10 has In multiple ways, the data in this intimate partner violence (IPV), been stalked; and nearly 1 in 2 report indicate that IPV reported the National Intimate Partner and has experienced psychological by women was typically more Sexual Violence Survey (NISVS) aggression. With regard to men’s severe and resulted in a greater was designed to examine and lifetime experience of violence by number of negative impacts describe in more detail the context an intimate partner: approximately than IPV victimization reported of IPV victimization experienced 1 in 12 has experienced sexual by men. Specifically, during their by women and men. This report violence other than rape; nearly lifetime, women were more likely describes a number of these 1 in 7 has experienced severe than men to experience: severe important contextual elements physical violence and 1 in 4 has physical violence; sexual violence such as the frequency, severity, been slapped, pushed or shoved; other than rape by an intimate and the overlap of violence types, nearly 1 in 48 has been stalked; partner; stalking by an intimate as well as the need for services, and nearly 1 in 2 has experienced partner; and expressive aggression. and impact of IPV victimization. psychological aggression. Furthermore, women were more Moving beyond the primary focus likely than men to experience: of IPV prevalence allows for a Further, the results indicate that a multiple forms of intimate partner deeper understanding of the broad significant proportion of IPV victims violence (including rape, physical range of victimization experiences. experience negative impacts as a violence, and stalking), both across From a public health perspective, result of IPV victimization. Although the life span and within individual a better understanding of the no demographic group is immune violent relationships; a need for context in which intimate partner to these forms of violence, consistent services in general; and at least one violence occurs is necessary to patterns emerged with respect to the of the negative IPV-related impacts inform and focus preventive subpopulations in the United States that were measured, including services and community responses that are most heavily affected. injury and having missed at least to the needs of victims. one day of work or school. Women are Disproportionately Intimate Partner Violence Affected by Intimate Looking at the variation in IPV Remains a Significant Public Partner Violence experiences among victims only, Health Problem Consistent with previous national female victims were more likely than The results presented in this studies (Tjaden & Thoennes, male victims to experience: a greater report indicate that IPV remains a 2000), the findings in this number of discrete physically violent, public health issue of significant report indicate that women are sexually violent, and psychologically importance, affecting many disproportionately affected by IPV. aggressive behaviors within an women and men in the United While women have a significantly individual violent relationship; each States. Specifically, with regard higher lifetime prevalence of rape, of the negative IPV-related impacts to women’s lifetime experience physical violence, or stalking by that was measured, including injury, of violence by an intimate an intimate partner, compared need for housing services, need for partner: nearly 1 in 10 has been to men, it is important to look victim’s advocate services, and having raped; approximately 1 in 6 has beyond the overall numbers as missed at least one day of work or experienced sexual violence other they encompass a wide range of school; and a greater number of 66 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

discrete IPV-related impacts within Furthermore, a comparison of the Women and Men with an individual relationship. Finally, differences in 12-month prevalence Lower Incomes are female victims were more likely estimates show much smaller Disproportionately Affected than male victims to experience differences between men and by Intimate Partner Violence more than the median number of women (e.g., unwanted sexual The 12-month prevalence of rape, violent behaviors in an individual contact, various forms of severe physical violence, or stalking by relationship for: sexual violence physical violence) and, in some an intimate partner was signifi- (two or more sexually violent cases, more men than women cantly higher among women and behaviors), physical violence (three experienced certain behaviors men with a combined household or more physically violent behaviors), in the 12 months preceding the income of less than $25,000 and and psychological aggression survey such as being slapped between $25,000 and $50,000 (four or more psychologically and being kicked. Additionally, than for women and men with a aggressive behaviors). men had a higher 12-month combined income over $75,000. prevalence of psychological The median U.S. household income Many Men Experience Severe aggression than women. in 2010 was $49,455, so the two IPV and Negative Impacts lowest income groups combined Despite numerous indicators Racial/Ethnic Minorities are roughly correspond to the bottom suggesting that women are more Disproportionately Affected 50th percentile for household likely to experience severe IPV by Intimate Partner Violence income (U.S. Census Bureau, 2011). compared to men, and are more Consistent with other studies, This finding is consistent with likely to be negatively impacted, the burden of IPV is not shared previous studies demonstrating the data show that many men also equally among racial/ethnic an inverse relationship between experience severe forms of IPV and groups. This report indicates that income and IPV prevalence negative impacts. Specifically, in Black and multiracial non-Hispanic (Breiding, Black, & Ryan, 2008). the United States: women had significantly higher • Nearly 14% of men have lifetime prevalence of rape, Victimization is More experienced severe physical physical violence, or stalking by Prevalent among violence by an intimate partner an intimate partner, compared to Young Adults in their lifetime. White non-Hispanic women; Asian For women and men, the 12-month • Nearly 10% of men have or Pacific Islander non-Hispanic prevalence of rape, physical experienced rape, physical women had significantly lower violence, or stalking was highest violence, or stalking by an prevalence than non-Hispanic among the youngest age group intimate partner in their lifetime White women. Also, American (18 to 24). Prevalence decreased and experienced at least one Indian or Alaska Native men, within each subsequent age group. IPV-related impact. as well as Black and multiracial Furthermore, nearly 60% of female non-Hispanic men, had a victims and over 55% of male • Approximately 4% of men significantly higher lifetime victims first experienced some have been physically injured prevalence of rape, physical form of intimate partner violence in their lifetime as a result of violence, or stalking compared to prior to age 18. violence experienced in an White non-Hispanic men. These intimate relationship. findings may be a reflection of Victimization is Associated • Approximately 4% of men have the many stressors that racial with Recent Food and missed at least one day of work and ethnic minority communities Housing Insecurity or school in their lifetime as a continue to experience. For Higher levels of 12-month result of violence experienced in example, a number of social prevalence of rape, physical an intimate relationship. determinants of mental and violence, or stalking by an intimate physical health, such as low income partner were observed among and limited access to education, those with food and housing community resources, and services, insecurity. Additional analysis is likely play important roles. needed to fully understand the The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 67

independent effects of income, at some point during their lifetime. disclosure to particular sources such education, employment status, and The estimated number of men as police, psychologists/counselors, other sociodemographic variables and women who reported that friends, family members, and “others.” that may be related to both food they needed services as result of and housing insecurity and to IPV. victimization in their lifetime was Intimate Partner Violence more than 20 million. However, Is Associated with Negative Foreign-born Adults women, in particular, had a need Physical and Mental Health Experienced Lower Levels for housing and victim’s advocate Conditions of Victimization services, with millions of women The findings in this report confirm The lifetime prevalence of rape, needing each of these forms and extend the literature by physical violence, or stalking of assistance in their lifetime. documenting the association was significantly lower for Importantly, less than 50% of female between IPV and a wide range adults that were born outside victims who indicated a need of adverse physical and mental of the United States compared for housing or victim’s advocate health conditions as the findings to those born in the United services during their lifetime presented here are the first to States. Additional analysis is reported that they received them. examine these associations in a needed to better understand nationally-representative dataset. whether this finding reflects a Overall, among female victims that The significant associations lower likelihood of experiencing needed services during their lifetime, between IPV victimization and IPV among immigrants in their 44.9% did not receive any services. negative health outcomes country of origin, or whether it is For male victims, nearly 2 out of 3 remained after controlling for the result of a lower likelihood of (65.7%) that needed services during sexual violence and stalking by experiencing IPV since arriving their lifetime did not receive any non-intimates, suggesting that IPV in the United States. Another services. Clearly, there is a need to uniquely contributes to long-term possible explanation is that there better understand the barriers to health difficulties. are cultural differences in reporting receiving these services for both violence experiences, and that women and men. Specifically, Results Provide Greater those cultural differences, and not there is a need for an improved Context Surrounding a true difference in prevalence, may understanding of whether the IPV Victimization explain the differences found. barriers are largely due to lack of The methodology used in the availability or other factors that lead survey responds to calls from Bisexual Women are at to a victim choosing not to access the field to add greater context Greater Risk of Victimization available services. to prevalence estimates that Bisexual women were significantly frequently do not explicate the more likely to experience lifetime A larger percentage of female range of severity that exists among rape, physical violence, or stalking victims disclosed their lifetime IPV victims. Specifically, by examining by an intimate partner, compared experiences, in general, compared to information related to individual to lesbian and heterosexual men (84.2% and 60.9%, respectively), perpetrators, including the overlap women. While the prevalence of and a larger percentage of female of types of IPV, discrete number rape, physical violence, or stalking victims disclosed their IPV to of violent behaviors experienced, for bisexual men was somewhat individual sources compared to frequency and severity of the elevated compared to gay men and men. However, among victims violence experienced, and the heterosexual men, there were no that disclosed their lifetime IPV impact of violence perpetrated statistically significant differences. victimization, the proportion of men by a specific intimate partner, the who considered the disclosure as results described in this report allow Services and Disclosure being “very helpful” was significantly for a better understanding of the A range of services have been lower than the proportion of women patterns of violence that exist within needed by a large number of who considered the disclosure as individual relationships, shedding people in the United States as a being “very helpful.” This was true light on the totality of the violence result of having experienced IPV for disclosure in general and for experienced. Additionally, this 68 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

information allows for a description Limitations violent behaviors. However, results of the range in severity of from the cognitive testing process victimization experiences that is not The findings of this report undertaken in the development fully represented by IPV prevalence are subject to a number of of NISVS suggested that victims estimates that combine many limitations. Random digit dial who experienced multiple forms diverse victimization experiences (RDD) telephone surveys face two of violence with a perpetrator would into a binary outcome measure. substantive challenges that have have a difficult time distinguishing the potential to affect the national which type of violence from that Despite these methodological representativeness of the sample perpetrator resulted in a particular improvements that shed light on population. This includes declining type of impact. For example, a the context of IPV victimization, response rates and an increasing respondent may not be able to the data do not speak to other key number of households without attribute their concern for safety aspects of context, specifically, landline telephones (Peytchev, to the psychological aggression motive on the part of perpetrator Carley-Baxter, & Black, 2011). While or the physical violence that they (e.g., self-defense) and whether the overall response rate for the experienced. Second, because we the victim also engaged in 2010 National Intimate Partner used victims’ reports of their age perpetration of IPV. Prior research and Sexual Violence Survey was and relationship at the time violence suggests that IPV is reciprocal in relatively low, the cooperation started with each perpetrator, it many relationships (Graham-Kevan rate was high. A number of efforts was not always possible to calculate & Archer, 2003). Consequently, it were also made to mitigate the respondent’s age or specify the is likely that a certain number of the potential for non-response relationship at the time specific victims identified within this report and non-coverage bias. These types of violent behavior occurred. were themselves perpetrators include a non-response follow-up Based on the data we have of IPV who may or may not have in which randomly selected about the relationship at the first acted in self-defense. It is also non-responders were contacted victimization and last victimization, possible that some of the victims and offered an increased incentive we estimate that less than 3% of identified within this report may for participation. In addition, the perpetrators had a relationship with have been the primary perpetrator inclusion of a cellphone component the victim that changed categories within the relationship and that provided increased coverage of a over time between the experience the victimization they reported growing population that would of the first and last victimizations may have occurred solely when a have otherwise been excluded. (e.g., from acquaintance to intimate partner was acting in self-defense. The cellphone-only population partner). All of the estimates in this Perpetration of IPV is not measured tends to be young, low income, report reflect the relationship at the within NISVS because data and comprised of racial/ethnic time the perpetrator first committed from the NISVS pilot found that minorities (Peytchev, Carley-Baxter, any violence against the victim. perpetration was significantly & Black, 2011). Importantly, these underreported relative to demographic groups have Even though NISVS captures a full victimization. Further, the motives a higher prevalence of IPV. range of victimization experiences, of perpetrators were not assessed the estimates reported here likely in NISVS, given the difficulties Follow-up questions were designed underestimate the prevalence of a respondent would have in to reflect the victim’s experience intimate partner violence for a accurately assessing the specific with each perpetrator across the number of reasons. These include: motives of another person. Not victim’s lifetime. There are several (1) potential respondents that only is asking a victim to describe limitations associated with how are currently involved in violent the motive of a perpetrator likely these questions were asked. First, relationships may not participate unreliable, but motives behind respondents were asked about the in the survey or fully disclose the the violence are likely to change impact from any of the violence violence they are experiencing over time and change with the inflicted by each perpetrator. because of concern for their safety; specific circumstances surrounding Therefore, it is not possible to (2) although the survey gathers multiple episodes of IPV. examine the impact of specific information on a wide range of The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 69

victimizations, it is not feasible to affect those who have experienced reluctance for respondents to measure all of the violent behaviors recent severe IPV. Additionally, it discuss specific types of violence that may have been experienced; is possible that those who have (e.g., forced vaginal sex) or specific (3) given the sensitive nature of experienced recent severe IPV types of perpetrators (e.g., same these types of violence, it is likely may be less likely to participate at sex). These are factors that might that some respondents who all. One study found that women impact the accuracy of estimates had been victimized did not feel who had experienced severe IPV in unpredictable ways and in a comfortable participating or did within the past 12 months were manner that could potentially not feel comfortable reporting their less likely to participate in a study vary across subgroups of victims experiences because of ongoing of IPV (Waltermaurer, Ortega, & (e.g., by age or sex). Despite these emotional trauma or the social McNutt, 2003). There are a number limitations, population-based stigma associated with being a of potential reasons why those surveys that collect information victim of these forms of violence; who have experienced recent directly from victims remain one (4) although potentially mitigated severe IPV may be less willing to of the most important and most by the use of a cell phone sample, participate in a survey. First, a victim reliable sources of data on IPV. For RDD surveys may be less likely of severe IPV who is currently living example, the wide range of impacts to capture populations living in with the perpetrator may fear of IPV that was measured by institutions (e.g., nursing homes, for their safety. Second, a recent NISVS can only be captured from military bases, college dormitories), victim of IPV who has recently the victim directly. Furthermore, or those in prison, those living in left a relationship may be in a less population-based surveys are likely shelters, or those who are homeless stable living arrangement, such to capture IPV victimization that or transient; and (5) it is possible as a shelter, or temporarily living does not come to the attention of that some respondents could no with a friend or family member, police, as well as IPV victimization longer recall violence experiences and may be less likely to have that does not require treatment that were less severe in nature or the opportunity to participate. or is not reported to a health that occurred long ago. Third, those who are currently provider. Population-based surveys involved in a particularly controlling that are carefully conducted, with This report provides lifetime and relationship may have restricted well-trained interviewers who are 12-month prevalence estimates, or no use of a telephone. For these able to build rapport and trust as both estimates are important reasons, 12-month prevalence with participants, are essential to indicators of the burden of IPV. estimates of IPV victimization the collection of valid data and the For an ongoing public health may be an underestimate of the well-being of respondents. surveillance system, 12-month current public health burden of IPV. prevalence estimates are important Because women are more likely to Considerations Related to indicators needed to determine experience severe IPV compared to Combining Violence Types the current public health burden of men, women’s 12-month prevalence Many of the results in this report these forms of violence and to track may be particularly affected. focus on a summary measure trends over time. However, given that examined whether a victim the sensitivity of these outcomes, In addition to the possible experienced some combination of there are important limitations to causes of underestimation of rape, physical violence, or stalking. consider when interpreting the the prevalence, it is important to This summary measure utilized 12-month prevalence of IPV. As consider other potential limitations is a conservative representation, mentioned, some respondents related to the data being based including only those violence may be less likely to disclose IPV on self-reports. For example, types for which there is broad victimization due to ongoing 12-month estimates may reflect a agreement regarding inclusion, but emotional trauma or discomfort, degree of recall bias with victims most certainly excludes a number or due to concern for their safety believing that victimization of violence types that in specific due to an ongoing relationship experiences occurred closer in instances should be classified as with a perpetrator. We would time than they actually did (i.e., IPV. The exclusion of certain forms expect that this would particularly telescoping). Also, there may be of IPV from the summary measure 70 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

is not meant to suggest these and boys experience. With further forms of IPV that were measured research, and with broader in NISVS (i.e., sexual violence agreement within the field, other than rape, psychological changes may be warranted to the aggression, control of reproductive summary measure by including or sexual health) are less important. some of the forms of IPV that are One overriding concern about currently described outside of the including all types of IPV measured summary measure. In so doing, a by NISVS into a single summary broader summary measure would measure is that by combining describe a more comprehensive many forms of IPV, ranging from representation of IPV experiences. severe to less severe, the meaning of the summary measure is lost. Specifically, the summary measure may lead to the false impression that all experiences are equivalent under the umbrella of the summary measure. However, it is important to consider the variation in severity that exists and is represented by the other measures described in this report.

The reasons for not including specific types of IPV in the summary measure vary. For some types of IPV, such as psychological aggression, there is little agreement in the field from a measurement perspective about when psychological aggression becomes psychological abuse or violence. The prevalence estimate included in this report describes the number of people who experienced any form of psychological aggression at least once. As the understanding of psychological aggression improves (for example, how to make the distinction between psychological aggression and psychological abuse), the ability to appropriately describe and present this important data will improve. Similarly, another form of violence, being made to penetrate someone else, is a relatively new addition that may be particularly important to improve our understanding of the sexual violence that men The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 71 72 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 73

10: Implications for Prevention

This report documents the public DELTA FOCUS grantees are working being most at risk. Further work health burden that intimate partner toward changing the conditions needs to be done to test existing violence (IPV) exerts on a wide that lead to IPV through activities strategies with specific groups, as range of populations with differing such as: promoting healthy well as to develop and test other demographic characteristics. relationships and communications strategies to determine whether Consequently, a community-level skills, engaging men and boys in they are effective in preventing response is needed to implement violence prevention, developing IPV. One of the goals of CDC’s effective and appropriate measures youth assets and leaders, and Dating MattersTM program, which to prevent and respond to those working with communities is a comprehensive program for who are affected by IPV. to implement and evaluate youth, their parents, educators, and population-level strategies that the neighborhoods in which they prevent IPV. live, is to test evidence-based and Primary Prevention evidence-informed strategies within CDC places an emphasis on high-risk urban communities (Teten The Centers for Disease Control and primary prevention, prioritizing the Tharp, 2012). By making adaptations Prevention’s (CDC's) core strategy for prevention of IPV from occurring to existing evidence-based program preventing IPV is the promotion of in the first place. This report components to make them more respectful, nonviolent relationships indicates that IPV victimization culturally relevant and developing through individual, relationship, begins early with nearly 70% of and testing other strategies tailored community, and societal change. female victims and nearly 54% of for urban communities, this This prevention strategy is male victims having experienced program will help identify potential organized around the following IPV prior to age 25. This suggests strategies for groups at high-risk for principles: understanding ways to that primary prevention of IPV teen dating violence. Outside of this interrupt the development of IPV must begin at an early age. CDC’s specific program, continued efforts perpetration; improving knowledge approach to primary prevention are needed to develop prevention of factors that contribute to of IPV is the promotion of healthy strategies that address the culturally respectful relationships and protect relationship behaviors among specific concerns of at-risk groups against IPV; creating and evaluating young people, with the goal of across the United States. new approaches to prevention; reaching adolescents prior to their and building community capacity. first relationships. By influencing Efforts to build positive and healthy Comprehensive community-based relationship behaviors and patterns parent-child relationships are approaches building upon and early through dating violence also important for the primary joining well-organized, broad- prevention programs, the hope is prevention of IPV. Children benefit based coalitions are important to promote healthy relationship from safe, stable, and nurturing and can effectively create change behaviors and patterns that can be familial environments that in communities. One example carried forward into adulthood. facilitate respectful interactions of these efforts, The Domestic and open communication. Other Violence Prevention Enhancement This report identified groups that opportunities to build parent-child and Leadership Through Alliances are at most risk for IPV victimization. relationships include programs (DELTA) FOCUS program seeks to While primary prevention programs to promote effective parenting prevent IPV at the national, state, exist, it is unknown whether they skills and efforts to include and and local levels by funding states are effective within specific groups support relationships between and communities to implement and of people, particularly among fathers and children. Beyond evaluate IPV prevention strategies. those identified in this report as providing children an opportunity 74 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

to share with their parents the the likelihood of IPV perpetration. needed medical services; nearly experiences they have had with Protective factors are particularly half said they needed housing, dating violence and other forms critical to developing prevention victim’s advocacy, and community of violence, parents who model programs as they are more likely to services; and a third of women healthy, respectful intimate point to environments or situations needed legal services. Among the relationships free from violence that reduce the likelihood of female victims who needed at least foster these relationship patterns violence perpetration, in general, one of these services at some point in their children. Furthermore, or reduce the likelihood of IPV during their lifetime, nearly half children who have experienced perpetration in the first place did not receive any of the services adverse childhood events, such among those who are at high risk. that were needed. Among the male as witnessing violence between victims who needed at least one parents, are at increased risk of Finally, as the risk and protective of these services, approximately short- and long-term health and factors for IPV perpetration are two-thirds did not receive any of social problems (Felitti, et al., 1998). better understood, additional the needed services. This indicates Reducing parental IPV is likely to research is needed to develop and that a significant gap has existed decrease the risk of IPV and other evaluate strategies to effectively over time, and may still exist, forms of violence in the next prevent the first-time perpetration between a need for services and generation, decrease the likelihood of IPV. This includes research that the receipt of those services. Future of children engaging in risky addresses the social and economic work is needed to understand the behaviors, and decrease the risk conditions that increase the risk for degree to which this gap currently of a wide range of adverse perpetration and victimization — exists and, if so, whether this gap is health conditions. such as poverty, food and housing due to services being unavailable insecurity, and sexism — as well as or because available services were The focus of this report is on other forms of discrimination and not utilized. Regardless, a better describing the public health social exclusion. Such research will understanding of the current burden of victimization. To better complement efforts focused on barriers to service utilization is understand how to prevent IPV, preventing initial victimization and always important. CDC also supports work that seeks the recurrence of victimization. to better understand the causes Disclosing victimization of IPV perpetration. Research experiences is a necessary first step examining risk and protective Secondary and for victims to be able to obtain the factors is key to understanding how resources and services they need. perpetration of violence develops Tertiary Prevention One primary method by which IPV and to determine the optimal Secondary and tertiary prevention victims may disclose victimization strategies for preventing intimate programs and services are essential and receive appropriate help is partner violence. While much is for mitigating the short- and through disclosure to medical known about risks factors at the long-term consequences of IPV professionals. While 84.2% of individual and couple level, there among victims, as well as reducing female victims and 60.9% of have been few studies examining the violence-related health burden male victims disclosed their IPV community- and societal-level across the life span. This report victimization to someone, only factors related to perpetration of examined a range of services 21.0% of female victims and 5.0% IPV. Identifying community and that victims reported needing as of male victims reported having societal-level factors, while difficult, a result of IPV at some point in disclosed their victimization to could be most useful in identifying their lifetime and whether they a medical professional at some perpetration prevention strategies received them, including medical point in their lifetime. A number that have the most potential for care, housing, victim’s advocacy, of medical associations (e.g., broad impact. In addition, future legal, and community services. The American Congress of Obstetricians research is needed to identify vast majority of women who were [ACOG] and Gynecologists, protective factors that decrease victims of IPV indicated that they American Medical Association [AMA]) The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 75

recommend asking all patients contain adequate information about their experiences with IPV at on IPV (Hamberger, 2007). To every visit and providing referrals train health care providers to for services as indicated (AMA, effectively identify, treat, and 1992; ACOG, 1995). Further, in provide secondary prevention for 2013, the U.S. Preventive Services victims of IPV, there remains an Task Force recommended that urgent need to raise awareness clinicians should screen all women about the pervasiveness of IPV and of childbearing age for IPV and the far-reaching implications for provide or refer women who screen patient health (Block, 2005). positive to intervention services (Moyer, 2013). The questions about disclosure in National Intimate Conclusion Partner and Sexual Violence Survey were asked in relation to To reduce the burden of intimate the violence experienced by an partner violence in the United individual perpetrator and were States, it is essential to have solid not specific to any particular data to inform IPV prevention time period. However, the efforts and to provide services findings suggest a need to better and resources to those who have understand any potential barriers been victimized. Additionally, it that may prevent victims from is critical for all sectors of society, disclosing to a medical professional including peer groups, schools, or those that may make some medical professionals, and medical professionals reluctant communities, to work together to assess patients’ victimization to decrease IPV. Continued experiences, even among those efforts are required to extend the that show signs of victimization gains that have been made in (Black, 2011). Victims choosing to understanding and implementing disclose to health care providers IPV prevention strategies. is likely to improve if clinicians are prepared and able to ask about IPV in a compassionate and non-judgmental manner. One of the largest barriers to physicians asking about IPV is that they frequently feel inadequate and unprepared to appropriately respond to a patient who reports experiencing IPV. A study of final-year primary care residents regarding “perceived preparedness” found that only 21% reported being prepared to talk about IPV (Park, Wolfe, Gokhale, Winichoff, & Rigotti, 2005). The amount of time spent on IPV training remains quite limited and the majority of medical textbooks still do not 76 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 77

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Appendix A: Violence Victimization and Other Domains Assessed

Violence Domains man, it also includes times when female using their fingers or a partner tried to get pregnant an object. Being made to Five types of intimate partner when the man did not want her penetrate someone else includes violence were measured in National to become pregnant. times when the victim was made Intimate Partner and Sexual to, or there was an attempt to Violence Survey (NISVS). These A list of the victimization questions make them, sexually penetrate include sexual violence, physical used in the survey can be found in someone without the victim’s violence, stalking, psychological Appendix B. consent because the victim was aggression, and control of physically forced (such as being reproductive/sexual health. Sexual Violence by an pinned or held down, or by the • Sexual violence includes rape, Intimate Partner use of violence) or threatened with being made to penetrate Five types of sexual violence were physical harm, or when the victim someone else, sexual coercion, measured in NISVS. These include was drunk, high, drugged, or unwanted sexual contact, and acts of rape (forced penetration), passed out and unable to consent. non-contact unwanted sexual being made to penetrate someone –– Among women, this behavior experiences, as described below. else, sexual coercion, unwanted reflects a female being made to • Physical violence includes a range sexual contact, and non-contact orally penetrate a man’s anus or of behaviors from slapping, unwanted sexual experiences. another female’s vagina or anus. pushing, or shoving to severe • Rape is defined as any completed It also includes perpetrators acts such as being beaten, or attempted unwanted vaginal attempting to make female burned, or choked. (for women), oral, or anal victims penetrate them, though penetration through the use of • Stalking victimization involves penetration did not happen. physical force (such as being a pattern of harassing or –– Among men, being made to pinned or held down, or by the threatening tactics used by penetrate someone else could use of violence) or threats to a perpetrator that is both have occurred in multiple physically harm and includes unwanted and causes fear or ways: being made to penetrate times when the victim was safety concerns in the victim as a female’s vagina or anus, or drunk, high, drugged, or passed described below. another man’s anus, using one’s out and unable to consent. Rape own penis; being made to • Psychological aggression includes is separated into three types, penetrate another man’s anus, expressive aggression (such completed forced penetration, or a woman’s vagina or anus, as name calling, insulting, or attempted forced penetration, using one’s own mouth; being humiliating an intimate partner) and completed alcohol- or made to penetrate a man’s or and coercive control, which drug-facilitated penetration. woman’s mouth using one’s includes behaviors that are Among women, rape includes own penis. It also includes intended to monitor and control vaginal, oral, or anal penetration perpetrators attempting to or threaten an intimate partner. by a male using his penis. It make male victims penetrate • Control of reproductive or sexual also includes vaginal or anal them, though penetration did health includes the refusal by an penetration by a male or female not happen. intimate partner to use a condom. using their fingers or an object. For a woman, it also includes Among men, rape includes oral • Sexual coercion is defined as times when a partner tried to get or anal penetration by a male unwanted sexual penetration her pregnant when she did not using his penis. It also includes that occurs after a person is want to become pregnant. For a anal penetration by a male or pressured in a nonphysical way. 82 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

In NISVS, sexual coercion refers burned on purpose and having a psychologically aggressive to unwanted vaginal, oral, or partner use a knife or gun against behavior becomes abusive and anal sex after being pressured the victim. While slapping, pushing, should be classified as IPV. Because in ways that included being and shoving can also be severe of the lack of consensus in the worn down by someone who in terms of the effect on victims, field at the time of this report, repeatedly asked for sex or this report distinguishes between the prevalence of psychologically showed they were unhappy; these forms of violence and the aggressive behaviors is reported, feeling pressured by being lied physical violence that is generally but is not included in the overall to, being told promises that were categorized as severe. prevalence estimates of IPV. untrue, having someone threaten to end a relationship or spread Stalking by an Control of Reproductive rumors; and sexual pressure due Intimate Partner or Sexual Health by an to someone using their influence Stalking victimization involves a Intimate Partner or authority. pattern of harassing or threatening Control of reproductive or sexual • Unwanted sexual contact is tactics used by a perpetrator that is health includes the refusal by an defined as unwanted sexual both unwanted and causes fear or intimate partner to use a condom. experiences involving touch but safety concerns in the victim. For the For a woman, it also includes times not sexual penetration, such as purposes of this report, a person was when a partner tried to get her being kissed in a sexual way, or considered a stalking victim if they pregnant when she did not want to having sexual body parts fondled experienced multiple stalking tactics become pregnant. For a man, it also or grabbed. or a single stalking tactic multiple includes times when a partner tried times by the same perpetrator and to get pregnant when the man did • Non-contact unwanted sexual felt very fearful, or believed that they not want her to become pregnant. experiences are those unwanted or someone close to them would be experiences that do not involve harmed or killed as a result of the any touching or penetration, perpetrator’s behavior. including someone exposing Other Domains Assessed their sexual body parts, flashing, Psychological Aggression IPV-related Impact or masturbating in front of the by an Intimate Partner For each perpetrator of IPV, victim, someone making a victim Psychological aggression, including respondents were asked about show his or her body parts, expressive aggression and coercive whether they had experienced: someone making a victim look at control, is an important component • Being fearful or participate in sexual photos or of intimate partner violence (IPV). movies, or someone harassing the • Being concerned for safety Expressive aggression includes victim in a public place in a way • Symptoms of post-traumatic behaviors such as name-calling, that made the victim feel unsafe. stress disorder (PTSD) insults, and humiliation. Coercive control includes behaviors that – Having nightmares Physical Violence by are intended to monitor and – Trying hard not to think about an Intimate Partner control an intimate partner it or avoiding being reminded Physical violence includes a wide through threats to harm, of it range of behaviors from slapping, interference with family and – Feeling constantly on guard, pushing, or shoving to more severe friends, and limiting access to watchful, or easily startled behaviors such as being beaten, money. Although research – Feeling numb or detached burned, or choked. In this report, suggests that psychological severe physical violence includes from others, activities, aggression may be even more or surroundings being hurt by pulling hair, being hit harmful than physical violence with something hard, being kicked, by an intimate partner (Follingstad, • Being injured being slammed against something, Rutledge, Berg, Hause, & Polek, • Needing health care attempts to hurt by choking or 1990), there is little agreement • Needing housing services suffocating, being beaten, being about how to determine when The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 83

• Needing victim’s advocate violence was experienced. This services report describes violence for which • Needing legal services the respondent indicated that the perpetrator was a current or former • Contacting a crisis hotline intimate partner at the time when • Missing days of work or school the violence first began. • For those reporting rape by an intimate partner: Services and Disclosure – Contracting a sexually Respondents who reported transmitted infection experiencing violence were subsequently asked whether they – Becoming pregnant (for women) needed various services (e.g., medical care, housing services, The questions were assessed in advocacy services, crisis hotline). If relation to specific perpetrators a respondent indicated a need for without regard to the time period a particular service, the respondent in which they occurred. Because was asked whether that service was violent acts often do not occur received. In addition, respondents in isolation and are frequently who reported experiencing experienced in the context of other IPV were asked whether they violence committed by the same disclosed their victimization to perpetrator, questions regarding various sources (e.g., health care the impact of the violence were provider, family member, friend). asked in relation to all forms of Respondents who sought services violence (sexual violence, physical or disclosed their victimization were violence, stalking, expressive asked the degree of helpfulness of aggression, coercive control, and that source. reproductive control) committed by the perpetrator in that relationship. Such information provides a better understanding of how individual and cumulative experiences of violence interact to result in harm to victims and provides a more nuanced understanding of the overall impact of violence.

Perpetrator Information Respondents who reported experiencing IPV were subsequently asked to identify individual perpetrators by initials, nickname, or in some other general way so that each violent behavior reported could be tied to a specific perpetrator. For each perpetrator reported, respondents were asked their age and their relationship to the perpetrator at the time violence first began and at the last time 84 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 85

Appendix B: Victimization Questions

Sexual Violence How many people have ever… • exposed their sexual body parts to you, flashed you, or masturbated in front of you? • made you show your sexual body parts to them? Remember, we are only asking about things that you didn’t want to happen. • made you look at or participate in sexual photos or movies?

How many people have ever… • harassed you while you were in a public place in a way that made you feel unsafe? • kissed you in a sexual way? Remember, we are only asking about things that you didn’t want to happen. • fondled or grabbed your sexual body parts?

When you were drunk, high, drugged, • had vaginal sex with you? By vaginal sex, we mean that {if female: a man or boy put his penis or passed out and unable to consent, in your vagina} {if male: a woman or girl made you put your penis in her vagina}? how many people ever… • {if male} made you perform anal sex, meaning that they made you put your penis into their anus? • made you receive anal sex, meaning they put their penis into your anus? • made you perform oral sex, meaning that they put their penis in your mouth or made you penetrate their vagina or anus with your mouth? • made you receive oral sex, meaning that they put their mouth on your {if male: penis} {if female: vagina} or anus?

How many people have ever used physical • have vaginal sex? force or threats to physically harm you to • {if male} perform anal sex? make you… • receive anal sex? • make you perform oral sex? • make you receive oral sex? • put their fingers or an object in your {if female: vagina or} anus?

How many people have ever used physical • {if male} try to make you have vaginal sex with them, but sex did not happen? force or threats of physical harm to… • try to have {if female: vaginal} oral, or anal sex with you, but sex did not happen?

How many people have you had vaginal, • doing things like telling you lies, making promises about the future they knew were untrue, oral, or anal sex with after they pressured threatening to end your relationship, or threatening to spread rumors about you? you by… • wearing you down by repeatedly asking for sex or showing they were unhappy? • using their authority over you, for example, your boss or your teacher? 86 The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010

Stalking Tactics How many people have ever… • watched or followed you from a distance, or spied on you with a listening device, camera, or GPS [global positioning system]? • approached you or showed up in places, such as your home, workplace, or school when you didn’t want them to be there? • left strange or potentially threatening items for you to find? • snuck into your home or car and did things to scare you by letting you know they had been there? • made unwanted phone calls to you or left you messages? This includes hang-ups, text, or voice messages. • sent you unwanted emails, instant messages, or sent messages through websites like MySpace or Facebook? • left you cards, letters, flowers, or presents when they knew you didn’t want them to?

Expressive Aggression How many of your romantic or sexual • acted very angry toward you in a way that seemed dangerous? partners have ever… • told you that you were a loser, a failure, or not good enough? • called you names like ugly, fat, crazy, or stupid? • insulted, humiliated, or made fun of you in front of others? • told you that no one else would want you?

Coercive Control How many of your romantic or sexual • tried to keep you from seeing or talking to your family or friends? partners have ever… • made decisions for you that should have been yours to make, such as the clothes you wear, things you eat, or the friends you have? • kept track of you by demanding to know where you were and what you were doing? • made threats to physically harm you? • threatened to hurt him or herself or commit suicide when he or she was upset with you? • threatened to hurt a pet or threatened to take a pet away? • threatened to hurt someone you love? • hurt someone you love? • {if applicable} threatened to take your children away? • kept you from leaving the house when you wanted to go? • kept you from having money for your own use? • destroyed something that was important to you? • said things like, “If I can’t have you then no one can”? The National Intimate Partner and Sexual Violence Survey | Intimate Partner Violence in the United States—2010 87

Control of Reproductive or Sexual Health How many of your romantic or sexual • {if female: tried to get you pregnant when you did not want to become pregnant; if male: partners have ever… tried to get pregnant when you did not want them to get pregnant} or tried to stop you from using birth control? • refused to use a condom when you wanted them to use one?

Physical Violence How many of your romantic or sexual • slapped you? partners have ever… • pushed or shoved you? • hit you with a fist or something hard? • kicked you? • hurt you by pulling your hair? • slammed you against something? • tried to hurt you by choking or suffocating you? • beaten you? • burned you on purpose? • used a knife or gun on you? Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division of Violence Prevention

4770 Buford Highway NE, MS-F64 Atlanta, Georgia 30341-3742 www.cdc.gov/violenceprevention

National Center for Injury Prevention and Control Division of Violence Prevention