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Modern Scientific Evidence - Battered Woman Syndrome

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§ 12:22 MODERN SCIENTIFIC EVIDENCE

convenient, more accurately depicts the social and psychological

consequences of domestic violence. In time, this research will do
much to advance our understanding and will mold our responses
to this important and disturbing problem. A good faith applica-
tion of admissibility standards should lead courts to move from
the simple solutions embodied in syndrome-based defenses to a
greater appreciation of the complex circumstances surrounding
these cases. For example, in attempting to explain why women
do not leave violent relationships, courts can be expected to reject
opinions on learned helplessness that are now offered with virtu-
ally no research basis to support them. Such rejection of facile
expert opinion, however, will not leave battered women with no
explanation for their conduct, for good research indicates that
many factors conspire to trap women in violent relationships.11 In
the end, battered women, and society in general, will benefit from
a more discriminating evaluation of ostensibly scientific research
in this area. Good research should make clear the factual picture
from which legal policy should be made. To date, the research
has only muddied that picture. Courts should expect, indeed
demand, more from social science.

II. SCIENTIFIC STATUS

by Regina Schuller* & Caroline Erentzen**

§ 12:23 Introductory discussion of the science—The

general questions
Scientific research on intimate partner violence (IPV) and its
impact was initiated in the early 1970s, and began with an
exclusive focus on male violence against women in intimate
relationships. It was during this time that researchers began to
document the widespread scope and severity of the problem.
Researchers primarily directed their attention to delineating the
dynamics of abusive relationships and to understanding women’s

11
§§ 12:24 to 12:29.
*Regina A. Schuller, PhD, is Pro-
fessor of Psychology at York University
in Toronto, Ontario, Canada. She is
actively engaged in both research and
teaching. Her research interests focus
on the impact of social science testi-
mony, in particular, expert testimony
pertaining to battered women and on
juror/jury decision processes in trials
involving intimate partner violence.
She also serves on the editorial board
of Law and Human Behavior.
**Caroline Erentzen is a doctoral
candidate working under the supervi-
sion of Dr. Regina Schuller in the
Department of Psychology at York
University in Toronto, Ontario, Can-
ada. Prior to attending doctoral stud-
ies, Caroline completed a law degree
at Queen’s University and was called
to the Ontario Bar in 2007. Her re-
search interests focus on the study of
religious and race-based hate crimes,
as well as juror/jury bias.

412
BATTERED WOMAN SYNDROME § 12:24

experience of and reactions to male violence. The high prevalence

rate of IPV has now been well-documented in intimate same-sex
relationships,1 as has violence directed against male partners by
women.2 Since this time, national surveys and crime statistics
continue to document the scope and severity of IPV in the United
States. The present chapter will begin with a discussion of the
estimated prevalence of intimate partner abuse, followed by an
historical overview of the battered woman syndrome literature,
including the early ideas of the cycle of violence and learned
helplessness. Following this, we will discuss the physical and
psychological effects of domestic violence, areas of general agree-
ment and controversy in the literature.

§ 12:24 Introductory discussion of the science—The

general questions—The scope of the problem

[Section 12:23] women are not real perpetrators of

1 violence and that men should be able
In describing the dynamics of
abuse within same-sex relationships,
researchers note both similarities and
differences between battered hetero-
sexual women and battered gay men
and lesbian women. For example, West
recently reviewed the literature on
ethnic and sexual minority IPV, and
found few gender differences in IPV
among ethnic minorities, but did find
that IPV was higher among persons
with a history of same-sex
cohabitation: Carolyn M. West, Partner
Abuse in Ethnic Minority and Gay,
Lesbian, Bisexual and Transgender
Populations, 3 Partner Abuse 336
(2012). Similarly, Messinger found
that, regardless of gender, those with
a history of same sex partnership were
more likely to have experienced IPV,
with highest rates among behaviorally
bisexual persons: Adam M. Messinger,
Invisible Victims: Same-Sex IPV in the
National Violence Against Women
Survey, 22 J. of Interpersonal Violence
2228 (2011). See also Christine E.
Murray & Keith Mobley, Empirical
Research About Same-Sex Intimate
Partner Violence: A Methodological
Review, 56 J. of Homosexuality 361
(2009).
2
Dutton (2007) notes that Ameri-
can culture is more accepting of female
violence against men than the reverse,
due in part from the perception that
to defend themselves against women.
This problem is confounded by the lack
of community resources and shelters
for male victims of domestic violence
committed by female or same-sex
partners: Mary Ann Dutton, The
Complexities of Domestic Violence, 62
Amer. Psychologist 708 (2007). Hines
& Douglas (2015) note that widescale
population-based studies estimate that
40-50% of IPV victims are men, who
may suffer severe violence at the
hands of their partners and who simi-
larly develop post-traumatic stress dis-
order and depression as a result: Denise
A. Hines & Emily M. Douglas, Relative
Influences of Various Forms of Partner
Violence on the Health of Male Victims:
Study of a Help Seeking Sample, 16
Psychology of Men & Masculinity 1
(2015). Among a sample of 302 men
who sought help for IPV, 90.4% experi-
enced severe physical injury and 54%
had a life-threatening injury: Denise
A. Hines & Emily M. Douglas, Predict-
ing Potentially Life-Threatening
Partner Violence by Women Toward
Men: A Preliminary Analysis, 28
Violence and Victims 751 (2013). For a
review of the literature on male vic-
tims of IPV, see Sabrina N. Nowinski
and Erica Bowen, Partner Violence
Against Heterosexual and Gay Men:
Prevalence and Correlates, 17 Aggres-
sion and Violent Beh. 36 (2012).

413
§ 12:24 MODERN SCIENTIFIC EVIDENCE

Perhaps one of the earliest and most cited works documenting

the pervasiveness of wife abuse involved a series of national
surveys conducted by a group of sociologists at the Family
Research Laboratory.1 In 1975, these researchers interviewed
more than 2,000 individuals, and found that one of every six
women reported that they were struck during the course of their
marriage; 12% of the women were physically attacked during the
year of the survey, with 4% of these attacks involving severe
violence. 2 Ten years later the study was replicated with a
nationally-representative sample of more than 6,000 individuals.3
Again, a substantial rate of husband-to-wife violence was found,
with 11% of wives reporting violence in the past year, and 3%
reporting severe violence. Roughly another decade after that,
Straus and Kantor conducted a third study with approximately
2,000 respondents, and found that the rate of both minor and
serious violence decreased overall from 1975 to 1993.4
Later prevalence estimates provided more nuance, considering
differential rates among various ethnic and sexual sub-
populations as well as different forms of partner abuse (i.e.,
sexual violence, emotional and psychological maltreatment, and
physical abuse, stalking). Carney and Barner (2012) provided a
systematic review of the abuse prevalence literature, assessing
more than 200 articles published after 1990.5 The review revealed
very high rates of verbal and emotional abuse, with an average of
40% of women and 32% of men reporting verbal or emotional ag-
gression, and 43% of men and 41% of women reporting coercive
control.6 Similarly high rates were detected by the National
Intimate Partner Violence Survey in 2011, which surveyed more

[Section 12:24]
1
Murray A. Straus et al., Behind
Closed Doors: Violence in the Ameri-
can Family (1980); Richard J. Gelles
& Murray A. Straus, Intimate
Violence: The Causes and Conse-
quences of Abuse in the American
Family (1988). For these surveys a
‘‘Conflict Tactics Scale’’ was developed,
which measured the use of rational
discussion and agreement as well as
verbal or behavioral expressions of
hostility, physical force, and violence.
2 ing access to transportation, food, com-
Murray A. Straus et al., Behind
Closed Doors: Violence in the Ameri-
can Family (1980).
3
Richard J. Gelles & Murray A.
Straus, Intimate Violence: the Causes
and Consequences of Abuse in the
American Family (1988).
4
Richard J. Gelles, Estimating
the Incidence and Prevalence of Vio-
lence Against Women: National Data
Systems and Sources, 6 Violence
Against Women at 797 (2000).
5
Michelle Mohr Carney and John
R. Barner, Prevalence of Partner
Abuse: Rates of Emotional Abuse and
Control, 3 Partner Abuse 286 (2012).
6
Coercive control includes ac-
tions intended to harm, humiliate and
dominate the victim, including isola-
tion from friends and family, restrict-
munication, finances, and
employment. Michelle Mohr Carney
and John R. Barner, Prevalence of
partner abuse: Rates of emotional
abuse and control, 3 Partner Abuse
286 at 289 (2012), citing E. Stark,
Coercive Control: How Men Entrap

414
BATTERED WOMAN SYNDROME § 12:24

than 16,000 men and women in the United States and reported
that 35.6% of women and 28.5% of men had been the victim of
rape, physical violence and/or stalking by an intimate partner
during their lifetime.7
Varying estimates of domestic violence have been found
depending on the particular sample studied, the time frame
considered, and the way in which violence is measured. For
example, Thompson et al. (2006) assessed IPV rates among 3568
women enrolled in a health maintenance organization (HMO)
and found that 44% reported lifetime exposure to IPV, with 8%
reporting some form of IPV in the past year and 15% in the past
three years.8 Miller (2006) reviewed data collected from more
than 8,000 women in connection with the National Violence
Against Women Survey, and found that 19% of women reported
that they had been the victim of a physical assault by their
partner, and that 6% had been raped by their partner.9 Although
intimate partner violence has been noted in all segments of the
population, a number of variables have been identified as risk
markers for victimization: female gender,10 age,11 income,12 race/

Women in Personal Life (Oxford of violence than do men and suffer

University Press: Oxford, United
Kingdom, 2007).
7 and Lesia Ruglass, Interpersonal Part-
Michele C. Black, Kathleen C.
Basile, Matthew J. Breiding, Sharon
G. Smith, Mikel L. Walters, Melissa T.
Merrick, Jieru Chen & Mark R. Ste-
vens, The National Intimate Partner
Survey: 2010 Summary Report. Na-
tional Centre for Injury Prevention
and Control (Centres for Disease Con-
trol and Prevention: Atlanta, GA,
2011).
8 Keith E. Davis, Ileana Arias, Sujata
Robert S. Thompson, Amy E.
Bonomi, Melissa Anderson, Robert J.
Reid, Jane A. Dimer, David Carrell, &
Frederick R. Rivara, Intimate Partner
Violence: Prevalence, Types, and Chro-
nicity in Adult women, 30 Amer. J. of
Prev. Med. 447 (2006).
9 Higher levels of violence have
JoAnn Miller, A Specification of
the Types of Intimate Partner Violence
Experienced by Women in the General
Population, 12 Violence Against
Women 1105 (2006). Of the women
who had been physically assaulted,
31% were also raped by that partner
and 23% were stalked (at 1114).
10
Women experience higher rates
more severe consequences. For a re-
view of this literature, see Denise Hien
ner Violence and Women in the United
States: An Overview of Prevalence
Rates, Psychiatric Correlates and Con-
sequences and Barriers to Help Seek-
ing, 32 Intern’l J. Law and Psychiatry
48 (2009). Similarly, Tjaden and Thoe-
nnes (2000) found that 20% of women
versus 7% of men reported a lifetime
history of IPV. See also Ann L. Coker,
Desai, Maureen Sanderson, Heather
M. Brandt, & Paige H. Smith, Physi-
cal and Mental Health Effects of Inti-
mate Partner Violence for Men and
Women, 23 Amer. J. of Prev. Medicine
260 (2002).
11
been found for women who are
younger: See e.g., Sherry Lipsky, Raul
Caetano, Craig A. Field, & Shahrzad
Barargan, The Role of Alcohol Use and
Depression in Intimate Partner Vio-
lence Among Black and Hispanic Pa-
tients in Urban Emergency Depart-
ment, 31 Amer. J. of Drug and Alcohol
Abuse 22 (2005).

415
§ 12:24
ethnicity,13 pregnancy,14 separation,15 alcohol consumption on the
part of the batterer,16 experiencing abuse as a child,17 and witness-
12
Although wife abuse is not con-
fined to low income families, it is more
likely to be reported in these house-
holds. For example, Kaplan found
that, compared to women living in
households with higher incomes,
women in households with incomes of
less than $10,000 per year were four
times more likely to be attacked by
their partners. See A. Kaplan, Domes-
tic Violence and Welfare Reform, I(8)
Welfare Information Network: Issues
Notes 1 (1997).
13
The prevalence of IPV is sub-
stantially higher for ethnic minority
women compared to white women. For
instance, Williams, Oliver, and Pope
(2008) found that Blacks are typically
overrepresented as victims and perpe-
trators of domestic violence, and that
Black women suffer more extreme
violence than do White women: Oliver
J. Williams, William Oliver and Mar-
cus Pope, Domestic Violence in the
African American Community, 16 J.
Aggression, Maltreatment and Trauma
229 (2008). However, the authors note
that racial differences disappear when
controlling for income, and warn that
a “one-size-fits-all” approach to domes-
tic violence may overlook important
differences between ethnic groups (at
235). Similarly, Taft et al. (2009) ob-
serve that IPV research was based on
studies of white women and has ne-
glected women with a different cul-
tural worldview. They further note
that distinguishing between White
and Black ethnicities is a very crude
distinction, as there are important
socio-cultural differences between sub-
groups of Black identities such as
Caribbean, African, and American.
The authors review a number of large-
scale studies consistently finding that
Black men commit higher rates of IPV
but that this difference typically disap-
pears when family income and socio-
economic status are taken into ac-
count. They note that victims may be
trapped by a lack of resources in some
416
MODERN SCIENTIFIC EVIDENCE
Black communities such as employ-
ment counselling, transportation, or
shelters: Casey T. Taft, Thema Bryan-
Davis, Halley E. Wooward, Shaquita
Tillman, & Sandra E. Torres, Intimate
Partner Violence Against African
American Women: An Examination of
the Sociocultural Context, 14 Aggres-
sion and Violent Beh. 50 (2009).
14
Although some evidence sug-
gests that violence escalates during
pregnancy, other research suggests
that pregnant women may be at no
greater risk for abuse and that the
increase in reporting of violence dur-
ing pregnancy may be accounted for
by age (younger women are more likely
to be pregnant than older women):
Ballard et al., Violence During
Pregnancy: Measurement Issues, 88
Am. J. of Public Health 274 (1998);
Mary Ann Dutton et al., Impact of
Violence on Women’s Health, in Health
Care for Women, Psychological, Social,
and Behavioral Influences 43, 44-45
(Sheryle J. Gallant et al., eds., 1997).
See also Plichta, who notes that 13-
24% of pregnancy related deaths are
related to IPV: Stacey B. Plichta,
Intimate Partner Violence and Physi-
cal Health Consequences: Policy and
Practice Implications, 19 J. of Inter-
personal Violence, 1296-1323 (2004).
15
See Douglas A. Brownridge, Vio-
lence Against Women Post-Separation,
11 Aggression and Violent Behavior
514 (2006); Walter S. De Keseredy &
Martin D. Schwartz, Separation/
Divorce Assault in Rural Ohio: Survi-
vors’ Perceptions, 36 J. Prevention &
Intervention in the Community 105
(2008); Koepsell, Kernic, & Holt, Fac-
tors that Influence Battered Women to
Leave their Abusive Relationships, 21
Violence and Victims 131 (2006); Rich-
ard J. Gelles, Intimate Violence in
Families 82 (3rd ed., 1997).
16
Although alcohol is neither nec-
essary nor sufficient for the occurrence
of violence, the association between
the batterer’s alcohol use and his
BATTERED WOMAN SYNDROME § 12:24

ing battering in childhood.18 As the field advances, research has

begun to uncover the way in which these variables may interact
and function together. For instance, with respect to ethnicity and
race, research finds higher rates of IPV among ethnic minorities
compared to those of White women, but these differences gener-
ally disappear or dissipate when socio-demographic variables are

violence has been demonstrated in a A. Dimer, David Carrell, and Frank P.

number of studies. See Howard, Trevil-
lion, Khalifeh, Woodall, Agnew-Davies,
& Feder, Domestic Violence and Se-
vere Psychiatric Disorders: Prevalence
and Interventions, 40 Psychol. Med.
893 (2010). Coker et al. (2002) found
that alcohol use predicted likelihood of
victimization for both genders, control-
ling for other factors: Ann L. Coker,
Keith E. Davis, Ileana Arias, Sujata
Desai, Maureen Sanderson, Heather
M. Brandt, & Paige H. Smith, Physi-
cal and Mental Health Effects of Inti-
mate Partner Violence for Men and
Women, 23 Amer. J. of Prev. Medicine
260 (2002). Lipsky et al. (2005) found
that substance use did not predict
victimization, but did predict perpe-
tration of violence among 385 Black
and Hispanic persons admitted to an
emergency room: Sherry Lipsky, Raul
Caetano, Craig A. Field, & Shahrzad
Barargan, The Role of Alcohol Use and
Depression in Intimate Partner Vio-
lence among Black and Hispanic Pa-
tients in Urban Emergency Depart-
ments, 31 Amer. J. of Drug and Alcohol
Abuse 225 (2005). But see Doris F.
Chang, Biing-Jiun Shen, & David T.
Takeuchi, Prevalence and Demo-
graphic Correlates of Intimate Partner
Violence in Asian Americans, 32 Int. J.
of Law and Psychiatry 167 (2009), who
found that Asian American women
who reported alcohol use were five
times more likely to report being the
victim of IPV.
17
See Ann L. Coker, Keith E. Da-
vis, Ileana Arias, Sujata Desai, Mau-
reen Sanderson, Heather M. Brandt,
& Paige H. Smith, Physical and Men-
tal Health Effects of Intimate Partner
Violence for Men and Women, 23 Amer.
J. of Prev. Medicine 260 (2002); Robert
S. Thompson, Amy E. Bonomie, Me-
lissa Anderson, Robert J. Reid, Jane
Rivara, Intimate Partner Violence
Prevalence, Types, and Chronicity in
Adult Women, 30 Amer. J. of Prev.
Med. 447 (2006); Tracie O. Afifi, Har-
riet MacMillan, Brian J. Cox, Gordon
J.G. Asmundson, Murray B. Stein, and
Jitender Sareen, Mental Health Cor-
relates of Intimate Partner Violence in
Marital Relationships in a Nationally
Representative Sample of Males and
Females, 24 J. of Interpersonal Vio-
lence 1398 (2009); L. Bensley, J. Van
Eenwyk & K.W. Simmons, Childhood
Family Violence History and Women’s
Risk for Intimate Partner Violence and
Poor Health, 25 Amer. J. of Prev. Med.
38 (2003).
18
The elevated risk of becoming a
victim or perpetrator of intimate vio-
lence associated with witnessing vio-
lence in childhood has been well docu-
mented in the literature. See M.K.
Ehrensaft, P. Cohen, J. Brown, E.
Smailes, H. Chen & J.G. Johnson,
Intergenerational Transmission of
Partner Violence: A 20-Year Prospec-
tive Study, 71 J. Counselling and
Clinical Psychology 741 (2003); L.
Bensley, J. Van Eenwyk & K.W. Sim-
mons, Childhood Family Violence His-
tory and Women’s Risk for Intimate
Partner Violence and Poor Health, 25
Amer. J. of Preventative Medicine 38
(2003). As researchers have pointed
out (e.g., Richard J. Gelles, Intimate
Violence in Families 82 (3rd ed.,
1997)), although exposure to violence
as a child may increase the likelihood
of becoming a victim or batterer, this
relationship is far from predetermined.
Not all men exposed to such violence
in their childhood grow up to be abus-
ers and, conversely, men not exposed
to such violence in their childhood may
become violent in their marital rela-
tionships.

417
§ 12:24 MODERN SCIENTIFIC EVIDENCE

taken into account.19 While most large scale population based

studies do not assess sexual orientation of respondents, some evi-
dence exists that suggests that IPV may be a more severe problem
with sexual minorities than among heterosexual couples.20 Mur-
ray and Mobley (2009) provided a systematic review of the
research methods used to investigate same-sex IPV, noting that
this area is still understudied for a number of reasons.21 They
note a common misconception that IPV involves male against
female violence, which in turn is assumed to be more serious
than other forms. Moreover, the feminist origins of the battered
women’s movement originally viewed IPV as rooted in patriarchy
and sexism against women. The authors note that research fund-
ing for IPV often gets redirected into male-against-female
violence, and that there is a tendency for LGBT research to focus

19
See e.g., P. Tjaden & N. Thoe-
nnes, Full report of the Prevalence,
Incidence, and Consequences of Vio-
lence Against Women: Findings from
the National Violence Against Women
Survey (NCJ183781). Washington, DC:
U.S. Department of Justice, National
Institute of Justice (2000); Denise
Hien and Lesia Ruglass, Interpersonal
Partner Violence and Women in the
United States: An Overview of Preva-
lence Rates, Psychiatric Correlates
and Consequences and Barriers to
Help Seeking, 32 International J. Law
and Psychiatry 48 (2009). For a recent
review, see Carolyn M. West, Partner
Abuse in Ethnic Minority and Gay,
Lesbian, Bisexual and Transgender
Populations, 3 Partner Abuse 336
(2012).
20
Hughes et al. (2010) found that
sexual minority men and women were
at higher rates of lifetime victimiza-
tion and substance abuse than hetero-
sexual persons: Tonda Hughes, Sean
Estaban McCabe, Sharon C. Wilsnack,
Brady T. West and Carol J. Boyd,
Victimization and substance use disor-
ders in a national sample of hetero-
sexual and sexual minority women
and men, 105 Addiction 2130 at 2137
(2010). Carolyn M. West, Partner
Abuse in Ethnic Minority and Gay,
Lesbian, bisexual and transgender
populations, 3 Partner Abuse 336
(2012). Reviewing data from the Na-
tional Violence Against Women Survey,
Messinger (2011) found that those
with a history of same sex relation-
ships were more likely to have experi-
enced violence, controlling behaviors,
and sexual violence than were hetero-
sexual women, but that bisexual per-
sons were most likely to have been
abused by an opposite sex partner:
Adam M. Messinger, Invisible Victims:
Same-Sex IPV in the National Violence
against Women Survey, 22 J. Interper-
sonal Violence 2228 (2011). Balsam et
al. (2005) found that sexual orienta-
tion did not differentially predict IPV
victimization in the past year, but that
sexual minorities reported a higher
lifetime exposure to IPV: K.F. Balsam,
E.D. Rothblum, & T.P. Beauchaine,
Victimization over the Life Span: A
Comparison of Lesbian, Gay, Bisexual,
and Heterosexual Siblings, 73 J. Coun-
seling and Clinical Psychology 477
(2005). Rhodes et al. found that gay
men reported a higher incidence of
IPV than did heterosexual men: S.D.
Rhodes, T.P. McCoy, A.M. Wilkin, & M.
Wolfson, Behavioral Risk Disparities
in a Random Sample of Self-
Identifying Gay and Non-Gay Male
University Students, 56 J. Homosexu-
ality 1083 (2009).
21
Christine E. Murray & Keith
Mobley, Empirical Research About
Same-Sex Intimate Partner Violence:
A Methodological Review, 56 J. Homo-
sexuality 361 (2009).

418
BATTERED WOMAN SYNDROME § 12:24

on other issues facing the community.22 In addition, Murray and

Mobley address methodological issues affecting research into
same-sex IPV, including non-representative sampling (i.e.,
participants are recruited through queer publications or at pride
events), unclear determination of participant sexual orientation,
and a lack of sufficient detail to permit replication.23
Although traditionally much of the early research focused pri-
marily on the physical aspects of violence, the nonphysical forms
of abuse to which battered women were subjected has also
received considerable attention. Through surveys and interviews,
researchers find that, along with physical and sexual abuse, bat-
tered women are also subjected to many other forms of control
and maltreatment, including restriction of economic finances,
threats of harm to both self and others, destruction of property
and pets, ridicule, social isolation, and restriction of the woman’s
behavior.24
The results of these surveys document a range of violent and
abusive behaviors experienced by women at the hands of an
intimate male partner. We must be mindful, however, of the ret-
rospective self-report nature of the information collected through
these surveys.25 Given the private and hidden nature of intimate
violence, as well as the social stigma and embarrassment at-
tached to disclosure of violence at the hands of a partner, under-
(as opposed to over-) reporting is more likely to occur. In short,
figures derived from these surveys may actually underestimate
the severity of the problem.26 But given the sampling techniques
employed, certain segments of the population may not be reached
in these surveys, such as those lacking telephones, those who do

22
Christine E. Murray & Keith
Mobley, Empirical Research About
Same-Sex Intimate Partner Violence:
A Methodological Review, 56 J. Homo-
sexuality 361 at 363 (2009).
23
Christine E. Murray & Keith
Mobley Empirical Research About
Same-Sex Intimate Partner Violence:
A Methodological Review, 56 J. of
Homosexuality 361 at 375 (2009).
24
Dobash et al., Separate and
Intersecting Realities, A Comparison
of Men’s and Women’s Accounts of
Violence Against Women, 4 Violence
Against Women 382, 404 (1998); Diane
R. Follingstad & M. Jill Rogers, The
Nature and Prevalence of Partner
Psychological Abuse in a National
Sample of Adults, 29 Violence and
Victims 3 (2014); Leslie A. Sackett &
Daniel G. Saunders, The Impact of
Different Forms of Psychological Abuse
on Battered Women, 14 Violence &
Victims 105 (1999).
25
See Ronet Bachman & Linda E.
Saltzman, Violence Against Women:
Estimates From the Redesigned Sur-
vey, Washington, DC: U.S. Department
of Justice, Bureau of Justice Statistics
(1995). For critiques of such surveys,
see Holly Johnson, Response to Allega-
tions About the Violence Against
Women Survey, in Wife Assault & the
Canadian Criminal Justice System
148 (Mariana Valverde et al., eds.,
1995).
26
See Gelles, Estimating the Inci-
dence and Prevalence of Violence
Against Women: National Data Sys-
tems and Sources, 6 Violence Against
Women at 796 (2000).

419
§ 12:24 MODERN SCIENTIFIC EVIDENCE

not speak English fluently, which limits our confidence in the

representativeness of the population of assaulted women in
general.27

§ 12:25 Introductory discussion of the science—The

general questions—Dynamics of abusive
relationships
The most influential research in this area was pioneered by Dr.
Lenore Walker and considerable attention, especially within the
courtroom, has been given to her work. In 1979, Walker published
The Battered Woman1 in which she first described observations
she derived from interviews with more than 100 battered women,
who were either self-referred volunteers or drawn from her clini-
cal practice. The women were predominantly White and middle
class.2 In collaboration with her colleagues, Walker subsequently
conducted a more extensive study in which in-depth interviews
were conducted with more than 400 battered women.3 These
women were self-referred and no claims to the representative-
ness of the sample can be made. In the interviews, a 200-page
questionnaire was administered, taking approximately six to
eight hours to complete. In addition to providing demographic in-
formation, attitudes, and measures of psychological functioning,
the women were also asked to describe four battering episodes
they had experienced: the first, the second, one of the worst, and
the last.
It was through this research that Walker developed the two
key theoretical constructs underlying the ‘‘battered woman
syndrome’’: the Cycle Theory of Violence, and Learned Helpless-
ness, which will be discussed in turn. On the basis of the
interviews, Walker discerned that the violence was not constant,
but rather was characterized by a three-stage, repetitive cycle
with no specific time frame defining either the length of the cycle
or the phases within it. As described by Walker, in the first ‘‘ten-
sion building’’ phase there is a buildup of ‘‘minor’’ abusive

27
Black, M.C., Basile, K.C., Brei- (1979).
ding, M.J., Smith, S.G., Walters, M.L., 2
See Lenore Walker, The Battered
Merrick, M.T., Chen, J., & Stevens,
Woman, Harper & Row: New York at
M.R. The National Intimate Partner
xiii (1979).
and Sexual Violence Survey: 2010
3
Summary Report. (Atlanta, GA: Na- See Lenore Walker, The Battered
tional Center for Injury Prevention Woman Syndrome (1984, 2000 2nd
and Control, Centers for Disease Con- ed.).
trol and Prevention, at 85 (2011)).
[Section 12:25]
1
See Lenore Walker, The Battered
Woman, Harper & Row: New York

420
BATTERED WOMAN SYNDROME § 12:25

incidents (e.g., emotional threats, verbal outbursts) in which the

woman is hyper-vigilant to her spouse’s cues and moods, modify-
ing her behavior in an effort to calm and placate the batterer.
The tension eventually escalates, however, and the woman is
subjected to a severe battering incident (‘‘acute battering’’ phase).
This phase is then followed by a third or ‘‘loving contrition’’ phase
in which the batterer is remorseful for his actions, promising
never to harm the woman again.4 According to Walker, this
repetitive three-stage cycle of violence is key to understanding
the psychological impact of the abuse on the woman and why she
remains in the relationship. Specifically, the third (“contrition”)
stage in which the husband is loving and remorseful provides
initial hope to the woman and reinforces her likelihood of staying.
Believing his promises, the woman gives him another chance,
hoping he will change.5 Eventually, however, the cycle begins
again and the woman is subjected to further violence at the hands
of her partner. Given this cyclical pattern, however, the woman
never feels completely out of danger and is reduced to a perpet-
ual state of fear.
To assess the validity of the cycle theory, interviewers in
Walker’s research solicited open-ended descriptions of the abusive
incidents, and asked the women whether the abuser’s behavior
prior to the beating was ‘‘irritable, provocative, aggressive,
hostile, threatening’’ and whether the batterer’s behavior follow-
ing the abusive incident was ‘‘nice, loving, contrite?’’6 For each of
these adjectives the women provided a rating on a five-point scale.
On the basis of the woman’s open-ended description and her re-
sponses to the series of close-ended questions, the interviewer re-
corded whether there was ‘‘evidence of tension building and/or
loving contrition.’’ Although no data regarding the percentage of
cases in which all three phases of the cycle occurred were
reported, in approximately two-thirds of the episodes there was
‘‘evidence of a tension-building phase prior to the battering’’7 and
‘‘in 58 percent of all cases there was evidence of loving contrition
afterward.’’8 Walker also noted that over the course of the rela-
tionship, tension building increased while contrition declined.9
On the basis of these findings, Walker concluded that the data

4 7
Lenore Walker, The Battered Lenore Walker, The Battered
Woman Syndrome at 95 (1984, 2000 Woman Syndrome at 96 (1984, 2000
2nd ed.). 2nd ed.).
5 8
See Lenore Walker, The Battered Lenore Walker, The Battered
Woman Syndrome at 65-70 (1984, Woman Syndrome at 96 (1984, 2000
2000 2nd ed.). 2nd ed.).
6 9
Lenore Walker, The Battered See Lenore Walker, The Battered
Woman Syndrome at 96 (1984, 2000 Woman Syndrome at 97 (1984, 2000
2nd ed.). 2nd ed.).

421
§ 12:25 MODERN SCIENTIFIC EVIDENCE

provide ‘‘support for the cycle theory of violence in a majority of

battering incidents.’’10 Given that almost half of the cases did not
conform to the three-stage pattern,11 several researchers have
questioned this conclusion. 12 Since no psychological theory
purports to account for total variability in behavior, these find-
ings do not completely invalidate the theory;13 at the very least,
however, they place limits on the universality of the cycle. At a
more basic level, however, the methodology of the study itself has
been criticized.14 These concerns stem from the interview format
employed, specifically the inclusion of ‘‘leading’’ questions by the
interviewers. Thus, it is possible that the questions used may
have conveyed the researcher’s hypotheses to the women and
thus provided them with responses that they might otherwise not
have given. As well, since the interviewers were aware of the
hypotheses under investigation, they may also have interpreted
more consistency with the hypotheses than the responses in fact
warranted (i.e., what is referred to as experimenter expectancy
effects).15
A second study addressing the cycle theory of violence was

10
See Lenore Walker, The Battered
Woman Syndrome at 97 (1984, 2000
2nd ed.). See also third edition at 96
“It is clear, however, that our data sup-
port the existence of the Walker Cycle
of Violence.”
11
The percentage of cases in
which all three stages of the cycle were
identified is not provided, but given
the findings that are reported, this
value could not exceed 58%.
12
D. Faigman & A. Wright, The
Battered Woman Syndrome and the
Age of Science, Arizona Law Review,
39 (1997); McMahon, Battered Women
and Bad Science: The Limited Validity
and Utility of Battered Woman
Syndrome, 6 Psychiatry, Psychol. & L.
23, 33 (1999). For recent commentary,
see Christopher Slobogin, Psychologi-
cal Syndromes and Criminal Responsi-
bility, 6 Annual Rev. of Law and Social
Science, 109 (2010); Marina Angel,
Symposium Article: VAWA at 20 Where
Do We Go From Here? The Myth of the
Battered Woman, 24 Temple Political
& Civil Rights Law Review 301 (2015).
13
See Schuller & Vidmar, Battered
Woman Syndrome Evidence in the
Courtroom, 16 L. & Human Behav.
273, 280 (1992).
14
D. Faigman & A. Wright, The
Battered Woman Syndrome and the
Age of Science, Arizona Law Review,
39 (1997); Faigman, The Battered
Woman Syndrome and Self Defense: A
Legal and Empirical Dissent, 73 Va. L.
Rev. 619 (1986); McMahon, Battered
Women and Bad Science: The Limited
Validity and Utility of Battered
Woman Syndrome, 6 Psychiatry, Psy-
chol. & L. at 32-33 (1999).
15
Walker provides too little infor-
mation to completely rule out these
possibilities and little information at-
testing to the reliability of the assess-
ments is provided. Open- and closed-
ended questions, however, have
complementary strengths and weak-
nesses and an interview format that
incorporates open-ended questions, fol-
lowed by a series of detailed items that
serve as probes, is a common research
approach. See Charles M. Judd et al.,
Research Methods in Social Relations
241 (6th ed. 1991).

422
BATTERED WOMAN SYNDROME § 12:25

conducted by Angela Browne in the late 1980s.16 Using a similar

interview format to that employed by Walker, Browne interviewed
42 battered women who had been charged with the murder or at-
tempted murder of their partners. Her contact with these women
was initiated by the women’s attorneys’ requests for psychologi-
cal assessments, and, again, no claims to the representativeness
of the sample can be made. The women in this sample were asked
to describe the first, most typical, worst, and last violent incident
they had experienced. Although Browne does not report data for
each stage of the cycle, some data regarding the final or contri-
tion phase are provided. Initially, the men expressed contrition
(87% for the first violent incident),17 but this behavior dropped
drastically over the course of the relationship (73% after the
second or a typical violent incident and 58% after the worst).18
Thus, for these women there was evidence of a more variable pat-
tern than was initially articulated by Walker in the three-phase
cycle of violence.
Dobash and Dobash, on the basis of in-depth interviews with
109 battered women drawn from shelters, further questioned
whether contrition is demonstrated by the husband even in the
early stages of a relationship.19 These latter studies demonstrated
that the cycle does not characterize all battering relationships
and that the pattern is not necessarily an invariable cycle with
three clear and distinct phases. Indeed in her later work, Walker
indicates that a more detailed analysis of the research data
reveals that not all relationships follow the common cycle pattern
and that variations in the pattern can be found.20 Similarly, Mary
Ann Dutton concludes that not all violent relationships follow the
cycle and other patterns can be evidenced.21 The sequence of phys-
ical, sexual, psychological, and property assaults to which women

16
Angela Browne, When Battered
Women Kill (New York: Free Press,
1987).
17
See Angela Browne, When Bat-
tered Women Kill at 62 (1987).
18
See Angela Browne, When Bat-
tered Women Kill at 64 (1987).
19
See R. Dobash & Dobash, The
Nature and Antecedents of Violent
Events, 24 Crit. J. Criminol. 269, 272
(1984). Similar to Browne’s study, the
women in this research described the
first, most typical, worst, and last vio-
lent incident. For each incident, Do-
bash and Dobash asked the women to
‘‘tell me exactly what happened during
the . . . assault?’’ This was then fol-
lowed by a series of detailed, system-
atic questions about the incidents. On
the basis of these interviews, a some-
what different pattern from the three-
phase cycle of violence emerged. Im-
mediately following the most typical
incident of abuse, only 8% of the
women reported that the husband
apologized or expressed regret. This
was somewhat higher, albeit still low
(22%), for the first incidence of vio-
lence.
20
See Walker, Psychology and Law,
Symposium: Women and the Law, 20
Pepp. L. Rev. 1170, 1184 (1993); Lenore
E. A. Walker (2009). The Battered
Woman Syndrome (3rd ed). New York,
NY: Springer Publishing Company.
21
Mary Ann Dutton, Empowering
and Healing the Battered Woman a

423
§ 12:25 MODERN SCIENTIFIC EVIDENCE

are subjected seems to ‘‘deny a characteristic cycle of violence,’’

such as when the beating comes without warning or when there
is no contrition following the abuse.”22 As such, Dutton conceptu-
alized the violence more as a ‘‘single and continuing entity.’’23
Another central aspect of Walker’s initial research involved the
theory of learned helplessness and its application to the battered
woman’s situation. This theory was first developed by Martin
Seligman through a series of experiments in which dogs were
trapped in cages and administered a set of random shocks from
which they could not escape.24 The experimenters noted that,
over time, the dogs would not attempt to leave the cage when
shocks were administered, even when escape routes were made
possible. The dogs, learning that they had no control over the
shocks, eventually lost any motivation to alter their situation;
they remained submissive and passive. Drawing on this research,
Walker analogized the battered woman’s situation to that of the
dogs. To assess whether battered women in fact exhibit learned
helplessness, Walker compared the responses of women who were
still in battering relationships to those of women who had left the
relationship.25 Other forms of comparison groups (e.g., women not
in battering relationships or women terminating non-abusive
relationships) were not included.26 Walker reasoned that battered
women who were still in abusive relationships should report more
‘‘fear, anxiety, and depression’’ and less ‘‘anger, disgust, and
hostility’’ over the course of the relationship than women who
had escaped the relationship. Although Walker concluded that

Model for Assessment and Interven- Violence: A Redefinition of Battered

tion 27, 29 (1992).
22
Mary Ann Dutton, Empowering
and Healing the Battered Woman a
Model for Assessment and Interven-
tion 27, 29 (1992).
23
She explains, ‘‘several physi-
cally and sexually violent assaults
may recur over a period of time with
periods of psychological abuse inter-
spersed between them. Fitting this
pattern of abuse to the cycle of violence
suggests that the acute battering
phase may involve repeated occur-
rences of violence over an extended pe-
riod of time, which are not separated
by the other phases of the cycle.’’ Mary
Ann Dutton, Empowering and Healing
the Battered Woman a Model for As-
sessment and Intervention at 29
(1992). See also Dutton, Understand-
ing Women’s Response to Domestic
Woman Syndrome, 21 Hofstra L. Rev.
at 1208 (1993).
24
See Martin Seligman,
Helplessness: on Depression, Develop-
ment and Death (1975).
25
See Lenore Walker, The Bat-
tered Woman Syndrome at 87 (1984,
2000, 2nd ed.).
26
See D. Faigman & A. Wright,
The Battered Woman Syndrome and
the Age of Science, Arizona Law Re-
view, 39 (1997); Faigman, The Bat-
tered Woman Syndrome and Self
Defense: A Legal and Empirical Dis-
sent, 73 Va. L. Rev. at 642 (1986); see
also McMahon, Battered Women and
Bad Science: The Limited Validity and
Utility of Battered Woman Syndrome,
6 Psychiatry, Psychol. & L. at 31
(1999).

424
BATTERED WOMAN SYNDROME § 12:25

the results were ‘‘compatible with learned helplessness theory,’’27

no statistical tests of the differences between the groups were
provided. Moreover, the pattern of responses across the three
battering incidents reported by the women did not conform to the
pattern articulated by Walker.28 Other responses of the women
also were not consistent with this interpretation.29 Even if the
hypothesized pattern had been found, it is questionable whether
it provides support for the theory of learned helplessness, since
the indices collected focused only on the affective responses of the
women and completely ignored actual behavioral responses
women may exhibit.30
Many researchers have taken exception to the passive charac-
terization of battered women conveyed through the theory of
learned helplessness, arguing that the data pertaining to
behavioral responses do not support this portrayal.31 To address
this issue, early studies asked women who had been battered to
describe the ways in which they attempted to stop the abuse. For
instance, Lee Bowker conducted both in-depth interviews and
surveyed 1,000 battered or formerly battered women who
responded to a questionnaire in a women’s magazine.32 Similar to
Walker’s study, the women were asked to describe the ways in

27
Lenore Walker, The Battered
Woman Syndrome at 89 (Springer,
1984, 2nd ed.).
28
See Lenore Walker, The Bat-
tered Woman Syndrome at 88
(Springer, 1984, 2nd ed.).
29
For instance, data pertaining to
the women’s level of self-esteem were
relatively mixed. Walker found the
women’s self-reported level of self-
esteem to be high compared to their
ratings of either a man or a woman in
general (although no statistical tests
of this difference are provided), a find-
ing she suggests may be due to having
survived a violent relationship. Lenore
Walker, The Battered Woman Syn-
drome at 80-82 (1984, 2nd ed.). In fair-
ness to Walker, she describes the com-
plexity of the woman’s response as
neither ‘‘extremely passive or mutu-
ally combative. Rather these data sug-
gest that battered women develop sur-
vival or coping strategies that keep
them alive with minimal injuries.’’
Lenore Walker, The Battered Woman
at 33 (1979).
30
Faigman has similarly argued
that there is ‘‘little theoretical basis
for Walker’s selection of these factors
as the variables representing learned
helplessness.’’ Faigman, The Battered
Woman Syndrome and Self Defense: A
Legal and Empirical Dissent, 73 Va. L.
Rev. at 641 (1986).
31
Lee H. Bowker, Beating Wife
Beating (1983). It has been suggested
that the choice of the term ‘‘learned
helplessness’’ may have been a poor
one and a misnomer, as ‘‘battered
women are often resourceful and ac-
tive in their efforts to avoid violence.’’
Julie Blackman, Intimate Violence: A
Study of Injustice 192 (1989). Biggers
(2003) notes that not all women fall
into the cycle of violence or learned
helplessness models, and that many
women remain in abusive relation-
ships out of financial or social con-
straints and concern for children:
Jacquelyne R. Biggers, A Dynamic As-
sessment of the Battered Woman Syn-
drome and its Legal Relevance, 3 J.
Forensic Psychology Practice 1 (2003).
32
This sample consisted of the 146
in-depth interviews with formerly bat-
tered wives plus 854 questionnaires

425
§ 12:25 MODERN SCIENTIFIC EVIDENCE

which they attempted to stop the abuse (first, second, third,

worst, and last). The women used a wide range of strategies33 and
help sources34 in their attempt to end the violence in their lives.
Although no statistical tests are provided, Bowker noted an
increase, not a decrease, in the frequency of women’s help-seeking
behavior over time.35 In light of these findings, Bowker concluded
that the difficulty women have in freeing themselves from violent
relationships had more to do with ‘‘the intransigence of their
husbands’ penchant for domination and the lack of support from
traditional institutions,’’ than passivity or helplessness.36
Relying on their survey methodology, Richard Gelles and Mur-
ray Straus found that, although the notion of learned helpless-
ness applied to some battered women, the vast majority of woman
surveyed also engaged in a variety of responses in an attempt to
end the abuse.37 Similarly, Dobash and Dobash, in the interviews
they conducted with battered women, also found that the women
employed a range of behaviors throughout the course of their re-
lationship that were inconsistent with the notion of learned
helplessness.38 Fischer et al. found that the battered women they
interviewed employed an average of 13 different strategies in an
attempt to end the abuse.39 Further, rather than decreasing over
time, the frequency and variety of these strategies increased over
time.40 It should be noted that in Walker’s later descriptions of
the concept of learned helplessness, she emphasizes the battered

sent in by women throughout the U.S. Family Violence 154 at 155.

in response to an ad in Women’s Day
Magazine. See Lee H. Bowker, Ending
the Violence (1986), Learning Publica-
tions.
33
Seven personal strategies were
identified by Bowker: talking, extract-
ing promises, nonviolent threatening,
hiding, passive defense, avoidance,
and counterviolence. See Lee H.
Bowker, Ending the Violence at 62
(1986).
34
Both informal (turning to fam-
ily, in-laws, neighbors, friends, and
shelter services), and formal help
sources (turning to police, social-
service agencies, lawyers/district at-
torneys, clergy, women’s groups) were
identified. See Lee H. Bowker, Ending
the Violence at 75, 87 (1986).
35
See Lee H. Bowker, Ending the
Violence at 71-72 (1986).
36
Lee H. Bowker, Battered Wom-
en’s Problems are Social, Not Psycho-
logical, in Current Controversies on
37
See Richard J. Gelles & Murray
A. Straus, Intimate Violence: the
Causes and Consequences of Abuse in
the American Family at 149 (1988).
38
See Dobash & Dobash, The Na-
ture and Antecedents of Violent
Events, 24 Crit. J. Criminol. at 281
(1984); see also Edward W. Gondolf &
Ellen R. Fisher, Battered Women as
Survivors: An Alternative to Treating
Learned Helplessness (1988); Hutchi-
son & Hirschel, Abused Women, Help-
Seeking Strategies and Police Utiliza-
tion, 4 Violence Against Women 436
(1998).
39
Reported in Fischer et al., The
Culture of Battering and the Role of
Mediation in Domestic Violence Cases,
46 S.M.U. L. Rev. at 2136 (1993).
40
See Fischer et al., The Culture
of Battering and the Role of Mediation
in Domestic Violence Cases, 46 S.M.U.
L. Rev. at 2136 (1993). Walker’s own
data provided some evidence for this

426
BATTERED WOMAN SYNDROME § 12:25

woman’s limited repertoire of behaviors as opposed to the notion

of passivity.41 Indeed, in the most recent edition of her 1984 book,
she notes that the use of learned helplessness was used to con-
template that what had been learned could be unlearned.42 Ac-
cording to Walker, “battered women are not helpless at all but
rather they are extremely successful at staying alive and
minimizing their physical and psychological injuries in a brutal
environment.”43
In a recent review of empirical research examining data
pertaining to victimized women’s decisions to terminate the rela-
tionship, Deborah Rhatigan and her colleagues (2006) found evi-
dence contradicting learned helplessness theory’s predictions.
They note that women experiencing more severe violence report
greater efforts to get help and support to manage the relationship.
The authors identify a number of reasons that a woman may stay
in an abusive relationship, such as limited financial resources,
fear of retaliation, emotional attachment to the abuser, or
concerns about the reaction of family and community.44 Rhatigan
et al. note that learned helpless does not explain how or why
some women do eventually leave the relationship, nor the

as well. She indicated that as the
violence increased over time so did the
probability that the woman would seek
help. See Lenore Walker, The Battered
Woman Syndrome at 26 (1984, 2nd
ed.). Indeed, battered women typically
don’t simply stay, but attempt to leave
an average of 5-7 times: Bess Rothen-
berg, “We Don’t Have Time for Social
Change”: Cultural Compromise and
the Battered Woman Syndrome, 17
Gender & Society, 771 (2003). Simi-
larly, Goodman et al. found that 87%
of their sample of abused women had
attempted to end the abusive relation-
ship in the prior year: L.A. Goodman,
M.A. Dutton, K. Weinfurt, and S.
Cook, The Intimate Partner Violence
Strategies Index, 9 Violence Against
Women 163 (2003). Biggers observed
that women who kill their partners
usually do so “after having endured
years of physical abuse, after they
have exhausted all resources available
to them, when they feel trapped, and
because they fear for their lives:”
Jacquelyne R. Biggers. A Dynamic As-
sessment of the Battered Woman Syn-
drome and its Legal Relevance, 3 J.
Forensic Psychology Practice 1 at 3
(2003).
41
See Lenore E. A. Walker, Assess-
ment of Abusive Spousal Relation-
ships, in Handbook of Relational Diag-
nosis and Dysfunctional Family
Therapy 343 (Florence W. Kaslow ed.,
1996). See also McMahon, Battered
Women and Bad Science: The Limited
Validity and Utility of Battered
Woman Syndrome, 6 Psychiatry, Psy-
chol. & L. at 28-29 (1999).
42
Lenore E. A. Walker (2009). The
Battered Woman Syndrome (3rd ed).
New York, NY: Springer Publishing
Company at p. 14.
43
Lenore E. A. Walker (2009). The
Battered Woman Syndrome (3rd ed).
New York, NY: Springer Publishing
Company at p. 14.
44
Deborah L. Rhatigan, Amy E.
Street, & Danny K. Axsom, A Critical
Review of Theories to Explain Violent
Relationship Termination: Implica-
tions for Research and Intervention,
26 Clinical Psychology Rev. 321 (2006).
For other discussions of the reasons
women may remain in abusive rela-
tionships, see G. Butts Stahly, Bat-
tered Women: Why Don’t They Just
Leave? In J. C. Chrisler, C. Golden, &
P. Rozee (Eds.), Lectures on the psy-

427
§ 12:25 MODERN SCIENTIFIC EVIDENCE

external factors that may interfere or prevent a woman from

leaving.45
Others commentators have argued that the terminology sur-
rounding the “battered woman syndrome” conveys an image of
disorder or pathology on the part of the victim. Indeed, there is
some consensus that the effects of battering and abuse are di-
verse and varied, and that there is no single profile of the “bat-
tered woman.”46 Ferraro (2003) observed that the concept of
learned helplessness has led to expectations of passivity among
female defendants who had been battered.47 She notes that the
syndrome “contributed to an image of battered women as
psychologically defective or pathological and diverted attention
away from the rational and deliberate strategies of survival that
women employ when they are in violent situations.”48 Moreover,
the stereotype of passivity makes it hard to reconcile a woman’s
violent actions against her abuser. Biggers advocates against the
use of diagnostic or syndrome terminology in cases of battered
women who kill, as this establishes stereotypes against which
she will be measured.49
Mary Ann Dutton (2009) posits four central arguments against
the use of syndrome terminology, noting a general agreement in
the literature that the focus should be on the effects of battering

chology of women, 2nd ed. 289–306
(Boston, MA: McGraw-Hill, 2000);
Margaret E. Bell, Lisa A. Goodman
and Mary Ann Dutton, The Dynamics
of Staying and Leaving: Implications
for Battered Women’s Emotional Well-
Being and Experiences of Violence at
the End of the Year, 22 J. Fam. Vio-
lence 413 (2007).
45
Deborah L. Rhatigan, Amy E.
Street, & Danny K. Axsom, A Critical
Review of Theories to Explain Violent
Relationship Termination: Implica-
tions for Research and Intervention,
26 Clinical Psychology Rev. 321 (2006).
46
E.g., Dutton notes that women
demonstrate wide responses to domes-
tic violence, which may include post-
traumatic stress disorder, but that this
is only a subset of victim experiences.
Indeed, Dutton warns against relying
on expert testimony regarding the
“battered woman,” as there is no single
profile: Mary Ann Dutton (1996), Cri-
tique of the “Battered Woman Syn-
drome” Model, Applied Research Paper
Series, 2; Dutton, M.A. (2009). Update
of the “Battered Woman syndrome”
critique. Harrisburg, PA.
47
Kathleen J. Ferraro, The Words
Change but the Melody Lingers: The
Persistence of the Battered Woman
Syndrome in Criminal Cases Involv-
ing Battered Women, 9 Violence
Against Women 110 (2003).
48
Kathleen J. Ferraro, The Words
Change but the Melody Lingers: The
Persistence of the Battered Woman
Syndrome in Criminal Cases Involv-
ing Battered Women, 9 Violence
Against Women 110 at 112 (2003).
49
Jacquelyne R. Biggers, The Util-
ity of Diagnostic Language as Expert
Witness Testimony: Should Syndrome
Terminology Be Used in Battering
Cases? 5 J. Forensic Psychology Prac-
tice 43 (2005); Jacquelyne R. Biggers,
A Dynamic Assessment of the Battered
Woman Syndrome and Its Legal Rel-
evance, 3 J. Forensic Psychology Prac-
tice 1 (2003).

428
BATTERED WOMAN SYNDROME § 12:25

on an individual woman rather than the existence of a syndrome.50

She outlines four main limitations with the use of battered
woman syndrome testimony:
a) BWS may not be relevant to the issues before the court;
b) BWS lacks standard definition and has not been scientifi-
cally validated;
c) BWS is inconsistent with current research findings on the
effects of abuse; and
d) BWS can be stigmatizing and pathologizing.51
Similarly, Briere and Jordan (2004) note that not all abused
women develop battered woman syndrome, nor do the traits as-
sociated with it appear uniquely in abused women.52 Rather, the
reactions to violence and abuse will be as complex and varied as
the violence itself, and influenced by the presence of prior
psychological health issues or prior victimization. Regardless of
the criticisms of battered women syndrome and its utility, Hien
and Ruglass (2009) note that “the label BWS was an important
step towards highlighting the social contexts in which abused
women are living (e.g., fear, domination, few alternative options
to the abusive relationship, etc.) and offered a less stigmatizing
approach to understanding these women’s experiences.”53
In their attempts to end the abuse, battered women may
employ a variety of strategies (e.g., trying to change the man’s
behavior, attempting to leave, protect themselves and other
members of the family). These acts of ‘‘rebellion or resistance’’ to
the man’s control may be met with increased control and violence
by the batterer. For instance, a woman may be physically and
violently restrained from leaving, she may be held prisoner in
her own home, her savings may be taken away, or she may be
threatened with custody battles.54 Martha Mahoney has described
and labeled this form of assault on a woman’s attempt to sepa-
rate as separation assault: ‘‘a specific type of attack that occurs

50
Mary Ann Dutton (2009). Up-
date of the battered women syndrome
critique. National Online Resource
Centre on Violence Against Women,
avail. at http://www.vawnet.org/Assoc_
Files_VAWnet/AR_BWSCritique.pdf.
51
Mary Ann Dutton (2009). Up-
date of the battered women syndrome
critique. National Online Resource
Centre on Violence Against Women,
available at http://www.vawnet.org/As
soc_Files_VAWnet/AR_BWSCritiqu
e.pdf (pp. 5-8).
52
John Briere and Carol E. Jor-
dan, Violence Against Women: Out-
come Complexity and Implications for
Assessment and Treatment, 19 J. In-
terpersonal Violence 1252 (2004).
53
Denise Hien & Lesia Ruglass,
Interpersonal Partner Violence and
Women in the United States: An Over-
view of Prevalence Rates, Psychiatric
Correlates and Consequences and Bar-
riers to Help Seeking, 32 International
J. Law and Psychiatry 8 at 52 (2009).
54
See Mahoney, Legal Images of
Battered Women: Redefining the Issue
of Separation, 90 Mich. L. Rev. at 63
(1991).

429
§ 12:25 MODERN SCIENTIFIC EVIDENCE

at or after the moment she decides on a separation or begins to

prepare for one.’’55 Indeed, attempts at separation are not without
risk. Empirical research suggests an elevated risk of violence for
battered women when they separate from their abusers.56 Data
collected from the Canadian national survey found that 19% of
women who had separated from a violent partner indicated that
the violence continued after the separation, with one-third of
these women reporting that the assaults actually increased in
severity. Wilson and Daly using police records investigated the
frequency of homicides for cohabiting and estranged women in
three samples (Canada; New South Wales, Australia; and
Chicago). In all three samples women incurred substantially
elevated risks when separated as compared to when living
together with their partner.57
Beyond risks of assault or sexual violence, women escaping

55
Mahoney, Legal Images of Bat-
tered Women: Redefining the Issue of
Separation, 90 Mich. L. Rev. at 63
(1991).
56
An early study of separation as-
sault investigated 150 women in the
Midwest who were pursuing a divorce,
finding that 15% experienced non-
lethal violence during the process of
leaving: J.E. O’Brien, Violence in Di-
vorce Prone Families, 33 J. of Mar-
riage and the Family, 692−698 (1971).
Giles-Sims (1983) found that 44% of
women in a shelter who had not re-
turned to their abuser within 4-6
months had experienced violence at
least once since leaving that shelter: J
Giles-Sims, Wife-Battering: A Systems
Theory Approach (New York: Guilford
Press, 1983). Johnson and Sacco (1995)
found that 19% of women in a Cana-
dian sample experienced violence dur-
ing the process of leaving an abusive
relationship: Similarly, McMurray et
al. found that 21% of men in an Aus-
tralian sample had been violent dur-
ing their separation process: A.M.
McMurray, I.D. Froyland, D.G. Bell, &
D.J. Curnow, Post-Separation
Violence: The Male Perspective. 6 J.
Family Studies, 89−105 (2000). An
American study found that 36% of
women were assaulted in the two-year
period after separation, and 20% were
raped by their ex-partner: R.E. Fleury,
C.M. Sullivan, & D.I. Bybee (2000).
When Ending the Relationship Does
Not End the Violence: Women’s Expe-
riences of Violence by Former Part-
ners, 6 Violence Against Women,
1363−1383 (2000). For a review of the
literature, see Brownridge (2006), who
concludes that decades of research
have demonstrated that abused
women are at an “elevated risk for
violence post-separation relative to
intact unions”: Douglas A. Brownridge,
Violence Against Women Post-
Separation, 11 Aggression and Violent
Beh. 514-530 at 516 (2006). See also
D.A. Brownridge, K.L. Chan, D.
Hiebert-Murphy, J. Ristock, A. Tiwari,
W. Leung, & S.C. Santos, The Elevated
Risk for Non-Lethal Post-Separation
Violence in Canada: A Comparison of
Separated, Divorced, and Married
Women, 23 J. of Interpersonal Violence
117 (2008); T.K. Logan & R. Walker,
Separation as a Risk Factor for Vic-
tims of Intimate Partner Violence: Be-
yond the Lethality and Injury, 19 J.
Interpersonal Violence 1478 (2004).
57
See Margo Wilson & Martin
Daly, Spousal Homicide Risk and Es-
trangement, 8 Violence & Victims 3
(1993). It is not necessarily the case
that separation is causally linked to
increased risk. An alternative explana-
tion might be that women leave at a
time when the violence is already
escalating. Other case descriptions,
however, suggest that there is a link

430
BATTERED WOMAN SYNDROME § 12:25

abusive relationships also face a significant risk of lethal violence

and death at the hands of their batterer.58 Many studies have
established that the violence does not end upon terminating the
relationship, but that leaving the batterer often leads to
continued threats and abuse as well as threats against their
children.59 Estrangement has been identified as a risk factor for
intimate partner homicide, with most murders occurring within a
year of leaving.60 Coupled with the batterer’s domination and
control is a social reality that provides these women with few
easy or viable options and it is against this backdrop that the
battered woman’s actions must be understood.
Most prominent among the factors that further entrap women
within the relationship is the woman’s financial or economic de-
pendence on the batterer, which, as described earlier, may be ex-
acerbated by the batterer’s financial control of the woman.61 In
one of the first studies that addressed the issue of economic de-

between separation and murder. See
Daniel G. Saunders & Angela Browne,
Domestic Homicide, in Case Studies in
Family Violence at 384-387 (Robert T.
Ammerman & Michel Hersen eds.,
1991).
58
Ruth. E. Fleury, Cris M. Sul-
livan, and Deborah I. Bybee, When
Ending the Relationship Does Not End
the Violence: Women’s Experience of
Violence by Former Partners, 6 Vio-
lence Against Women 1363 (2000); J.
McFarlane, J.C. Campbell, and K.
Watson, Intimate Partner Stalking
and Femicide: Urgent Implications for
Women’s Safety, 20 Beh. Science and
the Law 51 (2002). A Canadian study
of femicides between 1991 and 2000
found that 16% were committed by
estranged married partners, 9% by for-
mer partners, 4% by former common-
law partners, and 2% by divorced
partners; thus, roughly one-third of
intimate partner femicides occurred
after separation: H. Johnson & T. Hot-
ton, Losing Control: Homicide Risk in
Estranged and Intact Intimate Rela-
tionships, 7 Homicide Studies 58
(2003). See also Desmond Ellis &
Walter S. DeKeseredy Rethinking
Estrangement, Interventions, and
Intimate Femicide, 3 Violence Against
Women 590 (1997); Jennifer L. Hard-
esty, Separation Assault in the Context
of Postdivorce Parenting: An Integra-
tive Review of the Literature, 8 Vio-
lence Against Women 597 (2002); Jen-
nifer L. Hardesty & Grace H. Chung,
Intimate Partner Violence, Parental
Divorce, and Child Custody: Directions
for Intervention and Future Research,
55 Fam. Relations 200 (2006).
59
Laura A. McCloskey, The “Me-
dea Complex” Among Men: The Instru-
mental Abuse of Children to Injure
Wives, 16 Violence and Victims 19
(2001).
60
Jacquelyn C. Campbell, Nancy
Glass, Phyllis W. Sharps, Kathryn
Laughon, & Tina Bloom, Intimate
Partner Homicide: Review and Impli-
cations of Research and Policy, 8
Trauma, Violence & Abuse 246 (2007).
61
Diane R. Follingstad & M. Jill
Rogers, The Nature and Prevalence of
Partner Psychological Abuse in a Na-
tional Sample of Adults, 29 Violence
and Victims 3 (2014); Jinseok Kim &
Karen A. Gray, Leave or Stay? Bat-
tered Women’s Decision After Intimate
Partner Violence, 23 J. Interpersonal
Violence 1462 (2008); Deborah K. An-
derson and Daniel G. Saunders, Leav-
ing an Abusive Partner: An Empirical
Review of Predictors, the Process of
Leaving, and Psychological-Well Be-
ing, 4 Trauma, Violence, & Abuse 163
(2003).

431
§ 12:25 MODERN SCIENTIFIC EVIDENCE

pendence, it was found that women who remained in abusive

relationships were more likely to be unemployed and were less
educated than women who had left abusive relationships.62 Since
this study, other researchers, using a variety of methodologies,
have similarly found that women who lack the financial means
are less likely to leave violent partners or, if they do leave, are
more likely to return.63 Part of the reason for returning may be
the extremely adverse conditions women find themselves in after
separating. Baker and colleagues found that 38% of women who
left an abusive relationship reported homelessness, and a
similarly high percentage experienced precarious housing and se-
curity due to late rent payments, threatened evictions, and
missed meals.64 One review suggests that battering can have both
a direct (e.g., batterer’s negative interference) and an indirect
(e.g., via its impact on a woman’s health) impact on a women’s
job stability.65
Empirical support also exists for the claim that traditional
social services provide limited assistance to battered women at-
tempting to end the abuse.66 For instance, in a review of this
work, medical personnel often fail to ask about the abuse, are
unlikely to identify abused women, and are evaluated by abused

62
See Gelles, Abused Wives: Why
Do They Stay? 38 J. of Marriage & the
Fam. 659 (1976).
63
See Deborah K. Anderson and
Daniel G. Saunders, Leaving an Abu-
sive Partner: An Empirical Review of
Predictors, the Process of Leaving, and
Psychological-Well Being, 4 Trauma,
Violence, & Abuse, 163 (2003); Jinseok
Kim & Karen A. Gray, Leave or Stay?
Battered Women’s Decision After Inti-
mate Partner Violence, 23 J. Interper-
sonal Violence 1462 (2008); O.W. Bar-
nett, Why Battered Women Do Not
Leave, Part 1: External Inhibiting Fac-
tors Within Society, 1 Trauma, Vio-
lence, & Abuse 343 (2000); A. Hetling
& C.E. Born, Examining the Impact of
the Family Violence Option on Wom-
en’s Efforts to Leave Welfare, 15 Re-
search on Social Work Practice 143
(2005).
64
Charlene K. Baker, Sarah L.
Cook, & Fran H. Norris, Domestic
Violence and Housing Problems: A
Contextual Analysis of Women’s Help-
Seeking, Received Informal Support,
and Formal System Response, 9 Vio-
lence Against Women 754 (2003).
65
See Tolman & Raphael, A Re-
view On Welfare and Domestic Vio-
lence, 56 J. of Soc. Issues 655 (2000).
For example, Raphael found that
women in abusive relationships faced
many obstacles to both obtaining and
maintaining employment. These ob-
stacles included, ‘‘sabotage (e.g., de-
stroying work, educational materials,
or clothing, or bruising the woman’s
face), stalking, menacing the work
site, traumatic aftereffects of violence,
and even two documented murders
when battered women neared financial
independence.’’ Raphael, Prisoners of
Abuse: Domestic Violence and Welfare
Receipt. A Second Report of the
Women, Welfare, and Abuse Project
397 (1996).
66
For a review of studies that
have examined the types of community
and professional services contacted by
battered women and women’s percep-
tions of their usefulness, see Gordon,
Community Services for Abused
Women: A Review of Perceived Useful-
ness and Efficacy, 11 J. Fam. Violence
315 (1996).

432
BATTERED WOMAN SYNDROME § 12:25

women as one of the least helpful resource groups.67 Donnelly et

al. (1999) conducted interviews with the executive directors of 44
battered women’s agencies in the Southern United States.68 With
scarce resources available, decisions have to be made regarding
which women were deemed acceptable and not acceptable for
services. The results suggested that stereotypical views influenced
these decisions, and that women of color, lesbians, homeless
women, mentally ill women, middle class, or elderly women were
not always treated responsively and in some cases excluded
entirely. In a study of 19 women in a domestic violence shelter,
Moe (2007) found that more than half of the women had moved
to escape the abuse, with 21% actually crossing state lines.69 All
of the women returned to the abuser for a variety of reasons
including poverty, stalking and harassment by the abuser, pres-
sure to reconcile, guilt, and loneliness. Moe notes that “the
women’s help-seeking efforts occurred amid the realization that
ending their abusive relationships was not as simple as leaving a
physical residence . . . they were very active help seekers who
felt entrapped in their relationships, largely because of the
failures of various agencies to adequately assist them.”70
Similarly, research has documented the unwillingness on the
part of the police to respond to domestic disputes and to provide
women with legal action.71 In response to police minimization of
the problem, several jurisdictions have implemented mandatory

67
See P. Lynn McDonald, Helping
With the Termination of an Assaultive
Relationship, in Intervening With As-
saulted Women: Current Theory, Re-
search, & Practice at 104 (Barabara
Pressman et al., eds., 1989). Stark et
al. (1995) observed that 29% of women
attempting suicide showed evidence of
domestic abuse, but that this issue
tended to be overlooked by medical
staff with no referrals for help or
support: Stark & Flitcraft, Killing the
Beast Within: Woman Battering and
Female Suicidality, 25 Int’l J. Health
Services 43 (1995). Similarly, a study
of gynecological patients in five Nordic
countries revealed that, although a
high percentage of women reported
abuse to their doctors, very few gyne-
cologists identified this as a problem:
B. Wijtma, B. Schei, K. Swanberg, M.
Hilden, K. Offerdal, U. Pikarinen, K.
Sidenius, T. Steingrimsdottir, H.
Stoum, E. Halmesm€aki, Emotional,
Physical, and Sexual Abuse in Patients
Visiting Gynaecology Clinics: A Nordic
Cross-Sectional Study, 361 Lancet
2107 (2003).
68
Denise A Donnelly, Kimberly J.
Cook, & Linda A. Wilson, Provision
and Exclusion: The Dual Face of Ser-
vices to Battered Women in Three
Deep South States, 5 Violence Against
Women 710 (1999).
69
Angela M. Moe, Silenced Voices
and Voices and Structured Survival,
13 Violence Against Women 676
(2007).
70
Angela M. Moe, Silenced Voices
and Structured Survival, 13 Violence
Against Women 676 at 684 (2007).
71
For example, in one study, 58%
of victims called the police and less
than 25% of the batterers were ar-
rested. See Coulter et al., Police-
Reporting Behavior and Victim-Police
Interactions as Described by Women
in a Domestic Violence Shelter, 14 J.
of Interpersonal Violence 1290 (1999).
Similarly, in another study research-
ers reported that of 53% of the women

433
§ 12:25 MODERN SCIENTIFIC EVIDENCE

arrest or no-drop prosecution policies. 72 The findings in the

literature, however, are fairly mixed with respect to the impact of
mandatory arrest in terms of deterring the batterers’ subsequent
abuse.73 Moreover, the extent to which these laws and policies
have altered the actual behavior of the police has been questioned,
and some have criticized mandatory arrest policies as further
disempowering battered women.74 Thus, it is not surprising that
battered women may not always call or turn to the police for
help. A U.S. study explored the extent to which a sample of 137

who called for police assistance, only of a Battering Partner, 14 J. of Inter-

15% of calls resulted in the arrest of
the batterer and 32% of women re-
ported incidents in which the police
did nothing. Furthermore, this re-
search discovered the police response,
as is the case in many contexts, to be
more influenced by the antisocial na-
ture of the batterer’s behavior (e.g., a
previous arrest was found to be the
most influential) rather than the ac-
tual nature of the wife abuse. The
importance of police response was
highlighted by Baker et al. (2003), who
found that a positive police response
to a domestic violence call was associ-
ated with a 30% lower rate of home-
lessness among women who left the
relationship: Charlene K. Baker, Sarah
L. Cook, & Fran H. Norris, Domestic
Violence and Housing Problems: A
Contextual Analysis of Women’s Help-
Seeking, Received Informal Support,
and Formal System Response, 9 Vio-
lence Against Women 754 (2003).
72
See Feder, Police Handling of
Domestic Violence Calls: An Overview
and Further Investigation, 10 Women
& Crim. Just. 49 (1999); see also Mills,
Mandatory Arrest and Prosecution
Policies for Domestic Violence: A Criti-
cal Literature Review and the Case for
More Research to Test Victim Empow-
erment Approaches, 25 Crim. Just. &
Behav. 306 (1998). For research exam-
ining women’s experiences in the pros-
ecution of battering partners, see Dut-
ton et al., Court-Involved Battered
Women’s Responses to Violence: The
Role of Psychological, Physical, and
Sexual Abuse, 14 Violence & Victims
89 (1999); Bennett et al., Systematic
Obstacles to the Criminal Prosecution
personal Violence 761 (1999).
73
See Sherman, The Influence of
Criminality on Criminal Law: Evaluat-
ing Arrest for Misdemeanor Domestic
Violence, 85 J. of Crim. L. & Criminol-
ogy 901 (1992). For instance, the initial
Minneapolis Domestic Violence Exper-
iment concluded that arrest was the
most effective response in deterring
subsequent abuse. Sherman & Berk,
The Specific Deterrent Effects of Ar-
rest for Domestic Assault, 49 Am. Soc.
Rev. 261 (1984). In contrast, replica-
tions of this study have reported no
differences in recidivism across differ-
ent types of police responses. See
Dunford et al., The Role of Arrest in
Domestic Assault: The Omaha Police
Experiment, 28 Criminology 183
(1990); see also Hirschel & Hutchison,
Female Spouse Abuse and the Police
Response: The Charlotte, North Caro-
lina Experiment, 83 J. of Crim. L. &
Criminology 73 (1992).
74
See Feder, Police Handling of
Domestic Violence Calls: An Overview
and Further Investigation, 10 Women
& Crim. Just. at 52 (1999). Another
study found no relation between hav-
ing a negative experience with police
in relation to a battering incident and
a woman’s decision to leave or stay:
Jinseok Kim & Karen A. Gray, Leave
or Stay? Battered Women’s Decision
after Intimate Partner Violence, 23 J.
Interpersonal Violence 1465 (2008); L.
Bennet, L. Goodman, and M.A. Dut-
ton, Systemic Obstacles to the Crimi-
nal Prosecution of a Battering Partner:
A Victim Perspective, 14 J. Interper-
sonal Violence 761 (1999).

434
BATTERED WOMAN SYNDROME § 12:25

women recruited from a battered women’s shelter, called the po-

lice over a six-month period.75 Sixty-seven percent of the sample
had contacted the police and the majority of women reported that
they had not had as much contact as they felt they needed. A
range of situational barriers such as being physically prevented
from calling, lacking a telephone, the ineffectiveness of the police
response on a previous contact, and fear for their physical safety
were cited for not calling the police.76 Through interviews with
146 formerly battered women, Lee Bowker found that, over the
course of five incidents of abuse, the police were contacted only
9% to 38% of the time.77 Further, when asked to rate the success
of the police intervention, only 34% of the interventions were
viewed by the women as successful.78 Finally, there may be
sociocultural factors militating against reporting to police among
ethnic minorities. For example, Black women may be reluctant to
contact police due to a lack of trust in the criminal justice system,
or due to social pressures within their communities to resort to
prayer and church, particularly where the abuser is a high rank-
ing member of the community (e.g., priest, doctor, police officer).79
As Hien and Ruglass observe, “African American female victims
face a ‘double bind’ when they are making the difficult decision to
seek help and protect themselves versus report their violent
African American partners and ‘betray’ their community.”80
The impact of police intervention on subsequent revictimiza-

75
See Fleury et al., ‘‘Why Don’t
They Just Call the Cops?’’: Reasons for
Differential Police Contact Among
Women with Abusive Partners, 13
Violence & Victims 333 (1998).
76
See Fleury et al., ‘‘Why Don’t
They Just Call the Cops?’’: Reasons for
Differential Police Contact Among
Women with Abusive Partners, 13
Violence & Victims 333 (1998).
77
See Lee H. Bowker, Beating
Wife Beating at 87 (1983). In a sample
of more than 300 abused pregnant
Hispanic women, only 23% had used
the police during the past year. See
Wiist & McFarlane, Utilization of Po-
lice by Abused Pregnant Hispanic
Women, 4 Violence Against Women
677 (1998). Johnson found that women
were ‘‘unlikely to call the police until
they [had] been beaten up, and that
well over half of all women who had
been beaten up or choked . . . did not
report the abuse to the police.’’ John-
son, Dangerous Domain, Violence
Against Women In Canada at 205
(1996). Moreover, the women who
reported turning to the police reported
experiencing more severe violence
(e.g., multiple instances of violent
episodes, use of a weapon, injury, pres-
ence of children).
78
See Lee H. Bowker, Beating
Wife Beating at 89 (1983).
79
Krim K. Lacey, When Is It
Enough for Me to Leave? Black and
Hispanic Women’s Response to Violent
Relationships, 25 J. Fam. Violence 669
(2010); Thema Bryan-Davis, Halley E.
Wooward, Shaquita Tillman, & Sandra
E. Torres, Intimate Partner Violence
Against African American Women: An
Examination of the Sociocultural Con-
text, 14 Aggression and Violent Beh
50 (2009).
80
Denise Hien and Lesia Ruglass,
Interpersonal Partner Violence and
Women in the United States: An Over-
view of Prevalence Rates, Psychiatric
Correlates and Consequences and Bar-

435
§ 12:25 MODERN SCIENTIFIC EVIDENCE

tion is unclear. There is some evidence that police intervention

generally deters future violence, but this may be the case only for
men who have “something to lose” from being re-arrested.81 Be-
yond calling police or deciding to press charges, abused women
face many challenges navigating the criminal justice system.
MacFarlane and colleagues (2000) interviewed 90 women who
had pressed charges against their batterer, and found that 48%
were deemed to have insufficient evidence to proceed with filing;
and in all cases the women experienced no reduction in violence.82
The decision to prosecute is complex and not easily made for
many abused women. Hare (2006) interviewed 94 abused women
and found that 70% favored prosecution against their abuser,
and this was not influenced by demographic variables such as
income, education, number of children at home, or race.83 Among
those who opposed prosecution, several main reasons emerged: a)
minimization of the abuse and lack of desire for retribution, b)
emotional or financial dependence or commitment to the abuser,
c) a desire for the abuser to be rehabilitated rather than incarcer-
ated, and d) in a small minority of cases, fear of retaliation.84
Some women may also or alternatively attempt to obtain a
protection order, although one study found that less than half of
women completed the process due to fear of retaliation and the
abuser’s threats to their children.85 Another study found that
perceived barriers to obtaining protection orders included fear of
retaliation, belief that the order would be ineffective, economic

riers to Help Seeking, 32 Int. J. Law ment of Justice, 2001).

and Psychiatry 48 at 51 (2009).
81
Denise Hien and Lesia Ruglass,
Interpersonal Partner Violence and
Women in the United States: An Over-
view of Prevalence Rates, Psychiatric
Correlates and Consequences and Bar-
riers to Help Seeking, 32 Int. J. Law
and Psychiatry 48 at 51 (2009); C.E.
Jordan, Intimate Partner Violence and
the Justice System: An Examination
of the Interface, 19 J. Interpersonal
Violence 1412 (2004). Note that some
researchers have noted an increase in
violence after arrest: E.S. Buzawa &
C.G. Buzawa, Domestic Violence: The
Criminal Justice Response, 3rd ed.
(Thousand Oaks, CA: Sage, 2003); L.
Dugan, D. Nagin & R. Rosenfeld, Ex-
posure Reduction or Backlash? The Ef-
fects of Domestic Violence Resources
on Intimate Partner Homicide. Final
Report (Washington, DC: U. S. Depart-
82
J. McFarlane, P. Willson, D.
Lemmey, & A. Malecha, Women Filing
Assault Charges on an Intimate
Partner: Criminal Justice Outcome
and Future Violence Experienced, 6
Violence Against Women 396 (2000).
83
Sarah C.Hare, What Do Bat-
tered Women Want? Victims’ Opinions
on Prosecution, 21 Violence and Vic-
tims 611 at 619 (2006).
84
Sarah C.Hare, What Do Bat-
tered Women Want? Victims’ Opinions
on Prosecution, 21 Violence and Vic-
tims 611 at 623, 624 (2006).
85
Zoellner, L. A., Feeny, N. C.,
Alvarez, J.,Watlington, C., O’Neill, M.
L., Zager, R., et al., Factors Associated
with Completion of the Restraining
Order Process in Female Victims of
Partner Violence, 15 J. Interpersonal
Violence 1081 (2000).

436
BATTERED WOMAN SYNDROME § 12:25

barriers, lack of enforcement, and strict eligibility requirements.86

If the case is prosecuted, many women find the experience to be
stressful, adversarial, and demoralizing, as their credibility and
honesty are challenged.87 Rivera et al. (2012) followed 19 women
divorcing an abusive husband, who were undergoing family court
mediation.88 The findings revealed that the existence of abuse
was rarely considered or contemplated by mediators in making
recommendations for custody of the children, as most court-
appointed mediators preferred joint custody. This finding is
particularly concerning, as research has found that between 30-
60% of children whose mothers are abused also experience abuse
from their father.89 It is also disheartening, as many experts on
IPV believe that mediation is ineffective and potentially unsafe
when there has been domestic violence.90
Zeoli et al. (2013) examined abused women’s experiences in
obtaining protection through the legal system.91 They conducted
in-depth interviews with 19 mothers who had divorced abusive

86
Logan, T. K., Shannon, L.,
Walker, R., & Faragher, T. M. Protec-
tive Orders: Questions and Conun-
drums, 7 Trauma, Violence, and Abuse
175 (2006). See also T.K. Logan & Rob-
ert Walker, Civil Protective Order
Outcomes: Violations and Perceptions
of Effectiveness, 24 J. Interpersonal
Violence 675 (2009) who found that
violence continued after obtaining a
protection order in 60% of cases, and
that only 9% of women dropped the or-
der.
87
Jordan, C. E., Intimate Partner
Violence and the Justice System: An
Examination of the Interface, 19 J.
Interpersonal Violence 1412; Denise
Hien and Lesia Ruglass, Interpersonal
Partner Violence and Women in the
United States: An Overview of Preva-
lence Rates, Psychiatric Correlates
and Consequences and Barriers to
Help Seeking, 32 Int. J. Law and Psy-
chiatry 48 (2009).
88
Echo A. Rivera, April M. Zeoli,
& Cris M. Sullivan, Abused Mothers’
Safety Concerns and Court Mediators’
Custody Recommendations, 27 J. Fam.
Violence 321 (2012). The authors also
found that mediators tended to dismiss
claims of IPV where there was no in-
dependent evidence of the abuse.
89
J.L. Edleson, The Overlap Be-
tween Child Maltreatment and
Woman Battering, 5 Violence Against
Women 134 (1999).
90
E.g., Connie J.A. Beck & Lynda
E. Frost, Defining a Threshold for Cli-
ent Competence to Participate in Di-
vorce Mediation, 12 Psychology, Public
Policy, and Law 1 (2006); Clare Dalton,
Hon. Susan Carbon, & Nancy Olesen,
High Conflict Divorce, Violence, and
Abuse: Implications for Custody and
Visitation Decisions, 54 Juvenile and
Fam. Court J. 11 (2003); Peter G.
Jaffe, Nancy K.D. Lemon, & Samantha
E. Poisson, Child Custody and Domes-
tic Violence: A Call for Safety and Ac-
countability (Thousand Oaks: Sage,
2003); Nancy E. Johnson, Dennis P.
Saccuzzo, & Wendy J. Koen, Child
Custody Mediation in Cases of Domes-
tic Violence: Empirical Evidence of a
Failure to Protect, 11 Violence Against
Women 1022 (2005); Salem, P., &
Dunford-Jackson, B. L. (2008). Beyond
Politics and Positions: A Call for Col-
laboration Between Family Court and
Domestic Violence Professionals. Fam-
ily Court Review, 46, 437-453.
91
April M. Zeoli, Echo A. Rivera,
Cris M. Sullivan, & Sheryl Kubiak,
Post-Separation Abuse of Women and
Their Children: Boundary-Setting and
Family Court Utilization among Vic-
timized Mothers, 28 J. Fam. Violence

437
§ 12:25 MODERN SCIENTIFIC EVIDENCE

husbands 1-3 years prior. Many of the women were unsatisfied

with the family court’s ability to protect their children;92 most
fathers retained partial custody or access to the children, and
many continued to act violently or negligently toward them. Most
of the women experienced stalking, emotional and physical abuse,
and death threats post-separation. The women used multiple
strategies and changed tactics over time as needed (e.g., restrain-
ing orders, changes to custody orders, restricting access). Their
findings again demonstrate that abused women are not the help-
less, passive victims contemplated in previous research, but ac-
tive agents seeking to make the best of an impossible situation.
Another theory posited to explain the dynamics involved in
battering relationships involves the notion of ‘‘traumatic
bonding.’’93 This term describes ‘‘the development and course of
strong emotional ties’’ that develop ‘‘between two persons where
one person intermittently harasses, beats, threatens, abuses or
intimidates the other.’’94 The phenomenon is not unique to bat-
tered women, but can develop in a variety of contexts (e.g., be-
tween hostages and their captors) that share two common
features: (1) a power imbalance in which the abused individual
perceives himself to be dominated by the other; and (2) intermit-
tent exposure to abuse.95 As the power imbalance increases be-
tween the two parties, the individuals in the low power position
begin to feel more ‘‘negative in their self-appraisal, more
incapable of fending for themselves, and thus more in need of the

547 (2013).
92
For example, one woman asked
the court to impose supervised visits
with the father due to the severity of
his violence against her (witnessed by
the children) and his tendency to
become intoxicated. The court refused
this request, taking the father’s word
that he would not drink around the
children. The court told the woman
that she would be found in contempt
of court if she denied visitation (at
556). Although she was eventually al-
lowed to refuse the visitation if she felt
the children would be at risk (a right
she already possessed legally), she was
in the impossible position of having to
determine the father’s alcohol con-
sumption prior to the visit. As it
turned out, the father indeed contin-
ued to drink to impairment during his
visits with the children (at 557).
93
Donald G. Dutton & Susan
Painter, Traumatic Bonding: The De-
velopment of Emotional Attachments
in Battered Women and Other Rela-
tionships of Intermittent Abuse, 6
Victimology: An Int’l J. 139 (1981). See
also Dee L.R. Graham, Loving to Sur-
vive Sexual Terror, Men’s Violence and
Women’s Lives (1994).
94
Donald G. Dutton & Susan
Painter, Traumatic Bonding: The De-
velopment of Emotional Attachments
in Battered Women and Other Rela-
tionships of Intermittent Abuse, 6
Victimology: An Int’l J. at 146-147
(1981).
95
See Donald G. Dutton & Susan
Painter, Traumatic Bonding: The De-
velopment of Emotional Attachments
in Battered Women and Other Rela-
tionships of Intermittent Abuse, 6
Victimology: An Int’l J. at 147 (1981).

438
BATTERED WOMAN SYNDROME § 12:25

high power person.’’96 What develops is a cycle of dependency and

lowered self-esteem on the part of the low power person that
eventually results in a strong affective bond to the high power
person. The other feature, ‘‘periodicity of abuse,’’ involves the
intermittent nature of the abuse. That is, the abuse is not
constant but rather is characterized by bouts between maltreat-
ment and ‘‘more normal and acceptable social behavior.’’ Using
Walker’s cycle theory of violence, Donald Dutton and Susan
Painter described a range of cognitive and affective alterations
that occur in the woman as the relationship progresses through
the various phases of the cycle. The arousal the woman experi-
ences during the battering, which is followed by a collapse ‘‘ac-
companied by inactivity, depression, self-blame and feelings of
helplessness,’’ leaves the woman extremely vulnerable and de-
pendent after the battering incident.97 The theory of traumatic
bonding has received limited empirical testing and support.98
Most research suggests that a woman’s inability to permanently
leave an abusive relationship are related to more pragmatic
reasons, such as lack of financial independence, limited educa-
tion, lack of access to transportation, or concerns about the
welfare of shared children.99
More general descriptions of the dynamics of battering relation-
ships focus on the batterer’s domination and control of the
woman’s behavior.100 Indeed, a number of researchers view the
batterer’s attempts at domination and control as key to under-

96
Dutton & Painter, Traumatic
Bonding: The Development of Emo-
tional Attachments in Battered
Women and Other Relationships of
Intermittent Abuse, 6 Victimology: An
Int’l J. at 147 (1981).
97
Donald G. Dutton & Susan
Painter, Traumatic Bonding: The De-
velopment of Emotional Attachments
in Battered Women and Other Rela-
tionships of Intermittent Abuse, 6
Victimology: An Int’l J. at 150 (1981).
98
Deborah L. Rhatigan, Amy E.
Street, & Danny K. Axsom, A Critical
Review of Theories to Explain Violent
Relationship Termination: Implica-
tions for Research and Intervention,
26 Clinical Psychology Review 321 at
334 (2006).
99
E.g., Deborah K. Anderson and
Daniel G. Saunders, Leaving an Abu-
sive Partner: An Empirical Review of
Predictors, the Process of Leaving, and
Psychological Well Being, 4 Trauma,
Violence & Abuse 163 (2003); Ola W.
Barnett, Why Battered Women Do Not
Leave, Part 1: External Inhibiting Fac-
tors Within Society, 1 Trauma, Vio-
lence and Abuse 343 (2000); Deborah
L. Rhatigan & Danny K. Axsom, Us-
ing the Investment Model to Under-
stand Battered Women’s Commitment
to Abusive Relationships, 21 J. Fam.
Violence 153 (2006); Deborah L. Rhati-
gan, Amy E. Street, & Danny K. Ax-
som, A Critical Review of Theories to
Explain Violent Relationship
Termination: Implications for Re-
search and Intervention, 26 Clinical
Psychology Review 321 (2006).
100
The context of coercion and con-
trol is also central to Walker’s work.
See Lenore Walker, The Battered
Woman Syndrome (1984, 2000 2nd
ed.).

439
§ 12:25 MODERN SCIENTIFIC EVIDENCE

standing the battering relationship.101 Along these lines, Karla

Fischer described four elements that are characteristic of batter-
ing relationships that underlie the batterers’ domination and
control.102 The first element involves the abuser’s definition of
himself as the ‘‘rule-maker’’ and everyone else as ‘‘the ones who
follow the rules.’’103 His domination may range from control over
household rules to control over each family member’s behavior
and activities. 104 The second element involves the battered
woman’s internalization of the batterer’s rules or what Fischer
refers to as the process of self-censorship. In response to fears of
violence, the woman censors her behavior, and eventually, as
time goes on, the batterer needs to do less and less to control his
family’s behavior. This process is further reinforced by the
woman’s feelings of responsibility for the marriage and its suc-
cess105 and by the abuser’s constant denigration of the woman for
everything that goes wrong.106
Eventually, these rules become established in a pattern and
are enforced through the use of punishment (third element); ‘‘bat-
terers may either simply respond with abuse when a rule is
broken, or they may make it clear that the abuse is punishment
for violations.’’107 Throughout this process ‘‘the batterer’s behavior
forms a cohesive pattern of coercive control.’’108 Emotional and
abusive controlling acts on the part of the batterer form the ongo-

101
See, e.g., Mahoney, Legal Images
of Battered Women: Redefining the
Issue of Separation, 90 Mich. L. Rev.
1, 53-60 (1991); Karla Fischer et al.,
The Culture of Battering and the Role
of Mediation in Domestic Violence
Cases, 46 S.M.U. L. Rev. at 2126
(1993); R. Emerson Dobash & Russell
P. Dobash, Woman, Violence and Social
Change 232 (1992); Del Martin, Bat-
tered Wives (1976); Stark, Re-
presenting Woman Battering: From
Battered Woman Syndrome to Coer-
cive Control, 58 Alb. L. Rev. 973.
102
See Fischer et al., The Culture
of Battering and the Role of Mediation
in Domestic Violence Cases, 46 S.M.U.
L. Rev. 2117, 2120-2121 (1993).
103
Fischer et al., The Culture of
Battering and the Role of Mediation in
Domestic Violence Cases, 46 S.M.U. L.
Rev. at 2126 (1993).
104
See Fischer et al., The Culture
of Battering and the Role of Mediation
in Domestic Violence Cases, 46 S.M.U.
L. Rev. at 2126-2129 (1993).
105
These feelings of responsibility
have been noted by a number of re-
searchers and have been attributed to
the woman’s internalization of societal
norms regarding sex roles. It should
be noted, however, that rigid sex role
socialization has not been observed in
battered women as a group. See Mary
Ann Dutton, Empowering and Healing
the Battered Woman a Model for As-
sessment and Intervention at 82-84
(1992).
106
See Fischer et al., The Culture
of Battering and the Role of Mediation
in Domestic Violence Cases, 46 S.M.U.
L. Rev. at 2129-2130 (1993).
107
Fischer et al., The Culture of
Battering and the Role of Mediation in
Domestic Violence Cases, 46 S.M.U. L.
Rev. at 2131 (1993).
108
Fischer et al., The Culture of
Battering and the Role of Mediation in
Domestic Violence Cases, 46 S.M.U. L.
Rev. 2117, 2120-2121 (1993).

440
BATTERED WOMAN SYNDROME § 12:25

ing backdrop against which the physical abuse occurs.109 At the

core of the batterers’ control is the woman’s fear of future violence
(fourth element).110 This fear may stem from past abuse or from
threats of future physical or sexual abuse. Moreover, the woman’s
fear can be further intensified by the batterer’s threats against
other family members, his use of emotional or financial abuse,
and the woman’s social isolation.111 Finally, the fear itself may
also be triggered indirectly as the result of some verbal or
nonverbal symbolic action of the batterer that is associated with
the onset of an abusive incident.112 Along these lines, Wilson,
Johnson, and Daly found that the severity and recurrence of
violence on the part of the batterer was positively related to both
his psychological control of the woman (i.e., his attempts to limit
her autonomy) and the woman’s reported feelings of fear.113
Some authors have attempted to create a typology of battering
men. For example, Donald Dutton (1995, 2007) characterized one
type of male batterer as having borderline personality disorder,
which is characterized by unstable relationships, mood swings,
fear of abandonment and impulsive outbursts.114 It is argued that
a man with this personality disorder would appear superficially
normal to most people, but that his jealousy and emotional insta-
bility would emerge in intimate relationships. Another type of
batterer would be generally violent in nature and would be
predisposed to violence, impulsive behavior and may be reliant
on drugs or alcohol. Another typology was attempted by Amy
Holzworth-Munroe and colleagues, who classified batterers into
three types: a) men who are violent exclusively within their fam-

109
See Fischer et al., The Culture
of Battering and the Role of Mediation
in Domestic Violence Cases, 46 S.M.U.
L. Rev. 2117, 2120-2121 (1993). For
recent measures and conceptualiza-
tions of the battering context that at-
tempt to capture the dynamic, ongo-
ing, and continuous nature of intimate
violence within the measures used to
assess the experience of violence in
battered women’s lives, see Paige Hall
Smith et al., Beyond the Measurement
Trap: A Reconstructed Conceptualiza-
tion and Measurement of Woman Bat-
tering, 23 Psychol. of Women Q. 177
(1999); see also Mary Ann Dutton,
Multidimensional Assessment of
Woman Battering: Commentary on
Smith, Smith, and Earp, 23 Psychol.
of Women Q. 195 (1999); Jody Brown,
Working Toward Freedom From Vio-
lence, 3 Violence Against Women 5
(1997).
110
See Fischer et al., The Culture
of Battering and the Role of Mediation
in Domestic Violence Cases, 46 S.M.U.
L. Rev. at 2131 (1993).
111
See Fischer et al., The Culture
of Battering and the Role of Mediation
in Domestic Violence Cases, 46 S.M.U.
L. Rev. at 2121-2132 (1993).
112
See Fischer et al., The Culture
of Battering and the Role of Mediation
in Domestic Violence Cases, 46 S.M.U.
L. Rev. at 2121-2132 (1993).
113
See Wilson et al., Lethal and
Nonlethal Violence Against Wives, Ca-
nadian J. Criminology 331, 341 (1995).
114
Don Dutton (1995). The
batterer: A psychological profile. New
York, NY: Basic Books; Don Dutton,
The Abusive Personality, 2nd ed (New
York, NY: Guilford Press, 2007).

441
§ 12:25 MODERN SCIENTIFIC EVIDENCE

ilies, b) men who are generally violent in nature, and c) men who
have borderline-dysphoric personality problems.115 The types are
determined by looking at the level of violence within the mar-
riage, the generality or specificity of the violent behavior, and the
presence of other psychopathology such as substance abuse or
personality disorders.116 Some recent research has found associa-
tions between male batterers and antisocial or psychopathic
traits. For example, Rock et al. (2013) studied 483 convicted male
batterers who were assigned to a court-mandated treatment
programs, and found that psychopathy scores were associated
with recidivism and treatment failure at one-year follow-up.117
Johnson et al. (2006) found that 47% of batterers in their study
had antisocial traits, and 28% had borderline features.118 Gibbons
et al. (2011) found that 54% of their sample of male batterers
demonstrated some form of personality disorder, with 37% of the
total sample showing severe personality pathology.119 The authors
noted, however, that there was “considerable diversity” in the
pathologies presented, which suggested that there may not be a
single batterer profile.120
Finally, in the culmination of some battering relationships an

115
Amy Holzworth-Munroe & G.L
Stuart, Typologies of Male Batterers:
Three Subtypes and the Differences
among Them. 116 Psychological Bul-
letin 476 (1994); Amy Holzworth-
Munroe, J.C. Meehan, K. Herron, U.
Rehman, & G.L. Stuart, Do Subtypes
of Maritally Violent Men Continue to
Differ over Time? 71 J. Consulting and
Clinical Psychology 728 (2003).
116
This typology has received some
empirical support: Amy Holzworth-
Munroe, J.C. Meehan, K. Herron, U.
Rehman, & G.L. Stuart, Do Subtypes
of Martially Violent Men Continue to
Differ over Time? 71 J. Consulting and
Clinical Psychology 728 (2003); J.
Waltz, J.C. Babcock, N.S. Jacobson, &
J.M. Gottman, Testing a Typology of
Batterers. 68 J. Consulting and Clini-
cal Psychology 658 (2000); Z. Walsh,
M.T. Swogger, B.P. O’Connor, G.L.
Stuart, M.T. Shea, & Y Chatav, Psy-
chopathy and Subtypes of Partner Vio-
lent Men and Women, 119 J. Abn.
Psychology 563 (2010). See also Re-
becca Brasfield, The Absence of Evi-
dence is not Evidence of Absence: The
Abusive Personality as a Disordered
Mental State, 19 Aggression and Vio-
lent Behavior 515 (2014) for a review
of the literature examining an “abu-
sive personality” of female batterers
as a distinct psychological disorder.
She proposes that, at a minimum, psy-
chiatry ought to consider batterer
characteristics for a possible distinct
mental disorder.
117
Rachel C. Rock, Martin Sellbom,
Yosseff S. Ben-Porath & Randall T.
Salekin. Concurrent and Predictive
Validity of Psychopathy in a Batterer’s
Intervention Sample. 37 Law and Hu-
man Beh. 144 (2013).
118
Rebecca Johnson, E. Gilchrist,
Anthony R. Beech, Samantha Weston,
Rachel Takriti & Richard Freeman, A
Psychometric Typology of U.K. Domes-
tic Violence Offenders, 21 J. Interper-
sonal Violence 1270 (2006).
119
Gibbons, P., Collins, M., & Reid,
C., How Useful are Indices of Person-
ality Pathology When Assessing Do-
mestic Violence Perpetrators, 23 Psy-
chological Assessment 164 (2011).
120
Gibbons, P., Collins, M., & Reid,
C., How Useful are Indices of Person-
ality Pathology When Assessing Do-
mestic Violence Perpetrators, 23 Psy-

442
BATTERED WOMAN SYNDROME § 12:25

abused woman may kill her batterer, ultimately ending the abuse
she suffers. A number of studies, involving in-depth interviews
with battered women who have killed, have attempted to exam-
ine the dynamics of violent relationships more specifically within
these fatal relationships. 121 In the earliest of these studies,
Browne compared battered women charged with the death or at-
tempted death of their partners to a sample of battered women
who had not killed.122 No differences between these groups were
found as a function of the women’s characteristics or behavior. In
contrast, the features that distinguished the experiences of
women in these two groups were specific to the batterers’
behavior. When compared to the comparison group, men in the
homicide group were more likely to use drugs, were intoxicated
more often, threatened and engaged in more frequent and harm-
ful abuse of their partner, and were more likely to have abused a
child or children.123 Similar findings have been found in investiga-
tions comparing the responses of incarcerated battered women
who have killed their abusers to battered women who have not
killed (the comparison groups involved either battered women
incarcerated for other crimes,124 battered women drawn from
community samples,125 or battered women drawn from battered
women’s shelters).126 Specifically, factors such as the frequency
and severity of the violence, the severity of the woman’s injuries,

chological Assessment 164 at 171 tered Women Kill 100, 70 (1987).

(2011).
121
Jordan, C. E., Clark, J.,
Pritchard, A., & Charnigo, R. Lethal
and Other Serious Assaults: Disentan-
gling Gender and Context, 58 Crime &
Delinquency 425 (2012); O’Keefe, In-
carcerated Battered Women: A Com-
parison of Battered Women Who Killed
Their Abusers and Those Incarcerated
for Other Offences, 12 J. Fam. Violence
1 (1997); Roberts, Battered Women
Who Kill: A Comparative Study of
Incarcerated Participants with a Com-
munity Sample of Battered Women, 11
J. Fam. Violence 291 (1996); Gloria
Hamilton & Tammy Sutterfield, Com-
parison Study of Women Who Have
and Have Not Murdered Their Abusive
Partners, in Breaking the Rules:
Women in Prison and Feminist
Therapy 45 (Judy Harden & Marcia
Hill eds., 1998).
122
See Angela Browne, When Bat-
tered Women Kill 100, 70 (1987).
123
See Angela Browne, When Bat-
124
See Carol E. Jordan, James
Clark, Adam Pritchard, and Richard
Charnigo, Lethal and Other Assaults:
Disentangling Gender and Context, 58
Crime and Delinquency 425 (2012);
O’Keefe, Incarcerated Battered
Women: A Comparison of Battered
Women Who Killed Their Abusers and
Those Incarcerated for Other Offences,
12 J. Fam. Violence 1 (1997).
125
Roberts, Battered Women Who
Kill: A Comparative Study of Incarcer-
ated Participants with a Community
Sample of Battered Women, 11 J. Fam.
Violence 291 (1996).
126
See Gloria Hamilton & Tammy
Sutterfield, Comparison Study of
Women Who Have and Have Not Mur-
dered Their Abusive Partners, in
Breaking the Rules: Women in Prison
and Feminist Therapy 45-55 (Judy
Harden & Marcia Hill eds., 1998); see
also Blount et al., Alcohol and Drug
Use Among Abused Women Who Kill,
Abused Women Who Don’t, and Their

443
§ 12:25 MODERN SCIENTIFIC EVIDENCE

and the batterer’s threats to kill or harm have been found to

distinguish battered women who had resorted to lethal violence
from those who had not.127 In addition, in comparison to battered
women who have not killed, greater alcohol involvement (on the
part of both the women128 and the partner129) has been found in
some of the samples of the women who had killed. Jordan et al.
(2007) compared women who had killed an intimate partner with
incarcerated women who had killed a person that was not an
intimate partner.130 Their results revealed that women who killed
an intimate partner were less likely to suffer from substance
abuse problems or have a criminal background, but were more
likely to have suffered abuse in adulthood. The authors concluded
that women kill or seriously assault intimate partners do so
“under a variety of circumstances, not just as passive abuse
victims who conform to an ‘ideal type.’ ’’131 A number of studies
have also compared the characteristics of intimate partner
homicides committed by men versus women. Men who kill their
female partners tend to exhibit jealousy, possessiveness, loss of

Abusers, 24 J. Drug Issues 165 (1994).
127
See Roberts, Battered Women
Who Kill: A Comparative Study of
Incarcerated Participants with a Com-
munity Sample of Battered Women, 11
J. Fam. Violence at 297-298 (1996); see
also O’Keefe, Incarcerated Battered
Women: A Comparison of Battered
Women Who Killed Their Abusers and
Those Incarcerated for Other Offences,
12 J. Fam. Violence at 10-13 (1997);
Dutton et al., Traumatic Responses
Among Battered Women Who Kill, 7
J. Traumatic Stress at 553 (1994).
128
See Roberts, Battered Women
Who Kill: A Comparative Study of
Incarcerated Participants with a Com-
munity Sample of Battered Women, 11
J. Fam. Violence at 297 (1996); see
also Blount et al., Alcohol and Drug
Use Among Abused Women Who Kill,
Abused Women Who Don’t, and Their
Abusers, 24 J. Drug Issues at 173
(1994).
129
For example, only 34% of the
women in the shelter group reported
that their partners used alcohol on a
daily basis compared to 62% of the
women from the homicide sample. See
Blount et al., Alcohol and Drug Use
Among Abused Women Who Kill,
Abused Women Who Don’t, and Their
Abusers, 24 J. Drug Issues at 172
(1994). At the same time, however, an-
other study revealed no differences in
the spouse’s alcohol use. High rates of
alcohol abuse were reported for the
woman’s partner in both the sample of
women who had killed their abuser
and those who had not. See O’Keefe,
Incarcerated Battered Women: A Com-
parison of Battered Women Who Killed
Their Abusers and Those Incarcerated
for Other Offences, 12 J. Fam. Violence
1 (1997).
130
Carol E. Jordan, James Clark,
Adam Pritchard, and Richard
Charnigo, Lethal and Other Assaults:
Disentangling Gender and Context, 58
Crime and Delinquency 425 (2012).
131
Carol E. Jordan, James Clark,
Adam Pritchard, and Richard
Charnigo, Lethal and Other Assaults:
Disentangling Gender and Context, 58
Crime and Delinquency 425 at 449
(2012). Jordan et al. (2012) note that
the absence of a criminal record has
been observed in prior research, and
may contribute to a stereotype of the
model battered woman who is passive
and innocent.

444
BATTERED WOMAN SYNDROME § 12:26

control, rage, and fears of infidelity.132 In comparison, women who

kill their partners were more likely to report fear and despera-
tion resulting from the domestic violence and abuse,133 feeling
that they have exhausted all resources.134

§ 12:26 Introductory discussion of the science—The

general questions—Battered woman syndrome
and psychological sequelae
The term that the courts are perhaps most familiar with in
terms of expert testimony pertaining to an abused partner that
has received recognition in the courts has been the ‘‘battered
woman syndrome.’’ Indeed, this term is most likely to be used in
the legal area rather than the scientific and clinical sphere. Al-
though experts may be called upon to provide testimony regard-
ing the impact of abuse and the dynamics of an abusive relation-
ship, it is neither a psychological profile nor a standalone legal
defense. Examination of the term battered woman syndrome in
the legal literature indicates that it has been used loosely to refer
to a wide range of phenomena.1 Unfortunately, many myths
remain regarding the use of expert testimony pertaining to bat-
tered women as a legal defense. 2 As Osthoff and Maguigan
explain, in reality, there is no such thing as the battered woman

132
M . D a l y a n d M . Wi l s o n ,
Homicide (New York, NY: Aldine de
Gruyter, 1988); H. Johnson & T. Hotton,
Losing Control: Homicide Risk and
intact intimate relationships, 7
Homicide Studies 58 (2003).
133
Jordan, C. E., Clark, J.,
Pritchard, A., & Charnigo, R. Lethal
and Other Serious Assaults: Disentan-
gling Gender and Context, 58 Crime &
Delinquency 425 (2012); H. Gertie
Pretorius & Shirley-Ann Botha, The
Cycle of Violence and Abuse in Women
Who Kill an Intimate Male Partner: A
Biographical Profile, 39 South African
J. Psychol. 242 (2009); R. Emerson
Dobash, Russell P. Dobash, Kate Ca-
vanagh and Juanjo Medina-Ariza, Le-
thal and Non-Lethal Violence Against
an Intimate Female Partner: Compar-
ing Male Murderers to Nonlethal
Abusers, 13 Violence Against Women
329 (2007).
134
M. Adinkrah, Female Perpe-
trated Spousal Homicides—The Case
of Fiji, 28 Journal of Criminal Justice
151 (2000); H. Gertie Pretorius and
Shirley-Ann Botha, The Cycle of Vio-
lence and Abuse in Women Who Kill
an Intimate Male Partner: A Bio-
graphical Profile, 39 South African J.
Psychol. 242 (2009).
[Section 12:26]
1
It has been used to refer to both
the pattern of violence battered women
experience as well as the psychological
effects of the violence on women. Dut-
ton, Understanding Women’s Response
to Domestic Violence: A Redefinition of
Battered Woman Syndrome, 21 Hofs-
tra L. Rev. at 1195 n.14 (1993); McMa-
hon, Battered Women and Bad
Science: The Limited Validity and
Utility of Battered Woman Syndrome,
6 Psychiatry, Psychol. & L. at 26
(1999). Similarly, Walker notes that
‘‘the legal system uses BWS to de-
scribe both the clinical syndrome and
the dynamics of the battering relation-
ship.’’ Walker, Understanding the Bat-
tered Woman Syndrome, 31 Trial 30,
32 (1995).
2
See Sue Osthoff and Holly
Maguigan, Explaining Without

445
§ 12:26 MODERN SCIENTIFIC EVIDENCE

defense; rather, most women charged with killing their abusers

rely on traditional self-defense law. In addition, expert testimony
is not admitted in all cases, and when it is admitted it is only one
piece of evidence. Moreover, expert testimony on battered women
involves a range of social and psychological issues that help to
explain the reasonableness of her apprehension of harm and use
of force.
In addition, battered woman is not recognized as a diagnostic
category in the DSM-5, nor in any previous versions of the
Diagnostic and Statistical Manual of Mental Disorders.3 There is
considerable variation within the psychological literature. For
Lenore Walker, who first coined the term in 1979, the term takes
on a more specific and clinical meaning. ‘‘Battered woman
syndrome’’ describes ‘‘a group of usually transient psychological
symptoms that are frequently observed in a particular recogniz-
able pattern in women who report having been physically, sexu-
ally, and/or psychologically abused.’’4 Since this initial descrip-
tion, Walker has devoted considerable attention to the delineation
of the syndrome. In a book chapter, she notes that battered
woman syndrome has been discussed as a subcategory of PTSD,
but warns that they have not been shown empirically to have the
same symptoms.5
To determine whether exposure to a trauma results in PTSD
pursuant to the DSM-5, two threshold criteria must first be met:
presence of a stressor that could cause a traumatic response (e.g.,
the battering),6 and symptoms that persist for more than one
month and cause clinically significant distress in the victim’s life,

Pathologizing. In D. R. Loseke, R. J. matic event, it may involve witnessing

Gelles, & M. M. Cavanaugh (Eds.),
Current Controversies on Family Vio-
lence, 2nd ed., pp. 225–240 at 226
(Thousand Oaks, CA: Sage, 2005).
3 has suffered a violent or accidental
American Psychiatric Associa-
tion. Diagnostic and statistical man-
ual of mental disorders (5th ed., Ar-
lington, VA: American Psychiatric
Association, 2013).
4
Walker, Psychology and Law,
Symposium: Women and the Law, 20
Pepp. L. Rev. at 135 (1993).
5 tered women discussion, it may be
Lenore E. A. Walker. The Bat-
tered Woman Syndrome (New York,
NY: Springer Publishing Company, 3rd
ed. 2009) at 15.
6
Exposure to the event may oc-
cur in a number of ways. It may in-
volve directly experiencing the trau-
the event happen to someone else, it
may involve learning about traumatic
events that have happened to another
person (e.g., learning that a loved one
death), or it may be through repeated
exposure to negative details of trau-
matic events (e.g., a first responder or
police officer collecting human re-
mains; it does not apply to exposure
through electronic means such as tele-
vision or movies unless it is work-
related). For the purposes of the bat-
assumed that the first form of expo-
sure, direct experience, is the ap-
plicable exposure form: American Psy-
chiatric Association. Diagnostic and
statistical manual of mental disorders
(5th ed., Arlington, VA: American Psy-
chiatric Association, 2013).

446
BATTERED WOMAN SYNDROME § 12:26

occupation, social or other areas of functioning. Within the newly

revised DSM-5, PTSD results from exposure to a traumatic event,
with a list of 20 possible symptoms that are clustered into four
types.7 For a positive diagnosis, at least one or more intrusive
symptoms must be present such as recurring nightmares,
flashbacks, or physiological and psychological reactions to
reminders. At least one or more avoidance symptoms must be
present, such as avoiding places, things, or thoughts related to
the triggering event. At least two or more mood and cognition
symptoms must be identified, including alterations in mood (neg-
ative), alterations in cognitions (negative), loss of interest, and
social withdrawal. Finally, at least two or more arousal symptoms
must be identified, including an exaggerated startle response, be-
ing constantly ‘on guard’ or hypervigilant, irritability, angry
outbursts, and difficulty concentrating or sleeping. In the bat-
tered woman’s case, the high arousal of the woman’s physical
and mental systems result in such symptoms as pervasive anxi-
ety, panic attacks, phobias, and hypervigilance to cues of further
harm. 8 The woman becomes ‘‘hypervigilant to cues of any
potential danger, recognizing the little things that signal an
impending incident, and often acts as though she is nervous,
jumpy, and highly anxious.’’9 The second set of symptoms refers
to the woman’s re-experiencing of the traumatic event through
nightmares, repetitive intrusive memories, flashbacks, dissocia-
tive states, and intense fear of recurrence of the trauma.10 Given
the woman’s exposure to the violence in the past, ‘‘certain
behaviors such as specific verbal responses (e.g., yelling obsceni-
ties that had previously been paired with violence) or gestures
(e.g., pounding fist on table) may trigger a PTSD reaction, even
when there is no actual danger.’’11 In such an instance, these
intrusive symptoms ‘‘may lead a battered woman to believe that
she must take immediate action to protect herself.’’12
Finally, the third cluster of symptoms, avoidance symptoms,

7
American Psychiatric Associa- (1992).
10
tion. Diagnostic and statistical man- Walker, Battered Women Syn-
ual of mental disorders (5th ed., Ar- drome and Self-Defense, 6 Notre Dame
lington, VA: American Psychiatric J. of L. Ethics & Pub. Pol’y at 327-328
Association, 2013). (1992); Walker (1996), supra note 57
8 at 345.
See Lenore E. A. Walker, Assess-
11
ment of Abusive Spousal Relation- See Dutton & Goodman, Post-
ships, in Handbook of Relational Diag- traumatic Stress Disorder Among Bat-
nosis and Dysfunctional Family tered Women: Analysis of Legal Impli-
Therapy at 217 (Florence W. Kaslow cations, 12 Behav. Sci. & L. 215, 225
ed., 1996). (1994).
9 12
Walker, Battered Women Syn- See Dutton & Goodman, Post-
drome and Self-Defense, 6 Notre Dame traumatic Stress Disorder Among Bat-
J. of L. Ethics & Pub. Pol’y 321, 328 tered Women: Analysis of Legal Impli-

447
§ 12:26 MODERN SCIENTIFIC EVIDENCE

involve the woman’s ‘‘denial, minimization and repression’’ of the

abuse.13 These symptoms are employed as survival ‘‘techniques
. . . to avoid having to deal with the dangerousness of the situa-
tion,’’14 and explain why battered women may not respond to the
violence in a way in which one might expect—for instance, with
denial and minimization of the abuse, ‘‘she is less likely to ac-
knowledge the abuse to herself, name it for others, or seek help
in responding to it.’’15 The fourth cluster of symptoms was newly
added to the DSM-5, including negative emotions and cognitions,
which may include difficulty concentrating, detachment from oth-
ers, social isolation, persistent distorted cognitions (e.g., belief
that no one can be trusted, belief that the world is dangerous),
and persistent negative mood (e.g., constant fear, anger, guilt,
shame).
Walker claims that most battered women easily meet PTSD
criteria, ‘‘usually with more symptoms observed than is needed
for diagnosis.’’16 Although she provides no data pertaining to the
reliability or validity of this statement, a number of investigators
have now examined this issue directly by assessing the extent to
which battered women are at risk for developing PTSD. Certainly,
intimate partner violence has been associated with a wide range
of negative health outcomes (e.g. depression, suicide, anxiety,
PTSD). Estimates of PTSD among battered women range from
33% to more than 84%, depending on the population sampled.17
For instance, using self-report measures that included PTSD
indicators, Anita Kemp and her colleagues 18 found that ap-
proximately 85% of a sample of 77 battered women drawn from a
shelter residence were diagnosed with PTSD.19 Houskamp and

cations, 12 Behav. Sci. & L. 215, 225
(1994).
13
Walker, Battered Women Syn-
drome and Self-Defense, 6 Notre Dame
J. of L. Ethics & Pub. Pol’y at 328
(1992); Lenore E. A. Walker, Assess-
ment of Abusive Spousal Relation-
ships, in Handbook of Relational Diag-
nosis and Dysfunctional Family
Therapy at 344-345 (Florence W.
Kaslow ed., 1996).
14
Walker, Battered Women Syn-
drome and Self-Defense, 6 Notre Dame
J. of L. Ethics & Pub. Pol’y at 328
(1992).
15
Dutton & Goodman, Posttrau-
matic Stress Disorder Among Battered
Women: Analysis of Legal Implica-
tions, 12 Behav. Sci. & L. at 225 (1994).
16
Walker, Psychology and Law,
Symposium: Women and the Law, 20
Pepp. L. Rev. at 329 (1993).
17
Kathleen C. Basile, Ileana
Arias, Sujata Desai & Martie
P.Thompson, The Differential Associa-
tion of Intimate Partner Physical,
Sexual, Psychological, and Stalking
Violence on Posttraumatic Stress
Symptoms in a Nationally Represen-
tative Sample of Women, 17 J. Trau-
matic Stress 413 at 414 (2004).
18
See Kemp et al., Post-Traumatic
Stress Disorder (PTSD) in Battered
Women: A Shelter Sample, 4 J. of
Traumatic Stress 137 (1991).
19
The criteria set out in the DSM-
III-R for PTSD was used: one re-
experiencing symptom, three avoid-

448
BATTERED WOMAN SYNDROME § 12:26

Foy,20 using both self-report measures and a Structured Interview

for PTSD,21 found that 45% of a sample of 26 women who had
contacted a domestic violence clinic met full criteria for PTSD.
Moreover, in both of these studies the presence of PTSD
symptomotology was positively related to the frequency and se-
verity of the violence. Another study conducted by Kemp and her
colleagues22 found that 81% of a sample of 179 battered women23
were diagnosed with PTSD. Again, the severity of the abuse was
related to the severity of symptomatology; battered women with
PTSD ‘‘experienced more physical abuse, more verbal abuse, more
injuries, a greater sense of threat, and more forced sex’’ than bat-
tered women without PTSD. This study also included a control
group of nonbattered but verbally abused women.24 Sixty-two
percent of this sample was also diagnosed with PTSD. It should
be noted, however, that, as in the sample of battered women,
high rates of past abuse were reported in this latter sample.25
In a series of studies, Mary Ann Dutton and her colleagues ex-
plored PTSD symptomotology in various samples of battered
women. In one such study, a sample of 33 battered women
charged with actual or attempted homicide of their abusive part-

ance symptoms, and two persistent
symptoms of increased arousal. Also,
in an effort to examine the validity of
the self-report measures, 20 of the
women were additionally interviewed
face to face following completion of the
self-report questionnaire. Similar re-
sults were found using the interview
method. See Kemp et al., Post-
Traumatic Stress Disorder (PTSD) in
Battered Women: A Shelter Sample, 4
J. of Traumatic Stress at 140 (1991).
20
See Houskamp & Foy, The As-
sessment of Posttraumatic Stress Dis-
order in Battered Women, 6 J. of Inter-
personal Violence 367 (1991).
21
See Houskamp & Foy, The As-
sessment of Posttraumatic Stress Dis-
order in Battered Women, 6 J. of Inter-
personal Violence at 370-371 (1991).
22
See Kemp et al., Incidence and
Correlates of Posttraumatic Stress
Disorder in Battered Women, 10 J. of
Interpersonal Violence 43 (1995).
23
Women were recruited from
shelters, support groups, therapist
referrals, and newspaper advertise-
ments. Eighty-two percent were Cau-
casian and 14% were African-
American. See Kemp et al., Incidence
and Correlates of Posttraumatic Stress
Disorder in Battered Women, 10 J.
Interpersonal Violence 43 (1995).
24
Women were recruited primar-
ily from newspaper advertisements.
Eighty-five percent were Caucasian
and 10% were African-American.
Kemp et al., Incidence and Correlates
of Posttraumatic Stress Disorder in
Battered Women, 10 J. of Interper-
sonal Violence 43 (1995).
25
Ninety-six percent of the ver-
bally abused women reported being
abused as a child, 31% reported expe-
riencing unwanted sexual contact by a
family member as a child, 21% re-
ported being raped as an adult, and
15% reported experiencing other
physically abusive relationships in the
past. The rates for the physical abuse
group were 71%, 26%, 50%, and 41%,
respectively: Kemp et al., Incidence
and Correlates of Posttraumatic Stress
Disorder in Battered Women, 10 J.
Interpersonal Violence at 45 (1995).

449
§ 12:26 MODERN SCIENTIFIC EVIDENCE

ners26 were compared to a group of 30 battered women matched

for age and ethnicity (drawn from a mental health clinic). Two
variables believed to mediate the effects of the violence on the
women—the severity of the violence and the woman’s perceived
level of social support—were also measured. The study did not
assess for a full clinical diagnosis of PTSD, but rather assessed
the level of post-traumatic indicators. Overall, more women in
the forensic sample reported greater levels of post-traumatic
stress (on both general and specific indicators), more severe
violence, and less social support, than did the comparison group.27
When group differences in terms of social support and severity of
violence were statistically controlled for, however, group differ-
ences in general levels of post-traumatic stress were eliminated.28
In contrast, even after controlling for these group differences,
battered women who had killed their abusers still reported more
intrusion and avoidance symptoms than did the comparison
sample.29
Dutton and her colleagues explored the psychological impact
that battering can have on women (i.e., depression, PTSD
symptomatology, acute stress), with particular attention given to
the component of psychological abuse that battered women
experience.30 This investigation examined court-involved battered
women’s responses to intimate violence (i.e., using the criminal
justice system, terminating the relationship) and included sepa-
rate measures of physical, psychological, and sexual abuse.31 Con-
sistent with other research, more severe violence lead to greater
help-seeking behavior and more severe psychological stress
symptoms. Moreover, the measures of physical abuse were more

26
See Dutton et al., Traumatic Re-
sponses Among Battered Women Who
Kill, 7 J. Traumatic Stress 549 (1994).
27
See Dutton et al., Traumatic Re-
sponses Among Battered Women Who
Kill, 7 J. Traumatic Stress at 554-556
(1994).
28
See Dutton et al., Traumatic Re-
sponses Among Battered Women Who
Kill, 7 J. Traumatic Stress at 554-556
(1994).
29
A number of possible explana-
tions for this finding are offered: (1)
the groups may have differed in terms
of their expectations of lethal violence,
a variable not measured in the study;
(2) the forensic sample may have been
exposed to a greater number of trau-
matic events unrelated to the batter-
ing; and (3) social support may offer
less of a buffer for these particular
symptoms. See Dutton et al., Trau-
matic Responses Among Battered
Women Who Kill, 7 J. Traumatic
Stress at 560-561 (1994).
30
See Dutton et al., Court-
Involved Battered Women’s Responses
to Violence: The Role of Psychological,
Physical, and Sexual Abuse, 14 Vio-
lence & Victims 89 (1999).
31
The sample consisted of 149
women seeking assistance from a do-
mestic violence intake center that was
located in the court. Participants were
predominately African-American
(91%). See Dutton et al., Court-
Involved Battered Women’s Responses
to Violence: The Role of Psychological,
Physical, and Sexual Abuse, 14 Vio-
lence & Victims 89 (1999).

450
BATTERED WOMAN SYNDROME § 12:26

important determinants of the women’s use of the legal system

and their decisions to leave the relationship, while the measure
of psychological abuse played a greater role in predicting the
women’s traumatic responses (acute and post-traumatic stress).
Dutton and colleagues concluded that in the context of physical
assault, it is the ‘‘psychological abuse that is more determinant of
stress disorder symptoms.’’32
In an attempt to differentiate the effects of psychological abuse
from those associated with physical violence, Vitanza and col-
leagues 33 examined levels of emotional distress and PTSD
symptomotology in a sample of 93 psychologically abused women
(predominantly white and middle class)34 who differed in terms of
the level of physical violence they had sustained at the hands of
their male partner (none, moderate, severe).35 The women were
recruited through advertisements that were targeted for ‘‘women
in long-term ‘bad’ or ‘stressful’ relationships.’’36 Although the
researchers found that the severity of violence was positively re-
lated to PTSD symptoms, high levels of emotional distress
symptoms were evidenced across all three groups. 37 Higher
reports of suicide attempts were also found for the women who
experienced severe violence.38
Similar to Vitanza and colleagues, Arias and Pape attempted

32
Dutton et al., Court-Involved
Battered Women’s Responses to
Violence: The Role of Psychological,
Physical, and Sexual Abuse, 14 Vio-
lence & Victims at 102 (1999).
33
See Vitanza et al., Distress and
Symptoms of Posttraumatic Stress
Disorder in Abused Women, 10 Vio-
lence & Victims 21 (1995).
34
Eighty-nine percent were white
and 70% were middle class. See Vi-
tanza et al., Distress and Symptoms of
Posttraumatic Stress Disorder in
Abused Women, 10 Violence & Victims
at 26 (1995).
35
The women were first screened
to ensure that they had been subjected
to high levels of psychological abuse
from their partner. A second level of
screening, based on the women’s re-
sponses to a 46-item measure assess-
ing the male’s level of violence, re-
sulted in three groups of women: (1)
those that had not sustained any level
of violence; (2) those that had sus-
tained a moderate level of violence;
and (3) those that had sustained high
levels of violence in the relationship.
See Vitanza et al., Distress and Symp-
toms of Posttraumatic Stress Disorder
in Abused Women, 10 Violence & Vic-
tims at 26-27 (1995).
36
Vitanza et al., Distress and
Symptoms of Posttraumatic Stress
Disorder in Abused Women, 10 Vio-
lence & Victims at 26 (1995).
37
The PTSD subscale employed
identified approximately 56% of the
sample as having PTSD. Using a more
conservative score on the measure, ap-
proximately 33% of the sample was
classified with PTSD. Breakdowns for
the three groups are not provided. See
Vitanza et al., Distress and Symptoms
of Posttraumatic Stress Disorder in
Abused Women, 10 Violence & Victims
at 31 (1995).
38
Forty-three percent of women in
the severe group had attempted sui-
cide compared to 23% in the psycho-
logical abuse group. Those experienc-
ing moderate levels of violence
reported the lowest level of attempted
suicide (13%). See Vitanza et al., Dis-

451
§ 12:26 MODERN SCIENTIFIC EVIDENCE

to examine the role of psychological abuse on women’s psychologi-

cal adjustment ‘‘above and beyond the effects of their physical
abuse.’’39 Their study also looked at the relationship between
psychological abuse and a woman’s decision to terminate the re-
lationship, again controlling for the effects of physical abuse. To
this end, 68 women recruited from battered women’s shelters
were administered a range of self-report measures that assessed
the frequency and severity of physical and psychological violence
in their lives, as well as coping strategies, and psychological
symptomatology. High levels of physical violence, psychological
abuse, and PTSD symptomatology, were reported by the women
(88% of the sample reaching the cutoff score of suspected PTSD).40
As expected there was a strong association between physical and
psychological abuse. Of particular note, however, was the finding
that, while physical abuse was not predictive of PTSD symptom-
atology or a woman’s intention to end the relationship, psychologi-
cal abuse was predictive of these two variables, even after con-
trolling for the effects of physical abuse. The more extreme the
psychological abuse reported, the more extreme the PTSD

tress and Symptoms of Posttraumatic behavior in a sample of low income,

Stress Disorder in Abused Women, 10
Violence & Victims at 28 (1995). Con-
sistent with this finding, Stark &
Flitcraft, Killing the Beast Within:
Woman Battering and Female Suicid-
ality, 25 Int’l J. Health Services 43
(1995), investigated the association be-
tween abuse and attempted suicide by
examining the medical records of 176
women who presented to an emer-
gency hospital during a one-year pe-
riod. Using a conservative estimate of
battering (documented injury requir-
ing medical attention), they found evi-
dence of abuse in approximately 29%
of the women (with black women and
those pregnant overrepresented in the
group of women). Moreover, ‘‘over a
third of the battered women visited
the hospital with an abuse-related
injury or complaint on the same day
as their suicide attempt.’’ See supra at
53. Also of note was the finding that
the medical response to the women
identified as battered neglected the is-
sue of their abuse history. These
women were more likely to be sent
home or receive no referrals for mental
health or social services. Another
study examined the association be-
tween partner abuse and suicidal
African-American women. The sample
consisted of 119 women presenting to
a hospital following a nonfatal suicide
attempt. These women were compared
to a control group of 85 women who
presented to the hospital for non-
emergency medical problems. Women
who had attempted suicide were about
‘‘three times more likely to report both
physical and nonphysical partner
abuse, and three times more likely to
meet criteria for PTSD than women
with no history of suicide behavior.”
Tompson et al., Partner Abuse and
Posttraumatic Stress Disorder as Risk
Factors for Suicide Attempts in a
Sample of Low-Income, Inner City
Women, 12 J. Traumatic Stress 59
(1999).
39
Arias & Pape, Psychological
Abuse: Implications for Adjustment
and Commitment to Leave Violent
Partners, 14 Violence & Victims 55, 57
(1999).
40
See Arias & Pape, Psychological
Abuse: Implications for Adjustment
and Commitment to Leave Violent
Partners, 14 Violence & Victims at 60
(1999).

452
BATTERED WOMAN SYNDROME § 12:26

symptomatology exhibited and the stronger the woman’s resolve

to leave the batterer.41
Coker et al. (2002) analyzed data from the National Violence
Against Women Survey, a nationally representative sampling of
men and women aged 18-65.42 They assessed the prevalence of
physical, psychological and sexual IPV, as well as the develop-
ment of mental and physical health problems. The results re-
vealed that 29% of women and 23% of men reported a lifetime
exposure to IPV, and that for both genders, physical IPV was as-
sociated with an increased risk of poor health, depression,
substance abuse, chronic disease, and chronic mental illness. In a
subsequent study, Coker and her colleagues analyzed the
National Violence against Women Survey for frequency and se-
verity of PTSD symptoms among abused men and women.43
Results revealed that 24% of women and 20% of men had moder-
ate to severe PTSD symptoms, with women scoring higher than
men. Moreover, higher PTSD symptomotology was associated
with more severe abuse (physical or psychological), having cur-
rent depressive symptoms, and having left the relationship at
least once.
Bennice et al. (2003) assessed 62 women seeking help for an
abusive relationship, and found a significant and positive correla-
tion between PTSD symptoms and severity of abuse.44 Those
women who experienced sexual and physical violence had more
severe PTSD symptoms than did women who experienced physi-
cal violence alone.45 Basile et al. (2004) reviewed data collected
through the National Violence Against Women Survey, and
examined the data for 380 women who reported that they had
been the victim of IPV.46 The authors assessed the relative role of
each of four forms of violence on PTSD symptoms: physical,

41
Arias & Pape, Psychological
Abuse: Implications for Adjustment
and Commitment to Leave Violent
Partners, 14 Violence & Victims at 64
(1999).
42
Ann L. Coker, Keith E. Davis,
Ileana Arias, Sujata Desai, Maureen
Sanderson, Heather M. Brandt, &
Paige H. Smith, Physical and Mental
Health Effects of Intimate Partner
Violence for Men and Women, 23 Amer.
J. Preventive Medicine 260 (2002).
43
Ann L. Coker, Rebecca Weston,
Daniel L. Creson, Blair Justice, & Pa-
tricia Blakeney, PTSD Symptoms
Among Men and Women Survivors of
Intimate Partner Violence: The Role of
Risk and Protective Factors, 20 Vio-
lence and Victims 625 (2005).
44
Jennifer A. Bennice, Patricia A.
Ressick, Mindy Mechanic & Millie
Astin, The Relative Effects of Intimate
Partner Physical and Sexual Violence
on Post-Traumatic Stress Disorder
Symptomatology, 18 Violence and Vic-
tims 87 (2003).
45
Jennifer A. Bennice, Patricia A.
Ressick, Mindy Mechanic & Millie
Astin, The Relative Effects of Intimate
Partner Physical and Sexual Violence
on Post-Traumatic Stress Disorder
Symptomatology, 18 Violence and Vic-
tims 87 at 92 (2003).
46
Kathleen C. Basile, Ileana
Arias, Sujata Desai & Martie P.
Thompson, The Differential Associa-

453
§ 12:26 MODERN SCIENTIFIC EVIDENCE

sexual, psychological, and stalking. The results revealed that

each form of violence predicted PTSD symptoms, even when con-
trolling for the presence of other forms of violence.47 Thus, for
example, when controlling for the effects of physical abuse,
psychological abuse still significantly predicted PTSD symptoms.
Further, the authors noted that as more forms of violence were
present, PTSD symptoms increased.
Coker et al. (2005) noted that PTSD rates are very high among
IPV victims, and that the range of PTSD rates may be due to the
presence or absence of protective factors.48 The authors reviewed
the National Violence Against Women Survey to assess rates of
PTSD symptoms among survivors of IPV. They found that 24% of
women and 20% of men had moderate to severe symptoms of
PTSD, and that protective factors included higher education,
higher income, being married, and reporting that the abuse had
stopped.49 Higher PTSD symptoms were associated with more se-
vere abuse, having current depressive symptoms, and having at-
tempted to leave the relationship at least once. It seems that the
negative psychological effects may be long-lasting, as one study
by Zlotnick et al. (2006) assessed 3,173 abused and non-abused
women in a nationally-representative sample and followed up
five years later. The results revealed that women who reported
IPV exposure at Time 1 experienced lower self-esteem, poorer
social functioning, greater depression symptoms, and less life sat-
isfaction five years later.50 Similar results were obtained in an
11-year longitudinal study by Schei et al. (2006), who followed
438 Australian women aged 45-55.51 The authors found that IPV
victimization was associated with poorer mental and sexual

tion of Intimate Partner Physical, Risk and Protective Factors, 20 Vio-

Sexual, Psychological, and Stalking
Violence on Posttraumatic Stress
Symptoms in a Nationally Represen-
tative Sample of Women, 17 J. Trau-
matic Stress 413 (2004).
47
Kathleen C. Basile, Ileana
Arias, Sujata Desai & Martie P.
Thompson, The Differential Associa-
tion of Intimate Partner Physical,
Sexual, Psychological, and Stalking
Violence on Posttraumatic Stress
Symptoms in a Nationally Represen-
tative Sample of Women, 17 J. Trau-
matic Stress 413 at 417 (2004).
48
Ann L. Coker, Rebecca Weston,
Daniel L. Creson, Blair Justice, & Pa-
tricia Blakeney, PTSD Symptoms
among Men and Women Survivors of
Intimate Partner Violence: The Role of
lence and Victims 625 (2005).
49
Ann L. Coker, Rebecca Weston,
Daniel L. Creson, Blair Justice, & Pa-
tricia Blakeney, PTSD Symptoms
among Men and Women Survivors of
Intimate Partner Violence: The Role of
Risk and Protective Factors, 20 Vio-
lence and Victims 625 at 639 (2005).
50
Caron Zlotnick, Dawn M. John-
son & Robert Kohn, Intimate Partner
Violence and Long-Term Psychosocial
Functioning in a National Sample of
American Women, 21 J. Interpersonal
Violence 262 at 269 (2006).
51
B. Schei, J.R. Guthrie, L.
Dennerstein, and S. Alford, Intimate
Partner Violence and Health Outcomes
in Mid-Life Women: A Population-
Based Cohort Study, 9 Archives of

454
BATTERED WOMAN SYNDROME § 12:26

health measures, negative mood, lower overall well-being, depres-

sive symptoms, and an increased rate of separation and divorce.
Consistent with the above, Pico-Alfonso et al. (2006) found that
women who were exposed to psychological and/or physical abuse
had higher rates of and more severe symptoms of depression,
anxiety and PTSD than did non-abused women. The authors fur-
ther determined that sexual IPV uniquely contributed to depres-
sion and suicidal behavior, and that PTSD rarely occurred
without another comorbid disorder such as anxiety or
depression.52 Bonomie et al. (2007) surveyed more than 2800
women regarding their lifetime exposure to IPV and assessed
their physical and mental health status.53 Their results revealed
that approximately 40% of the sample had experienced some
form of physical and/or sexual abuse in adulthood. Women who
had been both sexually and physically victimized by an intimate
partner showed the worst health symptoms, and those with
sexual violence showed 40-60% increase in depression scores.
These negative health effects often occurred for years after the
abuse had ended. The authors concluded that the health scores of
women living with physical and sexual abuse were comparable to
someone suffering from a chronic illness such as cancer, diabetes,
heart disease or arthritis.54
Mechanic et al. (2008) investigated the independent effects of

Women’s Mental Health 317 (2006).
52
Maria A. Pico-Alphonso, M. Isa-
bel Garcia-Linares, Nuria Celda-
Nevarro, Concepcion Blasco-Ros, En-
rique Echueburua, and Manuela
Martinez, The Impact of Physical,
Psychological, and Sexual Intimate
Partner Violence on Women’s Mental
Health: Depressive Symptoms, Post-
traumatic Stress Disorder, State Anxi-
ety and Suicide, 15 J. Women’s Health
599 at 608 (2006).
53
Amy E. Bonomie, Melissa L.
Anderson, Frederick P. Rivara & Rob-
ert S. Thompson, Health Outcomes in
Women with Physical and Sexual Inti-
mate Partner Violence Exposure, 16 J.
Women’s Health 987 (2007).
54
Amy E. Bonomie, Melissa L.
Anderson, Frederick P. Rivara & Rob-
ert S. Thompson, Health Outcomes in
Women with Physical and Sexual Inti-
mate Partner Violence Exposure, 16 J.
Women’s Health 987 at 993 (2007). In
addition to PTSD, researchers report
that a host of other physical, emo-
tional, and psychological problems can
occur as a result of the violence. In-
deed, through interviews and observa-
tion of battered women, researchers
have identified symptoms such as
multiple somatic complaints, agita-
tion, anxiety, insomnia (frequented by
violent nightmares), depression, and
suicidal behavior. Plichta (2004) re-
viewed the empirical literature on the
effects of IPV on physical health, and
concluded that IPV indeed poses a ma-
jor risk for women’s overall health. She
found that abused women are at a
significantly increased risk of mortal-
ity at the hands of their abusers, and
suffer a wide range of negative health
outcomes. Between 40-60% of abused
women suffer injuries each year, in-
cluding scratches, bruises, welts, bro-
ken bones and teeth, lacerations, knife
wounds, internal injuries, and burns:
Stacey B. Plichta, Intimate Partner
Violence and Physical Health
Consequences: Policy and Practice
Implications, 19 J. Interpersonal Vio-
lence 1296 (2004). Similarly, Dutton et

455
§ 12:26 MODERN SCIENTIFIC EVIDENCE

four different types of IPV (physical violence, sexual violence,

psychological abuse, and stalking) on depression and PTSD
symptoms.55 Noting that few women experience only one form of
abuse, the authors studied 413 severely battered women who had
experienced high levels of violence in the past year and were
seeking help from community programs. The authors found
moderate to severe PTSD and depression in the sample, which
were predicted by all forms of abuse. It was further found that
psychological abuse and stalking remained significant predictors
of PTSD and depression, even after controlling for physical
violence, injuries and sexual coercion. The authors noted that
recovery from the harms of IPV may be hindered by continued
exposure to other stressors such as poverty, community violence,
and the lack of resources and support.
Mary Ann Dutton (2009) notes that research has only begun to
investigate possible pathways by which IPV might lead to PTSD.56
She proposes an ecological model of IPV as applied to PTSD,
which suggests that multiple factors might influence the relation-
ship between victimization and potential PTSD outcomes. She
identified several factors that can influence whether a victim of
IPV might develop PTSD. Among these are the characteristics of
the abuse itself, such as the presence of physical violence, sexual
abuse, stalking, coercive control, and domination. Each has been
shown to increase the risk of PTSD development, with risk of the
disorder increasing with severity and multiplicity of abuse types.57
Second, a number of sociodemographic factors have been associ-

al. (2006) outlined twenty years of (2006).

research into the effects of IPV and
PTSD, noting that women who are ex-
posed to IPV experience much poorer
physical and mental health. Common
health complaints include chronic
chest and back pain, insomnia, diges-
tive problems, headaches, and hyper-
ventilation. Women also sustain com-
monly observed physical injuries,
including broken bones, fractures,
sprains, lacerations, contusions, and
injuries to the head, abdomen and
chest. Injuries sustained during preg-
nancy include miscarriage, premature
labour, fetal fractures, uterine ruptur-
ing, hemorrhaging, and fetal death:
Mary Ann Dutton, Bonnie L. Green,
Stacey I. Kaltman, Darren M. Roesch,
Thomas A. Zeffiro, and Elizabeth D.
Krause, Intimate Partner Violence,
PTSD, and Adverse Health Outcomes,
21 J. Interpersonal Violence 955
55
Mindy B. Mechanic, Terri L.
Weaver & Patricia A. Resick, Mental
Health Consequences of Intimate Part-
ner Abuse: A Multidimensional Assess-
ment of Four Different Forms of
Abuse, 14 Violence Against Women
634 (2008).
56
Mary Ann Dutton, Pathways
Linking Intimate Partner Violence and
Posttraumatic Disorder, 10 Trauma,
Violence & Abuse 211 (2009). See also
Mary Ann Dutton, Battered Women’s
Strategic Responses to Violence: The
Role of Context. In J.L. Edleson & Z.
Eisikovits (Eds.), Future interventions
with battered women and their fami-
lies. (pp. 105-124, Thousand Oaks, CA:
Sage, 1996).
57
Mary Ann Dutton, Pathways
Linking Intimate Partner Violence and
Posttraumatic Disorder, 10 Trauma,

456
BATTERED WOMAN SYNDROME § 12:26

ated with increased risk of PTSD generally, including female

gender, the degree of exposure to violence, childhood victimiza-
tion, and the presence of pre-existing psychiatric conditions.
Third, coping styles and social support play an important role,
with better outcomes expected with greater perceived self-efficacy
and greater social supports. 58 Re-victimization also predicts
increased rates of PTSD development, although there is some
suggestion that the development of PTSD may actually predict
the likelihood of being re-victimized.59
More recently, research has recognized that victims of chronic
and ongoing abuse display symptoms that are somewhat differ-
ent than those observed in traditional PTSD. Original conceptual-
izations of PTSD were developed from observations based on war
veterans, survivors of disasters, and rape victims. Herman (1992)
noted that the traditional notions of PTSD did not fully explain
the range of symptoms observed in victims of chronic trauma,
such as survivors of childhood abuse or domestic violence.60 He
proposed a new diagnostic category, complex PTSD, to account
for the different symptom patterns often seen. Resick et al. (2012)
discuss the symptoms of complex PTSD as overlapping with sev-
eral criteria of PTSD (i.e., avoidance symptoms, numbing,
hyperarousal, re-experiencing), and well as additional self-
regulatory symptoms. These additional symptoms fall into five
categories: a) difficulties in emotion regulation, b) altered atten-
tion and consciousness (e.g., dissociation), c) disturbed social rela-
tions, d) adversely affected belief systems, and e) somatic
distress.61 The authors reviewed the literature on complex PTSD,
noting wide variation in definitions of complex PTSD, many sug-
gestions for alternative/related disorders, as well as the types of
traumas that might give rise to it. One proposed alternative was

Violence & Abuse 211 at 214 (2009).
58
Mary Ann Dutton, Pathways
Linking Intimate Partner Violence and
Posttraumatic Disorder, 10 Trauma,
Violence & Abuse 211 at 216 (2009).
59
Mary Ann Dutton, Pathways
Linking Intimate Partner Violence and
Posttraumatic Disorder, 10 Trauma,
Violence & Abuse 211 at 217 (2009).
60
Herman, J. , Trauma and Recov-
ery (New York: Basic Books, 1992). See
also Patricia A. Resick, Michelle J.
Bovin, Amber L. Calloway, Alexandra
M. Dick, Matthew W. King, Karen S.
Mitchell, Michael K. Suvak, Stephanie
Y. Wells, Shannon Wiltsey Stirman, &
Erika J. Wolf, A Critical Evaluation of
the Complex PTSD Literature: Impli-
cations for DSM-5, 25 J. Traumatic
Stress 241 (2012).
61
Patricia A. Resick, Michelle J.
Bovin, Amber L. Calloway, Alexandra
M. Dick, Matthew W. King, Karen S.
Mitchell, Michael K. Suvak, Stephanie
Y. Wells, Shannon Wiltsey Stirman, &
Erika J. Wolf, A Critical Evaluation of
the Complex PTSD Literature: Impli-
cations for DSM-5, 25 J. Traumatic
Stress 241 at 243 (2012). See also
Cloitre, M., Courtois, C. A., Charuvas-
tra, A., Carapezza, R., Stolbach, B.
C.,& Green, B. L., Treatment of Com-
plex PTSD: Results of the ISTSS Ex-
pert Clinician Survey on Best Prac-
tices, 24 J. Traumatic Stress 615
(2011).

457
§ 12:26 MODERN SCIENTIFIC EVIDENCE

Disorders of Extreme Stress Not Otherwise Specified (DESNOS),

but a trial study determined that nearly all persons who met the
criteria for DESNOS also met the criteria for PTSD, suggesting
that DESNOS did not provide sufficient clinical utility in its
existing form.62
Taken in their entirety, the studies indicate that battered
women are indeed at risk for developing PTSD. Moreover, across
the majority of studies, the severity of the violence experienced
was positively related to PTSD diagnosis and symptomotology.
The criteria employed across the studies have varied widely, with
the majority primarily relying on self-report measures, which, in
turn, have employed different criteria for a positive diagnosis.
The studies also vary in terms of the stage in the woman’s rela-
tionship at which the assessment occurs. All of these variables
can affect the prevalence rates reported. For instance, measures
administered shortly after arrival at a shelter may yield inflated
estimates as the symptomotology evidenced may reflect a
temporary crisis rather than PTSD symptomotology.63 Moreover,
the samples have varied in terms of the extent to which the
women have suffered other forms of trauma in their lives (both
past and present). It was not uncommon for battered women to
have experienced multiple traumatic stressors in their lives (e.g.,
prior history of abusive relationships), thus rendering explana-
tions for the elevated level of risk of PTSD difficult to
disentangle.64
In one of the more representative studies, Gelles and Harrup65
examined 3,002 currently or previously (within the last year)
coupled woman respondents interviewed for the Second National
Family Violence Survey.66 Women were divided into three groups
depending on the level of reported violence (no violence, minor,

62
S. Roth, E. Newman, D. Pelco-
vitz, B.A.van der Kolk, & F.S. Mandel,
Complex PTSD in Victims Exposed to
Sexual and Physical Abuse: Results
from the DSM-IV Field Trial for Post-
traumatic Stress Disorder, 10 J. Trau-
matic Stress 539 (1997). Note that the
newly revised DSM-5 includes a PTSD
dissociative subtype to address per-
sons with these unique symptom
clusters: American Psychiatric As-
sociation. Diagnostic and statistical
manual of mental disorders (5th ed.,
Arlington, VA: American Psychiatric
Association, 2013).
63
See Astin et al., Posttraumatic
Stress Disorder Among Battered
Women: Risk and Resiliency Factors,
8 Violence & Victims at 18 (1993).
64
For instance, the association be-
tween PTSD and history of past abuse
(primarily sexual abuse) is well docu-
mented in the literature. See Christine
Wekerle & David A. Wolfe, Child Mal-
treatment, in Child Psychopathology
(Eric J. Mash & Russell A. Barkle eds.,
1996).
65
See Gelles & Harrup, Violence,
Battering, and Psychological Distress
Among Women, 4 J. Interpersonal
Violence 400 (1989).
66
See Richard J. Gelles & Murray
A. Straus, Intimate Violence: The
Causes and Consequences of Abuse in
the American Family (1988).

458
BATTERED WOMAN SYNDROME § 12:26

and severe violence). In general, the higher the level of violence

experienced, the greater the proportion of women reporting some
form of psychological distress (e.g., these women reported feeling
nervous or stressed, bad/worthless, unable to cope, hopeless, and
considered taking their own lives). A longitudinal study that
involved in-depth interviews with 98 battered women who were
interviewed at three points in time over a three-year period.67
The sample was divided into three groups: those abused only at
Time 1 (n=28); those abused at Times 1 and 2 (n=22); and those
abused at all three times of assessment (n=39). Women who were
abused at all three time periods evidenced a deterioration in
their mental health (e.g., self-esteem, depression), whereas the
other two groups evidenced improvements over time (e.g.,
improvements in self-esteem, depression). The only identifiable
difference across the three groups at Time 1, in terms of the
demographic and abuse-related variables that were measured,
involved an index of the woman’s assessment of danger, with
those abused at all three time periods significantly higher in
terms of their assessment of danger, compared to the other two
groups.68
Using meta-analytic techniques, Golding 6 9 reviewed the
literature on the prevalence of mental health problems among
women who have been physically abused by an intimate male
partner.70 Her analyses document the high prevalence rates of
depression,71 suicidality,72 PTSD,73 alcohol abuse or dependence,74

67
See Campbell & Soeken, Wom-
en’s Responses to Battering Over
Time, An Analysis of Change, 14 J.
Interpersonal Violence 21 (1999).
68
See Campbell & Karen L.
Soeken, Women’s Responses to Batter-
ing Over Time, An Analysis of Change,
14 J. Interpersonal Violence at 30
(1999).
69
See Golding, Intimate Partner
Violence as a Risk Factor for Mental
Disorders: A Meta-Analysis, 14 J.
Fam. Violence 99 (1999).
70
In her review she includes only
those studies that have provided spe-
cific prevalence rates of mental health.
Golding, Intimate Partner Violence as
a Risk Factor for Mental Disorders: A
Meta-Analysis, 14 J. Fam. Violence at
103 (1999).
71
Across the 18 studies that in-
cluded measures of depression, the
weighted mean prevalence of depres-
sion was 47.6% (with rates ranging
from 15% to 83% across the studies). A
weighted mean gives greater weight to
the estimates associated with greater
precision (i.e., smaller variability). See
Golding, Intimate Partner Violence as
a Risk Factor for Mental Disorders: A
Meta-Analysis, 14 J. Fam. Violence at
106 (1999).
72
The weighted mean prevalence
across the 13 studies that included
suicidality was 17.9% (ranging from
4.6% to 77% across the studies). See
Golding, Intimate Partner Violence as
a Risk Factor for Mental Disorders: A
Meta-Analysis, 14 J. Fam. Violence at
112 (1999).
73
Across the 11 studies that as-
sessed PTSD the mean prevalence rate
was 63.8% (with rates varying from
31% to 84.4%). See Golding, Intimate
Partner Violence as a Risk Factor for

459
§ 12:26 MODERN SCIENTIFIC EVIDENCE

and drug abuse or dependence found among battered women.75

When compared to the rates for women in the general population
and control groups (for those studies that included them), the
prevalence rates in all cases were substantially higher for bat-
tered women. Golding also found that the variation in rates evi-
denced across the studies was largely due to the methodological
differences in the research such as the samples employed (e.g.,
high prevalence rates for depression observed in shelter residents;
the highest rates for suicidality found among psychiatric patients)
or the methods of data collection (e.g., higher rates of PTSD were
evidenced in studies that used self-administered measures of
PTSD as opposed to structured interviews). Finally, with respect
to depression and PTSD, the prevalence rate was also related to
the severity or duration of the violence experienced, with greater
abuse associated with more elevated levels of depression and
PTSD.
In sum, over the years a range of studies have documented the
profound impact that intimate violence can have on women’s
physical and mental health, with a host of psychological problems
or symptomotology identified among battered women. There does
not, however, appear to be overwhelming support for a single
profile that captures the impact of abuse on a woman. On the
contrary, the research demonstrates that battered women’s
psychological reactions to abuse are varied and cannot be
captured by a single profile. Although some women clearly meet
the full criteria for a diagnosis of PTSD, this diagnosis character-
izes only a subset of some battered women’s experiences.76

§ 12:27 Introductory discussion of the science—The

general questions—The scientific methods
applied in the research
The scope and dynamics of violence within intimate relation-
ships and its impact on a woman have been studied using a vari-
ety of methods. These include clinical observations, wide scale
social surveys, psychological tests and questionnaires, and in-
depth interviews. Each of these methods is associated with vari-

Mental Disorders: A Meta-Analysis, 14 studies was 8.9% (ranged from 7% to

J. Fam. Violence at 116 (1999).
74
For the 10 studies that included
assessments of alcohol abuse or depen-
dence, the weighted mean was 18.5%
(6.6% to 44%). See Golding, Intimate
Partner Violence as a Risk Factor for
Mental Disorders: A Meta-Analysis, 14
J. Fam. Violence at 120 (1999).
75
For drug abuse or dependence,
the weighted mean across the four
25%). See Golding, Intimate Partner
Violence as a Risk Factor for Mental
Disorders: A Meta-Analysis, 14 J.
Fam. Violence at 124 (1999).
76
See Mary Ann Dutton (2004).
Complexity of women’s response to
violence: Response to Briere and Jor-
dan. Journal of Interpersonal Violence,
19, 1277-1282.

460
BATTERED WOMAN SYNDROME § 12:27

ous strengths and limitations. The national surveys document

the prevalence and types of abuse utilizing large representative
samples, but typically fail to get at the complex nuances of the
abuse experienced and its impact. On the other hand, in-depth
interviews provide a rich and detailed description and impact of
abuse experiences, but typically employ small and select samples,
making claims to representativeness difficult.
Previous work has been criticized as relying on relatively small
and non-representative samples of white, middle class women.1
However, there has been a strong trend in more recent work to
study both men and women, new immigrants, racial minorities,
and gay, lesbian, and bisexual persons. In addition, researchers
are increasingly considering the intersectionality of gender, race,
and sexual orientation as it uniquely affects a particular
community. For example, Taft et al. (2009) observed that black
women may be subjected to specific cultural pressures that do not
affect other groups, and that these factors should be considered
in outreach efforts.2 Continued work along these lines is essential
since definitions of what is abusive as well as women’s perceived
and actual levels of safety and their alternatives to violence may
differ across cultural and other groupings.3
Also at issue in this research is the fact that the women typi-
cally assessed or interviewed have been identified when seeking
assistance from various social agencies (e.g., shelters, police,
hospitals), thus limiting the generalizability of the findings. The
practicality of such a criticism must be considered, however,
within the context of battered woman research. Do the responses
of women who have failed to seek assistance differ from those

[Section 12:27] Mental and Physical Health of Women

1
See Strube, The Decision to
Leave an Abusive Relationship: Em-
pirical and Theoretical Issues, 104
Psychol. Bull. at 238 (1988); Faigman,
The Battered Woman Syndrome and
Self Defense: A Legal and Empirical
Dissent, 73 Va. L. Rev. at 642 (1986).
2 Minority and Gay, Lesbian, Bisexual
Casey T. Taft, Thema Bryan-
Davis, Halley E. Wooward, Shaquita
Tillman and Sandra E. Torres, Inti-
mate Partner Violence against African
American Women: An Examination of
the Sociocultural Context, 14 Aggres-
sion and Violent Beh. 50 (2009).
3
See, e.g., Krim K. Lacey, Melnee
Dilworth McPherson, Preethy S. Sam-
uel, Karen Powell Sears, & Doreen
Head, The Impact of Different Types
of Intimate Partner Violence on the
in Different Ethnic Groups, 28 J. Inter-
personal Violence 359 (2013); Krim K.
Lacey, When is it Enough for Me to
Leave? Black and Hispanic Women’s
Response to Violent Relationships, 25
J. Fam. Violence 669 (2010); Carolyn
M. West, Partner Abuse in Ethnic
and Transgender Populations, 3 Part-
ner Abuse 336 (2012); Oliver J. Wil-
liams, William Oliver & Marcus Pope,
Domestic Violence in the African Amer-
ican Community, 16 J. Aggression,
Maltreatment and Trauma 229 (2008);
Doris F. Chang, Biing-Jiun Shen, &
David T. Takeuchi, Prevalence and
Demographic Correlates of Intimate
Partner Violence in Asian Americans,
32 International J. of Law and Psychi-
atry 167 (2009).

461
§ 12:27 MODERN SCIENTIFIC EVIDENCE

who have not? Given the private and hidden nature of violence in
intimate relationships, this question may ultimately be
unanswerable. Indeed, because some women may not actually
think of themselves as victims (i.e., do not recognize the violence
as such),4 or may be afraid to report the abuse or may not seek
help for it, the population itself is difficult, if not impossible to
identify. The extent of psychiatric problems identified in these
studies, in particular those that have relied on clinical samples,
however, must be treated with caution as their results might be
specific to the type of sample employed (e.g., women identified in
psychiatric settings, or women seeking help from community
resources).
Another major concern raised regarding research in this area
involves the lack of control or comparison groups,5 what is often
viewed as a hallmark of scientific methodology. If the research-
ers’ goal is to assess trauma symptomotology in battered women,
then comparisons with other samples may be warranted. For
example, if the researcher wishes to determine whether depres-
sion is a reaction specific to the fear experienced in an abusive
situation, a control group of women not in an abusive relation-
ship provides useful insights. The failure to include such a
comparison can limit the conclusions that can be drawn from
such a study and raises questions regarding the specificity of the
findings to the population of interest. In some cases, because
there are national norms available on these trauma symptoms,
the researcher can employ these for comparison purposes. If,
however, the researchers’ goal is to identify the features unique
to the use of violence in a relationship or to assess the relation-
ship between these features (e.g., form, severity, and pattern)
and its impact on a woman, the need for a comparison group is
not readily apparent. Thus, as in any area of research, the neces-
sity of a comparison group depends upon the researchers’
questions. In the early research, few studies employed comparison
or control groups.6
Another limitation to this area of research, specifically in refer-

4
See Dutton & Goodman, Post-
traumatic Stress Disorder Among Bat-
tered Women: Analysis of Legal Impli-
cations, 12 Behav. Sci. & L. at 225
(1994).
5
Christopher Slobogin, Psycho-
logical Syndromes and Criminal Re-
sponsibility, 6 Ann. Rev. Law and Soc.
Sci. 109 (2010); Deborah K. Anderson
and Daniel G. Saunders, Leaving an
Abusive Partner: An Empirical Review
of Predictors, the Process of Leaving,
and Psychological-Well Being,
4Trauma, Violence, & Abuse 163
(2003).
6
See Aguilar & Nunez Nightin-
gale, The Impact of Specific Battering
Experiences on the Self-Esteem of
Abused Women, 9 J. of Fam. Violence
35 (1994); see also Gleason, Mental
Disorders in Battered Women: An
Empirical Study, 8 Violence & Victims
53 (1993); Christopoulos et al.,
Children of Abused Women: Adjust-

462
BATTERED WOMAN SYNDROME § 12:27

ence to the work examining the factors related to relationship

maintenance or termination, concerns the retrospective and self-
report nature of the research.7 While many of the interview stud-
ies attempt to obtain women’s accounts of the relationship and
its impact upon them throughout the course of the relationship,
the potential biases inherent in these data limit both the reli-
ability and validity of the findings. For example, as most of the
studies that report the percentage of women who return to an
abusive relationship used brief follow-up periods, the findings are
likely an underestimation of the return rate.8 There tends to be
an overreliance on cross-sectional rather than longitudinal data,
assessing PTSD rates or IPV prevalence as a snapshot in time,
rather than following the course of IPV throughout a relationship
or the progression of PTSD symptoms. 9 Similarly, battered
women’s tendencies towards denial and minimization of the
violence would suggest that women’s reports may underestimate
their actual experiences of the violence.10 For models attempting
to explain the dynamics of why a woman remains in an abusive
relationship (e.g., learned helplessness, traumatic bonding), the

ment at Time of Shelter Residence, 49
J. Marriage & the Fam. 611 (1987).
7 mate Partner and Sexual Violence
See Miriam K. Ehrensaft, Terrie
E. Moffitt, and Avshalom Caspi, Is
Domestic Violence Followed by an
Increased Risk of Psychiatric Disorders
among Women but not among Men? A
Longitudinal Cohort Study, 163 The
American Journal of Psychiatry 885
(2006).
8 Linking Intimate Partner Violence and
For example, Black et al. (2011)
note that prevalence rates are likely
to be underestimated for several rea-
sons. First, survey respondents who
are currently in an abusive relation-
ship may choose not to participate in
surveys of domestic violence out of
concerns for their safety; second, the
entire range of violent experiences
may not be captured by survey ques-
tions; third, victims may have been
uncomfortable disclosing their experi-
ences due to the sensitive and often
stigmatized nature of the information;
fourth, large scale surveys may not
capture women in prisons, nursing
homes, college dormitories or other
less accessible places; fifth, respon-
dents may forget about incidents that
were less severe or which occurred in
the distant past: Black, M.C., Basile,
K.C., Breiding, M.J., Smith, S.G.,
Walters, M.L., Merrick, M.T., Chen, J.,
& Stevens, M.R. The National Inti-
Survey (NISVS): 2010 Summary Re-
port. Atlanta, GA: National Center for
Injury Prevention and Control, Cen-
ters for Disease Control and Preven-
tion at 85 (2011).
9
See Mary Ann Dutton, Pathways
Posttraumatic Disorder, 10 Trauma,
Violence & Abuse 211 (2009); Erika
Lawrence, Jeungeun Yoon, Amie
Langer & Eunyoe Ro, Is psychological
aggression as detrimental as physical
aggression? The Independent Effects
of Psychological Aggression on Depres-
sion and Anxiety Symptoms, 24
Violence and Victims 20 (2009); Miriam
K. Ehrensaft, Terrie E. Moffitt, and
Avshalom Caspi, Is Domestic Violence
Followed by an Increased Risk of
Psychiatric Disorders Among Women
But Not Among Men? A Longitudinal
Cohort Study, 163 The American J.
Psychiatry 885 (2006).
10
See Dutton & Goodman, Post-
traumatic Stress Disorder Among Bat-
tered Women: Analysis of Legal Impli-
cations, 12 Behav. Sci. & L. at 225
(1994).

463
§ 12:27 MODERN SCIENTIFIC EVIDENCE

retrospective nature of the research also poses interpretive

problems since the direction of causality cannot be ascertained.
Given the ethical considerations involved in research in this area,
prospective studies of the effects of violence are extremely dif-
ficult, if not impossible, since such examination would be
precluded by the inherent impact or intervention of the research
process itself.11 Despite this difficulty, researchers are now adopt-
ing longitudinal designs and results of such research will
undoubtedly increase our understanding of the dynamics and
impact of abuse on women.12
In addition, across the studies there is considerable variability
in the measures that have been employed, making comparisons
across them difficult. While the early research tended to focus its
attention on objective measures of violence (e.g., degree,
frequency), greater attention is now given to the subjective mean-
ing that the violence has for the woman. Also, incorporation of
contextual variables such as the battered woman’s expectation of
lethal violence by her partner, which may be based on such fac-
tors as timing (e.g., imminent threat vs. potential threat
sometime in the future), recent events (e.g., verbal threats to kill
the battered woman, a battered woman’s escalation of resistance
to abuser’s control or violence), setting in which violence occurred
and so forth, would provide greater insight into the severity of
the violence to which the woman responds.13 Some research along
these lines can now be found in the literature and more work in
this area holds considerable promise.14

§ 12:28 Areas of scientific agreement and disagreement

11
See Dutton & Lisa A.Goodman,
Posttraumatic Stress Disorder Among
Battered Women: Analysis of Legal
Implications, 12 Behav. Sci. & L. at
252 (1994).
12
Margret E. Bell, Lisa A. Good-
man, & Mary Ann Dutton, The Dy-
namics of Staying and Leaving: Impli-
cations for Battered Women’s
Emotional Well-Being and Experi-
ences of Violence at the End of the
Year, 22 J. Fam. Violence 413 (2007).
13
See Strube, The Decision to
Leave an Abusive Relationship: Em-
pirical and Theoretical Issues, 104
Psychol. Bull. at 558 (1988).
14
Several studies have addressed
whether abused women are able to
predict revictimization, and this re-
search generally shows that they are
more likely to be right than wrong in
their predictions, and are better at
predicting than practitioners or risk
markers: Margret E. Bell, Lauren
Bennett Cattaneo, Lisa A. Goodman,
and Mary Ann Dutton, Assessing the
Risk of Future Psychological Abuse:
Predicting the Accuracy of Battered
Women’s Predictions, 23 J. Fam.
Violence 69 (2008); Bennett Cattaneo,
L., Bell, M. E., Goodman, L. A., &
Dutton, M. A. Intimate partner violence
victims’ accuracy in assessing their
risk of reabuse. 22 Journal of Family
Violence, 429-440 (2007); Heckert, D.
A., & Gondolf, E.W., Battered Women’s
Perceptions of Risk Versus Risk Factors
and Instruments in Predicting Repeat
Reassault, 19 J. Interpersonal Violence
778 (2004).

464
BATTERED WOMAN SYNDROME § 12:28

Despite the difficulties of conducting this research, researchers

have gained considerable knowledge about the dynamics of
violence within intimate relationships and some consistency in
findings across the studies can be found. An area in which there
is considerable agreement among researchers involves the
pervasive nature and scope of woman abuse in intimate
relationships. The domineering and controlling behavior on the
part of the batterer has also been well documented. Co-occurring
with the batterer’s physical violence is a range of psychological
and emotional abuse including threats to the woman or members
of her family, restrictions on her finances and behavior, destruc-
tion of property, and the potential for fatal violence when at-
tempts to separate from the abuser are made. Researchers also
consistently cite numerous external and social barriers women
face when trying to end the abuse, documenting the lack of social
resources available to assist battered women in their attempts to
terminate the violence. Using the term ‘‘entrapment’’ to character-
ize the battering experience, Evan Stark argues that a woman’s
failure to leave the relationship has less to do with learned
helplessness than with the ‘‘actual level of control enforced
through violence, cultural restraints, and institutional collusion
with the batterer.’’1
Researchers in the area have also documented the profound
psychological impact that the violence has on a woman, viewing
these reactions not as pathologies, but rather as a response to
the violence the woman experiences. In addition to PTSD, a range
of indicators of distress and dysfunction have been identified in
battered women in the literature:
fear and terror, depression and grief, nightmares and flashbacks,
avoidance, and/or physiological reactivity to violence related stimuli,
anxiety, anger and rage, difficulty concentrating or memory
problems including amnesia and dissociation, hypervigilance or
suspiciousness, feelings of shame, lowered self-esteem, somatic
complaints, sexual dysfunction, morbid hatred, addictive behaviors,
and other forms of impaired functioning.2
With the exception of intrusion, avoidance, and physiological
arousal symptoms, ‘‘few of these indicators . . . are specific only
to trauma or victimization,’’3 thus pointing to the varied respon-
ses an individual may exhibit. Most authors confer that there is

[Section 12:28] en’s Response to Domestic Violence: A

1 Redefinition of Battered Woman Syn-
Evan Stark, Framing and Re-
framing Battered Women, in Domestic drome, 21 Hofstra L. Rev. at 1222
Violence: The Changing Criminal Jus- (1993).
3
tice Response at 280 (Eve S. Buzawa Dutton, Understanding Wom-
& Carl G. Buzawa eds., 1992). en’s Response to Domestic Violence: A
2
Dutton, Understanding Wom- Redefinition of Battered Woman Syn-

465
§ 12:28 MODERN SCIENTIFIC EVIDENCE

no single profile of a battered woman, but that each victim will

have his or her own reactions to IPV.4 Indeed, use of syndrome
terminology can lead to stereotypical expectations for how a bat-
tered woman should act and feel.5
As the earlier discussion highlights, little support exists for the
universality of Walker’s cycle theory of violence or the theory of
learned helplessness can be found in the literature. Although the
cycle of violence may characterize some battering relationships,
not all follow this pattern. Further, throughout the relationship
the pattern may change. Considerable research also documents
the wide range of responses taken by battered women in violent
relationships. Moreover, given the reality and inherent danger
that some of these actions may provoke, these behaviors have
been viewed more as a response to a realistic appraisal of the sit-
uation as opposed to a helpless reaction to the violence. If we
turn to the scientific evidence, research supports both the conten-
tion that violence in an intimate relationship has a profound
psychological impact upon a woman (although a single psychologi-
cal profile does not emerge), and documents the constrictive social
realities confronting a battered woman’s attempts to end the
violence. Although issues in conceptualization across fields might
invariably lead to disagreements, the experiences of battered
women appear to be quite varied and it is possible that, as Dut-
ton suggests, some of the confusion may be alleviated if a singular
term or profile is not employed to characterize this body of

drome, 21 Hofstra L. Rev. at 1222
(1993).
4 withdrawn) were more likely to receive
Jacquelyne R. Biggers, The Util-
ity of Diagnostic Language as Expert
Witness Testimony: Should Syndrome
Terminology be Used in Battering
Cases? 5 J. Forensic Psychology Prac-
tice 43 (2005); John Briere & Carole
E. Jordan, Violence against Women:
Outcome Complexity and Implications
for Assessment and Treatment, 19 J.
Interpersonal Violence 1252 (2004);
Mary Ann Dutton, Complexity of Wom-
en’s Response to Violence: Response to
Briere and Jordan, 19 J. Interpersonal
Violence 1277 (2004); Jacquelyne R.
Biggers, A Dynamic Assessment of the
Battered Woman Syndrome and its
Legal Relevance, 3 J. Forensic Psychol-
ogy Practice 1 (2003).
5
Social psychological experi-
ments with mock jurors have found
that stereotypical representations of a
battered woman who killed her part-
ner (i.e., young, unemployed, socially
leniency and to have satisfied the
requirements for self-defence than
non-stereotypical victims (i.e., those
who were older, successful, vocal about
their abuse to coworkers), Brenda L.
Russell & Linda S. Melillo, Attitudes
Toward Battered Women Who Kill:
Defendant’s Typicality and Judgments
of Culpability, 33 Crim. Justice and
Beh. 219 (2006). For alternatives to
the syndrome testimony, see Regina
Schuller & Sara Rzepa, Expert Testi-
mony Pertaining to Battered Woman
Syndrome: Its Impact on Jurors’ Deci-
sions, 6 Law & Human Behav. 655-673
(2002); Regina Schuller & Patricia
Hastings, Trials of Battered Women
Who Kill: The Impact of Alternative
Forms of Expert Testimony, 20 Law
and Human Behav. 167-188 (1996).

466
BATTERED WOMAN SYNDROME § 12:29

research.6 At present, it is also difficult to determine why a bat-

tered woman responds one way as opposed to another. Investiga-
tions are now beginning to explore the potential mediating
variables that may explain the observed heterogeneity of bat-
tered women’s responses.7

§ 12:29 Future directions

As research in the area continues to accumulate, it appears
that the reactions of battered women can be quite varied and a
host of psychological sequelae may result as a function of the
violence. As such, Dutton argues that defining battered woman
syndrome ‘‘as a specific type of psychological reaction . . . fails to
account for the other possible psychological reactions to battering
recognized in the scientific literature.’’1 Moreover, utilizing a nar-
row definition or treatment of this large body of research is
problematic as it fails to include many other ‘‘relevant aspects of
the ecological context that may be central’’ to understanding a
battered woman’s reactions and responses.2 Accordingly, Dutton
argues that the term ‘‘battering and its effects’’ may more ‘‘ac-
curately represent the current state of knowledge in the area.’’3
Thus, rather than adopting the term ‘‘battered woman syndrome,’’

6
See Dutton, Understanding
Wo m e n ’ s R e s p o n s e t o D o m e s t i c
Violence: A Redefinition of Battered
Woman Syndrome, 21 Hofstra L. Rev.
at 1198 (1993).
7
For example, recent research
has investigated the existence of three
PTSD personality subtypes: e.g.,
Miller, M. W. (2003). Personality and
the etiology and expression of PTSD:
A three-factor model perspective.
Clinical Psychology: Science and Prac-
tice, 10, 373–393. See also Miller, M.
W., & Resick, P. A. (2007). Internal-
izing and externalizing subtypes in
female sexual assault survivors: Impli-
cations for the understanding of com-
plex PTSD. Behavior Therapy, 38, 58–
71. Carleton et al. (2015) assessed 129
Canadian women who had experienced
IPV, and found support for the three
subtypes: a “simple group,” who had
normative temperament and low co-
morbidity, an “internalizing group,”
with high scores on depression, detach-
ment, self harm and avoidant person-
ality disorder, and an “externalizing
group,” with higher scores on aggres-
sion, entitlement, impulsivity, sub-
stance abuse, and exhibitionism. The
implications of these subtypes for bat-
tered women who kill remain unclear.
[Section 12:29]
1
Mary Ann Dutton, Relevance of
the Psychological Effects of Battering
for Understanding a Battered Person’s
Behavior or State of Mind: Implica-
tions for Criminal and Civil Cases
(1995).
2
Dutton, Understanding
Wo m e n ’ s R e s p o n s e t o D o m e s t i c
Violence: A Redefinition of Battered
Woman Syndrome, 21 Hofstra L. Rev.
at 1198 (1993); Mary Ann Dutton,
Forensic Evaluation and Testimony
Related to Domestic Violence, in 16
Innovations in Clinical Practice: A
Source Book 306 (Leon Vandecreek et
al., eds., 1998).
3
Mary Ann Dutton, Forensic
Evaluation and Testimony Related to
Domestic Violence, in 16 Innovations
in Clinical Practice: A Source Book at
307 (Leon Vandecreek et al., eds.,
1998).

467
 § 12:29 MODERN SCIENTIFIC EVIDENCE

Dutton argues that ‘‘descriptive references should be made to

expert testimony concerning battered woman’s experiences.” Oth-
ers have similarly followed suit. 4 Second, the scope of the
testimony should be framed within the overall social context that
is essential for explaining women’s responses to violence. Third,
evaluation and testimony concerning battered women’s psycho-
logical reactions to violence should incorporate the diverse range
of traumatic reactions described in the scientific literature.

4
Kathleen J. Ferraro, The Words Syndrome in Criminal Cases Involv-
Change but the Melody Lingers, The ing Battered Women. 9(1) Violence
Persistence of the Battered Woman Against Women 110 (2003).

468

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