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Factores de Riesgo
Factores de Riesgo
Factores de Riesgo
67
tim safety and which factors should be targets of intervention, whether in
the community, the couple, or the individual.
Because longitudinal research is scarce, we are generally not able to
determine that these factors precede violence, only that they tend to co-
occur with violence. Therefore, we are careful to describe these factors as
markers for violence, not predictors of violence. In addition, it is not always
clear whether the risk factors discussed (e.g., fear, strangulation) are simply
proxies for a history of more versus less severe IPV because most studies do
not control for severity of IPV.
This chapter is divided into three main sections. First, we give special
attention to factors that are related to lethal violence. Second, we review
risk factors that are shown to be related to IPV but have less evidence that
they are related to partner homicide. Because violence risk assessment is a
complex process, professionals are most likely to be successful in preventing
harm if they make use of evidence-based formal risk instruments. Therefore,
third, we discuss tools that could be used to assess the risk of violence. In
addition, we offer suggestions for prevention related to each of the risk fac-
tors throughout the chapter.
Because most of the risk factor research combines cohabiting couples
and married couples, this review pertains to violence in both types of rela-
tionships. Literature reviewing risk factors for dating violence is not included
in this review. However, previous research has found that risk factors for
dating violence are generally parallel to the risk factors for marital violence,
and that violent behavior in dating relationships often carries over into mar-
riage (O'Leary et al., 1989; O'Leary, Malone, & Tyree, 1994). Because most
of the research addresses male-to-female violence and because women are
more likely to be seriously injured in intimate partner relationships, the fo-
cus of this review is on male-to-female violence. However, when research
addresses female-to-male violence it is included. Violence in same-sex inti-
mate relationships is not included in this review.
The effects of IPV are far reaching on both an individual and a societal
level. Every year 5.3 million women in the United States are victims of IPV.
Almost half of these violent incidents result in injury, and roughly 1,300
result in death (National Center for Injury Prevention and Control, 2003).
In the United States, four women are killed every day by their intimate male
partners (Stout, 1991). Researchers have found that 30% of female homi-
cides (i.e., femicides) are due to intimate partner homicide (Brewer & Paulsen,
1999; Puzone, Saltzman, Kresnow, Thompson, & Mercy, 2000). Conversely,
intimate partner homicide accounts for 5% of male homicide victims
RISK FACTORS 69
Another study found that a victim's fear that her life was in danger
significantly predicted risk of minor and severe injuries due to an assault
committed by her intimate partner (Simon et al., 2001). H. Johnson (1995)
noted that "in a significant number of cases, [the woman] correctly assesses
the potential for life threatening violence by her spouse" (p. 166). It is im-
portant to recognize that the victim's perception of risk may not always be
accurate. The authors of a recent study (Cattaneo, Bell, Goodman, & Dutton,
2007) used a four-category (i.e., true positive, true negative, false positive,
and false negative) version of female victims' accuracy in predicting whether
their partner would be physically violent again. They found that, overall,
women were more likely to be accurate than to be inaccurate. However, it
was more likely that a victim would be a true positive if she had been more
frequently stalked by her partner and that it was more likely she would be a
false negative if she reported higher levels of substance abuse.
A victim's level of fear should be taken seriously. The victim's fear that
she may be seriously injured by her partner should be included as an impor-
tant risk factor for future severe violence. Women are often socialized to
disregard their needs and feelings, which, in terms of IPV, can be dangerous.
Dating violence prevention programs should educate participants about the
risk factors for IPV. Moreover, in the context of increasing awareness of risk
factors, programs should encourage youths to attend to their feelings of fear
and emphasize the importance of prioritizing their safety needs. Furthermore,
programs should emphasize the accuracy of the connection between partici-
pants' feelings of fear and the potential for danger.
RISK FACTORS 71
need to assess thoroughly for threats to harm or kill self or other and respond
to such threats appropriately.
RISK FACTORS 73
violence. In the sections that follow, we examine research related to jealousy
or stalking behaviors and previous criminal behavior unrelated to IPV as risk
factors for lethal violence.
RISK FACTORS 75
Victim Attempts to Leave the Relationship
One of the most dangerous times for victims of IPV is when the victim
attempts to leave or threatens to leave the relationship. Both leaving and
threatening to leave have been associated with the occurrence of IPV
(H. Johnson, 1995; Moracco et al., 1998; Wilson & Daly, 1993, 1994). In a
study of 12,000 women, H. Johnson (1995) found that abuse increased in
severity after separation for both mildly and severely abused women.
A link also exists between victims' attempts to leave and homicide risk
(Campbell, 1992; Moracco et al, 1998; Wilson & Daly, 1993,1994). Moracco
et al. (1998) found that 50% of the women killed by their partners had threat-
ened to leave, attempted to leave, or had recently separated from their part-
ners. These homicides were more than twice as likely to be preceded by other
incidents of IPV when compared with homicides that did not occur in the
context of separation.
Similarly, Wilson and Daly (1994) found a history of IPV in 80% of the
homicide cases involving separated couples, compared with 35% of the ho-
micide cases involving co-residing couples. Although spousal homicide may
occur months or even years after separation, the period immediately follow-
ing the separation appears to be especially risky for wives. Therefore, sepa-
rated wives are at greater risk of being killed by their estranged spouses than
co-residing wives, particularly immediately following separation. Of course,
leaving an offender can also become a protective factor. In fact, Fals-Stewart,
Lucente, and Birchler (2002) found that the frequency of both male-to-
female and female-to-male physical aggression is lower when days of face-to-
face contact is lower. One way to help victims safely leave violent homes is
to provide shelter housing services. Some qualitative evidence suggests that
women and their children who have escaped violent relationships benefit
greatly from shelter or transitional housing services (Whitaker, Baker, &
Arias, 2006). However, transitional housing and shelter services are often
combined with other services, increasing the difficulty in assessing the im-
pact of shelter housing in reducing revictimization. Offering these services to
women leaving abusive relationships appears to help protect victims.
In addition to factors that have been highlighted as risk factors for le-
thal violence, a number of other factors have been shown to be associated
with IPV. These factors include those related to offender behavior, attitudes,
or characteristics (including previous physical aggression in current or past
intimate relationships, emotional or verbal abuse in current or past intimate
partner relationship, high levels of anger or hostility, child abuse, use of power
RISK FACTORS 77
(1998) found that whereas 89% of severely violent men were emotionally abu-
sive, only 31% of the emotionally abusive men exhibited severe physical vio-
lence. Therefore, it appears that verbal aggression often occurs without physi-
cal violence, but rarely does physical violence occur without verbal aggression.
Emotional abuse also appears to be related to physical violence recidi-
vism. Jacobson et al. (1996) studied the differences between those batterers
who continued to use severe forms of violence and those who did not. They
found that verbal aggression was significantly higher at the time of the initial
assessment and 2 years after the initial assessment for husbands who contin-
ued to engage in severe violence against their spouse than it was for those
who ceased being aggressive. Aldarondo and Sugarman (1996) found that
men who reported higher levels of emotional abuse were significantly more
likely to continue to use violence over the study's 3-year period. Several studies
found the same relationship for women (O'Leary et al, 1994; Sagrestano,
Heavey, & Christenson, 1999). For example, O'Leary et al. (1994) found
that female psychological aggression 18 months after marriage is predictive
of female physical aggression 30 months after marriage.
These findings suggest that a history of verbal or psychological aggression
is an important risk assessment factor for both male- and female-perpetrated
aggression. A common misconception is that IPV occurs only in the form of
physical abuse. Prevention efforts must provide education and awareness of
the significant role other forms of abuse play in physical violence and the
escalation of violence. There is also some evidence that teaching couples to
resolve conflicts with less hostility can reduce the likelihood of IPV.
Child Abuse
A strong relationship has been demonstrated between child abuse and
the occurrence of IPV (Gondolf, 1988; McCloskey, 1996; Ross, 1996). Fa-
RISK FACTORS 79
Violence prevention programs should help participants be alert to this type
of behavior and the potential negative consequences that can emerge from
controlling relationships.
In general, men who abuse their spouse appear to have more psycho-
logical problems compared with nonviolent men (Riggs, Caufield, & Street,
2000). Four psychological syndromes have been identified as factors for men's
perpetration of IPV. Specifically, depression, borderline personality disorder,
posttraumatic stress disorder, and substance abuse have been consistently
related to perpetration of partner violence. In addition, higher levels of part-
ner violence have been found among individuals experiencing other types of
personality disorders (e.g., antisocial, narcissistic, or histrionic), those ex-
hibiting signs of severe mental illness (e.g., delusions, hallucinations, mania,
dementia), and those experiencing cognitive or intellectual impairments (e.g.,
brain damage, mental retardation; Kropp, 2005).
Depression
A number of studies have linked depression and IPV (Dinwiddie, 1992;
Pan, Neidig, & O'Leary, 1994; Straus & Yodanis, 1996). One of the first
studies to examine this relationship was conducted by Maiuro et al. (1988).
They studied depression across a sample of 100 violent men in treatment for
anger management and 29 nonviolent control participants. Two thirds of
the sample scored within the clinical range for depression. Significantly more
men in the domestically violent group scored as depressed than men in the
control or general assaulters groups.
Depression has also been linked to the severity of abuse (Pan et al,
1994; Straus & Yodanis, 1996; Vivian & Malone, 1997). For example, in a
study of 11,870 men from 38 army bases, Pan et al. (1994) found that men
who were mildly or severely physically aggressive reported significantly more
depressive symptoms than men who were not physically aggressive. Further-
more, the severely aggressive group reported significantly more depressive
symptoms than men in the mildly aggressive group. In fact, for every 20%
increase in depressive symptomatology, the odds of being mildly aggressive
increased by 30%, whereas the odds of being severely aggressive increased by
74%. Furthermore, while sampling 4,401 (2,557 women and 1,844 men) re-
spondents, Straus and Yodanis (1996) found that a wife's depression doubled
her odds of perpetrating physical violence against her spouse. In sum, re-
search finds that depression is a highly relevant factor related to physical
abuse for both men and women.
RISK FACTORS 81
Personality Disorders
Another mental disorder strongly linked to perpetration of IPV is bor-
derline personality disorder. In a series of studies (see Dutton, 1998, for a
review), Dutton and his colleagues examined personality profiles of violent
men. They found that 45% of self-referred and 27.5% of court-referred wife
abusers reached the 85th percentile on the Borderline Scale of the Millon
Clinical Multiaxial InventoryIII (Millon, Davis, & Millon, 1997) Fur-
thermore, clients scoring high on borderline personality organization (BPO)
scales report greater frequency, magnitude, and duration of anger. They also
report greater jealousy and more trauma symptoms, disassociation, anxiety,
sleep disturbance, and depression. Partners of these men described a constel-
lation of personality features (e.g., BPO, high anger, fearful attachment,
chronic trauma symptoms, recollection of paternal rejection) that accounted
for reports of abusiveness by their partner.
Kropp (2005) suggested that mental disorder is likely to be a causal
factor leading to impulsive or irrational decisions to act violently toward an
intimate partner for some violent offenders. Additionally, he proposed that
symptoms of mental disorders can interfere with an offender's ability or mo-
tivation to comply with treatment and supervision. Thus, not only should
clinicians assess for a variety of mental disorders to understand the risk of
future violence, but these disorders should also be a focus of treatment for
offenders with these disorders.
RISK FACTORS 83
cies and counseling services, should be aware of the increased vulnerability
to IPV during these times and offer resources to help these families safely
manage stress.
Relationship Issues
CONCLUSION
In this chapter, we reviewed risk factors for IPV that have been identi-
fied from extensive research. It is clear that the factors associated with IPV
are far too complex to be eliminated by any one specific prevention or inter-
vention program, or even one type of program. A much broader range of
prevention efforts is required. Knowledge of risk factors is critical to the man-
agement of offender risk and enhancement of victim safety. Furthermore,
understanding risk factors is vital to the development of programs to prevent
IPV or to prevent its escalation. Intervention or prevention programs should
address known risk factors and should determine whether the program they
are developing or the intervention they are proposing for an offender or vic-
tim target these risk factors.
RISK FACTORS 85
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