Restricted Awareness in Intimate Partner Violence.Pdf

MIAMI UNIVERSITY The Graduate School

Certificate for Approving the Dissertation

We hereby approve the Dissertation

Noga Zerubavel

Candidate for the Degree:

Doctor of Philosophy

______Director Terri L. Messman-Moore, Ph.D.

______Reader Margaret O’Dougherty Wright, Ph.D.

______Reader Aaron Luebbe, Ph.D.

______Graduate School Representative Sally Lloyd, Ph.D.

ABSTRACT

RESTRICTED AWARENESS IN INTIMATE PARTNER VIOLENCE: THE EFFECT OF CHILDHOOD SEXUAL ABUSE AND FEAR OF ABANDONMENT

by Noga Zerubavel

Betrayal trauma theory suggests that victims of intimate partner violence (IPV) may restrict awareness of the abuse in order to preserve what they perceive as a vital attachment, as well as to make it more psychologically bearable to live in an abusive context. This study builds upon betrayal trauma theory by examining multiple psychological mechanisms through which individuals restrict awareness of abuse, including dyadic splitting, dissociation, and lack of mindful awareness, in a sample of 378 community women who were currently in a relationship. The patterns of restricted awareness were examined separately, depending upon whether respondents reported severe, moderate, or no childhood sexual abuse (CSA) experiences, to determine whether such relationships were particularly relevant for women with a history of CSA. Overall, CSA victims, particularly victims of severe CSA, tended to rely on pathological processes (i.e., dyadic splitting, depersonalization, amnesia), and nonvictims tended to rely on non-pathological processes (i.e., absorption, lack of mindful awareness). The study is the first to demonstrate the role of fear of abandonment in contributing to a victim’s reliance on restricted awareness. Findings highlight that, particularly for CSA victims, fear of abandonment increases reliance on restricted awareness.

RESTRICTED AWARENESS IN INTIMATE PARTNER VIOLENCE: THE EFFECT OF CHILDHOOD SEXUAL ABUSE AND FEAR OF ABANDONMENT

A DISSERTATION

Submitted to the Faculty of Miami University in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Psychology

Noga Zerubavel Miami University Oxford, OH 2013

Dissertation Director: Terri L. Messman-Moore, Ph.D.

Table of Contents

Introduction ...... 1 Women in Relationships with Intimate Partner Violence...... 1 Dyadic Splitting...... 3 Dissociation ...... 4 Lack of Mindful Awareness...... 4 Fear of Abandonment...... 5 The Relevance of Childhood Sexual Abuse...... 6 Study Aims & Hypotheses ...... 7 Method ...... 8 Participants ...... 8 Procedure...... 9 Measures...... 9 Data Analytic Plan...... 11 Results...... 12 Descriptive Statistics...... 12 Preliminary Analyses...... 13 Evaluating the Interaction of IPV & Fear of Abandonment Predicting Restricted Awareness and the Influence of Childhood Sexual Abuse...... 14 Discussion ...... 16 Limitations...... 19 Implications for Intervention...... 19 Conclusion...... 20 References ...... 21 Tables...... 27 Figures...... 39

List of Tables

Table 1: Means, Standard Deviations, and Ranges of All Variables...... 27 Table 2: Zero-Order Correlations for Study Variables ...... 28 Table 3: Hierarchical Regression Analyses for Prediction of Dyadic Splitting Based on Intimate Partner Violence and Fear of Abandonment...... 29 Table 4: Hierarchical Regression Analyses for Prediction of Absorption Based on Intimate Partner Violence and Fear of Abandonment...... 31 Table 5: Hierarchical Regression Analyses for Prediction of Depersonalization Based on Intimate Partner Violence and Fear of Abandonment...... 33 Table 6: Hierarchical Regression Analyses for Prediction of Amnesia Based on Intimate Partner Violence and Fear of Abandonment...... 35 Table 7: Hierarchical Regression Analyses for Prediction of Lack of Mindful Awareness Based on Intimate Partner Violence and Fear of Abandonment...... 37

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List of Figures

Figure 1: The influence of fear of abandonment on the relationship between intimate partner violence and processes that restrict awareness ...... 39 Figure 2: The influence of fear of abandonment on the relationship between physical intimate partner violence and depersonalization among women with a history of severe childhood sexual abuse ...... 40 Figure 3: The influence of fear of abandonment on the relationship between physical intimate partner violence and amnesia among women with a history of severe childhood sexual abuse ...... 41 Figure 4: The influence of fear of abandonment on the relationship between sexual intimate partner violence and depersonalization among women with a history of severe childhood sexual abuse ...... 42 Figure 5: The influence of fear of abandonment on the relationship between sexual intimate partner violence and amnesia among women with a history of severe childhood sexual abuse ...... 43 Figure 6: The influence of fear of abandonment on the relationship between physical intimate partner violence and depersonalization among women with a history of moderate childhood sexual abuse ...... 44 Figure 7: The influence of fear of abandonment on the relationship between physical intimate partner violence and amnesia among women with a history of moderate childhood sexual abuse...... 45 Figure 8: The influence of fear of abandonment on the relationship between sexual intimate partner violence and lack of mindful awareness among women with no history of childhood sexual abuse (i.e., nonvictims)...... 46

Acknowledgements

This project was made possible through funding from the National Institute of Child Health & Human Development in a grant to Principal Investigator David DiLillo, University of Nebraska, and Co-investigators Terri Messman-Moore, Miami University, and Kim L. Gratz, University of Mississippi Medical Center. The grant funded was Sexual Revictimization: Emotion and Psychosocial Mechanisms; 2010-2015; grant number 1R01HD062226-01A2. I am grateful to the investigators for inviting me to collaborate on this important project, as well as to the members of the ProjectWISE team who have done an immense amount of work preparing the study and collecting data. I am also indebted to the research participants, who shared their personal experiences in the service of supporting research in clinical psychology.

In addition, I would like to acknowledge the important figures that guided me through the process of completing this research. I am grateful to Dr. Terri Messman-Moore, who has been my dissertation director, my academic advisor, my clinical supervisor, and most importantly, an extraordinary mentor whose support facilitated my growth in a multitude of directions and encouraged me at every step. She provided me with countless hours of thought provoking and inspiring conversations about our research, cultivated my academic curiosity, and energized my research projects. Heartfelt thanks go out to Dr. Margaret O’Dougherty Wright, who has been an abundant source of insight on each of my committees and an amazing clinical supervisor. She has been a wonderful provider of support and guidance and her strength has helped to foster my courage. I appreciate Dr. Aaron Luebbe for joining my dissertation committee and for his thoughtful input that benefited this project immensely. I am grateful to Dr. Sally Lloyd, whose knowledge of intimate partner violence from a family studies background brought a unique perspective to my committee and strengthened my pursuit of the research questions. My other mentors have also been critical to this project. I am thankful to Dr. Julie Rubin, who has been essential to my professional development, and whose tireless commitment to clinical work and training lives on within me. I am grateful to Janie Schuppie for being a constant source of warmth and light. Finally, I am indebted to the Domestic Violence & Rape Crisis (DVRC) Services of Saratoga County, where I began my clinical work, and to Maggie Fronk and Irene Safford who empowered me to train and supervise others in this important work. I have boundless appreciation for Irene Safford, my first clinical supervisor, whose exceptional wisdom and deep understanding of intervention for intimate partner violence inspired me, and promoted my growth and expertise in this area.

In my personal life, my supporters have been essential to maintaining my energy and positive outlook throughout the process of graduate school. I am eternally grateful to my partner, David Waller, who was a balance to the arduous academic work, a force of replenishment and restoration, and whose thoughtfulness and kindness nourished my spirit throughout these years. A lifetime of appreciation goes out to my parents, Yael and Eviatar Zerubavel, and my brother, Noam Zerubavel, for their endless encouragement and unwavering love and support. And great thanks to my dear friends, Raven Cuellar, Sara Lewis, Rebecca Ezechukwu, Julie Platten, Dana E. Crawford, Angela Volz, Alexandra Adame, Carol Humphreys, Julia Kaplinska, Lisa Smith Kilpela, Andréa Hobkirk, Kristin and William Bowe, and many others who provided me with laugher, fun, encouragement, strength, and the healing power of friendship.

Restricted Awareness in Intimate Partner Violence: The Effect of Childhood Sexual Abuse and Fear of Abandonment The complexity and insidiousness of intimate partner violence (IPV) is related to the fact that this form of abuse occurs in the context of a highly meaningful relationship in which the victim is deeply invested. The betrayal of the abuse in IPV does not negate the deep love and attachment that many victims of IPV feel toward their partners; in fact, many have surmised that the abuse itself promotes a deep attachment to the abusive partner (Dutton & Painter, 1993; Herman, 1992; Walker, 1979). A victim’s investment in the relationship may also be a product of situational constraints (e.g., financial constraints, shared children). As an adaptation to living in an abusive context, the victim may develop restricted awareness (i.e., “forget” about abuse), preserving psychologically safety by limiting awareness of the abuse. In her betrayal trauma theory, Freyd (1996) demonstrated the adaptiveness of restricted awareness when the victim is in a context in which awareness of the abuse would be a risk to physical and psychological safety. Although the theory was developed with a focus on the context of childhood sexual abuse (CSA), Freyd noted applications to IPV, pointing to the traumatic bond and physical and psychological dependence on the partner. Thus, victims of IPV may be so deeply invested in the relationship that they consciously or unconsciously restrict awareness of the abuse (Freyd, 1996; Platt, Barton, & Freyd, 2009). Indeed, victims of IPV report that, at times of closeness to the abuser, abuse is “forgotten” (Herman, 1992; Walker, 1979). Societal messages to “forgive and forget” and to “stand by your man” also can encourage victims to look past abuse. Given the developmental context of betrayal trauma theory, victims of CSA who are revictimized by IPV may be particularly likely to rely on restricted awareness. It is possible that the victim’s degree of investment in preserving the relationship through restricted awareness of abuse may be further influenced and intensified by important factors, particularly fear of abandonment. Women in Relationships with Intimate Partner Violence More than one third of women in the United States have experienced physical or sexual IPV (Black et al., 2011). Psychological IPV, which is not included in this prevalence estimate, almost always co-occurs with physical or sexual abuse, but may also occur separately and is no less damaging (Basile, Arias, Desai, & Thompson, 2004; Pico-Alfonso et al., 2006). IPV comes at a high psychological cost for women living in such a context; it has been associated with a wide range of mental health and physical health disturbances (e.g., depression, anxiety, PTSD;

Afifi et al., 2009; Basile et al., 2004; Black et al., 2011; Golding, 1999; Tjaden & Thoennes, 2000; Weaver & Clum, 1996). In addition, IPV is often associated with physical injury (Black et al., 2011; Tjaden & Thoennes, 2000). The research on IPV has been fragmented by the use of disparate terminology, including domestic violence, spouse abuse, marital rape, battered women, partner aggression, and dating violence. IPV is defined here as including psychological, physical, and sexual abuse by an intimate partner. Dutton and Painter (1993) suggested that the intermittent nature of the IPV cycle promotes traumatic bonding – through the building tension and then the abuse, the victim is yearning for the closeness of contrition. The intermittent alternating of aversive arousal (i.e., punishment) and relief (i.e., reinforcement) offered by abusive partners creates deeply ingrained patterns that are recognized from experimental paradigms in learning theory to be particularly challenging to extinguish, and that develop notably strong emotional bonds (for a review see Dutton & Painter, 1993). In her seminal work, Walker (1979) described that IPV victims suffer in a cycle of violence, as the abusive partner moves from building tension to eruption into abusive behaviors, and then into contrition. During the contrition phase, many abusive partners shower the victim with exceptional affection and expressions of devotion. Herman (1992) points out that no ordinary love could have this sort of intensity. Walker (1979) proposed that the victim longs for the intensity of the connection and the sense of dependence produced in that contrition phase during the more difficult parts of the cycle, and works to “make things better” and regain that sense of closeness. Walker observed that victims would set aside information related to the abuse and idealize the “real” him, which invariably was an idealized version of his behavior during the contrition phase. By idealizing and essentializing the “real him” of the contrition phase, the “him” who perpetrated the abuse is relegated to “not him” and thus de- essentialized (i.e., dyadic splitting). This segregating of the “not him” behaviors serves the function of dismissing the abuse, thus supporting the victim’s restricted awareness of the abuse. The process of idealizing the abuser and fragmenting away information about the abuse has been conceptualized as scaffolding for remaining in the relationship with IPV (Herman, 1992; Walker, 1979). This dyadic splitting makes it more psychologically bearable to be in an abusive environment, but also reduces the likelihood of accessing psychological or physical safety. In addition to dyadic splitting, other mechanisms of restricted awareness might facilitate betrayal blindness. Although there are multiple ways that individuals restrict awareness (e.g.,

substance abuse), this study focused on intrapsychic psychological mechanisms, including dyadic splitting, dissociation, and lack of mindful awareness. Dyadic Splitting Dyadic splitting refers to alternating between extreme valuations of idealization (e.g., over-admiration) and devaluation (e.g., contempt; Millon & Davis, 1996; Klein, 1940/1975; Siegel, 2006). Dyadic splitting relies on the individual committing fully to one polarized perspective at a time, thereby restricting awareness of the other perspective (often described as “forgetting”; Freyd, 1996; Herman, 1992; Walker, 1979). Thus, inherent in idealization is denial (Klein, 1940/1975; Siegel, 2006). IPV researchers have observed the tendency for the victim to idealize the abuser, thereby maintaining the attachment by ignoring or looking past the abuse (Dutton & Painter, 1993; Freyd, 1996; Platt et al., 2009; Siegel, 2006; Walker, 1979). Indeed, experientially, in times of peace, the abusive partner is a loved one, offering solace and affection, while when abusive he is a threatening presence imparting humiliation and danger. Note that these experiences are non-concurrent, thus the behaviors parallel the alternating nature of dyadic splitting, contributing to the tendency of the victim maintaining polarized perceptions that restrict awareness. In contrast to seeing both sides simultaneously and dialectically, dyadic splitting prevents integrated understanding. Dyadic splitting functions as a mechanism that allows a person who is feeling psychologically threatened to alter the meaning or implication of an experience (Presniak, Olson, & MacGregor, 2010; Siegel, 2006; Siegel & Forero, 2012). Chronic trauma and/or neglect often play a role in the development of dyadic splitting (Howell, 2002; Perry & Herman, 1993; Siegel, 2006). Elaborating this notion, betrayal trauma theory asserts that restricted awareness of abuse not only reduces psychological tensions and suffering, but also maintains necessary attachment to the abuser (Freyd, 1996). The abusive partner is often perceived as a crucial attachment figure, meeting needs of affection, belonging, security, and at times basic needs such as food, money, and home (Dutton & Painter, 1993; Herman, 1992; Platt et al., 2009; Walker, 1979). It is important to note that while dyadic splitting may be adaptive for maintaining attachment despite abuse, restricted awareness via compartmentalization may prevent victims from seeking safety and/or ending the relationship. Similar to the disturbances in representation of other (i.e., dyadic splitting) that we have discussed in this section, disturbances in representation of self (i.e., dissociation) are also mechanisms for restricted awareness. Studies

have not yet linked these various mechanisms for restricted awareness; thus, the present study makes a contribution to the literature by studying them in conjunction. Dissociation Dissociation is well recognized as a mechanism that relegates threatening information to restricted awareness in order to maintain psychological safety (Freyd, 1996; Kluft, 1996; Putnam, 1989). Dissociation is understood as a capacity that all individuals have but do not always utilize, one that can be adaptive in the context of a traumatic environment (i.e., IPV). Nonetheless, in the context of an IPV relationship, severe dissociation may also act as an insurmountable barrier to accessing safety or leaving the relationship. Most researchers conceptualize dissociation as having three forms: absorption, depersonalization, and amnesia (Brown, 2006; Carlson et al. 1993; Holmes et al., 2005; Ross, Joshi, & Currie, 1991; Stockdale, Gridley, Balogh, & Holtgraves, 2002). Absorption describes experiences of being disconnected from present moment experience while being immersed in internal stimuli (e.g., getting lost in thoughts or imagination). Researchers regard absorption as non-pathological, although at higher levels absorption becomes pathological (Dell, 2009), while the other two forms are considered pathological (Brown, 2006; Holmes et al., 2005). The second form is depersonalization and derealization (which we will refer to hereafter as depersonalization for the sake of brevity), which describes experiences of separation or detachment from present moment experience (e.g., feeling unreal as though one is in a dream, out-of-body experiences; Simeon, Guralnik, Schmeidler, Sirof, & Knutelska, 2001). Depersonalization is characterized as mental escape (Simeon et al., 2001). The third type is amnesia, which describes experiences of compartmentalization (e.g., memory impairment, fragmented identity, conversion symptoms). Both depersonalization and amnesia have demonstrated strong associations with a history of CSA (Freyd, DePrince, & Zurbriggen, 2001; Putnam, 1989; Simeon et al., 2001). Lack of Mindful Awareness Yet another mechanism for restricted awareness is maintaining a state of lack of mindful awareness. To act without paying attention or “run on autopilot” is a way of remaining detached from present moment experiences (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006). Lack of mindful awareness is similar to absorption (Bishop et al., 2004); both provide the ability to restrict awareness in a relatively non-pathological manner. However, although lack of mindful awareness and dissociation are both mechanisms for restricting awareness, they are distinct

constructs (Walach, Buchheld, Buttenmuller, Kleinknecht, & Schmidt, 2006). Although we would expect that women in IPV relationships are likely to rely on mechanisms for restricting awareness such as lack of mindful awareness, some research has shown that mindful awareness is linked to the tendency to tolerate intense negative emotion and mindfulness may improve the ability to be tolerant of one’s partner (Barnes, Brown, Krusemark, Campbell, & Rogge, 2007; Wachs & Cordova, 2007). However, it is important to note that this research was focused on marital satisfaction in non-IPV couples, and thus may not generalize to the context of IPV to help victims to cope while in abusive relationships. While in non-IPV relationships greater mindful awareness can be used to increase tolerance (e.g., remembering shared values), we anticipate that in the traumatic context of IPV restricted awareness is more apt to promote the victim’s ability to tolerate the abuse. In an abusive context, restricted awareness through any of the above processes (dyadic splitting, dissociative processes, and lack of mindful awareness) may be adaptive, in that it allows attachment to be maintained and for the relationship to be more tolerable. However, restricted awareness has various costs, most importantly that awareness of the abuse may be fundamental to motivating a victim to leave an abusive relationship. One reason that a victim may rely on restricted awareness is in order to protect the relationship. For individuals who fear abandonment, the possibility of losing the relationship looms as a fundamental psychological threat, and may create a strong motivation for restricted awareness. Fear of Abandonment For some individuals, the possibility of losing an important relationship is a dreaded danger. Such agonizing fears about being left alone or discarded may lead individuals to respond to perceptions of abandonment with frantic efforts to prevent such an outcome. Such fears are often rooted in childhood experiences of abandonment or of being threatened with abandonment or withdrawal of love, and great anxiety regarding abandonment may be carried into adulthood (Ledgerwood, 1999; Young, Klosko, & Weishaar, 2003). Significantly, fear of abandonment often develops in environments that are hostile, invalidating, and inconsistent (Herman, 1992; Ledgerwood, 1999; Linehan, 1993), demonstrating that an abusive environment (e.g., IPV) does not absolve the fear of losing the relationship, but rather may foster fear of abandonment. In fact, traumatic bonding may enhance attachment-related anxieties (Blizard & Bluhm, 1994; Dutton & Painter, 1993).

Fear of abandonment (and the closely related fear of being alone) may lead individuals to tolerate unhealthy relationship dynamics (Sperry, 2003), such as abuse. In fact, abuse may be considered “the inevitable price of relationship” (Herman, 1992, p. 112). If abandonment is viewed as the ultimate betrayal, then provided that this outcome is avoided, all other problems (including abuse) may be tolerated. Not only is the subjective feeling of fear of abandonment quite painful, but also it is associated with negative interpersonal and behavioral outcomes. When individuals respond to fear of abandonment with frantic efforts to avoid perceived abandonment, they paradoxically often alienate others in the process (Linehan, 1993; Millon & Davis, 1996). Fear of abandonment may also motivate maladaptive behaviors. Among emerging adult women, fear of abandonment has been linked to greater self-injurious behavior (Levesque, Lafontaine, Bureau, Cloutier, & Dandurand, 2010). That study also found that women in IPV relationships reported greater frequency of self-injurious behaviors (Levesque et al., 2010), but unfortunately did not explore the relationship between IPV and fear of abandonment. The current study elaborates this unexamined relationship, looking at fear of abandonment as a moderator of the relationship between IPV and restricted awareness. The Relevance of Childhood Sexual Abuse It is well recognized that women with a history of childhood sexual abuse (CSA) are at greater risk of IPV revictimization in adulthood (Briere & Runtz, 1987; Coid, Petruckevich, Feder, Chung, Richardson, & Moorey, 2001; Messman-Moore & Long, 2000; Schaaf & McCanne, 1998; Tjaden & Thoennes, 2000; Weaver & Clum, 1996; Whitfield, Anda, Dube, & Felitti, 2003). CSA victims are two to three times more likely to experience IPV than women without a history of CSA (Coid et al., 2001; Whitfield et al., 2003). In a comparison among multiple forms of childhood maltreatment predicting IPV, CSA predicted psychological and sexual IPV but not physical IPV, while physical and emotional childhood abuse did not predict IPV when controlling for CSA (Lang, Stein, Kennedy, & Foy, 2004). Messman-Moore and Long (2000) found that women who had experienced CSA were more likely than nonvictims to experience revictimization through psychological, physical, and sexual violence in adulthood. In a nationally representative study including 8,000 women, CSA victims were nearly three times more likely to have physical IPV in their current relationship than women without a history of CSA, and nearly six times more likely to have sexual IPV in their current relationship than nonvictims of CSA (Desai, Arias, Thompson, & Basile, 2002).

In addition, because the ability to restrict awareness of abuse is often learned during childhood due to the child’s developmental dependence on the abuser (Freyd, 1996; Herman, 1992; Putnam, 1989), women with a CSA history may be particularly likely to rely on restricted awareness to cope with adult abuse. CSA victims are particularly at risk for dissociation as well as problematic interpersonal dynamics (e.g., dyadic splitting and fear of abandonment; Alexander, 2009; Carlson, Egeland, & Sroufe, 2009; Herman, 1992; Putnam, 2003; Zanarini & Jager-Hyman, 2009). Although the variables in question in this study do not emerge exclusively in the context of CSA, they are more likely to occur in this population; therefore, it was important to evaluate the processes hypothesized here in application to women with a history of CSA (the current study investigated women with severe, moderate, and no history of CSA). Study Aims & Hypotheses Thus far, the applications to IPV of betrayal trauma theory with regard to restricted awareness have been discussed theoretically (Burton, Halpern-Felsher, Rankin, Rehm, & Humphreys, 2011; Freyd, 1996) and are supported by qualitative research (Platt et al., 2009), but have not yet been explored using quantitative methods. This study built on betrayal trauma theory’s applications to adult abuse by examining whether fear of abandonment increases reliance on restricted awareness in the face of increased IPV. This theoretical contribution also has the potential to help target intervention efforts as fear of abandonment can be addressed in psychotherapy. In addition, it explored whether betrayal trauma theory may also be applicable to other psychological mechanisms besides dissociation that may function to restrict awareness, such as dyadic splitting and lack of mindful awareness. Furthermore, while researchers have often noted that dyadic splitting is evident in the context of IPV, there is only minimal existing research focusing on this issue (Siegel & Forero, 2012). Question 1: Does IPV lead to greater reliance on restricted awareness? This study explored whether greater frequency of IPV leads to heavier reliance on restricted awareness through processes of dyadic splitting, dissociation, and lack of mindful awareness. Reliance on restricted awareness was hypothesized to increase in the context of more frequent IPV experiences. The analyses were conducted separately for psychological, physical, and sexual IPV in order to establish whether particular forms of abuse are differentially related to particular restricted awareness mechanisms. Given that previous research has shown that CSA victims had far more memory impairment than did victims of childhood physical or emotional abuse (Freyd

et al., 2001), we hypothesized that, likewise, in adulthood the experience of sexual IPV would be more likely to be related to restricted awareness than would psychological or physical IPV. Question 2: Is the relationship more pronounced in the presence of fear of abandonment? This study examined whether fear of abandonment interacts with IPV to produce greater reliance on restricted awareness. It was hypothesized that in the context of fear of abandonment, victims would rely more heavily on restricted awareness (see Figure 1). Given the paucity of research exploring the relationship between fear of abandonment and IPV, no hypotheses were developed regarding types of IPV and the influence of fear of abandonment on restricted awareness. Question 3: Does childhood sexual abuse influence reliance on restricted awareness in the context of IPV? This study explored whether a history of CSA leads to heavier reliance on restricted awareness. According to research supporting betrayal trauma theory, CSA is linked with a greater tendency to restrict awareness (Freyd, 1996; Freyd et al., 2001). Given that dissociation is developmentally relevant as an approach for coping with childhood abuse, we were interested in whether the presence of CSA leads to a greater likelihood of relying on dissociation to restrict awareness. In the context of IPV, CSA victims may be apt to rely on dissociation (Alexander, 2009) more than on other restricted awareness processes. Conversely, nonvictims of CSA may tend to rely on non-dissociative forms of restricted awareness. If nonvictims do rely on dissociation, they may be more apt to rely on absorption, and less likely to rely on depersonalization and amnesia (Steele, Dorahy, Van der Hart, & Nijenhuis, 2009). Method Participants Participants were 378 women between the ages of 18 and 25 recruited from 4 cities in 3 different states. Participants were ethnically diverse: 61.9% were Caucasian, 34.7% African American, 6.1% Hispanic, 3.7% American Indian, and 2.9% Asian (percentages add to greater than 100% given that women could endorse multiple ethnic identities). The sample was predominantly a low to lower-middle class socio-economic demographic: 77.9% reported an annual household income under $39,000, with 39.4% reporting under $10,000. The average age of participants was 21.79 (SD=2.24); most were unmarried (80.4%) and did not have children (77.8%). Approximately half of the participants were full-time students (51.9%), 10.3% were part-time students, and 37.6% were not students.

Procedure The institutional review boards at multiple universities authorized the procedures for this study. E-mail, postal mail letters sent to local zip codes with $1 cash enclosed, and newspaper advertisements were used for recruitment in order to achieve a large, diverse sample of community participants (advertisements and letters did not mention assessment of victimization history, and women were not selected in or out of the study based upon victimization history). All methods of contact invited women to call a central phone number, and those who met eligibility requirements for age, literacy, and commitment to ongoing participation over time were invited to participate in the study. Only women who were currently in a relationship responded to the questions regarding IPV, thus all participants in this study met that criterion. Participants gave written informed consent, and were debriefed following their participation. This was the first session of a longitudinal study. Data were collected in individual sessions including structured clinical interviews performed by female clinical psychology graduate students and self-report survey information was completed on a computer in a private room, overseen by two female research assistants. Participant responses were confidential and they were compensated financially for their time. Participants were provided with researcher contact information and counseling options. Measures Intimate Partner Violence. IPV was assessed with a modified version of the Conflict Tactics Scale (CTS-2; Straus, Hamby, & Warren, 2003). Participants indicate how many times in the past year their partner engaged in each of 39 abusive behaviors. The Psychological Aggression subscale has 8 items (α = .87), such as “My partner called me fat or ugly.” The Severe Physical Assault subscale has 7 items (α = .89), such as “My partner kicked me.” The Sexual Coercion subscale has 7 items (α = .74), such as “My partner used threats to make me have oral or anal sex.” Participants use an 8-point scale to indicate how often they experience a statement describing a partner’s abusive behavior. 0 is anchored by “this has never happened,” 1 by “once in the past year”, with growing frequency up to 6, anchored by “more than 20 times in the past year,” and 7, anchored by “Not in the past year, but it did happen before.” Responses of 7 were removed as they were neither current experiences of abuse nor could they be merged with 0 since they represented a history of IPV. The subscales were scored continuously. Dyadic Splitting. Dyadic splitting was evaluated using the Borderline Personality

Disorder subscale of the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV; Zanarini, Frankenburg, Sickel, & Yong, 1996). The DIPD-IV is a semi-structured clinical interview for assessing Axis II personality disorders. The instrument has been shown to have good inter-rater and test-retest reliability (Zanarini et al., 2000). Dyadic splitting is characterized by having chronic, pervasive experiences of alternating between idealization and devaluation within unstable relationships. Questions referenced the last two years and included, “Have you often felt hatred toward someone you care about and need?” Based on the responses to all of the questions, participants were given a score for this criterion item. Participants were coded as 0 (not meeting criteria), 1 (partially meeting criteria), or 2 (fully meeting criteria). Dissociation. Dissociation was assessed using the Dissociative Experiences Scale (DES; Bernstein & Putnam, 1986), a widely used self-report measure for assessing dissociation in clinical and research settings. The scale is comprised of 28 items that describe a range of normal to pathological dissociation. Participants rate the percentage of time that each item occurs in increments of 10 for a score of 0-100. The DES has good internal consistency, test-retest reliability, and criterion, construct, and discriminant validities (Bernstein and Putnam 1986; Carlson et al. 1993; Frischholz et al., 1990). Factor structure investigations have consistently replicated a three-factor solution: absorption, depersonalization, and amnesia (Carlson et al. 1993; Ross et al. 1991; Stockdale et al., 2002). The Absorption subscale has 9 items (α = .88) and includes item such as “Some people find that they sometimes sit staring off into space, thinking of nothing, and are not aware of the passage of time.” The Depersonalization subscale has 6 items (α = .87) and includes items such as “Some people sometimes have the experience of feeling as though they are standing next to themselves or watching themselves do something and they actually see themselves as if they were looking at another person.” The Amnesia subscale has 8 items (α = .90) and includes items such as “Some people have the experience of finding themselves in a place and having no idea how they got there.” Lack of mindful awareness. Lack of mindful awareness was assessed using the Acting with Awareness subscale of the Five Facet Mindfulness Questionnaire (FFMQ; Baer et al., 2006). The FFMQ is a self-report measure that consists of 39-items and includes 5 subscales capturing multiple aspects of mindfulness, which are scored by summing the item responses. Participants use a 5-point Likert scale to indicate how often the statements are true for them. The FFMQ has demonstrated acceptable convergent, incremental, and discriminatory validity with

measures of related constructs (Baer et al., 2006; Baer et al., 2008). The Acting with Awareness subscale includes 8 items such as “It seems I am ‘running on automatic’ without much awareness of what I’m doing.” For analyses, the Acting with Awareness subscale was reverse scored in order to assess lack of mindful awareness and had a Cronbach’s alpha of .91 in the current study. Fear of Abandonment. Fear of abandonment was assessed using the Borderline Personality Disorder subscale of the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV; Zanarini et al., 1996). Questions referenced the last two years and included, “Have you frequently made efforts to avoid feeling abandoned (e.g. often called someone you're close to try to reassure yourself that he or she still cared about you)?” Participants were coded as 0 (not meeting criteria), 1 (partially meeting criteria), or 2 (fully meeting criteria). For analyses, this item was scored dichotomously, with the “1” and “0” responders grouped together as nonclinical levels of fear of abandonment. Fear of abandonment was recoded for analyses with 1 representing clinical significance and 0 representing the absence of such concerns. Childhood Sexual Abuse. CSA was assessed using the Sexual Abuse subscale of the Childhood Trauma Questionnaire (CTQ; Bernstein & Fink, 1998). The CTQ is a 28-item inventory that begins questions with the stem “When I was growing up…” and minimizes the use of words such as abuse (Bernstein & Fink, 1998). The items are rated on a 5-point scale from 1 (never true) to 5 (very often true). The Sexual Abuse subscale has 5 items (α = .92) and contains items such as “Someone tried to make me do sexual things or watch sexual things.” The CTQ has demonstrated reliability and validity (Bernstein & Fink, 1998). Participants’ scores were classified into categories of abuse severity based on published recommendations (Bernstein & Fink, 1998); only those individuals reporting moderate or severe CSA were considered victims of CSA for this study, consistent with the commonly used convention that individuals in the CTQ’s low CSA category are grouped with the no abuse category (Heim et al., 2009; Houck, Nugent, Lescano, Peters, & Brown, 2010; Lang et al., 2004). Data Analytic Plan Analyses exploring the influence of childhood sexual abuse on the relationship between IPV, fear of abandonment, and restricted awareness were conducted as follows. Preliminary analyses verified that the processes that achieve restricted awareness are related and also distinct using zero-order correlation coefficients. Hierarchical regression analyses (Frazier, Tix, & Barron, 2004; Holmbeck, 1997) were used to determine the relationship between IPV severity

and restricted awareness processes (dyadic splitting, absorption, depersonalization, amnesia, and lack of mindful awareness), as well as whether fear of abandonment moderates those relationships. The analyses were tested for all three forms of IPV (psychological, physical, and sexual), and were conducted separately for women who reported severe CSA, moderate CSA or no CSA. Moderation analyses were tested using a continuous independent variable (IPV) and a categorical moderator (fear of abandonment). To minimize potential issues of multicollinearity, the independent variables were centered (Frazier et al., 2004). For each analysis, the main effect and moderating variable were entered in the first step, and the interaction term was entered with them in the second step (Holmbeck, 1997). Specific moderation effects were determined by testing the statistical significance of the slopes for the simple regression lines (Frazier et al., 2004; Holmbeck, 1997) using Jose’s (2008) ModGraph program to establish whether the slope of each line is different from zero. For each significant interaction, Jose’s (2008) ModGraph program was also used to generate figures depicting significant interactions. In analyzing the results, covariances were examined in order to better understand the degree of overlap or distinction in the various mechanisms individuals rely upon to restrict awareness. Results Descriptive Statistics The original sample consisted of 494 women; 4 women did not complete the study and were removed from analyses, leaving 490 women. In order to increase the reliability of IPV measurement, 112 women who were not in a current relationship were excluded. Of the remaining 378 women, 70% (n=254) endorsed experiences of psychological IPV in the past year, 16% (n=59) endorsed experiences of severe physical IPV in the past year, and 35% (n=128) endorsed experiences of sexual IPV in the past year. Among the women in the sample, 12% (n=44) were assessed as having clinically significant fear of abandonment. Of the 378 women included in analyses, 30% (n=112) endorsed a history of CSA. Given that research has demonstrated that the severity of childhood sexual abuse predicts differences in dissociative experiences (Simeon et al., 2001), the data were evaluated to determine whether CSA should be based on severity or dichotomously (present/absent). 17% (n=66) endorsed a history of severe CSA and 13% (n=48) endorsed a history of moderate CSA. ANOVA analyses demonstrated that although there were no statistically significant differences between the two revictimization groups, for both dyadic splitting and lack of mindful awareness, victims of severe

CSA differed from nonvictims while victims of moderate CSA did not (see Table 1). In addition, for fear of abandonment, victims of moderate CSA differed from nonvictims while victims of severe CSA did not. As such, the decision was made to separately categorize the participants who had experienced CSA into moderate and severe CSA groups (see Table 1 for descriptive statistics). In chi square analyses comparing the three groups (victims of severe CSA, moderate CSA, and nonvictims), the groups differed significantly on severe physical IPV, χ2(2, n=366) = 22.8, p < .001, and sexual IPV, χ2(2, n=365) = 12.0, p < .01, but not on psychological IPV, χ2(2, n=363) = 4.48, p = .11. Using standardized residuals > 1.96 to indicate which groups differed from expected values, victims of moderate CSA were more likely than expected to have current physical IPV, whereas nonvictims were less likely than expected (victims of severe CSA did not differ from expected values). Victims of moderate CSA were more likely than expected to have current sexual IPV; victims of severe CSA and nonvictims did not differ from expected values. Preliminary Analyses The initial hypotheses sought to establish a relationship between the variables and to confirm that the various processes that achieve restricted awareness are indeed distinct constructs. For victims of severe CSA, Pearson correlations between IPV type and the restricted awareness processes demonstrated that psychological IPV was only related to dyadic splitting, physical IPV was related to some measures of restricted awareness (dyadic splitting, depersonalization, and amnesia), but not to others (absorption and lack of mindful awareness), and sexual IPV was related to the dissociative restricted awareness processes (absorption, depersonalization, and amnesia), but not to the others (dyadic splitting and lack of mindful awareness; see Table 2 for the full correlation matrix). Fear of abandonment was significantly associated with physical IPV, but not with psychological or sexual IPV. In addition, fear of abandonment was significantly associated with dyadic splitting, but not with any of the other mechanisms of restricted awareness. Finally, among the mechanisms of restricted awareness, the three dissociative processes were significantly associated with one another and with lack of mindful awareness, but dyadic splitting was not significantly associated with any other mechanisms of restricted awareness. For victims of moderate CSA, Pearson correlations between IPV type and the restricted awareness processes demonstrated that psychological IPV was only related to dyadic splitting,

whereas physical and sexual IPV were related to the dissociative restricted awareness processes (absorption, depersonalization, and amnesia) and lack of mindful awareness, but not to dyadic splitting (see Table 2 for full correlation matrix). There were no significant associations between fear of abandonment and any type of IPV. Fear of abandonment was significantly associated with dyadic splitting, but not with any other mechanisms of restricted awareness. Finally, among the mechanisms of restricted awareness, the three dissociative processes were significantly associated with one another and with lack of mindful awareness, and dyadic splitting was significantly associated with lack of mindful awareness but not with any of the dissociative processes. For nonvictims of CSA, Pearson correlations between IPV type and the restricted awareness processes demonstrated that psychological IPV was related to all of the restricted awareness processes, physical IPV was related to some measures of restricted awareness (dyadic splitting, depersonalization, and amnesia), but not to others (absorption and lack of mindful awareness), and sexual IPV was related to the dissociative restricted awareness processes (absorption, depersonalization, and amnesia) and to dyadic splitting, but not to lack of mindful awareness (see Table 2 for the full correlation matrix). Fear of abandonment was significantly associated with each type of IPV. Fear of abandonment was significantly associated with dyadic splitting, but not with any other mechanisms of restricted awareness. Finally, among the mechanisms of restricted awareness, the three dissociative processes were significantly associated with one another and with lack of mindful awareness, and dyadic splitting was significantly associated with the dissociative processes but not with lack of mindful awareness. Evaluating the Interaction of IPV & Fear of Abandonment Predicting Restricted Awareness and the Influence of Childhood Sexual Abuse Hierarchical regression analyses were used to determine whether fear of abandonment moderates the relationship between IPV and restricted awareness processes. These relationships were assessed for each CSA group and for each form of IPV. Significant interactions were charted to clarify the nature of the moderation, and the simple slopes of the regression lines were tested for significant differences. The tables for the hierarchical regression analyses are presented according to each restricted awareness process (see Tables 3-7). Interactions. Consistent with hypotheses, fear of abandonment moderated the effect of IPV on restricted awareness in certain cases. For victims of severe CSA, fear of abandonment

moderated the effect of both physical and sexual IPV for depersonalization and amnesia. In fact, in these analyses the direct effect of IPV was no longer significant when considering the interaction term, demonstrating that frequency of IPV was relevant specifically in the context of the influence of fear of abandonment. For each of these analyses, those individuals without fear of abandonment had the same levels of restricted awareness regardless of frequency of IPV, while those with clinical levels of fear of abandonment demonstrated significant increases in depersonalization and amnesia in the context of greater frequency of IPV (see Figures 2-5). For victims of moderate CSA, fear of abandonment moderated the effect of physical IPV for depersonalization and amnesia. Interestingly, for depersonalization, regardless of whether the individuals had clinical fear of abandonment or not, they showed a higher level of depersonalization in the context of greater frequency of IPV (see Figure 6). For amnesia, the interaction was statistically significant and both individuals with and without clinical fear of abandonment showed a statistically increased level of amnesia in the context of greater frequency of IPV (see Figure 7). For nonvictims of CSA, fear of abandonment moderated the effect of sexual IPV for lack of mindful awareness, such that nonvictims with fear of abandonment reported experiencing more lack of mindful awareness than nonvictims without fear of abandonment, regardless of frequency of sexual IPV (i.e., neither group had a slope that differed from zero; see Figure 8). Direct effects. For psychological IPV, the nonvictims demonstrated that frequency of abuse had a significant direct effect on all five types of restricted awareness (dyadic splitting, absorption, depersonalization, amnesia, and lack of mindful awareness). In contrast, victims of moderate and severe CSA were specific in their reliance on restricted awareness: they showed a direct effect of both frequency of abuse and fear of abandonment on dyadic splitting, and victims of moderate CSA also showed a direct effect of fear of abandonment on absorption. For physical IPV, all three groups (both groups of CSA victims and nonvictims) showed a significant direct effect of fear of abandonment on dyadic splitting. Victims of severe CSA and nonvictims also showed a direct effect of frequency of abuse on dyadic splitting. Both groups of CSA victims demonstrated a direct effect of frequency of abuse on depersonalization and amnesia. Nonvictims of CSA showed a direct effect of frequency of abuse on depersonalization. Victims of moderate CSA also showed a direct effect of both frequency of abuse and fear of abandonment on absorption. Victims of moderate CSA showed a direct effect of both frequency

of abuse and fear of abandonment on lack of mindful awareness, and nonvictims showed a direct effect of fear of abandonment on lack of mindful awareness. For sexual IPV, all three groups (both groups of CSA victims and nonvictims) showed a direct effect of fear of abandonment on dyadic splitting. All three groups showed a direct effect of frequency of abuse on both absorption and depersonalization. Victims of moderate CSA also showed a direct effect of fear of abandonment on absorption. Both groups of CSA victims demonstrated a direct effect of frequency of abuse on amnesia. Victims of moderate CSA showed a direct effect of frequency of abuse on lack of mindful awareness; nonvictims showed a direct effect of fear of abandonment on lack of mindful awareness. Discussion Building on betrayal trauma theory, the current study highlights the various pathways through which restricted awareness is relied upon by IPV victims, specific to type of IPV and mechanism for restricting awareness. Findings suggest that history and severity of childhood sexual abuse may influence the mechanisms individuals rely on to restrict awareness in the context of adult IPV. Overall, among CSA victims, particularly victims of severe CSA, experiences of pathological processes (i.e., dyadic splitting, depersonalization, amnesia) were significantly associated with increasing frequency of IPV. However, among women without a history of CSA, experiencing non-pathological processes (i.e., absorption, lack of mindful awareness) was significantly associated with increasing frequency of IPV overall. This is the first study to demonstrate the role of fear of abandonment in contributing to reliance on restricted awareness among CSA survivors revictimized by adult IPV. Furthermore, revictimized women (those with a history of severe CSA and IPV) showed a unique tendency to rely upon more problematic dissociative processes. As hypothesized, CSA history did increase reliance on restricted awareness in the context of IPV revictimization. In particular, CSA victims demonstrated a readily available dissociative capacity, consistent with literature linking dissociation to CSA (Alexander, 2009, Carlson et al., 2009; Freyd, 1996; Herman, 1996; Putnam, 2003). In the context of physical and sexual IPV, only CSA victims relied on amnesia to restrict awareness, consistent with literature suggesting that amnesia is linked specifically with CSA (Freyd et al., 2001). Interestingly, the patterns of restricted awareness were different for victims of moderate and severe CSA. Victims of moderate CSA tended to rely on absorption (in the context of fear of abandonment in all types of

IPV) and lack of mindful awareness (in the context of increasing frequency of physical and sexual IPV); this relationship was not present for victims of severe CSA. Thus, victims of moderate CSA were more diffuse in their reliance on restricted awareness mechanisms, while victims of severe CSA tended to specifically rely on depersonalization, amnesia, and dyadic splitting. This is consistent with previous research findings that although individuals report absorption regardless of presence or absence of child abuse history, victims of child abuse are more likely to dissociate via depersonalization and amnesia (Steele et al., 2009). The literature has highlighted that restricted awareness can occur through non-pathological mechanisms such as absorption (Brown, 2006; Holmes et al., 2005; Steele et al., 2009) and lack of mindful awareness (Baer et al., 2006; Walach et al., 2006). The current study’s findings indicate that victims of severe CSA tend to rely on mechanisms that are considered pathological mechanisms to restrict awareness, victims of moderate CSA tend to rely on all types of restricted awareness, and nonvictims tend to rely on non-pathological mechanisms. Findings consistently indicated that fear of abandonment is an important factor that may determine the type and intensity of restricted awareness of the experience of IPV. Consistent with hypotheses, fear of abandonment demonstrated an important role in motivating reliance on restricted awareness. For victims of severe CSA, the interaction of fear of abandonment and frequency of IPV was strongly supported. In the context of fear of abandonment, frequency of physical and sexual IPV significantly increases the likelihood of depersonalization and amnesia. For victims of moderate CSA, the interaction of fear of abandonment and frequency of physical IPV (but not sexual IPV) was supported for depersonalization and amnesia. In addition, victims of moderate CSA experienced absorption in the context of fear of abandonment for all three types of IPV. All women, regardless of CSA history or severity, for all three types of IPV, were more likely to experience dyadic splitting in the context of greater fear of abandonment. While IPV has often been theoretically linked to dyadic splitting (Dutton & Painter, 1993; Herman, 1992; Siegel, 2006), research has only begun to emerge focusing on dyadic splitting in IPV (e.g., Siegel & Forero, 2012). The present study’s findings confirm that dyadic splitting does increase in the context of increasing frequency of IPV and highlight that this mechanism is consistently influenced by fear of abandonment. Together, these findings are consistent with earlier studies which suggest victims of IPV may be so deeply invested in the relationship that they may restrict

awareness of the abuse (Freyd, 1996; Platt et al., 2009), and that women with histories of CSA appear to rely on pathological types of dissociation to obtain restricted awareness. Findings are consistent with classic texts which suggest that victims of IPV “forget” about abuse, especially at times of closeness to the abuser (Herman, 1992; Walker, 1979). The results support the notion that attachment to the abuser may be maintained or protected through various mechanisms of restricted awareness (Dutton & Painter, 1993; Herman, 1992; Siegel, 2006; Siegel & Forero, 2012). Results are consistent with literature suggesting that victims of CSA are particularly susceptible to fear of abandonment (Herman, 1992; Ledgerwood, 1999; Young et al., 2003) and rely on mechanisms of restricted awareness to maintain connections while in abusive contexts (Freyd, 1996; Herman, 1992; Howell, 2002; Perry & Herman, 1993; Siegel, 2006). Fear of abandonment seemed to have an important role in increasing reliance on restricted awareness, demonstrating support for betrayal trauma theory as applied to IPV (Burton et al., 2011; Freyd, 1996; Platt et al., 2009) by highlighting that as fear of losing the relationship increases, restricted awareness does as well. Results revealed some unique and common patterns regarding different aspects of restricted awareness depending upon type of IPV. IPV victims varied in their patterns of restricted awareness in the context of psychological, physical, and sexual IPV. For sexual IPV, consistent with hypotheses, victims of both moderate and severe CSA tended to experience all forms of dissociation in the context of increasing frequency of sexual IPV. Nonvictims of CSA experienced absorption and depersonalization, but not amnesia, in the context of increasing frequency of sexual IPV. Nonvictims and victims of moderate CSA reported increased reliance on lack of mindful awareness. For physical IPV, a similar pattern was evident: victims of severe CSA increased reliance on depersonalization and amnesia in the context of greater frequency of physical IPV, and victims of moderate CSA demonstrated increased reliance on all forms of dissociation. As with sexual IPV, nonvictims and victims of moderate CSA increased reliance on lack of mindful awareness. For psychological IPV, it was evident that psychological abuse played a central role in the experience of restricted awareness among women who did not report a history of CSA; the nonvictims reported increased reliance on each type of restricted awareness in the context of increasing frequency of psychological IPV. The victims of severe CSA reported increased reliance on dyadic splitting in the context of increasing frequency of psychological IPV, and victims of moderate CSA reported increased reliance on dyadic splitting and

absorption. It is possible that psychological IPV elicits reliance on many mechanisms of restricted awareness for the women who had not experienced CSA because psychological abuse by an intimate partner may represent their first experience of a betrayal trauma. Overall, the findings indicated that patterns of restricted awareness produced by psychological IPV were distinct from those of physical and sexual IPV. In contrast to the patterns of restricted awareness endorsed by the victims of CSA, nonvictims relied on every mechanism of restricted awareness in the context of psychological IPV. CSA victims, regardless of severity, relied on more mechanisms of restricted awareness in the context of physical and sexual IPV than in the context of psychological IPV. Victims of moderate CSA were diffuse in the mechanisms relied upon to restrict awareness. Limitations The study offers a great deal to the understanding of how IPV and fear of abandonment influence restricted awareness, but also includes some significant limitations that can be improved upon in future studies. The most important limitation is that restricted awareness was not specifically linked to awareness of abuse, but rather the various processes were measured broadly. Another limitation is that the CSA experiences did not include information about the perpetrator, and thus could not be categorized as high betrayal trauma and low betrayal trauma. Previous research demonstrates that when CSA is perpetrated by a caregiver, the experience of restricted awareness (specifically dissociation) is much higher than in other contexts (Freyd, 1996; Freyd et al., 2001). Another limitation is that although this study examined multiple forms of IPV, other forms of childhood abuse may produce different patterns of restricted awareness. For instance, previous research has shown that depersonalization is more strongly predicted by a history of childhood emotional abuse than by a history of CSA (Michal, Beutel, Jordan, Zimmerann, Wolters, & Heidenreich, 2007; Simeon et al., 2001). Future studies may benefit from incorporating multiple types of childhood abuse. Finally, future studies would benefit from incorporating a measure of stay-leave decision-making in order to evaluate whether restricted awareness is truly a barrier to considerations of leaving an IPV relationship. Despite these limitations, the study introduces ideas that can improve intervention for IPV victims, most specifically with regard to highlighting the importance of targeting fear of abandonment. Implications for Intervention Implications of this study are quite meaningful. First, the importance of the role of fear of

abandonment is critical. For women with clinical levels of fear of abandonment, focusing on this issue in intervention might increase their ability to maintain awareness of abuse, potentially motivating outreach for support or desire to leave the relationship. While clinicians may be drawn to focusing on the restricted awareness mechanisms, such as teaching grounding skills for dissociation, we must not overlook the underlying factors that motivate restricted awareness. By targeting fear of abandonment directly (e.g., using schema therapy; Young et al., 2003), we can potentially reduce the need for restricted awareness as a downstream effect. To target restricted awareness, clinicians need to evaluate the mechanisms an IPV victim relies upon to limit awareness of abuse. Intervention for depersonalization might focus on mindfulness, grounding skills, and increasing internal connectedness. Intervention for amnesia might focus more on integrating aspects of the self (i.e., reducing self-fragmentation). Intervention for dyadic splitting might focus on developing the ability to hold both sides of ambivalent feelings simultaneously (e.g., dialectical behavior therapy; Linehan, 1993; motivational interviewing; Miller, Rollnick, & Moyers, 1998), practicing discussing positive and negative perspectives concurrently, synthesizing an integrated understanding of the partner. Conclusion This study contributes to the literature by increasing understanding of when IPV victims rely on restricted awareness. Multiple psychological mechanisms, including dyadic splitting, dissociation, and lack of mindful awareness, facilitate the restriction of awareness of abuse among IPV victims. In addition, findings indicate the importance of considering how CSA and type of IPV influence the process by which an individual restricts awareness. The findings suggest that depending on history and severity of CSA, type of IPV, and whether a woman struggles with fear of abandonment, patterns of restricted awareness vary. Fear of abandonment acts as a mechanism that increases the victim’s reliance on processes that restrict awareness, and in fact, for victims of CSA, at times interacts with frequency of IPV to increase restricted awareness. Consistent with betrayal trauma theory, results suggest that reliance on restricted awareness protects the attachment to the abuser and makes an abusive relationship more bearable. Findings suggest that IPV victims, particularly those with a history of CSA, should be assessed for fear of abandonment, and if it is present, intervention will likely benefit from making this a central therapeutic target.

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Table 1 Means, Standard Deviations, and Ranges of All Variables Victims of Victims of Variable Non-victims Severe CSA Moderate CSA Range Min- M SD M SD M SD Max

Psychological IPV 10.59 a 11.55 10.70 a 10.65 5.89 b 7.51 0 – 48

Physical IPV 2.20 a 5.17 2.37 a 4.55 0.70 b 2.86 0 – 42

Sexual IPV 2.92 a, b 5.85 4.22 a 6.97 1.52 b 3.34 0 – 42

Fear of 0.17 a, b 0.38 0.21 a 0.41 0.09 b 0.29 0 – 1 Abandonment

Dyadic Splitting 0.94 a 0.90 0.66 a, b 0.76 0.45 b 0.68 0 – 2

Absorption 24.03 a 19.62 20.16 a 16.91 12.72 b 10.45 0 – 90

Depersonalization 5.08 a 9.54 5.11 a 9.32 1.84 b 4.18 0 – 60

Amnesia 10.17 a 14.07 9.47 a 12.81 4.22 b 6.66 0 – 80

Lack of Mindful 22.09 a 7.99 20.04 a, b 8.75 17.76 b 6.77 8-40 Awareness

Note. IPV = Intimate Partner Violence; CSA = Childhood Sexual Abuse. Groups with different superscripts differ significantly at p < .05 based on Tukey’s posthoc tests in ANOVA analysis.

Table 2 Zero-Order Correlations for Study Variables 1 2 3 4 5 6 7 8 Women with a History of Severe Childhood Sexual Abuse 1. Psychological IPV - 2. Physical IPV .63*** - 3. Sexual IPV .68*** .64*** - Fear of 4. .17 .36** .20 - Abandonment 5. Dyadic Splitting .31* .40*** .21 .36** - 6. Absorption .21 .22 .34** .04 .17 - 7. Depersonalization .17 .37** .41*** .11 .16 .71*** - 8. Amnesia .12 .36** .34** .13 .18 .79*** .79*** - 9. Lack of Mindful .10 .05 .18 .02 .09 .46*** .35** .36** Awareness Women with a History of Moderate Childhood Sexual Abuse 1. Psychological IPV - 2. Physical IPV .53*** - 3. Sexual IPV .57*** .53*** - Fear of 4. .21 -.04 -.07 - Abandonment 5. Dyadic Splitting .41** .10 .07 .37** - 6. Absorption .11 .36* .45** .24 .12 - 7. Depersonalization .27 .51*** .58*** .16 .04 .75*** - 8. Amnesia .24 .59*** .56*** .05 -.03 .83*** .91*** - 9. Lack of Mindful .16 .30* .33* .27 .35* .65*** .57*** .50*** Awareness Women without a History of Childhood Sexual Abuse (Nonvictims) 1. Psychological IPV - 2. Physical IPV .55*** - 3. Sexual IPV .53*** .42*** - Fear of 4. .19** .25*** .14* - Abandonment 5. Dyadic Splitting .24*** .29*** .15* .23*** - 6. Absorption .30*** .11 .14* .11 .25*** - 7. Depersonalization .20** .16** .18** .09 .26*** .55*** - 8. Amnesia .27*** .14* .13* .07 .25*** .68*** .58*** - 9. Lack of Mindful .20*** -.07 .03 .12 .03 .34*** .15* .23*** Awareness

* p <. 05, ** p < .01, *** p < .001 Note. IPV = Intimate Partner Violence.

Table 3. Hierarchical Regression Analyses for Prediction of Dyadic Splitting Based on Intimate Partner Violence (IPV) and Fear of Abandonment (F of A) Women with a History of Severe Childhood Sexual Abuse IPV Type Step β B SE (B) F R2 1. IPV .26 0.18 * 0.09 F of A .31 0.24 * 0.09 6.53 ** .19 Psych 2. IPV .26 0.19 * 0.09 n = 58 F of A .34 0.26 * 0.11 Psych x F of A N/A -0.03 0.08 4.33 ** .19

1. IPV .31 0.20 * 0.08 F of A .26 0.20 * 0.09 8.48 *** .22 Phys 2. IPV .46 0.29 ** 0.10 n = 62 F of A .32 0.24 * 0.10 Phys x F of A N/A -0.07 0.05 6.39 *** .25

1. IPV .14 0.11 0.10 F of A .36 0.27 ** 0.09 5.75 ** .17 Sex 2. IPV .14 0.11 0.12 n = 60 F of A .36 0.27 ** 0.10 Sex x F of A N/A -0.00 0.06 3.77 * .17 Women with a History of Moderate Childhood Sexual Abuse IPV Type Step β B SE (B) F R2 1. IPV .32 0.20 * 0.08 F of A .44 0.30 *** 0.09 11.24 *** .35 Psych 2. IPV .36 0.23 * 0.09 n = 44 F of A .50 0.34 *** 0.10 Psych x F of A N/A -0.05 0.06 7.73 *** .37

1. IPV .12 0.07 0.08 F of A .43 0.27 ** 0.09 5.16 ** .20 Phys 2. IPV .11 0.07 0.09 n = 45 F of A .42 0.26 ** 0.09 Phys x F of A N/A 0.04 0.07 3.48 * .20

1. IPV .10 0.05 0.07 F of A .44 0.28 ** 0.09 4.95 * .19 Sex 2. IPV .08 0.04 0.07 n = 44 F of A .45 0.29 ** 0.10 Sex x F of A N/A -0.04 0.11 3.28 * .20

Women without a History of Childhood Sexual Abuse (Nonvictims) IPV Type Step β B SE (B) F R2 1. IPV .21 0.17 *** 0.05 F of A .20 0.15 *** 0.05 13.26 *** .10 Psych 2. IPV .22 0.18 *** 0.05 n = 248 F of A .21 0.16 *** 0.05 Psych x F of A N/A -0.04 0.04 9.18 *** .10

1. IPV .24 0.21 *** 0.05 F of A .18 0.14 ** 0.05 15.43 *** .11 Phys 2. IPV .31 0.26 *** 0.06 n = 248 F of A .19 0.14 ** 0.05 Phys x F of A N/A -0.05 0.03 11.06 *** .12

1. IPV .12 0.11 0.06 F of A .22 0.17 *** 0.05 9.41 *** .07 Sex 2. IPV .12 0.11 0.06 n = 252 F of A .22 0.17 *** 0.05 Sex x F of A N/A < 0.01 0.05 6.25 *** .07

* p <. 05, ** p < .01, *** p < .001 Note. Psych = Psychological IPV, Phys = Physical IPV, Sex = Sexual IPV

Table 4. Hierarchical Regression Analyses for Prediction of Absorption Based on Intimate Partner Violence (IPV) and Fear of Abandonment (F of A) Women with a History of Severe Childhood Sexual Abuse IPV Type Step β B SE (B) F R2 1. IPV .19 2.83 2.02 F of A -.09 -1.44 2.13 1.08 .04 Psych 2. IPV .18 2.69 2.03 n = 57 F of A -.15 -2.41 2.51 Psych x F of A N/A 1.34 1.82 0.89 .05

1. IPV .21 2.85 1.87 F of A -.04 -0.59 2.23 1.21 .04 Phys 2. IPV -.01 -0.08 2.47 n = 61 F of A -.12 -1.89 2.30 Phys x F of A N/A 2.16 1.21 1.90 .09

1. IPV .30 5.07 * 2.24 F of A -.01 -0.22 2.11 2.64 .09 Sex 2. IPV .21 3.66 2.74 n = 59 F of A -.04 -0.65 2.16 Sex x F of A N/A 1.31 1.46 2.02 .10 Women with a History of Moderate Childhood Sexual Abuse IPV Type Step β B SE (B) F R2 1. IPV .04 0.64 2.23 F of A .30 4.60 2.36 2.15 .10 Psych 2. IPV .10 1.49 2.38 n = 43 F of A .38 5.83 * 2.65 Psych x F of A N/A -1.65 1.61 1.79 .12

1. IPV .36 5.21 ** 2.05 F of A .24 3.32 1.94 4.63 ** .18 Phys 2. IPV .41 5.90 ** 2.05 n = 44 F of A .29 3.94 * 1.94 Phys x F of A N/A -2.62 1.62 4.09 ** .24

1. IPV .46 5.26 *** 1.51 F of A .31 4.48 * 1.91 8.44 *** .30 Sex 2. IPV .45 5.16 ** 1.60 n = 43 F of A .32 4.61 * 2.03 Sex x F of A N/A -0.48 2.27 5.51 ** .30

Women without a History of Childhood Sexual Abuse (Nonvictims) IPV Type Step β B SE (B) F R2 1. IPV .29 3.57 *** 0.75 F of A .06 0.65 0.71 12.94 *** .10 Psych 2. IPV .31 3.77 *** 0.77 n = 248 F of A .07 0.83 0.73 Psych x F of A N/A -0.74 0.61 9.15 *** .10

1. IPV .09 1.14 0.84 F of A .10 1.11 0.75 2.68 .02 Phys 2. IPV .14 1.75 1.02 n = 249 F of A .11 1.21 0.76 Phys x F of A N/A -0.57 0.55 2.15 .03

1. IPV .13 1.73 * 0.87 F of A .10 1.11 0.73 3.65 * .03 Sex 2. IPV .14 1.89 * 0.88 n = 252 F of A .11 1.23 0.74 Sex x F of A N/A -0.87 0.73 2.90 * .03

* p <. 05, ** p < .01, *** p < .001 Note. Psych = Psychological IPV, Phys = Physical IPV, Sex = Sexual IPV

Table 5. Hierarchical Regression Analyses for Prediction of Depersonalization Based on Intimate Partner Violence (IPV) and Fear of Abandonment (F of A) Women with a History of Severe Childhood Sexual Abuse IPV Type Step β B SE (B) F R2 1. IPV .13 .94 .97 F of A -.03 -.19 1.03 .47 .02 Psych 2. IPV .11 .79 .96 n = 57 F of A -.16 -1.21 1.19 Psych x F of A N/A 1.41 .86 1.22 .06

1. IPV .36 2.36 ** 0.86 F of A -.02 -0.19 1.02 4.18 * .13 Phys 2. IPV .08 0.51 1.10 n = 61 F of A -.13 -1.01 1.03 Phys x F of A N/A 1.36 ** 0.54 5.19 ** .21

1. IPV .36 2.98 ** 1.04 F of A .03 0.25 0.98 4.43 * .14 Sex 2. IPV .16 1.28 1.22 n = 59 F of A -.03 -0.27 0.97 Sex x F of A N/A 1.58 * 0.65 5.16 ** .22 Women with a History of Moderate Childhood Sexual Abuse IPV Type Step β B SE (B) F R2 1. IPV .24 1.89 1.23 F of A .14 1.14 1.30 1.92 .09 Psych 2. IPV .30 2.37 1.32 n = 42 F of A .22 1.82 1.46 Psych x F of A N/A -0.91 0.88 1.63 .11

1. IPV .52 4.09 *** 1.07 F of A .13 1.00 1.01 7.79 *** .28 Phys 2. IPV .59 4.70 *** 1.00 n = 43 F of A .21 1.55 1.95 Phys x F of A N/A -2.29 ** 1.79 9.00 *** .41

1. IPV .59 3.72 *** 0.78 F of A .24 1.91 0.99 12.76 *** .40 Sex 2. IPV .63 3.92 *** 0.82 n = 42 F of A .21 1.65 1.05 Sex x F of A N/A 0.95 1.16 8.65 *** .41

Women without a History of Childhood Sexual Abuse (Nonvictims) IPV Type Step β B SE (B) F R2 1. IPV .18 0.91 ** 0.32 F of A .05 0.25 0.30 4.95 ** .04 Psych 2. IPV .18 0.90 ** 0.33 n = 248 F of A .05 0.25 0.31 Psych x F of A N/A 0.01 0.26 3.29 * .04

1. IPV .15 0.80 * 0.35 F of A .06 0.27 0.31 3.76 * .03 Phys 2. IPV .13 0.66 0.42 n = 248 F of A .05 0.24 0.31 Phys x F of A N/A 0.13 0.23 2.60 .03

1. IPV .17 0.95 ** 0.35 F of A .07 0.32 0.30 4.71 ** .04 Sex 2. IPV .17 0.95 ** 0.36 n = 251 F of A .07 0.32 0.30 Sex x F of A N/A -0.01 0.30 3.13 * .04

* p <. 05, ** p < .01, *** p < .001 Note. Psych = Psychological IPV, Phys = Physical IPV, Sex = Sexual IPV

Table 6. Hierarchical Regression Analyses for Prediction of Amnesia Based on Intimate Partner Violence (IPV) and Fear of Abandonment (F of A) Women with a History of Severe Childhood Sexual Abuse IPV Type Step β B SE (B) F R2 1. IPV .10 1.06 1.40 F of A -.04 -.40 1.47 .30 .01 Psych 2. IPV .08 .83 1.38 n = 57 F of A -.18 -1.91 1.70 Psych x F of A N/A 2.07 1.24 1.14 .06

1. IPV .36 3.54 ** 1.31 F of A -.00 -0.05 1.56 4.18 *** .13 Phys 2. IPV .05 0.54 1.67 n = 61 F of A -.12 -1.38 1.56 Phys x F of A N/A -0.03 ** 0.82 5.53 *** .23

1. IPV .33 4.10 * 1.61 F of A .06 0.68 1.52 3.71 * .12 Sex 2. IPV .13 1.57 1.90 n = 59 F of A -.01 -0.08 1.50 Sex x F of A N/A 2.35 * 1.01 4.46 ** .20 Women with a History of Moderate Childhood Sexual Abuse IPV Type Step β B SE (B) F R2 1. IPV .23 2.49 1.72 F of A .05 0.57 1.82 1.24 .24 Psych 2. IPV .26 2.82 1.85 n = 43 F of A .09 1.05 2.06 Psych x F of A N/A -0.64 1.25 .90 .26

1. IPV .59 6.56 *** 1.40 F of A .04 0.44 1.33 11.09 *** .35 Phys 2. IPV .65 7.21 *** 1.36 n = 44 F of A .10 1.02 1.29 Phys x F of A N/A -2.46 * 1.07 9.93 *** .43

1. IPV .56 4.90 *** 1.13 F of A .12 1.35 1.43 9.71 *** .33 Sex 2. IPV .58 5.00 *** 1.20 n = 43 F of A .11 1.22 1.52 Sex x F of A N/A 0.45 1.70 6.35 *** .33

Women without a History of Childhood Sexual Abuse (Nonvictims) IPV Type Step β B SE (B) F R2 1. IPV .26 2.04 *** 0.49 F of A .03 0.20 0.46 9.53 *** .07 Psych 2. IPV .27 2.06 *** 0.50 n = 248 F of A .03 0.22 0.47 Psych x F of A N/A -0.09 0.39 6.35 *** .07

1. IPV .12 1.00 0.53 F of A .05 0.38 0.47 2.67 .02 Phys 2. IPV .11 0.87 0.64 n = 249 F of A .05 0.36 0.48 Phys x F of A N/A 0.13 0.35 1.82 .02

1. IPV .11 4.10 * 0.55 F of A .06 0.70 0.47 2.38 .02 Sex 2. IPV .11 1.57 0.56 n = 252 F of A .06 -0.08 0.47 Sex x F of A N/A 2.35 * 0.47 1.59 .02

* p <. 05, ** p < .01, *** p < .001 Note. Psych = Psychological IPV, Phys = Physical IPV, Sex = Sexual IPV

Table 7. Hierarchical Regression Analyses for Prediction of Lack of Mindful Awareness Based on Intimate Partner Violence (IPV) and Fear of Abandonment (F of A) Women with a History of Severe Childhood Sexual Abuse IPV Type Step β B SE (B) F R2 1. IPV .05 0.33 0.87 F of A -.02 -0.16 0.93 .08 < .01 Psych 2. IPV .04 0.27 0.88 n = 58 F of A -.09 -0.62 1.09 Psych x F of A N/A 0.62 0.79 .25 .01

1. IPV .01 0.03 0.79 F of A .01 0.05 0.93 < 0.01 .00 Phys 2. IPV -.17 -0.98 1.04 n = 62 F of A -.06 -0.39 0.98 Phys x F of A N/A 0.74 0.51 0.70 .04

1. IPV .11 0.76 0.95 F of A -.02 -0.11 0.90 0.32 .01 Sex 2. IPV .12 0.83 1.17 n = 60 F of A -.01 -0.09 0.93 Sex x F of A N/A -0.07 0.63 0.21 .01 Women with a History of Moderate Childhood Sexual Abuse IPV Type Step β B SE (B) F R2 1. IPV .11 0.83 1.13 F of A .24 1.91 1.20 1.86 .08 Psych 2. IPV .11 0.83 1.22 n = 44 F of A .24 0.91 1.36 Psych x F of A N/A -0.01 0.83 1.21 .08

1. IPV .32 2.23 * 0.96 F of A .30 2.09 * 0.97 4.80 * .19 Phys 2. IPV .33 2.28 * 0.98 n = 45 F of A .31 2.15 * 1.01 Phys x F of A N/A -0.25 0.82 3.16 * .19

1. IPV .35 1.97 * 0.79 F of A .25 1.83 1.03 4.41 * .18 Sex 2. IPV .33 1.84 * 1.31 n = 44 F of A .28 2.00 1.10 Sex x F of A N/A -0.60 1.23 2.97 * .18

Women without a History of Childhood Sexual Abuse (Nonvictims) IPV Type Step β B SE (B) F R2 1. IPV .17 1.40 ** 0.51 F of A .09 0.69 0.48 5.71 ** .04 Psych 2. IPV .20 1.61 ** 0.52 n = 248 F of A .12 0.88 0.49 Psych x F of A N/A -0.79 0.41 5.10 ** .06

1. IPV -.11 -0.94 0.55 F of A .15 1.16 * 0.49 3.44 * .03 Phys 2. IPV -.08 -0.71 0.67 n = 249 F of A .16 1.20 * 0.50 Phys x F of A N/A -0.21 0.36 2.40 .03

1. IPV .01 0.12 0.57 F of A .12 0.93 0.48 1.96 .02 Sex 2. IPV .03 0.30 0.58 n = 252 F of A .14 1.07 * 0.49 Sex x F of A N/A -0.98 * 0.48 2.71 * .03

* p <. 05, ** p < .01, *** p < .001 Note. Psych = Psychological IPV, Phys = Physical IPV, Sex = Sexual IPV

Figure 1 The influence of fear of abandonment on the relationship between intimate partner violence and processes that restrict awareness

Figure 2 The influence of fear of abandonment on the relationship between physical intimate partner violence and depersonalization among women with a history of severe childhood sexual abuse

Slope significance test: Clinical: p < .05 Nonclinical: nonsignificant

Figure 3 The influence of fear of abandonment on the relationship between physical intimate partner violence and amnesia among women with a history of severe childhood sexual abuse

Slope significance test: Clinical: p < .05 Nonclinical: nonsignificant

Figure 4 The influence of fear of abandonment on the relationship between sexual intimate partner violence and depersonalization among women with a history of severe childhood sexual abuse

Slope significance test: Clinical: p < .01 Nonclinical: nonsignificant

Figure 5 The influence of fear of abandonment on the relationship between sexual intimate partner violence and amnesia among women with a history of severe childhood sexual abuse

Slope significance test: Clinical: p < .05 Nonclinical: nonsignificant

Figure 6 The influence of fear of abandonment on the relationship between physical intimate partner violence and depersonalization among women with a history of moderate childhood sexual abuse

Slope significance test: Clinical: p < .05 Nonclinical: p < .001

Figure 7 The influence of fear of abandonment on the relationship between physical intimate partner violence and amnesia among women with a history of moderate childhood sexual abuse

Slope significance test: Clinical: p < .01 Nonclinical: p < .001

Figure 8 The influence of fear of abandonment on the relationship between sexual intimate partner violence and lack of mindful awareness among women with no history of childhood sexual abuse (i.e., nonvictims)

Slope significance test: Clinical: nonsignificant Nonclinical: nonsignificant